Flint: An American Failure
Published: | 9:25 pm | Posted in: Neoliberalism
The story of Flint—the Michigan city in which people were harmed by drinking water that contained lead and lethal bacteria—is a warning to all struggling US communities that confront disinvestment, declining population, excessive financial focus, incompetent leadership, nontransparent government, and racism. Flint is also a tale of a persevering community, good doctors and scientists, and […]
Developing Care: Recent Research on the Care Economy and Economic Development
Published: | 8:00 pm | Posted in: Poverty and Public Policy
Policy makers are beginning to appreciate the constraints that unpaid care work imposes on both economic development and the empowerment of women in low-income countries. Empirical research on these topics is in its infancy but is already yielding significant results. This paper contextualizes and reviews recent research on unpaid care work in the Global South, […]
Medicaid blues: Hospitals, insurers wage political battle over managed-care dollars
Published: | 7:53 pm | Posted in: MLTC
“That’s all I have to say about that—I have to go bury the dead,” undertaker Stephen Holland said after listing his grievances with his state’s Medicaid politics early one Friday morning in June. Holland is one of a handful of white Democrats left in Mississippi’s House of Representatives, and he helped shape the past 20 […]
Managed Medicaid Long-Term Services and Supports is the Answer, But What is the Question?
Published: | 5:08 pm | Posted in: MLTC
A Presentation for the Annual Meeting of the Gerontological Society of America, November 2018: Medicaid expenditures (25%) continue to dominate state policy HCBS Waivers Have Grown Dramatically over the past two decades The expansion means that HCBS and Nursing Homes need to be managed States have been trying to shift risk– financial and management to […]
Projected Coding Intensity In Medicare Advantage Could Increase Medicare Spending By $200 Billion Over Ten Years
Published: | 7:19 pm | Posted in: Medicare Advantage
Over the past decade, the average risk score for Medicare Advantage (MA) enrollees has risen steadily relative to that for fee-for-service Medicare beneficiaries, by approximately 1.5 percent per year. The Centers for Medicare and Medicaid Services (CMS) uses patient demographic and diagnostic information to calculate a risk score for each beneficiary, and these risk scores are […]
The Price of Health Care: Why Is the United States an Outlier?
Published: | 8:07 pm | Posted in: Health Care Policy and Reform
Higher prices are increasingly recognized as a significant cause of the outlier status of the United States in health care expenditures. At the same time, various explanations are often invoked to justify higher prices as rational or even defensible. We evaluate—and mostly counter—potential explanations of why health care prices are higher in the United States: […]
Modernizing Social Security: Caregiver Credits
Published: | 6:48 pm | Posted in: Caregiving, Social Security
Women still tend to work fewer years and earn less than men, which leads to less income in retirement. One reason is that women are often still the main family caregiver. Traditionally, Social Security has recognized this role by providing spousal and widow benefits for married women. Today, however, many women are not eligible for […]
Longevity Economics: Leveraging the Advantages of an Aging Society
Published: | 6:35 pm | Posted in: Inequality
An aging society is a fact for the United States, much of the developed world, and many developing countries. People are reaching traditional retirement ages with many years of expected life remaining and their functional capacity largely intact. Many of these people want to continue contributing to society through activities that are meaningful to the […]
In-Work Poverty in the United States
Published: | 6:26 pm | Posted in: Poverty
In-work poverty became a prominent policy issue in the United States long before the term itself acquired any meaning and relevance in other industrialized countries. With America’s embrace of an employment-centered antipoverty strategy, the working poor have become even more of an issue. This paper reviews some key trends, drivers and policy issues. How much […]
The fading American dream: Trends in absolute income mobility since 1940
Published: | 6:20 pm | Posted in: Wealth
One of the defining features of the “American dream” is the aspiration that children have a higher standard of living than their parents. When children are asked to assess their economic progress, they frequently compare their own standard of living to that of their parents. Such measures of “absolute income mobility”—the fraction of children earning […]
Health Care Cost Control: Where Do We Go From Here?
