Katherine Grace Carman, PhD, is an economist at the nonprofit, nonpartisan RAND Corporation and an alumna of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research program.
Since September 2013, the RAND Health Reform Opinion Study (HROS) has been collecting data about both public opinion regarding the Affordable Care Act (ACA) and insurance enrollment among respondents of the RAND American Life Panel.
The HROS uses panel data to track changes in public opinion regarding the ACA and insurance coverage. We survey the same respondents each month. This allows us to observe not only aggregate changes, but also individual respondents changing their opinion or insurance coverage over time. Respondents are split into four groups and one group is surveyed each week. This allows us to present updated information on a weekly basis, while not burdening survey respondents.
One of the most notable findings of our study has been the increase in insurance coverage between September 2013 and March 2014, with an estimated net gain of 9.3 million in the number insured. The margin of error for this estimate is 3.5 million. The newly insured have gained access to insurance through a variety of insurance types, with the largest gains through employer-sponsored insurance (ESI). One might expect larger gains through Medicaid or the exchanges than through ESI. While our data do not allow us to tease out the causes of this gain in ESI, some possible explanations include: greater take-up of previously offered benefits, an improved economy leading more people to hold jobs (or have family members with jobs) that offer ESI, or an increase in employers offering ESI. These results on insurance coverage transitions have been discussed widely in the media, so here we want to bring your attention to some of the other findings of the HROS.
The public opinion part of our survey contains three questions. First, we ask respondents to report whether their opinion of the ACA is generally favorable or unfavorable. (Click through to see related graphs.) Following an initial dip in favorable opinion in November, public opinion of the ACA has remained relatively stable, except for one week in March. Approximately 35 percent hold favorable opinions while approximately 52 percent hold unfavorable opinions. The remainder responds “don’t know.” While there have been fluctuations, nearly all are within the margin of error, suggesting very stable opinions.
RWJF Clinical Scholars Video Podcast: Professor Timothy Jost on What’s Ahead for the Affordable Care Act
Much of the media coverage of the Affordable Care Act’s implementation has focused on the rollout of the state and federal health care exchanges. But in a new Robert Wood Johnson Foundation Clinical Scholars program video podcast, law professor Timothy Jost, JD, highlights some of the remaining challenges to the new law’s success. These include what he describes as the “huge problem of reconciliation.” For people with unpredictable annual incomes, including those with multiple part-time jobs or who move from job to job, the task of estimating their annual income for purposes of qualifying for federal subsidies is daunting, he explains. If their estimates turn out to be wrong, they could miss out on subsidies to which they’re entitled, or owe the government money at the end of the year.
Jost is the Robert L. Willett Family professor of law at Washington and Lee University. The video podcast is part of a series of RWJF Clinical Scholars Health Policy Podcasts, co-produced with Penn’s Leonard Davis Institute of Health Economics.
The video is republished with permission from the Leonard Davis Institute.
This is part of the April 2014 issue of Sharing Nursing’s Knowledge.
“It is a truism that healthy children are in a better position to learn in the classroom.
Unfortunately, it’s also a sad fact of life that the role of a school nurse—who is on campus to help insure students’ well-being—often goes overlooked or underestimated.”
--Editorial, Board Should Work to Remedy Nursing Shortage, Burbank Leader, April 11, 2014
“Our goal is not just to be at the table [of policy-making discussions]. We need practiced, experienced nurses to vote at that table, and when our voices are heard, the patient’s voices are heard, and this means we must invest more time, attention, and resources to develop nurse leaders.”
--Karen Daley, PhD, RN, FAAN, president, American Nursing Association, Nursing Leaders Essential in Providing Quality Health Care, Houston Chronicle, April 4, 2014
“I have watched the industry grow over the years as nurses become more involved than just taking vital signs, giving medications and bathing patients. There is a more team-oriented approach, which has developed in hospitals, and this naturally makes it a more rewarding career option. As a result, more and more nursing programs are in demand.”
