Browsing by Subject "Affordable Care Act"
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Item Affordable Care Act: It’s Effect on Health Care Utilization and the Health of Minnesotans(2020-08-18) Uhde, TamaraIn the United States, there are several different types of health care, including the Veteran’s Health care system, Medicare/Medicaid systems and private health care systems. The introduction of the Affordable Care Act sparked an additional type of health care option and further empowerment of citizens to engage in their health outside of their employment status. My interest in this area was started from previous employment and interactions within these systems and the complex nature of how they affect health care outcomes; both positively and negatively. This paper focuses on a small portion of this complicated subject and how it interacts with individuals and their health. There is a large body of evidence showing that access to medical care improves health outcomes. Patients who see the doctor regularly are more likely to receive consistent preventative care, have conditions like cancer and diabetes detected early, and have a higher quality of life (Christopher, 2015). Coverage of preventative care services aims to reduce the amount of undiagnosed or untreated conditions. This is expected to reduce costs through less invasive or complex treatment options (Dixon, 2014).Item Can This Marriage Be Saved? Federalism and the Future of U.S. Health Policy Under the Affordable Care Act(Minnesota Journal of Law, Science and Technology, 2014-02-20) Rosenbaum, SaraAs with all transformational laws, the Patient Protection and Affordable Care Act, hereinafter referred to by its popular name, the Affordable Care Act (ACA or the Act), derives its power from the extent to which it realigns prior relationships and from adding new rights and duties: Between individuals and government through the creation of a right to accessible, affordable health insurance and a concomitant “personal responsibility” to secure it; between the insurance industry and the government through reforms aimed at assuring access to affordable coverage; between larger employers and workers through the Act’s “shared responsibility” requirements; and between health care providers and public and private insurers through provisions aimed at long-term restructuring in how health care is organized and paid for. But it is fair to say that no relationship within the health care system is more affected by the Act than that between the federal government and state governments. Indeed, the ACA establishes a legal approach to national health reform that, at its core, rests on the shoulders of this relationship. First, the Act expands the pre-existing federal-state partnership in the regulation of health insurance while establishing a new Marketplace for affordable coverage. Second, the Act expands the joint federal-state investment in health care for the poor (this time, with the lion’s share coming from the federal partner) through an expanded Medicaid program. As of May 2013, the Congressional Budget Office (CBO) has estimated that by 2022, twenty-five million Americans will gain coverage as a result of this recalibrated set of relationships. This Article takes a closer look at the two federalism relationships—one regulatory, the other investment—that lie at the heart of the Act. I surmise that even if sputtering and fragile, the regulatory partnership actually is built to weather current conditions and that ultimately, it will enable full implementation of the market reforms that the Act sets in motion. I also conclude, however, that at least where coverage of poor adults and their families is concerned, the Medicaid relationship is sufficiently under water to necessitate a federal fallback system, comparable in spirit to the federal fallback that has been designed for the regulatory side of the ledger. Creating such a fallback is essential if the nation is to avert the terrible spectacle of allowing any individual state to exclude its poorest residents from coverage.Item Developing a Durable Right to Health Care(2013-02-12) Fuse Brown, Erin C.The Patient Protection and Affordable Care Act’s (ACA) signature accomplishment was the creation of a statutory right to health care for the uninsured. This is a momentous change in policy, addressing one of the most vexing social issues of our time and affecting millions of people and billions of dollars of the U.S. economy. This ambition and the degree of societal and political debate leading up to the Act’s passage suggests that it is a “superstatute,” a rare breed of statute that can, among other things, create rights and institutions more typically thought to be the province of constitutional undertaking. Nevertheless, the structure of the ACA’s right to health care makes it fragile and reduces its chances of becoming a durable right. The ACA may end up as a “quasi-superstatute:” a statute that aspires but fails to become a superstatute through a failure of political and public entrenchment. The problem is that the right to health care is to be delivered largely through changes to the private health insurance market, requiring the collective action of many reluctant actors, including unwilling states and recalcitrant individuals. Even though it survived legal challenge before the Supreme Court, the ACA’s right to health care faces