The Secretary Shall . . . : Implementing the Affordable Care Act's Private Insurance Expansions

2020 ◽  
Vol 45 (4) ◽  
pp. 517-532
Author(s):  
Sherry Glied ◽  
Aryana Khalid ◽  
Marilyn B. Tavenner
Keyword(s):  
Private Insurance ◽  
Insurance Coverage ◽  
Critical Role ◽  
Implementation Process ◽  
Consumer Information ◽  
Three Dimensions ◽  
The Public ◽  
Department Of Health ◽  
Complex Design ◽  
Congressional Action

Abstract The federal bureaucracy played a critical role in implementing most aspects of the Affordable Care Act's private insurance coverage expansion. Through brief case studies, the authors review three dimensions of this role: the development of the Center for Consumer Information and Insurance Oversight, rulemaking in the formulation of the essential health benefits package, and the implementation of the federal website. They relate these to themes in the public administration literature. Politics—both through state decisions and through continuing congressional action (and inaction)—pervaded the implementation process. The challenges of staffing and situating the new bureaucracy effectively changed vertical boundaries within the Department of Health and Human Services, with long-lasting consequences. Finally, the complex design of the policy itself made passage of the legislation easier but implementation much more difficult. Ultimately, however, implementation was remarkably successful, achieving improvements in coverage consistent with the Congressional Budget Office's projections.

Insurance disparity in the United States cancer survivors’ smoking rates: A trend study from NHIS 2008-2017.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1553-1553
Author(s):  
Yannan Zhao ◽  
Binbin Zheng-Lin ◽  
Biyun Wang ◽  
Xi-Chun Hu ◽  
Changchuan Jiang
Keyword(s):  
Cancer Survivors ◽  
Statistical Power ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Smoking Behavior ◽  
The United States ◽  
Current Smoking ◽  
Complex Design ◽  
Adult Cancer Survivors ◽  
Smoking Behaviors

1553 Background: Smoking rates have been decreasing in the U.S over the last decade. Smoking cessation is a critical part of cancer treatment and survivorship care. However, little is known about the trend of smoking rates in U.S. cancer survivors and how it varied by individuals’ insurance coverages. Methods: We conducted a retrospective study to evaluate the temporal trend of smoking rates using the National Health Interview Survey from 2008 through 2017. Adult cancer survivors (n = 20122) were included in the analysis. The outcomes were self-reported current smoking behavior. Insurance coverage was categorized into any private (age ≤65), other coverage (age ≤65), uninsured (age ≤65), Medicare + any private (age > 65), and other coverage (age > 65). We combined every two years data to improve statistical power in the subgroup analysis. Weighted analyses were performed with SAS 9.4 to account for the complex design. Results: The smoking rates in cancer survivors decreased from 18.4% in 2008 to 12.5% in 2017. However, the smoking rates varied remarkably by insurance status (p < 0.001). There was a decreasing trend of smoking rates in participants with any private (age ≤65) (17.3% in 2008/2009 to 12.0% in 2016/2017), Medicare + any private (age > 65) (7.5% in 2008/2009 to 5.9% in 2016/2017), and other coverage (age > 65) (13.2% in 2008/2009 to 9.2% in 2016/2017) whereas the current smoking rates remains high in cancer survivors with other coverage (age ≤65) (40.1% in 2008/2009 to 34.4% in 2016/2017) and uninsured (age ≤65) (43.4% in 2008/2009 to 43,1% in 2016/2017). Conclusions: Cancer survivors report less smoking behaviors over the last decade which is similar to the general population. However, the smoking rate remains dangerously high in non-elderly cancer survivors without any private insurance.

Open Innovation Results in Smart Cities and Smart Villages

2019 ◽  
pp. 117-132
Author(s):  
Henry Chesbrough
Keyword(s):  
Private Sector ◽  
Open Innovation ◽  
Smart Cities ◽  
Critical Role ◽  
Business Development ◽  
Three Dimensions ◽  
The Public ◽  
Rural Markets ◽  
Rural Settings ◽  
Social Sectors

The dimensions of generation, dissemination, and absorption apply in the public and social sectors, as well as in the private sector. Smart Cities initiatives have generated a lot of possibilities, but to date have not delivered much social or business value. Much of the fault lies in not in the generation of technologies, but in the lack of dissemination and absorption of these initiatives beyond a narrow circle of specialists. Open Innovation can play a critical role in addressing the needs of rural villagers by enticing profit-seeking companies to engage in business development research in rural markets. These companies, if successful, become agents of dissemination and scaling via markets. Smart Villages is a promising new initiative for addressing the needs of villagers in poor, underdeveloped rural settings. However, the three dimensions of generation, dissemination, and absorption apply here as well.

