scholarly journals Uncompensated Care: How Much is Too Much?

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Zehra Hussain
Keyword(s):  
Population Growth ◽  
Medicaid Expansion ◽  
Uncompensated Care ◽  
Large Measure ◽  
Medicaid Eligibility ◽  
Individual Mandate ◽  
The Individual ◽  
Uninsured Population ◽  
Denton County ◽  
Local Medical Care

Texas is home to the largest uninsured population in the U.S. Such problems emerge, in large measure, from thestate’s rejection of Medicaid expansion. That decision has prevented Texas from receiving $100 billion in federalcash over a decade. Consequently, the number of uninsured residents either going without local medical care oroverloading adjacent communities is likely to increase. Therefore, this study seeks to explain the implicationsof Medicaid expansion in Denton county. This paper explores the effects of expanding Medicaid and how thatwould affect race, income, and Medicaid eligibility for indigent patients. The results of a Python–based simulationshow that, adjusting for Denton’s population growth at projected levels of uninsured, by 2020 the uncompensatedcare will cost Denton County $42,716,796. This number will continue to rise to a total of $61,462,134 as a resultof ceasing Medicaid expansion and getting rid of the individual mandate. These numbers are important as theyshow the rising costs of uncompensated care that are associated with an increase in population growth.

scholarly journals The Affordable Care Act’s Coverage Impacts in the Trump Era

2021 ◽  
Vol 58 ◽  
pp. 004695802110429
Author(s):  
Charles Courtemanche ◽  
Ishtiaque Fazlul ◽  
James Marton ◽  
Benjamin Ukert ◽  
Aaron Yelowitz ◽  
...  
Keyword(s):  
Affordable Care Act ◽  
Insurance Coverage ◽  
Community Survey ◽  
Medicaid Expansion ◽  
Percentage Points ◽  
Individual Mandate ◽  
Us Presidential Election ◽  
Causal Impact ◽  
The Individual ◽  
Trump Administration

The 2016 US presidential election created uncertainty about the future of the Affordable Care Act (ACA) and led to postponed implementation of certain provisions, reduced funding for outreach, and the removal of the individual mandate tax penalty. In this article, we estimate how the causal impact of the ACA on insurance coverage changed during 2017 through 2019, the first 3 years of the Trump administration, compared to 2016. Data come from the 2011–2019 waves of the American Community Survey (ACS), with the sample restricted to non-elderly adults. Our model leverages variation in treatment intensity from state Medicaid expansion decisions and pre-ACA uninsured rates. We find that the coverage gains from the components of the law that took effect nationally—such as the individual mandate and regulations and subsidies in the private non-group market—fell from 5 percentage points in 2016 to 3.6 percentage points in 2019. In contrast, the coverage gains from the Medicaid expansion increased in 2017 (7.0 percentage points) before returning to the 2016 level of coverage gains in 2019 (5.9 percentage points). The net effect of the ACA in expansion states is a combination of these trends, with coverage gains falling from 10.8 percentage points in 2016 to 9.6 percentage points in 2019.

scholarly journals Retail Therapy: How a Trip to the Store Can Make You Feel Better in the Evolving Health Care Landscape Created by the Affordable Care Act

2015 ◽  
Vol 33 (2) ◽  
pp. 239-260
Author(s):  
Cynthia Liba
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Physician ◽  
Poverty Level ◽  
Health Clinics ◽  
Medicaid Eligibility ◽  
Individual Mandate ◽  
The Individual

As the ACA expands Medicaid eligibility by creating a national Medicaid minimum eligibility level of 133% of the federal poverty level and requires U.S. citizens to purchase health insurance as a result of the individual mandate, the shortage of primary care physicians will become painfully apparent for those seeking treatment. As a result, many health policy analysts and lawmakers are examining the potential ability of retail health clinics (RHCs) to address the consequences of primary care physician shortages in the United States, among other deficiencies in the provision of health care.

scholarly journals The Taxing Power Of The Federal Government And The General Welfare: What Are The Limits In The Wake Of NFIB V. Sebelius?

2015 ◽  
Vol 76 (3) ◽  
Author(s):  
Mark Klock
Keyword(s):  
Health Insurance ◽  
Affordable Care Act ◽  
Medicaid Expansion ◽  
Federal Funds ◽  
Chief Justice ◽  
Commerce Clause ◽  
General Welfare ◽  
Individual Mandate ◽  
Constitutional Constraints ◽  
The Individual

The Affordable Care Act seeks to remedy the problem of information asymmetry in the health insurance market by mandating that everyone obtain health insurance or pay a penalty, and by requiring the States to expand Medicaid or lose existing federal funds. In NFIB v. Sebelius, Chief Justice Roberts held that Congress’ power to regulate under the Commerce Clause could not justify the Individual Mandate to purchase insurance, but that the penalty could be construed as a tax and upheld under the taxing power. Chief Justice Roberts also held the Medicaid Expansion to be an unconstitutional use of spending power, but determined that the Medicaid Expansion could remain with the States having the option to keep existing funding and not expand or expand and take the incremental funding. Eight Justices disagreed with the Chief Justice on the Individual Mandate, and six Justices disagreed with the Chief Justice on the Medicaid Expansion. This creates a paradox in that a supermajority of the Court believes the case was wrongly decided on both main questions. More distressing is the scant analysis given in all of the opinions to the constitutional constraints on taxes.

