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Past research on the effects of Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) on suicide rates has focused on the “expansion population,” or adults up to 138 percent of the federal poverty line (FPL), but little is known about if the effects extend to children and young adults. This paper uses panel data from the U.S. Census Bureau’s American Community Survey (ACS) 1-year Estimates Tables for the years 2013 through 2018 and a U.S. Centers for Disease Control and Prevention (CDC) National Vital Statistics Report to try and produce an unbiased estimate of the relationship between a state’s Medicaid expansion status and suicide rates per 100,000 for children and young adults ages 10 to 24. Multivariate regression analyses using both time and entity fixed effects find mixed results in terms of a statistically significant relationship between expansion status and suicide rates among children and young adults. Although only one of the four regression models finds a statistically significant relationship, all four models in this analysis show evidence that an expanded Medicaid program is associated with lower suicide rates among children and young adults at varying levels of significance. The results of this study could help inform future research on the effect of Medicaid expansion on suicide rates for children and young adults that may uncover more definitive evidence of expansion’s negative association with suicide rates. Any such evidence would help build on the existing research surrounding Medicaid expansion under the ACA and help better understand the program’s viability as a policy lever for suicide prevention.
Mental illness affects up to one in five people in the United States, and its multidimensional nature complicates efforts to tackle the issue. Improving health insurance access is one initiative that policy makers can pursue to help address the behavioral health needs of populations most at risk for mental disorders. The Patient Protection and Affordable Care Act (ACA) instituted eligibility expansions for the Medicaid program in 2014. Using data from the Behavioral Risk Factor Surveillance System (BRFSS), this paper examines the association between the Medicaid expansion policy and the likelihood of experiencing frequent mental distress (FMD) in a sample of low-income individuals. Results suggest that the expansion was associated with modest decreases in the probability of experiencing FMD for individuals in expansion states, but these results were not statistically significant. Additionally, data suggest that there was a marked increase in the prevalence of FMD in 2016 for both expansion and non- expansion states, which may suggest that there are factors external to health care access affecting FMD among low-income populations. Further research is needed to assess the effects of health care access as improved through the ACA's Medicaid expansion on mental health.
In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.
The Patient Protection and Affordable Care Act (ACA) was designed to increase access to affordable health coverage by reforming the individual health insurance market and expanding eligibility for Medicaid, the insurance program targeted towards low-income individuals. Since its passage, however, the ACA has been plagued by criticisms that it has produced significant premium hikes. Moreover, many states chose not to expand their Medicaid programs. I examine whether there is a relationship between Medicaid expansion decisions and insurance premiums in the individual market. Because Medicaid expansions remove lower income individuals from individual insurance markets - and since these individuals tend to have poorer health outcomes - premiums in the private insurance market could be lower in expansion states where the private market is priced for a healthier risk pool. My results indicate that this may not be the case: I find that there is a positive and statistically significant relationship between Medicaid expansion and premiums, although this relationship is small in magnitude. I also find, however, that the relationship is the opposite for states that retained some measure of control over the administration of their marketplaces. This finding makes a novel contribution to the literature by demonstrating how state-level policy decisions can impact the success of national legislation. My study also illustrates the need for additional research into the impact of Medicaid expansions on premiums, as studies conducted to date have found contradicting results.
The increase in prevalence and visibility of sexually gender diverse (SGD) populations illuminates the need for greater understanding of the ways in which current laws, systems, and programs affect their well-being. Individuals who identify as lesbian, gay, bisexual, asexual, transgender, non-binary, queer, or intersex, as well as those who express same-sex or -gender attractions or behaviors, will have experiences across their life course that differ from those of cisgender and heterosexual individuals. Characteristics such as age, race and ethnicity, and geographic location intersect to play a distinct role in the challenges and opportunities SGD people face. Understanding the Well-Being of LGBTQI+ Populations reviews the available evidence and identifies future research needs related to the well-being of SDG populations across the life course. This report focuses on eight domains of well-being; the effects of various laws and the legal system on SGD populations; the effects of various public policies and structural stigma; community and civic engagement; families and social relationships; education, including school climate and level of attainment; economic experiences (e.g., employment, compensation, and housing); physical and mental health; and health care access and gender-affirming interventions. The recommendations of Understanding the Well-Being of LGBTQI+ Populations aim to identify opportunities to advance understanding of how individuals experience sexuality and gender and how sexual orientation, gender identity, and intersex status affect SGD people over the life course.
