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1.
Health Aff (Millwood) ; 41(1): 13-25, 2022 01.
Article in English | MEDLINE | ID: covidwho-1574499

ABSTRACT

US health care spending increased 9.7 percent to reach $4.1 trillion in 2020, a much faster rate than the 4.3 percent increase seen in 2019. The acceleration in 2020 was due to a 36.0 percent increase in federal expenditures for health care that occurred largely in response to the COVID-19 pandemic. At the same time, gross domestic product declined 2.2 percent, and the share of the economy devoted to health care spending spiked, reaching 19.7 percent. In 2020 the number of uninsured people fell, while at the same time there were significant shifts in types of coverage.


Subject(s)
COVID-19 , Health Expenditures , Delivery of Health Care , Humans , Insurance, Health , Medicare , Pandemics/prevention & control , Patient Protection and Affordable Care Act , SARS-CoV-2 , United States
3.
Health Soc Work ; 46(4): 247-249, 2021 Nov 16.
Article in English | MEDLINE | ID: covidwho-1541526
4.
Lancet ; 397(10279): 1127-1138, 2021 03 20.
Article in English | MEDLINE | ID: covidwho-1525996

ABSTRACT

In 2010, the US health insurance system underwent one of its most substantial transformations with the passage of the Affordable Care Act, which increased coverage for millions of people in the USA, including those with and at risk of HIV. Even so, the system of HIV care and prevention services in the USA is a complex patchwork of payers, providers, and financing mechanisms. People with HIV are primarily covered by Medicaid, Medicare, private insurance, or a combination of these; many get care through other programmes, particularly the Ryan White HIV/AIDS Program, which serves as the nation's safety net for people with HIV who remain uninsured or underinsured but offers modest to no support for prevention services. While uninsurance has drastically declined over the past decade, the USA trails other high-income countries in key HIV-specific metrics, including rates of viral suppression. In this paper in the Series, we provide an overview of the coverage and financing landscape for HIV treatment and prevention in the USA, discuss how the Affordable Care Act has changed the domestic health-care system, examine the major programmes that provide coverage and services, and identify remaining challenges.


Subject(s)
Acquired Immunodeficiency Syndrome/epidemiology , COVID-19/economics , HIV Infections/drug therapy , HIV Infections/prevention & control , Insurance Coverage/legislation & jurisprudence , Insurance, Health/legislation & jurisprudence , Acquired Immunodeficiency Syndrome/drug therapy , Adult , Aged , Anti-Retroviral Agents/therapeutic use , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Female , Gender Identity , HIV Infections/economics , HIV Infections/epidemiology , Humans , Incidence , Male , Medicaid/statistics & numerical data , Medically Uninsured/statistics & numerical data , Medicare/statistics & numerical data , Middle Aged , Patient Protection and Affordable Care Act , Risk Assessment , SARS-CoV-2/genetics , United States/epidemiology
5.
Health Aff (Millwood) ; 40(11): 1680-1681, 2021 11.
Article in English | MEDLINE | ID: covidwho-1502083

ABSTRACT

The Affordable Care Act served as a pandemic safety net. Congress and the White House aim to further expand the law.


Subject(s)
Insurance Coverage , Patient Protection and Affordable Care Act , Humans , Insurance, Health , Medicaid , United States
6.
Health Aff (Millwood) ; 40(11): 1713-1721, 2021 11.
Article in English | MEDLINE | ID: covidwho-1502079

ABSTRACT

The Affordable Care Act provides tax credits for Marketplace insurance, but before 2021, families with incomes above four times the federal poverty level did not qualify for tax credits and could face substantial financial burdens when purchasing coverage. As a measure of affordability, we calculated potential Marketplace premiums as a percentage of family income among families with incomes of 401-600 percent of poverty. In 2015 half of this middle-class population would have paid at least 7.7 percent of their income for the lowest-cost bronze plan; in 2019 they would have paid at least 11.3 percent of their income. By 2019 half of the near-elderly ages 55-64 would have paid at least 18.9 percent of their income for the lowest-cost bronze plan in their area. The American Rescue Plan Act temporarily expanded tax credit eligibility for 2021 and 2022, but our results suggest that families with incomes of 401-600 percent of poverty will again face substantial financial burdens after the temporary subsidies expire.


