The dependent coverage expansion (DCE), a component of the Affordable Care Act, required private health insurance policies that cover dependents to offer coverage for policyholders' children through age 25. This review summarizes peer-reviewed research on the impact of the DCE on the chain of consequences through which it could affect public health. Specifically, we examine the impact of the DCE on insurance coverage, access to care, utilization of care, and health status. All studies find that the DCE increased insurance coverage, but evidence regarding downstream impacts is inconsistent. There is evidence that the DCE reduced high out-of-pocket expenditures and frequent emergency room visits and increased behavioral health treatment. Evidence regarding the impact of the DCE on health is sparse but suggestive of positive impacts on self-rated health and health behavior. Inferences regarding the public health impact of the DCE await studies with greater methodological diversity and longer follow-up periods.

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PREFACEPublic health emergencies often involve making difficult decisions, including when to notify the public of threats, when to close schools or suspend public events, when to dispense medication, and how to allocate scarce resources. Yet, public health practitioners often have little experience or training in crisis decision making and can be uncomfortable with the need to make decisions based on often-incomplete information and short time lines. Unfortunately, there are no established tools for identifying, measuring, and improving public health crisis decision making.This report describes an approach for assessing key features of good crisis decision making. The written assessment tool focuses on decision-making processes--specifically, situational awareness, action planning, and process control. The initial development of the tool was based on a literature review, review of after action reports, meetings with subject-matter experts, and observation of exercises. Thus, while it was designed with end-user input, it should be considered a draft or prototype pending more-extensive validation.This document will be of primary interest to those in public health. However, those involved in homeland security and emergency response will recognize familiar structures (e.g., the Incident Command Structure) and challenges (e.g., the need for contingency planning). The tool is designed to be used in a wide variety of decision-making group sizes and structures, including those in Emergency Operations Centers and distributed groups (to the extent that group discussion can be observed).

Efforts to respond to performance-based accountability mandates for public health emergency preparedness have been hindered by a weak evidence base linking preparedness activities with response outcomes. We describe an approach to measure development that was successfully implemented in the Centers for Disease Control and Prevention Public Health Emergency Preparedness Cooperative Agreement. The approach leverages insights from process mapping and experts to guide measure selection, and provides mechanisms for reducing performance-irrelevant variation in measurement data. Also, issues are identified that need to be addressed to advance the science of measurement in public health emergency preparedness.