Social versus Private Insurance

2018 ◽  
Author(s):  
Pierre Pestieau ◽  
Mathieu Lefebvre
Keyword(s):  
Social Insurance ◽  
Private Insurance ◽  
Population Ageing ◽  
Fiscal Competition ◽  
Public Insurance ◽  
The Public ◽  
Social Risks ◽  
The Family ◽  
Private And Public

This chapter looks at the role of the public versus the private sector in the provision of insurance against social risks. After having discussed the evolution of the role of the family as support in the first place, the specificity of social insurance is emphasized in opposition to private insurance. Figures show the extent of spending on both private and public insurance and the chapter presents economic reasons to why the latter is more developed than the former. Issues related to moral hazard and adverse selection are addressed. The chapter also discusses somewhat more general arguments supporting social insurance such as population ageing, unemployment, fiscal competition and social dumping.

Helping Children with Special Needs: Who Receives Tympanostomy Tubes?

2021 ◽  
pp. 000348942098742
Author(s):  
David W. Wassef ◽  
Nehal Dhaduk ◽  
Savannah C. Roy ◽  
Gregory L. Barinsky ◽  
Evelyne Kalyoussef
Keyword(s):  
Developmental Disorders ◽  
Developmental Disorder ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Tube Placement ◽  
Hospital Charges ◽  
Tympanostomy Tube ◽  
Tube Insertion ◽  
Tympanostomy Tubes

Objectives: Tympanostomy tubes can prevent sequelae of otitis media that adversely affect long term hearing and language development in children. These negative outcomes compound the existing difficulties faced by children who are already diagnosed with developmental disorders. This study aims to characterize this subset of children with developmental disorders undergoing myringotomy and tympanostomy tube insertion. Methods: A retrospective review using the Kids’ Inpatient Database (KID) was conducted, with codes from International Classification of Diseases, Ninth Revision used to query data from the years 2003 to 2012 to determine a study group of children with a diagnosis of a developmental disorder undergoing myringotomy and tympanostomy insertion. This group was compared statistically to patients undergoing these procedures who did not have a diagnosed developmental disorder. Results: In total, 21 945 cases of patients with myringotomy with or without tympanostomy tube insertion were identified, of which 1200 (5.5%) had a diagnosis of a developmental disorder. Children with developmental disorders had a higher mean age (3.3 years vs 2.9 years, P = .002) and higher mean hospital charges ($43 704.77 vs $32 764.22, P = .003). This cohort also had higher proportions of black (17.6% vs 12.3%, P < .001) and Hispanic (23.9% vs 20.6%, P = .014) patients, and had lower rates of private insurance coverage (39.6% vs 49%, P < .001). Conclusion: The population of children with developmental disorders undergoing myringotomy or tympanostomy tube placement has a different demographic composition than the general population and faces distinct financial and insurance coverage burdens. Further study should be done to assess if these differences impact long term outcomes.

scholarly journals Public and private sectors collective response to combat COVID-19 in Malaysia

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ching Siang Tan ◽  
Saim Lokman ◽  
Yao Rao ◽  
Szu Hua Kok ◽  
Long Chiau Ming
Keyword(s):  
Insurance Coverage ◽  
Healthcare Providers ◽  
Screening Tests ◽  
Public Healthcare ◽  
Private Hospitals ◽  
Public And Private ◽  
The Public ◽  
Private Healthcare ◽  
Care Services ◽  
Challenges And Opportunities