Subject(s)
Health Insurance Exchanges , Patient Protection and Affordable Care Act , Aged , Costs and Cost Analysis , Eligibility Determination , Humans , Insurance Coverage , Insurance, Health , Middle Aged , United States
7.
Health Aff (Millwood) ; 40(11): 1722-1730, 2021 11.
Article in English | MEDLINE | ID: covidwho-1496546

ABSTRACT

In 2020 the COVID-19 pandemic caused millions to lose their jobs and, consequently, their employer-sponsored health insurance. Enacted in 2010, the Affordable Care Act (ACA) created safeguards for such events by expanding Medicaid coverage and establishing Marketplaces through which people could purchase health insurance. Using a novel national data set with information on ACA-compliant individual insurance plans, we found large increases in Marketplace enrollment in 2020 compared with 2019 but with varying percentage increases and spending risk implications across states. States that did not expand Medicaid had enrollment and spending risk increases. States that expanded Medicaid but did not relax 2020 Marketplace enrollment criteria also had spending risk increases. In contrast, states that expanded Medicaid and relaxed 2020 enrollment criteria experienced enrollment increases without spending risk changes. The findings are reassuring with respect to the ability of Marketplaces to buffer employment shocks, but they also provide cautionary signals that risks and premiums could begin to rise either in the absence of Medicaid expansion or when Marketplace enrollment is constrained.


Subject(s)
COVID-19 , Health Insurance Exchanges , Humans , Insurance Coverage , Insurance, Health , Medicaid , Pandemics , Patient Protection and Affordable Care Act , SARS-CoV-2 , United States
10.
Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med ; 29(5): 1060-1065, 2021 Sep.
Article in Russian | MEDLINE | ID: covidwho-1478959

ABSTRACT

The article demonstrates that the restrictions introduced during the coronavirus pandemic affected the dynamics of mutual settlements between the territorial funds of the mandatory medical insurance (MMI, TFMMI). According to the results of the first nine months of 2020, medical institutions of a number of subjects were not able to earn even a half of the amount of sum that was presented for payment in 2019 on medical care support of patients from other regions. It was established that besides such relevant features of the Russian health care system as large territory, fragmentation of population, necessity to maintain a number of state medical institutions, there is also a number of factors that during the pandemic were most aggravated in those "weak" places in the MMI system that have been stagnating for a long time. Among them, insufficiently large listing of medical services covered by MMI, inability to provide medical services to all those in need due to shortage of equipment, working areas, qualified care, etc. It is noted that among the general trends of MMI, the Russian medical insurance system (not only that it is not a classical one), especially during the pandemic, is broken out of social insurance: two funds, structures, costs of informatization, etc. However, in Russia, even in such conditions, health care is funded through the MMI system up to 50%. The pandemic demonstrated that no private sector, no paid services, no commercial insurance companies can cover the whole spectrum of health care complicities during the pandemic crisis. Namely, the MMI system bore the brunt of the survival of medicine during the pandemic. It is concluded that namely the need in medical institutions with sufficient reserve of bed fund with MMI services can input into development of necessary stable basis for survival in difficult conditions of pandemic crisis. The proposal of the Audit Chamber of the Russian Federation of further reforming of the mandatory medical insurance system is considered reasonable and logical especially in difficult situation of struggle against COVID-19. The article also presents data concerning the state of MMI in 2020, at the height of the pandemic crisis in the regions of the Russian Federation.


