Category Archives: Affordable Care Act (ACA)

Jul 24 2014
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RWJF Scholars in the News: Stereotype threat, hand hygiene, misbehaving science, 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:

Anxiety caused by “stereotype threat” could help explain health disparities that persist across race, suggests research co-authored by Cleopatra Abdou, PhD, an RWJF Health & Society Scholars program alumna. News Medical covers the study, describing it as the first of its kind to empirically test, in the context of health sciences, the impact of the “threat of being judged by or confirming a negative stereotype about a group you belong to.” Abdou’s research offers a possible explanation for ethnic and socioeconomic differences in morbidity and mortality between Black and White women because, as Abdou says, the research goes beyond nature vs. nurture, “bringing situation and identity into the equation.” For example, in the study, Black women with a strong connection to their race had the highest anxiety levels when in waiting rooms filled with posters that displayed negative health-related racial stereotypes dealing with such topics as unplanned pregnancy and AIDS.

Having health insurance improves access to medical care for pregnant, low-income women, and results in long-term health benefits for their babies, according to a study by RWJF Scholar in Health Policy Research Sarah Miller, PhD, and RWJF Health & Society Scholar Laura Wherry, PhD, that was reported by Vox. Miller and Wherry found the expansion of Medicaid in the 1980s made prenatal care much more accessible to low-income women, many of whom would otherwise have been without insurance. The result was improvements in obesity, preventable hospitalizations, and preventable, chronic disease-related hospitalizations among children. 

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Jul 21 2014
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Federal Government Sets Aside Funds to Boost Access to Primary Care

The federal government announced on July 7 it had awarded more than $83 million to expand access to care by training hundreds of new primary care providers.

The money will be used to support primary care residency programs in family medicine, internal medicine, pediatrics, obstetrics and gynecology, psychiatry, geriatrics, and general dentistry at 60 health centers across the country. The expanded residency programs will help train more than 550 residents in coming academic year—about 200 more than were trained in the previous academic year, according to the U.S. Department of Health and Human Services (HHS). The funds will also be used to boost the number of states with teaching health centers from 21 to 24.

“This program not only provides training to primary care medical and dental residents, but also galvanizes communities,” said Mary K. Wakefield, PhD, RN, head of the Health Resources and Services Administration, a division of HHS. “It brings hospitals, academic centers, health centers, and community organizations together to provide top-notch medical education and services in areas of the country that need them most.”

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Jul 10 2014
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Quotable Quotes About Nursing, July 2014

This is part of the July 2014 issue of Sharing Nursing’s Knowledge.

“We can’t just sit back and wait for things to get created, to be made for a bigger market, to be made just for a patient like that, so we have to make and create what we need ...”
--Roxana Reyna, BSN, RNC-NIC, WCC, skin and wound care prevention specialist, Driscoll Children’s Hospital, MacGyver Nurse and Maker Nurse Program, KRISTV (Corpus Christi, TX), June 30, 2014

“Nurses make up the single largest segment of the health care workforce and spend more time delivering patient care than any other health care profession. Nursing’s unique ability to meet patient needs at the bedside and beyond puts us in a critical position to transform health care.”
--Michelle Taylor-Smith, RN, BSN, MSN, chief nursing officer, Greenville Health System, GHS to Require B.S. Degrees for Nurses, Greenville Online, June 28, 2014

“This country won’t succeed in its implementation of health care reform without more of these types of [nurse-led] clinics in underserved communities.”
--Tine Hansen-Turton, MGA, JD, FAAN, CEO, National Nursing Centers Consortium, At Paul’s Place, Partnership with Nursing School Promotes Good Health, Baltimore Sun, June 22, 2014

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Jul 10 2014
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RWJF Scholars in the News: Healthcare.gov, depression and mortality, stress among nurses, 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:

Young adult users of Healthcare.gov, the health insurance marketplace established under the Affordable Care Act, recommend that the site offer better explanations of terminology, more clarity about the benefits various plans offer, and checkboxes and other features that make it easier to compare plans. Those are among the findings of a study conducted by RWJF Clinical Scholar Charlene Wong, MD, along with alumni David Asch, MD, MBA, and Raina Merchant, MD, that looked at the experiences of young adults who used the website. The scholars write about their findings in the Philadelphia Inquirer. Wong told the Leonard Davis Institute of Health Economics blog that these users “may not know what insurance terms mean but they have a lot of expertise and insights about maximizing the usability of the digital platforms that have always been such an integral part of their lives.”

Major depression (also known as “clinical depression”) is associated with an elevated risk of death from cardiovascular disease, according to research covered by Kansas City InfoZine. The study, co-authored by Patrick Krueger, PhD, an RWJF Health & Society Scholars program alumnus, also found that the relationship between depression and early non-suicide mortality is independent of such factors as smoking, exercise, body mass, education, income, and employment status. The authors say the findings indicate that the relationship between depression and mortality is not due solely to the interplay between depression and health-compromising risk factors.