--Brenda McAllister, MSN, EdD, director of nursing, EDMC-Brown Mackie College, Health Care Industry Experiencing New Demands for Nurses, (Milwaukee) Journal Sentinel, April 3, 2014
Brendan Saloner, PhD, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar in residence at the University of Pennsylvania and a senior fellow at the Leonard Davis Institute of Health Economics.
In these early days of the Affordable Care Act, the uninsured rate has begun to sharply decrease. One recent estimate suggests 5.4 million adults gained insurance coverage in the first quarter of 2014. The Congressional Budget Office projects that enrollment in Medicaid and the health insurance Marketplaces will increase even more rapidly over the next two years.
The importance of increased health insurance coverage for improved access to health care justifiably receive much of the public’s attention, but the impact of coverage on the financial health of families may be equally important. Subsidized health insurance can increase the disposable income of families by freeing up money that was previously used to pay out-of-pocket for doctor’s visits and prescription drugs. Newly insured individuals also benefit from the risk-protection of health insurance since even people who use little or no health care are at risk of unexpected accidents or newly diagnosed diseases.
A recent study in Oregon that compared adults who received free health insurance through a lottery to those who applied but did not receive the free care found that the “winners” were much less likely to say that they needed to cut back on necessities to pay for health care. They also had much less medical debt and a lower likelihood of receiving a notice from a collection agency.
Two stories on the Robert Wood Johnson Foundation (RWJF) website report on new research by RWJF scholars.
Vanessa Grubbs, MD, MPH, and Kirsten Bibbins-Domingo, MD, PhD, both alumnae of the Harold Amos Medical Faculty Development Program (AMFDP), have discovered that obesity appears to be a driver of diminished kidney function, independent of a number of common kidney conditions. This suggests that overweight patients could face kidney troubles even if they avoid hypertension, diabetes, or other such conditions. The researchers also found that the standard measure used to gauge kidney function might miss early signals of deterioration that a more sensitive test can detect. This suggests that clinicians could identify emerging problems in otherwise asymptomatic patients, and help steer them toward healthier habits early in life.
New studies from RWJF scholars seek early markers for substance abuse, explore young adult sleep patterns, and gather data on health care providers’ counseling. RWJF Health & Society Scholar Julie Maslowsky, PhD, and colleagues found that mental health problems in eighth graders are a likely marker for subsequent substance abuse issues. In a separate study, Maslowsky’s research team studied the sleep patterns of more than 15,000 teens, because getting too little or too much sleep is related to a number of mental and physical health problems, including depression and anxiety. The same story reports on a survey by Aletha Akers, MD, MPH, an AMFDP alumna, examining the counseling health care providers give to parents of adolescent patients. The topics parents most frequently recalled discussing were the ones least associated with adolescent morbidity.
The Robert Wood Johnson Foundation’s LEAP National Program is working to create a culture of health by discovering, documenting, and sharing innovations in the primary care workforce. Across the country, innovative practices have found ways to make care more efficient and effective for both patients and providers, which can lead to improved health outcomes and health savings. The LEAP project has identified and visited practices based in large health systems and rural community clinics ranging from Maine to California, and has brought the sites together in person and via webinars to discuss their innovations.
LEAP stands for The Primary Care Team: Learning from Effective Ambulatory Practices. Over the past six months, the 31 “exemplar sites” have been actively engaged in discussing their workforce best practices. The goal is to allow others across the country to learn from and replicate these innovations, ultimately via a dissemination website.
RWJF Scholars in the News: Education levels and bone fractures, nursing research, hospital choice, and more.
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
Social class may have a significant bearing on the likelihood that middle-aged African American and Asian women will suffer bone fractures, a new study suggests. Co-author Rebecca Thurston, PhD, an RWJF Health & Society Scholars alumna, found that current income level or ability to pay for care is not associated with bone-fracture risk. However, educational levels among minorities, which the authors note are tightly associated with socioeconomic status, are directly related. This suggests that socioeconomic status over the entire course of a woman’s life is more relevant to bone health than current income status, Health Canal reports.
