Medicaid as a Driver of Health Equity

Chen, Alice Hm; Ghaly, Mark

doi:10.1001/jama.2022.14911

Cited by 5 publications

(2 citation statements)

References 7 publications

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“…Other nations, such as Canada and England, have a health insurance system that is separate from employment. Expanding US public insurance programs, such as Medicaid and Medicare, has been promoted by some as a means to improve equity . However, even with increasing premium costs, recent surveys show high worker satisfaction with ESI coverage .…”

Section: Discussionmentioning

confidence: 99%

“…Expanding US public insurance programs, such as Medicaid and Medicare, has been promoted by some as a means to improve equity. 32 However, even with increasing premium costs, recent surveys show high worker satisfaction with ESI coverage. 33 Prior to the passage of the Patient Protection and Affordable Care Act, ESI was voluntarily provided to recruit and retain talented employees.…”

Section: Discussionmentioning

confidence: 99%

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Employer-Sponsored Health Insurance Premium Cost Growth and Its Association With Earnings Inequality Among US Families

Hager,

Emanuel,

Mozaffarian

2024

JAMA Netw Open

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ImportanceCosts of employer-sponsored health care benefits have increased faster than workers’ wages for several decades, with important implications for disparities in earnings and wage stagnation.ObjectiveTo quantify how growth in employer-sponsored health insurance (ESI) premiums may have been associated with reduced annual wages, disparities in earnings by race and ethnicity and wage level, and wage stagnation among US families with ESI.Design, Setting, and ParticipantsIn this economic evaluation, serial cross-sectional analyses were performed of US families receiving ESI from 1988 to 2019 based on data from the Consumer Expenditure Survey, Kaiser Employer Health Benefits Survey, US Census Bureau’s Current Population Survey, and federal payroll taxation rates. Statistical analysis was conducted from February 2022 to July 2023.Main Outcomes and MeasuresPercentage of annual compensation associated with health care premiums (after accounting for tax deductibility) and lost wages associated with growth in cost of premiums from 1989 to 2019 based on 1988 compensation. To assess disparities, analyses were stratified by race and ethnicity and wage level.ResultsIn 1988, 44.7 million individuals (head of household: mean [SD] age, 43.3 [13.1] years; 30.1% were female; and 2.4% identified as Asian, 6.2% as Hispanic, 8.6% as non-Hispanic Black, and 82.8% as non-Hispanic White) were covered by ESI family plans; this number remained similar in 2019 at 44.8 million individuals (head of household: mean [SD] age, 47.1 [12.9] years; 41.3% were female; and 1.3% identified as Asian, 9.9% as Hispanic, 9.9% as non-Hispanic Black, and 78.9% as non-Hispanic White). In 1988, the mean (SD) household size was 3.3 (1.3) people, and in 2019, it was 3.4 (1.3) people. If ESI costs had remained at the same proportion of the 1988 average compensation package, then in 2019, the median US family with ESI could have earned $8774 (95% CI, $8354-$9195) more in annual wages. During all 32 years, health care premiums as a percentage of compensation were greater for non-Hispanic Black and Hispanic families than for non-Hispanic White families. By 2019, 13.8% (95% CI, 13.5%-14.1%) of compensation among non-Hispanic White families with ESI went to premium costs compared with 19.2% (95% CI, 18.8%-19.7%) among non-Hispanic Black families and 19.8% (19.3%-20.3%) among Hispanic families with ESI. In 2019, health care premiums as a percentage of compensation at the 95th percentile of earnings for families with ESI were 3.9% (95% CI, 3.8%-4.0%) compared with 28.5% (95% CI, 27.8%-29.2%) at the 20th percentile of earnings. From 1988 to 2019, the mean cumulative lost earnings associated with growth in health care premiums for the median US family with ESI was $125 340 (95% CI, $120 155-$130 525) in 2019 dollars, 4.7% of earnings over the 32-year period.Conclusions and RelevanceThis economic evaluation of US families receiving ESI suggests that 3 decades of increasing health care premiums were likely associated with reduced annual earnings and increased earnings inequality by race and ethnicity and wage level and were meaningfully associated with wage stagnation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Employer-Sponsored Health Insurance Premium Cost Growth and Its Association With Earnings Inequality Among US Families

Hager,

Emanuel,

Mozaffarian

2024

JAMA Netw Open

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Person-Centered Care Planning for People Living With or at Risk for Multiple Chronic Conditions

Watson,

Estenson,

Eden

et al. 2024

JAMA Netw Open

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ImportanceThe US has a growing population of people living with multiple chronic conditions (MCC), yet the health system is ill designed to meet their needs. Person-centered care planning (PCCP) is an approach to provide comprehensive care that is responsive to the individual to improve health outcomes and increase value.ObjectiveTo examine strategies used to provide PCCP for people living with or at risk for MCC, as well as facilitators and barriers to implementation.Design, Setting, and ParticipantsThis qualitative study uses thematic analysis of responses from a Request for Information (RFI) published in the Federal Register soliciting input on PCCP, posted by the Agency for Healthcare Research and Quality (AHRQ) in 2022. The RFI was available for public comment from September 16, 2022, to November 15, 2022. Responses were analyzed between January 2023 and February 2024. Respondents were individuals and organizations who identify as, provide care for, or seek to improve care for individuals living with or at risk for MCC. Some responses represent multiple individuals.Main Outcomes and MeasuresQualitative themes and subthemes of the RFI responses, developed using thematic analysis through inductive and deductive coding of the open-text responses.ResultsThere were a total of 58 respondents, including clinicians, researchers, patients, caregivers, and representatives from health care payer, practitioner, health system, advocacy, professional, and supporting nonprofit and industry organizations. Researchers identified 9 themes: (1) suboptimal quality of care; (2) person-centered, goal-concordant care; (3) multidisciplinary team–based care and care coordination; (4) prevention across the life course; (5) digital health solutions; (6) workflow; (7) education and self-management support; (8) payment; and (9) achieving community, health system, and payer goals.Conclusions and RelevanceIn this qualitative study of PCCP for people living with or at risk for MCC, challenges to widescale adoption of PCCP were identified along with strategies to address these challenges, including the alignment of payment, policy support, culture change, adoption of meaningful measures, and the need for evidence on strategies to scale and spread PCCP. Insights gained from this analysis can inform research priorities and implementation efforts to advance PCCP as an integral component of routine care.

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Kein Effekt auf das Schlaganfallrezidivrisiko

Diener¹

2023

InFo Neurologie

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Medicaid as a Driver of Health Equity

Cited by 5 publications

References 7 publications

Employer-Sponsored Health Insurance Premium Cost Growth and Its Association With Earnings Inequality Among US Families

Employer-Sponsored Health Insurance Premium Cost Growth and Its Association With Earnings Inequality Among US Families

Person-Centered Care Planning for People Living With or at Risk for Multiple Chronic Conditions

Kein Effekt auf das Schlaganfallrezidivrisiko

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