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The Unfinished Work of the Affordable Care Act

Dec 12, 2014, 8:45 AM, Posted by Brendan Saloner

Brendan Saloner

The United States is the last remaining rich country in the world where a large percentage of the population lacks health insurance coverage. This situation is being improved under the Affordable Care Act (ACA), with recent estimates showing that from early 2013 to mid-2014 the uninsured rate dropped from 19 percent of adults to 14 percent. The uninsured rate will no doubt continue to fall in 2015, but the problem of the uninsured will not go away with the ACA. It will not go away even if all 50 states expand Medicaid for poor adults, and will not go away if the U.S. Supreme Court rules against the plaintiffs in a pending challenge to the power of the administration to provide subsidies in the federally facilitated insurance exchanges.

In its 2012 baseline estimate, the Congressional Budget Office (CBO) projected that by 2022 the ACA might cut the number of uninsured by half, but would still leave behind 30 million people without insurance. This projection assumed full implementation of the ACA provisions. We don’t yet have a clear sense of how much larger that number will be with incomplete implementation of the core ACA coverage provisions, but even an optimistic assessment is that tens of millions of Americans will continue to spend periods of time without health insurance.

Who does the ACA leave behind? By design, the ACA excludes undocumented immigrants, a group that numbers around 11 million today. Some undocumented immigrants purchase private insurance, receive coverage from an employer, or participate in public programs funded with non-federal dollars, but the majority have no insurance. Undocumented immigrants are prohibited from enrolling in Medicaid, receiving subsidies, and purchasing coverage on the exchanges. Although President Obama recently signed an executive order protecting many undocumented immigrants from immediate deportation, the ACA exclusion will continue in the foreseeable future, barring an act of Congress. 

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Improving Mental Health Care for Veterans is Vital

Nov 12, 2014, 9:00 AM, Posted by Ilse Wiechers

Ilse Wiechers, MD, MPP, MHS is associate director at the Northeast Program Evaluation Center in the Office of Mental Health Operations of the U.S. Department of Veterans Affairs and faculty with the Yale Geriatric Psychiatry Fellowship. She is an alumna of the Yale Robert Wood Johnson Foundation (RWJF)/VA Clinical Scholars Program (2012-2014).

Ilse Wiechers

Health and disease are on a continuum.  We are at a point in time where we are trying to understand the constituents of health, whereas historically our focus has been on understanding disease. It is important to recognize that veterans have unique determinants of health not shared with the rest of the population, such as exposure to combat and prolonged time spent away from social support networks during deployment.

These exposures can put veterans at increased risk for mental health problems, such as posttraumatic stress disorder, depression, and substance use problems. The U.S. Department of Veterans Affairs (VA) has a health care system uniquely positioned to help improve the overall health of veterans because of its expertise in addressing these unique mental health needs.

I have the privilege to serve our nation’s veterans through my work as a geriatric psychiatrist conducting program evaluation for the Office of Mental Health Operations (OMHO) at the VA. My work provides me an opportunity to directly participate in several of the key components of the comprehensive mental health services the VA provides for veterans.

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U.S. Provides $283 Million to Increase Access to Care in Underserved Areas

Nov 5, 2014, 9:00 AM

Earlier this month, the U.S. Department of Health and Human Services (HHS) announced it is investing $283 million in the National Health Service Corps (NHSC), which provides scholarship and loan repayment services to health care providers who work in underserved areas.

The funds were authorized under the Affordable Care Act and will be used to boost the number of health care providers in underserved areas, which will increase access to care.

“Thanks to the Affordable Care Act, programs like the National Health Service Corps increase the primary care workforce in communities that need it most,” HHS Secretary Sylvia Burwell, AB, BA, said in a release. “These investments are another example of how the law is working to deliver accessible, affordable, quality care.”

The NHSC was founded in 1972 and provides care to nearly 10 million people across the nation.

In fiscal 2014, more than 5,100 loan repayment and scholarship awards were made to clinicians and students and 38 states received grants to support loan repayment programs, according to Mary Wakefield, PhD, RN, FAAN, head of the Health Resources and Services Administration.

“Primary care clinicians are the backbone of our health system, and thanks to the Affordable Care Act, programs like the National Health Service Corps increase the primary care workforce in medically underserved urban, rural and Tribal communities,” Wakefield said.

Read the news release.

For more information about NHSC programs, please visit NHSC.hrsa.gov.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

An Anthropological Approach to Medicine

Oct 31, 2014, 2:00 PM, Posted by Theresa Yera

Theresa Yera is a senior at the State University of New York (SUNY) at Buffalo. A project of the Robert Wood Johnson Foundation (RWJF), the Institute for Health, Health Care Policy and Aging Research, and Rutgers University, Project L/EARN is a 10-week summer internship that provides training, experience and mentoring to undergraduate college students from socioeconomic, ethnic and cultural groups that traditionally have been underrepresented in graduate education.

Theresa Yera

When I applied to the 2014 Project L/EARN cohort, I was seeking exposure to anthropological research that would lead me into a career of public health service. I wanted to pursue L/EARN because of my strong interest in anthropology and medicine. My previous experience in health care included studying for the Emergency Medical Technician (EMT) examinations, volunteering as a Campus Health Educator (CHE), and participating in qualitative and quantitative research projects for almost three years.