Published: | 5:58 pm | Posted in: Health Care Policy and Reform
Medical services are expensive. There is no getting around it. The average family health insurance premium in the US is approaching $20,000. By one estimate, average family premiums could rise to 100 percent of US median household income by 2033 if trends continue. What is more troubling is that there is considerable evidence that nearly one-third of health spending is […]
Inside the nation’s largest mental health institution: a prevalence study in a state prison system
Published: | 5:52 pm | Posted in: Mental Health
Background The United States has the highest incarceration rate in the world which has created a public health crisis. Correctional facilities have become a front line for mental health care. Public health research in this setting could inform criminal justice reform. We determined prevalence rates for mental illnesses and related comorbidities among all inmates in […]
The notion of precariousness among older adults living alone in the U.S.
Published: | 9:01 pm | Posted in: Inequality
This paper argues that older adults living alone in the U.S. face a set of unique challenges, as they are likely to experience a sense of precariousness. The term precariousness points to an intrinsic sense of instability and insecurity stemming from a lack of, or difficulty to, access essential resources. During a two-year ethnography of […]
Quality of life in the contemporary politics of healthcare: … but what is a life?
Published: | 8:57 pm | Posted in: Inequality
‘Quality of life’ (QoL) is a ubiquitous phrase in medicine. There is considerable literature on the meaning of ‘quality’ in ‘quality of life’, but little on the meaning of ‘life’. And yet, rooted in measurements of QoL, is a conceptualization of ‘a life’ used to judge ‘quality’. In this article I focus on ‘life’ within […]
Suffering: The darker side of ageing
Published: | 8:55 pm | Posted in: Ethics and Aging
Much of the literature on ageing is presaged upon a model of support that seeks to combat what is seen as the negative stereotyping of old age and old people. One consequence is that ageing studies has difficulty in confronting the darker side of ageing except in so far as age associated disability and distress […]
Precarity in late life: Understanding new forms of risk and insecurity
Published: | 8:52 pm | Posted in: Inequality
Population aging and longevity in the context of declining social commitments, raises concerns about disadvantage and widening inequality in late life. This paper explores the concept of precarity as a means to understand new and sustained forms of risk and insecurity that affect late life. The article begins with a review of the definition and […]
Medical Marijuana Laws May Be Associated With A Decline In The Number Of Prescriptions For Medicaid Enrollees
Published: | 6:38 pm | Posted in: Pain Management
In the past twenty years, twenty-eight states and the District of Columbia have passed some form of medical marijuana law. Using quarterly data on all fee-for-service Medicaid prescriptions in the period 2007–14, we tested the association between those laws and the average number of prescriptions filled by Medicaid beneficiaries. We found that the use of […]
After Defeat: Conservative Postenactment Opposition to the ACA in Historical-Institutional Perspective
Published: | 7:00 pm | Posted in: Health Care Policy and Reform
Since the enactment of the Affordable Care Act (ACA) in 2010, conservatives have sought to undermine the law’s entrenchment. While they have failed in their ambitious quest to repeal the ACA, opponents have succeeded in overturning one major provision (the individual mandate penalty), narrowing the law’s reach, complicating its implementation, and fomenting doubts about its […]
How Growing Inequality Is Altering The Long-Term Care Policy Battlefield, While Tightening The Financing Knot
Published: | 7:29 pm | Posted in: MLTC
For many years, long-term care (LTC) policy makers have tended to fall into two warring camps: those favoring expanded social insurance, and those wanting tighter Medicaid eligibility criteria to incentivize people to plan for and buy LTC insurance. Both sides have warned of looming financial catastrophe as the Baby Boomers move into retirement and more […]
Rhetoric and Reform in Waiver States
Published: | 5:06 pm | Posted in: MLTC
Abstract Seven states have used Section 1115 waivers to expand Medicaid as part of the Affordable Care Act (ACA). While each state pursued a unique plan, there are similarities in the types of changes each state desired to make. Equally important to how a state modified their Medicaid programs is how a state talked about […]