significant political and market challenges that threaten to retrench rather than entrench its benefits in the public’s mind. The vulnerability of this right to health care is concentrated early in its lifespan, and if it survives these early years, forces such as the endowment effect may strengthen the right’s durability as its benefits take hold. The fragility of the ACA’s right to health care and its uncertain path to durability provide lessons to future framers of a right to health care regarding the long timeframe for implementation, uncertainty, complexity, and structure. The risk of becoming a “quasi-superstatute” highlights the importance of how such social reforms ought to be structured to achieve entrenchment and durability after the ink is dry on the new legislation.Item Expectation, Challenge, and Opportunity: Minnesota's Community Health Centers and the Affordable Care Act(Hubert H. Humphrey School of Public Affairs, 2013-05-06) Kurt, AlexItem Importance of Preconception and Preventative Care: Women and the Affordable Care Act(2018) Xiong, PaheeIn the past, policy changes have been made to ensure insurance covers pregnant women. Public programs such as Medicaid were expanded to cover pregnant women. However, there has not been much focus on expanding health insurance coverage for non-pregnant, reproductive age women. Even though these women can obtain coverage during pregnancy, this is too late of an intervention to ensure women have healthy pregnancies (Atrash et al., 2006, pg.4). Women who are not pregnant nor have children are more likely to be uninsured (Johnson and Gee, 2012, pg. 225). Childbearing age women suffer from a variety of chronic conditions that could potentially contribute to adverse pregnancy outcomes (Atrash et al., 2006, pg.4). Preventative measures need to happen before pregnancy to detect, modify, and control risk factors that contribute to maternal and infant outcomes (Atrash et al., 2006, pg.4). Young adults between the ages of 19 to 24 are more likely to be uninsured and are among the most likely to be pregnant (Johnson and Gee, 2012, pg.225). Recent policy changes were implemented to expand access health care coverage under the Affordable Care Act (ACA). Due to this policy change, I am interested to see if the ACA expanded coverage for non-pregnant women. Studying the ACA expansion would be helpful to understand which provisions had a positive impact on women’s health care coverage. My paper will focus on how the ACA has affected trends in health insurance coverage among pregnant and reproductive-age women. I will also consider social factors such as age, race, education, and geographical location to examine their influence on recent trends in health insurance coverage. By using these socio-demographic factors in my analysis, I can better understand how each factor affects the status of insurance coverage.Item Inside The Lines: Essays on the Performance of Whole Organizational Networks(2019-05) Kim, KeymanThis dissertation is focused on the study of heterogeneous network performance. For decades, most strategy and organizational research has focused on understanding how networks influence a single “node,” typically an organization or individual. In contrast, I shift my perspective to view a whole network as the unit of analysis. This approach is designed to deepen scholarly understanding of strategic outcomes and collective performance that only exist at the higher level – the whole network level. The motivation for this dissertation is the realization many of society’s most complex problems and Grand Challenges require the concerted efforts of organizations towards shared goals, which may not always coincide with local (organization level) incentives. As such, I use the context of healthcare reform in the United States to examine how analyzing the complex patterns of interorganizational patient care may help us better understand the determinants of emergent outcomes at the whole network level. Specifically, the Affordable Care Act of 2010 led to the formation of hundreds of new interorganizational networks, called Accountable Care Organizations, within the Medicare system. Using patient treatment networks based on claims data, I examine two research questions. First, what are the relationships among various network level properties and collective performance? Second, how did the formation of Accountable Care Organizations alter existing patient care patterns and outcomes, if at all? In sum, this dissertation makes theoretical contributions to the study of organizational networks, particularly with regards to network level outcomes. Moreover, this research offers insights into how network studies may inform policy and practice in healthcare.Item The Relationship Between Income Growth and Uninsured Rate(2017) Lu, SiruiUsing data collected from the United States Census Bureau from 50 states spanning the years 2008 to 2015, I examine the relationship between uninsured rate and income growth. I use fixed effect model to do regression model to find that the lower uninsured rate, the higher income growth rate.Item The Supreme Court and Health Reform(2012-07-09) Keefer, Scott; Kofman, Mila; McKechnie, Andrew; Jacobs, Lawrence; Hage, DaveItem Systemic Change in a Community-Based HIV/AIDS Organization: A Case Study Examining the Response to Affordable Care Act Reforms(2015-07) Lee, MichaelBackground: The United