Subject(s)
COVID-19 , Insurance , Delivery of Health Care , Humans , Insurance, Health , Russia/epidemiology , SARS-CoV-2
11.
Int J Health Serv ; 52(1): 168-173, 2022 01.
Article in English | MEDLINE | ID: covidwho-1476937

ABSTRACT

The COVID-19 pandemic has wrought fundamental changes in the US workplace, placing employer-sponsored health insurance (ESI) in disarray. Before the pandemic, ESI was the single largest share of private health insurance in the country, including some 150 million Americans. Even before the pandemic, however, ESI had become increasingly volatile and more unaffordable for both employers and employees. During the pandemic, many workers found that they could work at home remotely. Job losses during the pandemic left many millions uninsured, with many jobs lost indefinitely. Today, many Americans are rethinking how and where they want to be involved in the workplace, while many businesses are considering a future when more people are working from home or being replaced by robots, placing ESI in further jeopardy. This article brings historical perspective to these problems, showing how the private health insurance industry has failed the public interest by being too fragmented and unreliable to be afforded or depended upon. Three major reform alternatives are described, only 1 of which-single-payer improved Medicare for All-can provide stable universal coverage that meets the needs of all Americans while being affordable for patients, families, and taxpayers.


Subject(s)
COVID-19 , Health Benefit Plans, Employee , Humans , Insurance Coverage , Insurance, Health , Medicare , Pandemics , SARS-CoV-2 , State Medicine , United States , Universal Health Insurance
12.
MMWR Morb Mortal Wkly Rep ; 70(41): 1435-1440, 2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1468852

ABSTRACT

Immunization is a safe and cost-effective means of preventing illness in young children and interrupting disease transmission within the community.* The Advisory Committee on Immunization Practices (ACIP) recommends vaccination of children against 14 diseases during the first 24 months of life (1). CDC uses National Immunization Survey-Child (NIS-Child) data to monitor routine coverage with ACIP-recommended vaccines in the United States at the national, regional, state, territorial, and selected local levels.† CDC assessed vaccination coverage by age 24 months among children born in 2017 and 2018, with comparisons to children born in 2015 and 2016. Nationally, coverage was highest for ≥3 doses of poliovirus vaccine (92.7%); ≥3 doses of hepatitis B vaccine (HepB) (91.9%); ≥1 dose of measles, mumps, and rubella vaccine (MMR) (91.6%); and ≥1 dose of varicella vaccine (VAR) (90.9%). Coverage was lowest for ≥2 doses of influenza vaccine (60.6%). Coverage among children born in 2017-2018 was 2.1-4.5 percentage points higher than it was among those born in 2015-2016 for rotavirus vaccine, ≥1 dose of hepatitis A vaccine (HepA), the HepB birth dose, and ≥2 doses of influenza vaccine. Only 1.0% of children had received no vaccinations by age 24 months. Disparities in coverage were seen for race/ethnicity, poverty status, and health insurance status. Coverage with most vaccines was lower among children who were not privately insured. The largest disparities between insurance categories were among uninsured children, especially for ≥2 doses of influenza vaccine, the combined 7-vaccine series, § and rotavirus vaccination. Reported estimates reflect vaccination opportunities that mostly occurred before disruptions resulting from the COVID-19 pandemic. Extra efforts are needed to ensure that children who missed vaccinations, including those attributable to the COVID-19 pandemic, receive them as soon as possible to maintain protection against vaccine-preventable illnesses.


Subject(s)
Vaccination Coverage/statistics & numerical data , Vaccines/administration & dosage , /statistics & numerical data , Health Care Surveys , Healthcare Disparities/statistics & numerical data , Humans , Immunization Schedule , Infant , Insurance, Health/statistics & numerical data , Poverty/statistics & numerical data , United States
15.
BMC Res Notes ; 14(1): 371, 2021 Sep 23.
Article in English | MEDLINE | ID: covidwho-1438305

ABSTRACT

OBJECTIVE: Health insurance is based on people's significant risks in receiving health services that they cannot afford alone. Since the outbreak of the corona epidemic, the health insurance system has suffered many economic problems. Designing a model of a health insurance system based on the requirements of a resilient economy can improve the functions of this system in the corona crisis. RESULTS: In this research 12, structural components were obtained in the form of 4 conceptual components. The 4 main conceptual components are Knowledge-based economy, Economic stability, Economic resilience, and justice. The knowledge-based economy is the basis for the formation of economic resilience in the health insurance systems. Health insurance systems will achieve two crucial intermediate results, namely economic resilience, and economic stability, by building the basic infrastructure of a knowledge-based economy. In the long run, maintaining such intermediate results is the foundation of justice in the health insurance system.


