Early reading at first grade predicts adult reading at age 42 in typical and dyslexic readers.

Research indicates that the achievement gap in reading between typical and dyslexic readers is already evident in first grade and persists through adolescence. However, it is not known whether this reading gap persists into adult life. In this report we use an epidemiologic sample of 312 children (typical readers = 246; dyslexic readers = 66), followed longitudinally from age 5 through adulthood and examine two fundamental questions: 1) Is reading level in 1st grade predictive of reading proficiency in adulthood in typical and dyslexic readers? and 2) Are the trajectories of reading development from 1st through 5th grade predictive of reading proficiency in adulthood in typical and dyslexic readers? Our findings indicate that early reading levels in 1st grade as well as the trajectory of reading development through the first five years of school were associated with reading scores in adulthood. This association was stronger for dyslexic than for typical readers, especially the latter factor. These findings indicate that the achievement gap between typical and dyslexic readers persists far beyond adolescence, in fact, into adult life.

Ten Years Later: Reflections on Critics' Worst-Case Scenarios for the Affordable Care Act.

The primary goals of the Affordable Care Act (ACA) were to increase the availability and affordability of health insurance coverage and thereby improve access to needed health care services. Numerous studies have overwhelmingly confirmed that the law has reduced uninsurance and improved affordability of coverage and care for millions of Americans. Not everyone believed that the ACA would lead to positive outcomes, however. Critics raised numerous concerns in the years leading up to the law's passage and full implementation, including about its consequences for national health spending, labor supply, employer health insurance markets, provider capacity, and overall population health. This article considers five frequently heard worst-case scenarios related to the ACA and provides research evidence that these fears did not come to pass.

Developmental trajectories of white matter structure in children with and without reading impairments.

Left temporal-parietal white matter structure is consistently associated with reading abilities in children. A small number of longitudinal studies show that development of this area over time is altered in children with impaired reading. However, it remains unclear how brain developmental patterns relate to specific reading skills such as fluency, which is a critical part of reading comprehension. Here, we examined white matter development trajectories in children with dysfluent reading (20 dysfluent and inaccurate readers, 36 dysfluent and accurate readers) compared to non-impaired readers (n = 14) over 18 months. We found typical age-related increases of fractional anisotropy (FA) in bilateral temporal-parietal areas in non-impaired readers, but a lack of similar changes in dysfluent readers. We also found steeper decreases of mean diffusivity (MD) in the right corona radiata and left uncinate fasciculus in dysfluent inaccurate readers compared to dysfluent accurate readers. Changes in diffusion parameters were correlated with changes in reading scores over time. These results suggest delayed white matter development in dysfluent readers, and show maturational differences between children with different types of reading impairment. Overall, these results highlight the importance of considering developmental trajectories, and demonstrate that the window of plasticity may be different for different children.

Identifying atypical change at the individual level from childhood to adolescence.

Identifying change at the individual level is an important goal for researchers, educators, and clinicians. We present a set of statistical procedures for identifying individuals who depart from a normative change. Using Latent Change Scores models (LCS), we illustrate how the Individual Likelihood computed from a statistical model for change (IL) and from an alternative unrestricted model (ILsat) can be used to identify atypical trajectories in situations with several measurement occasions. Using LCS and linear regression, we also show how the observed and latent change residuals can be used to identify atypical individual change between 2 measurement occasions. We apply these methods to a measure of general verbal ability (from WISC-R), from a large sample of individuals assessed every 2 years from Grade 1 to 9. We demonstrate the efficiency of these techniques, illustrate their use to identify individual change in longitudinal data, and discuss potential applications in developmental research. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Employer-Sponsored Insurance Stable For Low-Income Workers In Medicaid Expansion States.

We assessed rates of employer health insurance offer, take-up, and coverage in June 2013 and March 2017 among workers. Overall, offer rates remained stable, and take-up and coverage rates increased. In Medicaid expansion states, the share of workers with family incomes at or below 138 percent of the federal poverty level who had employer-based coverage held steady, while uninsurance rates declined.

Estimating the Counterfactual: How Many Uninsured Adults Would There Be Today Without the ACA?

Time lags in receiving data from long-standing, large federal surveys complicate real-time estimation of the coverage effects of full Affordable Care Act (ACA) implementation. Fast-turnaround household surveys fill some of the void in data on recent changes to insurance coverage, but they lack the historical data that allow analysts to account for trends that predate the ACA, economic fluctuations, and earlier public program expansions when predicting how many people would be uninsured without comprehensive health care reform. Using data from the Current Population Survey (CPS) from 2000 to 2012 and the Health Reform Monitoring Survey (HRMS) data for 2013 and 2015, this article develops an approach to estimate the number of people who would be uninsured in the absence of the ACA and isolates the change in coverage as of March 2015 that can be attributed to the ACA. We produce counterfactual forecasts of the number of uninsured absent the ACA for 9 age-income groups and compare these estimates with 2015 estimates based on HRMS relative coverage changes applied to CPS-based population estimates. As of March 2015, we find the ACA has reduced the number of uninsured adults by 18.1 million compared with the number who would have been uninsured at that time had the law not been implemented. That decline represents a 46% reduction in the number of nonelderly adults without insurance. The approach developed here can be applied to other federal data and timely surveys to provide a range of estimates of the overall effects of reform.