AbstractOver the last year, the dangerous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly around the world. Malaysia has not been excluded from this COVID-19 pandemic. The resurgence of COVID-19 cases has overwhelmed the public healthcare system and overloaded the healthcare resources. Ministry of Health (MOH) Malaysia has adopted an Emergency Ordinance (EO) to instruct private hospitals to receive both COVID-19 and non-COVID-19 patients to reduce the strain on public facilities. The treatment of COVID-19 patients at private hospitals could help to boost the bed and critical care occupancy. However, with the absence of insurance coverage because COVID-19 is categorised as pandemic-related diseases, there are some challenges and opportunities posed by the treatment fees management. Another major issue in the collaboration between public and private hospitals is the willingness of private medical consultants to participate in the management of COVID-19 patients, because medical consultants in private hospitals in Malaysia are not hospital employees, but what are termed “private contractors” who provide patient care services to the hospitals. Other collaborative measures with private healthcare providers, e.g. tele-conferencing by private medical clinics to monitor COVID-19 patients and the rollout of national vaccination programme. The public and private healthcare partnership must be enhanced, and continue to find effective ways to collaborate further to combat the pandemic. The MOH, private healthcare sectors and insurance providers need to have a synergistic COVID-19 treatment plans to ensure public as well as insurance policy holders have equal opportunities for COVID-19 screening tests, vaccinations and treatment.

scholarly journals Serendipitous crystallization and structure determination of bacterioferritin from Achromobacter

2018 ◽  
Vol 74 (9) ◽  
pp. 558-566
Author(s):  
Abhisek Dwivedy ◽  
Bhavya Jha ◽  
Khundrakpam Herojit Singh ◽  
Mohammed Ahmad ◽  
Anam Ashraf ◽  
...  
Keyword(s):  
Crystal Structure ◽  
Iron Homeostasis ◽  
Critical Role ◽  
Porphyrin Ring ◽  
Opportunistic Pathogens ◽  
Complex Design ◽  
Archaeal Species ◽  
Ferroxidase Center ◽  
Mycobacterial Protein

Bacterioferritins (Bfrs) are ferritin-like molecules with a hollow spherical 24-mer complex design that are unique to bacterial and archaeal species. They play a critical role in storing iron(III) within the complex at concentrations much higher than the feasible solubility limits of iron(III), thus maintaining iron homeostasis within cells. Here, the crystal structure of bacterioferritin from Achromobacter (Ach Bfr) that crystallized serendipitously during a crystallization attempt of an unrelated mycobacterial protein is reported at 1.95 Å resolution. Notably, Fe atoms were bound to the structure along with a porphyrin ring sandwiched between the subunits of a dimer. Furthermore, the dinuclear ferroxidase center of Ach Bfr has only a single iron bound, in contrast to the two Fe atoms in other Bfrs. The structure of Ach Bfr clearly demonstrates the substitution of a glutamate residue, which is involved in the interaction with the second Fe atom, by a threonine and the consequent absence of another Fe atom there. The iron at the dinuclear center has a tetravalent coordination, while a second iron with a hexavalent coordination was found within the porphyrin ring, generating a heme moiety. Achromobacter spp. are known opportunistic pathogens; this structure enhances the current understanding of their iron metabolism and regulation, and importantly will be useful in the design of small-molecule inhibitors against this protein through a structure-guided approach.

Implementation of a Dual-Frequency GLONASS and GPS L1 C/A Software Receiver

2010 ◽  
Vol 63 (2) ◽  
pp. 269-287 ◽  
Author(s):  
S. Abbasian Nik ◽  
M. G. Petovello
Keyword(s):  
Global Navigation Satellite System ◽  
Critical Role ◽  
Satellite System ◽  
Navigation Satellite ◽  
Dual Frequency ◽  
Software Receiver ◽  
The Public ◽  
Global Navigation ◽  
Global Navigation Satellite

These days, Global Navigation Satellite System (GNSS) technology plays a critical role in positioning and navigation applications. Use of GNSS is becoming more of a need to the public. Therefore, much effort is needed to make the civilian part of the system more accurate, reliable and available, especially for the safety-of-life purposes. With the recent revitalization of Russian Global Navigation Satellite System (GLONASS), with a constellation of 20 satellites in August 2009 and the promise of 24 satellites by 2010, it is worthwhile concentrating on the GLONASS system as a method of GPS augmentation to achieve more reliable and accurate navigation solutions.