scholarly journals Constitutional Ratemaking and the Affordable Care Act: A New Source of Vulnerability

2012 ◽  
Vol 38 (2-3) ◽  
pp. 243-268
Author(s):  
Richard A. Epstein ◽  
Paula M. Stannard
Keyword(s):  
Affordable Care Act ◽  
Medicaid Expansion ◽  
Federal Poverty Level ◽  
Poverty Level ◽  
Patient Protection ◽  
Commerce Clause ◽  
Different Types ◽  
Individual Mandate ◽  
The Government ◽  
The Individual

As this Article is being written, the Patient Protection and Affordable Care Act (ACA) is being besieged with two different types of challenges. The first is a Commerce Clause challenge to the individual mandate on the ground that, although the Commerce Clause allows the government to “regulate” the transactions into which people choose to enter, it does not allow the state to force people to enter into disadvantageous transactions against their own will. The second of these challenges deals with the imposition of the Medicaid expansion provisions requiring a state to forego all of its additional Medicaid support unless it is prepared to extend Medicaid coverage, partially at its own expense, to individuals whose income levels put them at 100% to 133% of the federal poverty level.

Geography and the Gerrymander

1918 ◽  
Vol 12 (3) ◽  
pp. 403-426 ◽  
Author(s):  
C. O. Sauer
Keyword(s):  
Public Opinion ◽  
Major Part ◽  
The Other ◽  
European Countries ◽  
Large Measure ◽  
Adequate Knowledge ◽  
Other Hand ◽  
Partial Suppression ◽  
Historical Basis ◽  
The Individual

The gerrymander is an American name for a political abuse, which, though by no means exclusively American, has been most widely practiced and generally tolerated in this country. It is a device for the partial suppression of public opinion that simulates agreement with democratic institutions. The subterfuge, therefore, has no place in countries in which oligarchic control is legitimized. Nor is it suited to European conditions, because it is difficult there to shift electoral boundaries. European electoral units in large part have a clearly defined historical basis, which in turn rests upon geographic coherence. This solidarity is commonly so great that it cannot be disregarded. American political divisions on the other hand show in major part very imperfect adjustment to economic and historic conditions, largely, because many of the divisions were created in advance of such conditions. They are, in the main, not gradual growths, but deliberate and arbitrary legislative creations, made without adequate knowledge of the conditions that make for unity or disunity of population within an area. Political divisions tend, therefore, to be less significant than in European countries and to be regarded more lightly. It is in particular the smaller unit, such as the county, that has been manipulated for electoral purposes. In spite of their poorly drawn individual boundaries, groups of counties can be organized into larger electoral units in such a manner as to represent a common body of interests predominating. On the other hand they can be so arranged as to mask these interests. The lack of proper coherence in the individual county may be rectified in large measure in the group, or it may be intensified. Gerrymandering accomplishes the latter result.

Does Medicaid expansion influence county health spending? A case of New York counties

2021 ◽  
pp. 1-16
Author(s):  
Shihyun Noh ◽  
Ji-Hyung Park
Keyword(s):  
Public Health ◽  
New York ◽  
Health Services ◽  
Local Governments ◽  
Health Spending ◽  
Medicaid Expansion ◽  
Health Administration ◽  
Public Health Services ◽  
York County ◽  
Uninsured Population

Abstract We investigated the impacts of Medicaid expansion on New York county total health spending and specifics of health spending, including health services, public health facilities and public health administration. Little research considered the financial effect of Medicaid expansion on local governments while well reported are its influences on uninsured rates and health services utilization. New York counties have contributed to health in their boundaries by providing or funding public health services, and supporting a part of the non-federal share of Medicaid expenditures and uncompensated care. Medicaid expansion can reduce the size of county expenditures for health by enrolling more previously uninsured population in the program and offering more generous federal funding for the expanded Medicaid. We offer empirical evidence that Medicaid expansion was associated with reduced county health spending.

scholarly journals Contextualizing the first-round failure of the AHCA: down but not out

2017 ◽  
Vol 9 (6) ◽  
pp. 595-600 ◽  
Author(s):  
Joshua A Hirsch ◽  
Andrew B Rosenkrantz ◽  
Greg N Nicola ◽  
H Benjamin Harvey ◽  
Richard Duszak ◽  
...  
Keyword(s):  
Tax Credits ◽  
Political Issues ◽  
Election Result ◽  
Legislative Action ◽  
Savings Accounts ◽  
Campaign Rhetoric ◽  
American Health Care ◽  
Individual Mandate ◽  
The Individual ◽  
Elected Office

On 8 November 2016 the American electorate voted Donald Trump into the Presidency and a majority of Republicans into both houses of Congress. Since many Republicans ran for elected office on the promise to ‘repeal and replace’ Obamacare, this election result came with an expectation that campaign rhetoric would result in legislative action on healthcare. The American Health Care Act (AHCA) represented the Republican effort to repeal and replace the Affordable Care Act (ACA). Key elements of the AHCA included modifications of Medicaid expansion, repeal of the individual mandate, replacement of ACA subsidies with tax credits, and a broadening of the opportunity to use healthcare savings accounts. Details of the bill and the political issues which ultimately impeded its passage are discussed here.