The training as an EMT introduced me to patient and health care provider interaction and raised questions on streamlining the process. It also trained me to think critically and quickly, sharpen my leadership skills, and develop interview questions. Patients complained of many chronic and acute health problems that stemmed from their health behaviors and environment. The CHE initiative led me to value a community approach for health problems. In CHE, I worked to end racial disparities in organ donation and increase awareness of the need for organ donation and a healthy lifestyle. I met many individuals with personal stories that explained why they either did or did not want to donate.

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RWJF Pioneering Ideas Podcast: Episode 6 | What if? Shifting Perspectives to Change the World

Oct 20, 2014, 9:00 AM, Posted by Pioneer Blog Team

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RWJF's Pioneering Ideas Podcast is on iTunes! Don’t miss an episode—click to subscribe.

Welcome to the sixth episode of RWJF’s Pioneering Ideas podcast, where we explore cutting edge ideas and emerging trends that can help build a Culture of Health. Your host is Lori Melichar, director at the foundation.

Ideas Explored in This Episode

Sharing Health Care Providers’ Notes (3:08) OpenNotesTom Delbanco and Jan Walker talk with RWJF’s Emmy Ganos about why they decided getting health care providers to share their notes with patients was an essential innovation–and where their work is headed next. Here’s a hint: what if the  3 million patients who now have easy access to their clinician’s notes could co-write notes with their providers?

Rethinking How We Solve Poverty (18:46) Kirsten Lodal, founder and CEO of LIFT, talks with RWJF’s Susan Mende and shares some simple ideas with the potential to revolutionize our approach to helping people achieve economic stability and well being. In a thought-provoking conversation, Lodal connects the dots between improving the well being of those living in poverty and building a Culture of Health.

A Historian’s Take on Building a Culture of Health (27:58) – Princeton historian Keith Wailoo and RWJF’s Steve Downs discuss how deeply held cultural narratives influence our perceptions of health, and how today’s “wild ideas” are often tomorrow’s cutting edge innovations.

Sound bites

...On opening up health care providers’ notes and what’s next:

“What I would like to do is spread the responsibility for health beyond the health care system. The health care system is good; I hope that it gets better, but there are so many other parts of our lives that contribute to our well being.” – Jan Walker, OpenNotes 

“It will be a very different world in the future. And we do think that OpenNotes is kind of giving people a peek into it. It's a first glimmer that this kind of transparency, this kind of approach to things, while it's passive now, it just opens up an enormous amount of possibilities for the future. And that's what really excites us.” – Tom Delbanco, OpenNotes

...On rethinking how we solve poverty:

“People's lives are like rivers... they flowed before coming into contact with us, and they will flow after having contact with us. And so the opportunity that we have, the privilege that we have is of most positively affecting the trajectory and the velocity of that flow. But if we forget that–if we get too swept up in having to own everything that happens in a person's life–then we won't build the best solutions, because we won't build solutions that provide people with the support they need to navigate the flow of that river over the long term.” – Kirsten Lodal, LIFT

...A historian’s take on building a Culture of Health: 

“Our concern with aggregate trends is an important one in tracing the shifting demographics of health in our country, but to understand what health actually means involves actually putting the data aside and thinking about lives and thinking about individuals and thinking about what these trends mean on an individual level.”– Keith Wailoo, Princeton University

Your Turn

Now that you’ve listened – talk about it! Did anything you heard today get you thinking in new ways about how you can help build a Culture of Health? Do you have a cutting-edge idea you’d like to discuss? Comment below or tweet at me at @lorimelichar, or consider submitting a proposal. Be sure to keep the conversation and explorations going at #RWJFpodcast.

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‘Virtual’ Dental Exams Help the Underserved: Q&A with Jenny Kattlove, The Children’s Partnership

Oct 9, 2014, 1:07 PM

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Lack of Coverage for Undocumented Patients Puts Pressure on the Health Care Safety Net

Sep 26, 2014, 9:00 AM, Posted by Michael K. Gusmano

Michael Gusmano

The nation’s 11 million undocumented immigrants constitute a “medical underclass” in American society. [1,2] Apart from their eligibility for emergency Medicaid, undocumented immigrants as a population are ineligible for public health insurance programs, including Medicare, Medicaid, the Child Health Insurance Program (CHIP), and subsidies available to purchase private health insurance under the Patient Protection and Affordable Care Act (ACA) of 2010, because they are not “lawfully present” in the United States. [3] Federal health policy does provide undocumented immigrants with access to safety-net settings, such as an acute-care hospital’s emergency department (ED), or a community health center (CHC). Since 1986, the Emergency Medical Treatment and Active Labor Act (EMTALA) has required that all patients who present in an ED receive an appropriate medical screening and, if found to be in need of emergency medical treatment (or in active labor), to be treated until their condition stabilizes. CHCs such as Federally Qualified Health Centers and other nonprofit or public primary care clinics serving low-income and other vulnerable populations trace their origins to health policy that includes the Migrant Health Act of 1962. [4]

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Reading, Writing and Hands-Free CPR: AHA Calls for More CPR Training in Schools

Sep 16, 2014, 1:12 PM

This commentary originally appeared on the RWJF New Public Health blog.

The Ebola Response: Q&A with Laurie Garrett, Council on Foreign Relations

Sep 9, 2014, 11:56 AM

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Better Health, Delivered by Phone: Q&A with Stan Berkow

Sep 4, 2014, 2:36 PM

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