The Richmond Times Dispatch reports on the importance and value of nursing research. Nursing “really looks at the whole person. So we consider the physiological issues in terms of health problems, as well as psychological components, which is a big part of any health problem,” Jacquelyn Campbell, PhD, RN, FAAN, director of the RWJF Nurse Faculty Scholars program, tells the Dispatch. “We also are very concerned with vulnerable populations, ending health inequalities. Some of our nurse scientists, including some of the Nurse Faculty Scholars, are actually doing physiological research in the lab, but they are very concerned with how that translates to the bedside and to the community.”
The first episode of Years of Living Dangerously, a new documentary series exploring the human impact of climate change, aired last Sunday on Showtime. I worked on the series as associate producer and producer, but I am also a scientist who has been studying the impact of climate change on human health for almost a decade. In all that time, I’d developed a good grasp of what climate change looks like from a scientific point of view. But working on the series made me learn a lot more about what climate change looks like, not just here in the United States but worldwide.
This documentary television series consists of nine episodes featuring star correspondents as they meet experts and visit ordinary people who have lived through extreme weather events triggered by climate change. James Cameron, Jerry Weintraub, and Arnold Schwarzenegger served as executive producers of the series, along with former 60 Minutes producers Joel Bach and David Gelber. I worked with Matt Damon on an upcoming segment about heat waves and with Michael C. Hall on another story focusing on Bangladesh, a nation already vulnerable to extreme weather.
E. Alison Holman, PhD, FNP, is an associate professor in nursing science at the University of California, Irvine and a Robert Wood Johnson Foundation Nurse Faculty Scholar.
A year ago today, on April 15, 2013, in the first major terror attack on U.S. soil since September 11, 2001, Dzhokhar and Tamerlan Tsarnaev planted two pressure cooker bombs near the finish line of the Boston Marathon. Three people died and more than 260 were injured. For a week authorities searched for the perpetrators, shootouts occurred, and Boston was locked down. As reporters and spectators filmed the mayhem, graphic images were shown repeatedly in both traditional and social media around the world. Like the September 11, 2001 (9/11) terrorist attacks, the population of the United States was the terrorists’ intended psychological target. Yet most research on reactions to such events focuses on individuals directly affected, leaving the public health consequences for populations living outside the immediate community largely unexplored.
Tens of thousands of individuals directly witnessed 9/11, but millions more viewed the attacks and their aftermath via the media. In our three-year study following 9/11, my colleagues and I found that people who watched more than one hour of daily 9/11-related TV in the week following the attacks experienced increases in post-traumatic stress (PTS) symptoms (e.g., flashbacks, feeling on edge and hyper vigilant, and avoidance of trauma reminders) and physical ailments over the next three years (Silver, Holman et al., 2013).
Improvements to Dermatology Curriculum and Residency Training Could Improve Patient Safety, Study Finds
Modifications to curricula, systems, and teacher development may be needed to bring down medical error rates among dermatology residents, according to a study published online by JAMA Dermatology.
The survey of 142 dermatology residents from 44 residency programs in the United States and Canada draws attention to several areas of concern. According to the survey:
- Just over 45 percent of the residents failed to report needle-stick injuries incurred during procedures;
- Nearly 83 percent reported cutting and pasting a previous author’s patient history information into a medical record without confirming its validity;
- Nearly 97 percent reported right-left body part mislabeling during examination or biopsy; and
- More than 29 percent reported not incorporating clinical photographs of lesions sampled for biopsy in the medical records at their institutions.
Also, nearly three in five residents reported working with at least one attending physician who intimidates them, reducing the likelihood of reporting safety issues. More than three-quarters of residents (78 percent) have witnessed attending physicians ignoring required safety steps.