Hispanic-Asian Immigrant Inequality in Perceived Medical Need and Access to Regular Physician Care.

In the face of continuing large immigrant streams, Hispanic and Asian immigrants' human and social capital inequalities will heighten U.S. race/ethnic health and health care disparities. Using data from the 2004 and 2008 panels of the Survey of Income and Program Participation, this study assessed Hispanic-Asian immigrant disparity in access to health care, measured by perceived medical need and regular access to a physician. Logistic regression results indicated that Hispanics had lower perceived met medical need and were less likely to see a doctor regularly. These disparities were significantly attenuated by education and health insurance. Assimilation-related characteristics were significantly associated with a regular doctor visit and were not fully mediated by socioeconomic variables. Findings indicate the importance of education above and beyond insurance coverage for access to health care and suggest the potential for public health efforts to improve preventive care among immigrants.

Reducing Medicaid Churning: Extending Eligibility For Twelve Months Or To End Of Calendar Year Is Most Effective.

Medicaid churning--the constant exit and reentry of beneficiaries as their eligibility changes--has long been a problem for both Medicaid administrators and recipients. Churning will continue under the Affordable Care Act because, despite new federal rules, Medicaid eligibility will continue to be based on current monthly income. We developed a longitudinal simulation model to evaluate four policy options for modifying or extending Medicaid eligibility to reduce churning. The simulations suggest that two options--extending eligibility either to the end of a calendar year or for twelve months after enrollment--would be the most effective methods for reducing churning. The other options--a three-month extension or eligibility based on projected annual income--would reduce churning to a lesser extent. States should consider implementation of the option that best balances costs while improving access to coverage and, thereby, the health of Medicaid enrollees.

Health insurance coverage predicts lower childbearing among near-poor adolescents.

PURPOSE: The impact of health insurance on adolescent childbearing takes on increased salience in the context of the ongoing United States health care debate. Health insurance coverage is important for accessing health care services, including reproductive health services, yet prior research has not examined the association between insurance coverage and childbearing. Consequently, the role of insurance in the prevention of adolescent childbearing has been unclear. METHODS: Using three panels (2001, 2004, and 2008) of the nationally representative Survey of Income and Program Participation data, hierarchical multilevel logistic regression models test the association between pre-pregnancy health insurance coverage and childbearing for a sample of 7,263 unmarried adolescent women (aged 16-19 years), controlling for known correlates of adolescent childbearing. Analyses examine variations in the association based on family income. RESULTS: The odds of reporting childbearing were almost twice as great for adolescents who were uninsured compared with those who were insured before a pregnancy occurred. Interaction models demonstrate this effect for near-poor adolescents (who are less likely to have health insurance coverage) compared with poor and more advantaged adolescents. CONCLUSIONS: The findings of the current nationally representative study suggest that health insurance coverage is associated with a lower probability of childbearing for near-poor adolescents. Future research should examine potential mechanisms through which insurance coverage influences adolescent childbearing.

New estimates of gaps and transitions in health insurance.

Changes in individual or family circumstances cause many Americans to experience gaps and transitions in public and private health insurance. Using data from the 2004-2007 Survey of Income and Program Participation, this article updates earlier analyses of insurance gaps and transitions. Eighty-nine million people (one third of nonelderly Americans) were uninsured for at least 1 month during those 4 years. Approximately 23 million lost insurance more than once. The analyses call attention to the continuing instability and insecurity of health insurance, can inform implementation of national reforms, and establish a recent baseline that will be helpful in evaluating the reforms' effects on coverage stability.

Maintaining coverage, affordability, and shared responsibility when income and employment change.

The Affordable Care Act builds on existing sources of public and private health insurance, while creating new health insurance exchanges and subsidies. A potential disadvantage of preserving many sources of health insurance is the likelihood of abrupt changes in coverage or financial responsibility when individual circumstances change. This brief describes four policy challenges related to such changes: adjusting premium and cost-sharing subsidies when incomes change; coordinating eligibility for premium credits, Medicaid, and the Children's Health Insurance Program; encouraging and facilitating continuous coverage; and minimizing transitions between individual and small-business exchanges. Policy recommendations to reduce uncertainty, simplify coverage decisions, and minimize insurance transitions include extending coverage to the open enrollment period at the end of the year, generous treatment of income gains in correcting premium tax credits, and unifying the small-business and individual exchanges.

Welfare reform and interstate migration of poor families.

The thesis of this study is that as a result of increased inequalities in welfare rules, the 1996 welfare reform act not only enhanced incentives for poor families to move but also (and perhaps more important) created disincentives for them to stay in "race to the bottom" states. In testing this thesis, we evaluated the mediating and moderating roles of state economic development and family structure. We merged data from three main sources: the 1996-1999 panel of the Survey of Income and Program Participation, the Urban Institute's Welfare Rules Database, and state economic data from the Bureau of Labor Statistics. Modeling both destination (pull) and departure (push) effects of welfare policy measures and selected covariates in a nested discrete-time event-history migration analysis, we found robust support for the thesis that stringency in state welfare-eligibility and behavior-related rules stimulated interstate out-migration of poor families in the United States. However poor families were not drawn to states with relatively more-lenient welfare rules, although stringency in state welfare dollar benefits inhibited in-migration and state unemployment patterns may have conditioned the migration effects of welfare-reform rules on the choice of destination. Single mothers were not more directly affected by welfare-eligibility and behavior-related rules than were poor married couples.

Battery-powered health insurance? Stability in coverage of the uninsured.

This study assesses the stability of Americans' health insurance status over a four-year period. Relatively few Americans were continuously uninsured for the four years 1996 to 1999, but a sizable number of the uninsured lacked a stable source of coverage. At least as many people were repeatedly uninsured as experienced a single gap in otherwise stable coverage. Given these dynamics, policymakers should think of "uninsured" as referring not to people, but rather to gaps in coverage over time. Reforms that stop short of universal coverage should be evaluated in terms of their likely effects on the continuity and stability of coverage.

Marriage among unwed mothers: whites, blacks and Hispanics compared.

CONTEXT: Much of the debate over welfare reauthorization centers on whether marriage promotion should play a key role. Few studies, however, have tracked the marriage and divorce histories of unwed mothers, including minority women, who are often the main targets of welfare reform. METHODS: Data from the 1995 National Survey of Family Growth were used to estimate the hazards of the transition to marriage for women who delayed childbearing until marriage and for teenagers and older women who had a nonmarital first birth, and of the transition to divorce among the ever-married. Life-table estimates calculated with these estimated transition hazards show the cumulative proportions married and divorced, by race and ethnicity, for women who had a nonmarital first birth and for those who did not. RESULTS Nonmarital childbearing reduces the likelihood of marriage. Some 82% of white women, 62% of Hispanics and 59% of blacks who had a nonmarital first birth had married by age 40; the corresponding proportions among those who avoided nonmarital childbearing were 89%, 93% and 76%, respectively. There is no evidence to suggest that the negative effect of nonmarital childbearing on marriage is caused by other observed or unobserved differences between unwed mothers and women who remain childless until marriage. Nonmarital childbearing raises the likelihood of divorce among unwed mothers who eventually marry, a finding that also varies by race and ethnicity. CONCLUSIONS: Marriage promotion policies should focus on lowering rates of nonmarital childbearing. Reductions in nonmarital childbearing, however, may not eliminate long-standing discrepancies in marriage rates between black and white women.