Journal of health politics, policy and law
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J Health Polit Policy Law · Apr 2020
Criminal Justice or Public Health: A Comparison of the Representation of the Crack Cocaine and Opioid Epidemics in the Media.
The opioid epidemic is a major US public health crisis. Its scope prompted significant public outreach, but this response triggered a series of journalistic articles comparing the opioid epidemic to the crack cocaine epidemic. Some authors claimed that the political response to the crack cocaine epidemic was criminal justice rather than medical in nature, motivated by divergent racial demographics. ⋯ Our analysis suggests that race and legality may influence policy responses to substance-use epidemics. Comparisons also suggest that the evolution of the media narrative on substance use cannot alone account for the divergence in framing between the two epidemics.
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J Health Polit Policy Law · Dec 2018
Health Insurance and Human Capital: Evidence from the Affordable Care Act's Dependent Coverage Mandate.
Prior to 2010, young adults between the ages of 18 and 34 had the highest rates of uninsurance in America. The "Dependent Care Provision" of the Affordable Care Act sought to increase insurance rates among young adults by allowing them to stay on their parents' policy until age 26. We examine the human capital decisions young adults make once they have an option for health insurance outside of employer-sponsored health insurance. ⋯ This result is robust to a variety of specifications. We did not find a consistent effect among men. Our results suggest that increased flexibility in health insurance markets has implications for human capital investment.
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J Health Polit Policy Law · Apr 2018
Supporting Transformation through Delivery System Reform Incentive Payment Programs: Lessons from New York State.
The New York Delivery System Reform Incentive Payment (DSRIP) waiver was viewed as a prototype for Medicaid and safety net redesign waivers in the Affordable Care Act (ACA) era. After the insurance expansions of the ACA were implemented, it was apparent that accountability, value, and quality improvement would be priorities in future waivers in many states. Despite New York's distinct provider relationships, previous coverage expansions, and local and state politics, it is important to understand the key characteristics of the waiver so that other states can learn how to better incorporate value-based arrangements into future waivers or attempts to limit spending under proposed Medicaid per-capita caps or block grants. In this article, we examine the New York DSRIP waiver by drawing on its design, early experiences, and evolution to inform recommendations for the future renewal, implementation, and expansion of redesigned or transformational Medicaid waivers.
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J Health Polit Policy Law · Dec 2017
Statewide Payment and Delivery Reform: Do States Have What It Takes?
States' role in payment as well as coverage will be subject to debate as the administration and the Congress decide how to address the Affordable Care Act (ACA) and otherwise reshape the nation's health policies. Acting as stewards of health care for the entire state population and stimulated by concern about rising costs and federal support under the ACA, the elected and administrative leaders of some states have been using their political influence and authority to improve their state's overall systems of care regardless of who pays the bill. ⋯ We found that despite these states' similar goals, differences in their statutory authority and purchasing power, along with their leaders' willingness to use them, significantly influence a state's ability to achieve reform objectives. We caution federal and state policy makers to recognize the reality that state leaders' political desire to exercise stewardship may not be enough to achieve it.
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J Health Polit Policy Law · Oct 2017
Cautious Citizenship: The Deterring Effect of Immigration Issue Salience on Health Care Use and Bureaucratic Interactions among Latino US Citizens.
Research shows that health care use among Latino immigrants is adversely affected by restrictive immigration policy. A core concern is that immigrants shy away from sharing personal information in response to policies that expand bureaucratic monitoring of citizenship status across service-providing organizations. This investigation addresses the concern that immigration politics also negatively influences health care utilization among Latino US citizens. ⋯ Results indicate that Latino US citizens are less likely to make an appointment to see a health care provider when the issue of immigration is mentioned. Additionally, Latino US citizens who know someone who has been deported are more inclined to perceive that information shared with health care providers is not secure. We discuss how cautious citizenship, or risk-avoidance behaviors toward public institutions in order to avoid scrutiny of citizenship status, informs debates about reducing health care inequities.