Early Experience with the ACA: Coverage Gains, Pooling of Risk, and Medicaid Expansion.

We provide an overview of the characteristics of those who have gained insurance coverage due to the ACA as well as the characteristics of the remaining uninsured. We also describe the implications for the broader sharing of health care risks required under the law, and how they vary by individuals' health status. Finally, we assess the implications of state decisions to expand or not expand Medicaid eligibility under the law, how those decisions affect state finances, health care providers, residents, and how the effects may vary for those states using waivers to expand eligibility using strategies designed to be more broadly politically acceptable.

Achievement Gap in Reading Is Present as Early as First Grade and Persists through Adolescence.

OBJECTIVES: To determine if differences between dyslexic and typical readers in their reading scores and verbal IQ are evident as early as first grade and whether the trajectory of these differences increases or decreases from childhood to adolescence. STUDY DESIGN: The subjects were the 414 participants comprising the Connecticut Longitudinal Study, a sample survey cohort, assessed yearly from 1st to 12th grade on measures of reading and IQ. Statistical analysis employed longitudinal models based on growth curves and multiple groups. RESULTS: As early as first grade, compared with typical readers, dyslexic readers had lower reading scores and verbal IQ, and their trajectories over time never converge with those of typical readers. These data demonstrate that such differences are not so much a function of increasing disparities over time but instead because of differences already present in first grade between typical and dyslexic readers. CONCLUSIONS: The achievement gap between typical and dyslexic readers is evident as early as first grade, and this gap persists into adolescence. These findings provide strong evidence and impetus for early identification of and intervention for young children at risk for dyslexia. Implementing effective reading programs as early as kindergarten or even preschool offers the potential to close the achievement gap.

An early look at changes in employer-sponsored insurance under the Affordable Care Act.

Critics frequently characterize the Affordable Care Act (ACA) as a threat to the survival of employer-sponsored insurance. The Medicaid expansion and Marketplace subsidies could adversely affect employers' incentives to offer health insurance and workers' incentives to take up such offers. This article takes advantage of timely data from the Health Reform Monitoring Survey for June 2013 through September 2014 to examine, from the perspective of workers, early changes in offer, take-up, and coverage rates for employer-sponsored insurance under the ACA. We found no evidence that any of these rates have declined under the ACA. They have, in fact, remained constant: around 82 percent, 86 percent, and 71 percent, respectively, for all workers and around 63 percent, 71 percent, and 45 percent, respectively, for low-income workers. To date, the ACA has had no effect on employer coverage. Economic incentives for workers to obtain coverage from employers remain strong.

An estimated $84.9 billion in uncompensated care was provided in 2013; ACA payment cuts could challenge providers.

Millions of uninsured people use health care services every year. We estimated providers' uncompensated care costs in 2013 to be between $74.9 billion and $84.9 billion. We calculated that in the aggregate, at least 65 percent of providers' uncompensated care costs were offset by government payments designed to cover the costs. Medicaid and Medicare were the largest sources of such government payments, providing $13.5 billion and $8.0 billion, respectively. Anticipating fewer uninsured people and lower levels of uncompensated care, the Affordable Care Act reduces certain Medicare and Medicaid payments. Such cuts in government funding of uncompensated care could pose challenges to some providers, particularly in states that have not adopted the Medicaid expansion or where implementation of health care reform is proceeding slowly.

Disruption of functional networks in dyslexia: a whole-brain, data-driven analysis of connectivity.

BACKGROUND: Functional connectivity analyses of functional magnetic resonance imaging data are a powerful tool for characterizing brain networks and how they are disrupted in neural disorders. However, many such analyses examine only one or a small number of a priori seed regions. Studies that consider the whole brain frequently rely on anatomic atlases to define network nodes, which might result in mixing distinct activation time-courses within a single node. Here, we improve upon previous methods by using a data-driven brain parcellation to compare connectivity profiles of dyslexic (DYS) versus non-impaired (NI) readers in the first whole-brain functional connectivity analysis of dyslexia. METHODS: Whole-brain connectivity was assessed in children (n = 75; 43 NI, 32 DYS) and adult (n = 104; 64 NI, 40 DYS) readers. RESULTS: Compared to NI readers, DYS readers showed divergent connectivity within the visual pathway and between visual association areas and prefrontal attention areas; increased right-hemisphere connectivity; reduced connectivity in the visual word-form area (part of the left fusiform gyrus specialized for printed words); and persistent connectivity to anterior language regions around the inferior frontal gyrus. CONCLUSIONS: Together, findings suggest that NI readers are better able to integrate visual information and modulate their attention to visual stimuli, allowing them to recognize words on the basis of their visual properties, whereas DYS readers recruit altered reading circuits and rely on laborious phonology-based "sounding out" strategies into adulthood. These results deepen our understanding of the neural basis of dyslexia and highlight the importance of synchrony between diverse brain regions for successful reading.