Young adulthood - ages approximately 18 to 26 - is a critical period of development with long-lasting implications for a person's economic security, health and well-being. Young adults are key contributors to the nation's workforce and military services and, since many are parents, to the healthy development of the next generation. Although 'millennials' have received attention in the popular media in recent years, young adults are too rarely treated as a distinct population in policy, programs, and research. Instead, they are often grouped with adolescents or, more often, with all adults. Currently, the nation is experiencing economic restructuring, widening inequality, a rapidly rising ratio of older adults, and an increasingly diverse population. The possible transformative effects of these features make focus on young adults especially important. A systematic approach to understanding and responding to the unique circumstances and needs of today's young adults can help to pave the way to a more productive and equitable tomorrow for young adults in particular and our society at large. Investing in The Health and Well-Being of Young Adults describes what is meant by the term young adulthood, who young adults are, what they are doing, and what they need. This study recommends actions that nonprofit programs and federal, state, and local agencies can take to help young adults make a successful transition from adolescence to adulthood. According to this report, young adults should be considered as a separate group from adolescents and older adults. Investing in The Health and Well-Being of Young Adults makes the case that increased efforts to improve high school and college graduate rates and education and workforce development systems that are more closely tied to high-demand economic sectors will help this age group achieve greater opportunity and success. The report also discusses the health status of young adults and makes recommendations to develop evidence-based practices for young adults for medical and behavioral health, including preventions. What happens during the young adult years has profound implications for the rest of the life course, and the stability and progress of society at large depends on how any cohort of young adults fares as a whole. Investing in The Health and Well-Being of Young Adults will provide a roadmap to improving outcomes for this age group as they transition from adolescence to adulthood.
Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.
The Shriver Report: A Woman’s Nation Takes on Alzheimer’s will be the first comprehensive multi-disciplinary look at these questions at this transformational moment. The Report will digest the current trends in thinking about Alzheimer’s, examine cutting-edge medical research, look at societal impacts, and include a groundbreaking and comprehensive national poll. It will feature original photography and personal essays by men and women – some from the public arena with names you know, some from everyday America – sharing their personal struggles with the disease as patients, caregivers and family members.
The Social Determinants of Mental Health aims to fill the gap that exists in the psychiatric, scholarly, and policy-related literature on the social determinants of mental health: those factors stemming from where we learn, play, live, work, and age that impact our overall mental health and well-being. The editors and an impressive roster of chapter authors from diverse scholarly backgrounds provide detailed information on topics such as discrimination and social exclusion; adverse early life experiences; poor education; unemployment, underemployment, and job insecurity; income inequality, poverty, and neighborhood deprivation; food insecurity; poor housing quality and housing instability; adverse features of the built environment; and poor access to mental health care. This thought-provoking book offers many beneficial features for clinicians and public health professionals: Clinical vignettes are included, designed to make the content accessible to readers who are primarily clinicians and also to demonstrate the practical, individual-level applicability of the subject matter for those who typically work at the public health, population, and/or policy level. Policy implications are discussed throughout, designed to make the content accessible to readers who work primarily at the public health or population level and also to demonstrate the policy relevance of the subject matter for those who typically work at the clinical level. All chapters include five to six key points that focus on the most important content, helping to both prepare the reader with a brief overview of the chapter's main points and reinforce the "take-away" messages afterward. In addition to the main body of the book, which focuses on selected individual social determinants of mental health, the volume includes an in-depth overview that summarizes the editors' and their colleagues' conceptualization, as well as a final chapter coauthored by Dr. David Satcher, 16th Surgeon General of the United States, that serves as a "Call to Action," offering specific actions that can be taken by both clinicians and policymakers to address the social determinants of mental health. The editors have succeeded in the difficult task of balancing the individual/clinical/patient perspective and the population/public health/community point of view, while underscoring the need for both groups to work in a unified way to address the inequities in twenty-first century America. The Social Determinants of Mental Health gives readers the tools to understand and act to improve mental health and reduce risk for mental illnesses for individuals and communities. Students preparing for the Medical College Admission Test (MCAT) will also benefit from this book, as the MCAT in 2015 will test applicants' knowledge of social determinants of health. The social determinants of mental health are not distinct from the social determinants of physical health, although they deserve special emphasis given the prevalence and burden of poor mental health.