Subject(s)
COVID-19 , Pandemics , Disease Outbreaks , Humans , Insurance, Health , SARS-CoV-2
19.
Soc Sci Med ; 287: 114356, 2021 10.
Article in English | MEDLINE | ID: covidwho-1373270

ABSTRACT

BACKGROUND: Identifying the factors that predict non-adherence to recommended preventive pediatric care is necessary for the development of successful interventions to improve compliance. PURPOSE: Given the substantial decline in well-child visits and influenza vaccinations, we sought to examine sociodemographic (i.e., parent age, education, employment status, child age, insurance coverage, household size, race and ethnicity, income, COVID-19 incidence in state) and psychosocial (i.e., child temperament, parent mental health, parent personality traits) factors associated with preventative pediatric care (well-child visits, influenza vaccines) during the COVID-19 pandemic. METHODS: As part of a larger, ongoing study, 1875 parents (96% mothers, 65% age 35 or younger, 58% with a college degree) reported whether they had missed any recommended or scheduled well-child visits since the pandemic and whether they had vaccinated their child against the flu. Using data collected during fall 2020, we examine differences in these health outcomes across social/demographic factors and psychological profiles. In addition, we use lasso logistic regression models to (1) estimate the accuracy with which we can predict adherence from these characteristics and (2) identify factors most strongly, independently associated with adherence. RESULTS: Parent psychological factors were associated with outcomes above and beyond known demographic and social factors. For example, parent industriousness and orderliness were associated with greater likelihoods of attending well-child visits and vaccinating children, while parent conservatism and creativity were associated with lower rates. We also replicate prior work documenting that health insurance, income, and household size are major factors in receiving adequate pediatric care. CONCLUSIONS: Adherence to preventive pediatric care varies as a function of psychological factors, suggesting that the current system of pediatric care favors some psychological profiles over others. However, the specific traits associated with non-adherence point to potentially fruitful interventions, specifically around increasing functional proximity.


Subject(s)
COVID-19 , Pandemics , Adult , Child , Female , Humans , Insurance, Health , Mothers , Pandemics/prevention & control , SARS-CoV-2
20.
Ther Adv Respir Dis ; 15: 17534666211037459, 2021.
Article in English | MEDLINE | ID: covidwho-1369479

ABSTRACT

INTRODUCTION: Outcomes in cystic fibrosis are influenced by multiple factors, including social determinants of health. Low socioeconomic status has been shown to be associated with lung function decline, increased exacerbation rates, increased health care utilization, and decreased survival in cystic fibrosis. The COVID-19 pandemic disrupted the US economy, placing people with cystic fibrosis at risk for negative impacts due to changes in social determinants of health. METHODS: To characterize the impact of COVID-19-related changes in social determinants of health in the adult cystic fibrosis population, a social determinants of health questionnaire was designed and distributed to patients as part of a quality improvement project. RESULTS: Of 132 patients contacted, 76 (57.6%) responses were received. Of these responses, 22 (28.9%) answered yes to at least one question that indicated an undesired change in social determinants of health. Patients with stable employment prior to COVID-19 were more likely to endorse undesired change in all domains of the questionnaire, and the undesired changes were most likely to be related to employment, insurance security, and access to medications. Patients receiving disability were more likely to report hardship related to utilities and food security compared with patients previously employed or unemployed. Of patients endorsing risk of socioeconomic hardship, 21 (95.5%) were contacted by a social worker and provided resources. CONCLUSION: Utilizing a social determinants of health questionnaire to screen for social instability in the context of COVID-19 is feasible and beneficial for patients with cystic fibrosis. Identifying social issues early during the pandemic and implementing processes to provide resources may help patients with cystic fibrosis mitigate social hardship and maintain access to health care and medications.


Subject(s)
COVID-19/epidemiology , Cystic Fibrosis , SARS-CoV-2 , Social Determinants of Health , Adult , Employment , Female , Humans , Insurance, Health , Male , Middle Aged , Social Class , Surveys and Questionnaires
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