Expanding scope of practice for advanced practice nurses and implementing better management practices could alleviate some stress factors for nurses and improve patient care, Matthew McHugh, PhD, JD, MPH, FAAN, tells Healthline News. For example, in some medical facilities, nurses are empowered to decide if a patient’s urinary catheter should be removed without consulting a doctor, thus preventing delays in care. “Lots of things that don’t require policy change” can have an important impact on patient outcomes and nurses’ job satisfaction, said McHugh, an RWJF Nurse Faculty Scholars alumnus.

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Jul 1 2014
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Federal Government Sets Aside Funds for Community Health Centers

The nation’s community health centers are poised for expansion thanks to the availability of new funds authorized under the Affordable Care Act.

In June, the U.S. Department of Health and Human Services announced the availability of up to $300 million to expand community health center services throughout the nation. The funds are intended to help centers expand service hours, hire more medical providers, and add services in areas including oral and behavioral health, pharmacy, and vision.

Community health centers “deliver comprehensive, high-quality preventive and primary care to patients regardless of their ability to pay,” according to the Health Resources and Services Administration (HRSA). Currently, nearly 1,300 such centers provide care to more than 21 million patients across the country.

"These funds will allow health centers to expand health services to better serve newly insured patients,” said HRSA Administrator Mary Wakefield, RN, PhD, FAAN.

Existing grantees of HRSA’s health center program are eligible to apply for funding. Applications demonstrating how funds will be used to expand services are due by July 1.

Learn more about the application process here.

Jun 11 2014
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Emergency Rooms Getting Busier, New Poll Finds

Expanded health care coverage under the Affordable Care Act (ACA) has led to a rise in emergency room (ER) visits this year, according to a survey by the American College of Emergency Physicians (ACEP). Nearly half of the 1,845 ACEP members who responded to an online poll conducted in April report higher ER patient loads since January 1. Additionally, 86 percent anticipate more increases over the next three years, and 77 percent say their ERs are not adequately prepared for significant increases.

“Emergency visits will increase in large part because more people will have health insurance and therefore will be seeking medical care,” ACEP President Alex Rosenau, DO, FACEP, said in a news release. “But America has severe primary care physician shortages, and many physicians do not accept Medicaid patients, because Medicaid pays so low. When people can't get appointments with physicians, they will seek care in emergency departments. In addition, the population is aging, and older people are more likely to have chronic medical conditions that require emergency care.”

U.S. Department of Health and Human Services spokesperson Erin Shields Britt told the Wall Street Journal that broad conclusions can’t be drawn from the study: “This survey, looking at only the first three months of coverage, cannot speak to the long-term effects of expanded coverage, which will be shaped by our continuing efforts to help people use their new primary care and preventive care benefits and to invest in innovative approaches aimed at improving our nation’s system of primary care.”

Read ACEP’s survey results

May 10 2014
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One Nurse’s Leadership Journey

Cynthia Crone, MNSc, APRN, CPNP, is deputy commissioner of the Arkansas Insurance Department, where she created and now leads the state’s Partnership Health Insurance Marketplace. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program

Cynthia Crone

Being asked to write a post about nurse leadership for National Nurses Week presents a wonderful opportunity to reflect on my nursing journey and express appreciation for the many nurses and other leaders who have played a supportive role in my development. A career in public health with an emphasis on vulnerable populations, including most recently directing efforts in Arkansas to implement the Health Insurance Marketplace, has reinforced with me the critical role nurse leaders play in the politics and policy of health care and how very important it is to foster and support community involvement and interdisciplinary collaboration by younger nurses. 

National Nurses Week HC Blog Logo

I started nursing school in the mid-1970s. Nurse practitioners were just coming on the scene. After graduation I obtained certification as a pediatric nurse practitioner and traveled to 10 rural counties to hold “well child clinics.” I learned a lot from the public health nurses. I loved my job. The work helped me better understand the bio-psycho-social-spiritual art and science of nursing and the social determinants of health. Further, through interaction with nurse and other community leaders, I learned that another element—political–can’t be ignored.

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Apr 27 2014
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How Can Health Systems Effectively Serve Minority Communities? Promote Health In Community Settings.

To mark National Minority Health Month, the Human Capital Blog asked several Robert Wood Johnson Foundation (RWJF) scholars to respond to questions about improving health care for all. In this post, Monica E. Peek, MD, MPH, assistant professor of medicine and associate director of the Chicago Center for Diabetes Translation Research at the University of Chicago, responds to the question, “What are the challenges, needs, or opportunities for health systems to effectively serve minority communities?” Peek is an alumnus of the Harold Amos Medical Faculty Development Program.

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With the health policy introduced by the Affordable Care Act, health systems have a unique opportunity (and admittedly, a challenge as well) to transform themselves in ways that promote health and not just treat illness. Such efforts are particularly relevant for racial/ethnic minorities, which disproportionately suffer from the morbidity and mortality of chronic diseases that are largely preventable in nature.  Lifestyle changes (e.g. dietary patterns, physical activity, tobacco cessation, and limited alcohol intake) can prevent or help manage the majority of chronic diseases in the United States, which are disproportionately present within minority communities.

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Apr 22 2014
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Tracking the Affordable Care Act with the RAND Health Reform Opinion Study

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.

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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.

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Apr 21 2014
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RWJF Clinical Scholars Video Podcast: 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.