States' HIV medical and social service systems remain "a fragile edifice with disparate parts" (Sherer, 2013, p. 133). While the Affordable Care Act (ACA) offers several opportunities, considerable uncertainty remains concerning its influence on HIV-affected populations, who face persistent socioeconomic service barriers. Since the early AIDS crisis, nonprofit HIV/AIDS service organizations ("ASOs") � have provided a critical link between healthcare providers and consumers. This qualitative case study examined the systemic change experiences of a nonprofit ASO, with specific attention to technological considerations, members' identification with HIV-affected consumers, and perceptions of the organization's ' history and service values. Methodology: This study aimed to examine an HIV/AIDS service organization's systemic change experiences via the perspectives of its members. Four central questions guided the investigation: 1) How do members of an HIV/AIDS service organization (i.e., Board, leadership, and staff) experience systemic change in the current policy environment? 2) What technological changes do members of the organization consider (i.e., interventions selected to carry out its mission) as they develop a strategic response to Affordable Care Act legislation? 3) To what extent does ASO members' knowledge of and/or identification with HIV-affected constituencies (e.g., gay/bisexual men, injection drug users, communities of color) influence the organization's systemic change process? 4) To what extent does ASO members' understanding of the organization's history and service values influence the organization's systemic change process? Data collection coincided with strategic plan implementation in 2013-2014 and included analysis of 40 documents, observation of 10 implementation meetings, and semi-structured interviews with 20 Board and staff members. This study was determined to be exempt by the university's Institutional Review Board. Results: Findings revealed ten unique themes. Members recognized an opportunity to reckon with external factors, including uncertain policy shifts and changing public perceptions. The rationale for change included both survival and positioning the organization as a sector leader and service destination. Technological considerations included defining measurable outcomes, identifying expansion opportunities, and addressing barriers to growth. Members described personal, longstanding familiarity with consumers, especially concerning stigma and marginalization. Consumers' needs were characterized as both medically and psychosocially complex. Defining organizational characteristics included nonjudgmental services tailored to consumers' needs and identities and longevity of operations. Perspectives on workplace culture were less settled concerning staff and leadership relationships, professionalism, and accountabilities. Appraisals of how to proceed included competing desires for quick, decisive action and cautious, collaborative deliberation. While most members expressed enthusiasm for the changes, some indicated waning confidence in leaders' decisions and communication, and staff departures sharply increased as the study concluded. Significance: This study is timely and relevant for understanding how changes in the U.S. health and human service system influence services targeting historically marginalized populations. Research and practice implications include the influence of shared historical trauma in organizational development and conceptually reframing community-level HIV suppression efforts around contributing social service factors. Social workers in this study demonstrated a continuing role for the profession in HIV services, including organizational leadership, policy advocacy, program supervision, and direct services to consumers.Item What are Network Breadth and Keeping Your Health Plan Worth?: Evidence from Covered California(2018-07) Drake, ColemanThe Health Insurance Marketplaces have received considerable attention for their narrow network health insurance plans. Yet, little is known about consumer tastes for network breadth and how it affects health plan selection. I estimate demand for health plans in California’s Marketplace, Covered California. Using 2017 individual enrollment data and provider network directories obtained from Covered California, I develop a geospatial measure of network breadth that reflects the physical locations of households and in-network providers. I find that households are sensitive to network breath in their plan choices, and that they tend to stay with their plan from the previous year (i.e., inertia). Overall willingness to pay (WTP) to switch from a narrow to a broad network plan is $21.94 in monthly premiums. Variation in this WTP by age indicates that a selection mechanism exists whereby older households sort into broader network plans. I also find that Covered California households are highly premium sensitive, which may be a result of plan standardization regulations in Covered California. Furthermore, I find that switching costs, as measured by the willingness to pay to stay in the same plan in a subsequent year, are $437.86 in monthly premiums on average, indicating that inertia impacts plan choice in the individual health insurance market despite relatively high churn and plan exit.Item What's Next for Obamacare?(2015-12-03) Rovner, Julie; Snowbeck, Chris