Kriterien der ethnischen Identität

1983 ◽  
Vol 7 (1) ◽  
pp. 21-42
Author(s):  
Harald Haarmann
Keyword(s):  
Ethnic Identity ◽  
A Priori ◽  
Real Life ◽  
Problem Area ◽  
Methodological Issues ◽  
Large Measure ◽  
Individual Features ◽  
The One ◽  
The Individual

SUMMARY Criteria for Ethnic Identity Despite numerous publications on theoretical and methodological issues regarding ethnic identity (ethnicity), many methodological problems relative to this topic remain insufficiently clarified. This article deals particularly with the problems involved in establishing and evaluating criteria of ethnic identity. The author assigns the complex of problems regarding ethnic identity significant status within a theory of the ecology of language. Specific points covered in methodological issues involving the formation of concepts and application of terminology involve: 1. problems of the weighting of distinctive features; 2. problems in the mutual boundary-marking between ethnic groups (i.e., problems of ethnic borders); 3. problems in the changeability of ethnic identity; 4. problems in the correlation of language and ethnicity; 5. problems of the polarity of subjective and objective features of ethnicity; 6. problems of multiple identities and the role of ethnic identity; 7. problems in the historical dimension of ethnic identity; 8. problems in the linking of groups within language communities of the same national identity. In international sociological and sociolinguistic research, unanimity of opinion exists only on the fact that ethnic identity cannot be characterized by a single feature but rather by a series of individual features (the accumulation of features). The priorities to be attached to the individual features are in large measure disputed. The author proceeds from the assumption that ethnic identities in real life are formed through a stronger or weaker dominance of individual features; they should be characterized accordingly. An unacceptable a priori evaluation or weighting of features is thus avoided. In the specific context of a long-term research program on the smaller language communities and ethnic languages of Europe, the author particularly examines the role of language in ethnicity. Contrary to most previous contributions to discussions of this problem area, the author distinguishes between the general linguistic affiliation as a characteristic of ethnic identity on the one hand (cf. the relationship in point 4) and the criterion of language-oriented group formations (cf. relationship in point 8). The problem area of the principle of language community is illustrated using the example of the Transcarpathian Gypsies in the Ukraine. RESUMO Kriterioj de la etna idento Malgraŭ multaj ĝisnunaj eldonajoj pri la etna idento (etneco), multaj metodaj pro-blemoj rilataj al tiu temaro restas nesufice klarigitaj. La jena artikolo aparte traktas la problemaron de la starigo kaj elvalorigo de kriterioj de la etna idento. La autoro al-jugas al la problemaro pri la etna idento gravan rangon interne de teorio pri la lingva ekologio. Apartaj punktoj, traktitaj en metodaraj demandoj, rilataj al la formado de konceptoj kaj la apliko de terminaro, estas: 1. problemaro pri la elvalorigo de karakteraj trajtoj; 2. problemaro de la reciproka limigo inter etnaj grupoj (t.e. problemoj pri etnaj limoj); 3. problemaro pri la šanĝebleco de la etna idento; 4. problemaro pri la rilato inter lingvo kaj etneco; 5. problemaro pri la polusigo de subjektivaj kaj objektivaj trajtoj de etneco; 6. problemaro de pluroblaj identoj kaj la rolo de etna idento; 7. problemaro ce la historia dimensio de la etna idento; 8. problemaro de la formiĝo de grupoj interne de lingvaj komunumoj de la sama nacia idento. En la internacia sociologia kaj socilingvistika esplorado, unuanimeco de opinio ekzistas nur pri la fakto, ke ne eblas karakterizi la etnan identon nur per unusola trajto, sed, male, per aro da opaj trajtoj (la kuniĝo de trajtoj). Oni grandparte disputas pri la prioritato, kiun oni aljuĝu al la opaj trajtoj. La autoro progresas ek de la asumo, ke la etnaj identoj en la vera vivo estas formitaj per, jen pli forta, jen pli malforta, rego de opaj trajtoj; oni karakterizu ilin lau tio. Tiel, oni evitas neakceptindan aprioran elvalorigon au elpezigon de trajtoj. En la aparta kunteksto de longdaura esplorprogramo pri la pli malgrandaj lingvaj komunumoj kaj etnaj lingvoj de Europo, la autoro aparte pristudas la rolon de la lingvo ce la etneco. Kontraue al la plejmultaj ĝisnunaj kontribuoj al diskutoj pri tiu problemaro, la autoro distingas inter la ĝenerala lingva aparteno kiel trajto de la etna idento unuflanke (komparu la rilton ce punkto 4) kaj la kriterion de la formigo de grupoj surbaze de lingvo (komparu la rilaton ce punkto 8). La problemaro de la prin-cipo de la lingva komunumo estas ilustrita per la ekzemplo de la transkarpataj ciganoj en Ukrajnio.

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