The Continuing Problem of Special Districts in American Government

2011 ◽  
Vol 11 (1) ◽  
pp. 52-67 ◽  
Author(s):  
Larita Killian
Keyword(s):  
New York ◽  
Local Governments ◽  
Census Bureau ◽  
Three Dimensions ◽  
The Public ◽  
Reporting Practices ◽  
Special Districts ◽  
Theoretical Perspectives ◽  
Policy Alignment ◽  
Definition Of

ABSTRACT Due to fiscal constraints and demands for increased accountability, scholars and public officials are reviewing the structure and reporting practices of local governments. These efforts are often incomplete, however, because they bypass special districts, which now comprise over 40 percent of all local governments. The proliferation of special districts has the potential to increase government costs, redirect the allocation of scarce resources, remove debt and expenditure practices from the public eye, and reduce democratic controls over elected officials. This paper highlights some of the public interest concerns related to these entities to inform future, localized research. For decades, scholars have approached special districts from two opposing theoretical perspectives: institutional reform and public choice. Literature from these opposing perspectives is used to analyze special districts along three dimensions: efficiency and economy of operations, policy alignment and allocation of resources, and democratic accountability. This paper uses the U.S. Census Bureau definition of special districts, though alternative definitions are discussed. Efforts by four states (Florida, Pennsylvania, Indiana, and New York) to improve local government, and their varying approaches to special districts, are reviewed, leading to the conclusion that the complex issues related to special districts must be resolved within state contexts.

scholarly journals Impact of the Affordable Care Act’s Dependent Coverage Expansion on the Health Care and Health Status of Young Adults: What Do We Know So Far?

2017 ◽  
Vol 75 (2) ◽  
pp. 131-152 ◽  
Author(s):  
Joshua Breslau ◽  
Bradley D. Stein ◽  
Bing Han ◽  
Shoshanna Shelton ◽  
Hao Yu
Keyword(s):  
Public Health ◽  
Health Status ◽  
Insurance Coverage ◽  
Health Impact ◽  
Care Utilization ◽  
The Public ◽  
Behavioral Health Treatment ◽  
Coverage Expansion ◽  
Dependent Coverage ◽  
The Impact

The dependent coverage expansion (DCE), a component of the Affordable Care Act, required private health insurance policies that cover dependents to offer coverage for policyholders’ children through age 25. This review summarizes peer-reviewed research on the impact of the DCE on the chain of consequences through which it could affect public health. Specifically, we examine the impact of the DCE on insurance coverage, access to care, utilization of care, and health status. All studies find that the DCE increased insurance coverage, but evidence regarding downstream impacts is inconsistent. There is evidence that the DCE reduced high out-of-pocket expenditures and frequent emergency room visits and increased behavioral health treatment. Evidence regarding the impact of the DCE on health is sparse but suggestive of positive impacts on self-rated health and health behavior. Inferences regarding the public health impact of the DCE await studies with greater methodological diversity and longer follow-up periods.

Health Insurance Differentials Among Minority Children With Chronic Conditions and the Role of Federal Agencies and Private Foundations in Improving Financial Access

PEDIATRICS ◽  
1993 ◽  
Vol 91 (5) ◽  
pp. 1040-1047
Author(s):  
Margaret A. McManus ◽  
Paul Newacheck
Keyword(s):  
Health Insurance ◽  
Race And Ethnicity ◽  
Health Care Policy ◽  
Private Insurance ◽  
Insurance Coverage ◽  
Minority Population ◽  
Hispanic Children ◽  
Health Services Use ◽  
Financial Barriers ◽  
White Children

Minorities experience a disproportionate share of the financial barriers resulting from higher rates of uninsuredness and a greater reliance on Medicaid vs private insurance. As a result, health services use and patterns of expenditures vary markedly by race and ethnicity.1,2 National survey data reveal a rapid increase in the number of uninsured black and Hispanic persons between 1977 and 1987.3 The major factors contributing to this increase are (1) overall growth in the size of the minority population, especially Hispanics; (2) reductions in private insurance coverage; and (3) the lack of significant expansions in public programs, largely Medicaid (note: several Medicaid eligibility expansions affecting poor children occurred during and after 1987). In 1987, 14% of white children younger than age 18 were uninsured compared to 22% of black children and 33% of Hispanic children (Cornelius LJ. Unpublished data). Black and Hispanic persons were more likely to rely on Medicaid as their primary financing source than were white persons.3 In 1987, 8% of white children were covered by Medicaid vs 38% of black and 28% of Hispanic children (Cornelius LJ. Unpublished data from the Agency for Health Care Policy and Research, 1992.). Despite Medicaid's importance as a financing source, low reimbursement rates have resulted in inadequate provider participation and corresponding access barriers.4,5 In comparison with white persons, minorities have less access to employer-based insurance benefits. Part of the reason lies in the types of jobs that are disproportionately held by minorities. Personal service and agricultural employers typically do not offer health insurance to their employees.

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