The health reform monitoring survey: addressing data gaps to provide timely insights into the affordable care act.

The Health Reform Monitoring Survey (HRMS) was launched in 2013 as a mechanism to obtain timely information on the Affordable Care Act (ACA) during the period before federal government survey data for 2013 and 2014 will be available. Based on a nationally representative, probability-based Internet panel, the HRMS provides quarterly data for approximately 7,400 nonelderly adults and 2,400 children on insurance coverage, access to health care, and health care affordability, along with special topics of relevance to current policy and program issues in each quarter. For example, HRMS data from summer 2013 show that more than 60 percent of those targeted by the health insurance exchanges struggle with understanding key health insurance concepts. This raises concerns about some people's ability to evaluate trade-offs when choosing health insurance plans. Assisting people as they attempt to enroll in health coverage will require targeted education efforts and staff to support those with low health insurance literacy.

Diffusion tensor imaging correlates of reading ability in dysfluent and non-impaired readers.

Many children and adults have specific reading disabilities; insight into the brain structure underlying these difficulties is evolving from imaging. Previous research highlights the left temporal-parietal white matter as important in reading, yet the degree of involvement of other areas remains unclear. Diffusion tensor imaging (DTI) and voxel-based analysis were used to examine correlations between reading ability and tissue structure in healthy adolescents and young adults (n=136) with a range of reading ability. Three complementary reading scores (word reading, decoding, and reading fluency) yielded positive correlations with fractional anisotropy (FA) that spanned bilateral brain regions, particularly in the frontal lobes, but also included the thalamus and parietal and temporal areas. An analysis of the unique effects of each reading assessment revealed that most of the variance in FA values could be attributed to sight word reading ability.

Why employers will continue to provide health insurance: the impact of the Affordable Care Act.

The Congressional Budget Office, the Rand Corporation, and the Urban Institute have estimated that the Patient Protection and Affordable Care Act (ACA) will leave employer-sponsored coverage largely intact; in contrast, some economists and benefit consultants argue that the ACA encourages employers to drop coverage, thereby making both their workers and their firms better off (a "win-win" situation). This analysis shows that no such "win-win" situation exists and that employer-sponsored insurance will remain the primary source of coverage for most workers. Analysis of three issues-the terms of the ACA, worker characteristics, and the fundamental economics of competitive markets-supports this conclusion.

How choices in exchange design for states could affect insurance premiums and levels of coverage.

The Affordable Care Act gives states the option to create health insurance exchanges from which individuals and small employers can purchase health insurance. States have considerable flexibility in how they design and implement these exchanges. We analyze several key design options being considered, using the Urban Institute's Health Insurance Policy Simulation Model: creating separate versus merged small-group and nongroup markets, eliminating age rating in these markets, removing the small-employer credit, and setting the maximum number of employees for firms in the small-group market at 50 versus 100 workers. Among our findings are that merging the small-group and nongroup markets would result in 1.7 million more people nationwide participating in the exchanges and, because of greater affordability of nongroup coverage, approximately 1.0 million more people being insured than if the risk pools were not merged. The various options generate relatively small differences in overall coverage and cost, although some, such as reducing age rating bands, would result in higher costs for some people while lowering costs for others. These cost effects would be most apparent among people who purchase coverage without federal subsidies. On the whole, we conclude that states can make these design choices based on local support and preferences without dramatic repercussions for overall coverage and cost outcomes.

The 2007-09 recession and health insurance coverage.

Loss of employment and declining incomes meant that five million Americans lost employment-based health insurance during the recent economic recession (2007-09). All groups of Americans were affected, but the growth in the number of uninsured people was particularly noticeable for whites, native-born citizens, and residents of the Midwest and South. Adults did not benefit nearly as much as children from public programs designed to offset the decline in employer-sponsored insurance and thus bore all of the burden of rising uninsurance. Throughout the past decade, even in good economic times, the number of Americans with employer-sponsored insurance has fallen, and the number of uninsured Americans has increased. This finding underscores the importance of planned coverage expansions under the Affordable Care Act.

Uncoupling of reading and IQ over time: empirical evidence for a definition of dyslexia.

Developmental dyslexia is defined as an unexpected difficulty in reading in individuals who otherwise possess the intelligence and motivation considered necessary for fluent reading, and who also have had reasonable reading instruction. Identifying factors associated with normative and impaired reading development has implications for diagnosis, intervention, and prevention. We show that in typical readers, reading and IQ development are dynamically linked over time. Such mutual interrelationships are not perceptible in dyslexic readers, which suggests that reading and cognition develop more independently in these individuals. To our knowledge, these findings provide the first empirical demonstration of a coupling between cognition and reading in typical readers and a developmental uncoupling between cognition and reading in dyslexic readers. This uncoupling was the core concept of the initial description of dyslexia and remains the focus of the current definitional model of this learning disability.