American journal of public health
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We describe the patterns of coverage gains associated with the Affordable Care Act (ACA) expansions and use these patterns to assess the potential impact of alternative repeal or repeal and replace strategies because Congress and the president are weighing options to repeal or replace the ACA. We find that specific provisions of the ACA, including the Medicaid expansion and the structure of premium subsidies, have been associated with large and robust gains in insurance coverage. ⋯ We find that many replacement proposal components, including flat tax credits and maintaining cost savings provisions, could jeopardize the ability of many of the ACA's primary beneficiaries, as well as other Americans, to access coverage and care. By leading to a deterioration of the safety net, these strategies could also imperil population health activities.
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In late 2015, an increase in the number of infants born with microcephaly in poor communities in northeast Brazil prompted investigation of antenatal Zika infection as the cause. Zika now circulates in 69 countries, and has affected pregnancies of women in 29 countries. ⋯ To date, public health responses have focused on mosquito vector eradication, sexual and reproductive health services, knowledge and technology including diagnostic test and vaccine development, and health system preparedness. We summarize responses to date and apply human rights and related principles including nondiscrimination, participation, the legal and policy context, and accountability to identify shortcomings and to offer suggestions for more equitable, effective, and sustainable Zika responses.