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Health Affairs' January Issue:  High-Cost Populations, Medicaid Spending, And More

Bethesda, MD — The January issue of Health Affairs explores the diverse needs of the small share of the population that accounts for the largest share of health spending in the United States. The issue also contains two studies examining how the Affordable Care Act (ACA) has--and has not--affected hiring decisions of employers and job-seeking behavior of individuals.

DataWatch:  The ACA's Effect On Part-Time Employment.
When the ACA took effect, some policymakers were concerned that the employer mandate would cause companies to reduce some employees' hours to avoid providing them with health insurance, and that incentives surrounding expanded access to affordable coverage would lead workers to voluntarily reduce the hours they work. Asako Moriya of the Agency for Healthcare Research and Quality (AHRQ) and coauthors examined data from the Current Population Survey (CPS) for the years 2005-15 and found very limited evidence to support this speculation. According to the authors, the adjusted probability of working part time before and after the ACA enactment, whether done voluntarily or involuntarily, did not show significant change. (See exhibit below for the overall adjusted trends in working full time versus part time.) The CPS data distinguishes between involuntary part-time work (wanting to work full time but unable to) and voluntary part-time work (choosing to work part time for a number of reasons). The authors recommend future research on this subject to further capture the phasing in of the employer mandate and any lagged effects of the ACA on employment.
A related study about the ACA's impact on employment:
Traditional Medicaid Expansion And "Private Option" Markedly Improve Access To Care.
Thirty states and the District of Columbia have expanded Medicaid eligibility to all nonelderly adults with incomes below 138 percent of the federal poverty level. While most states continue offering traditional Medicaid coverage, several states have used their Medicaid funds to purchase private insurance, also known as the "private option." To determine the impact of both public and private Medicaid expansions on access to care for some low-income Americans, Benjamin Sommers of the Harvard T.H. Chan School of Public Health and Brigham and Women's Hospital and coauthors surveyed nearly 3,000 low-income adults in the fall of 2013, and an additional 3,000 adults a year later, who lived in three southern states: Kentucky (traditional Medicaid), Arkansas (private option), and Texas (no expansion). The authors identified a significant decline in uninsurance--14 percentage points--in Arkansas and Kentucky compared to Texas, as well as gains in access to and affordability of health care. There were few appreciable differences in results between the two types of coverage expansions, suggesting that both approaches improved access among low-income adults. These findings suggest that deciding whether or not to expand matters more than which expansion model is chosen.
Other Medicaid-related studies:
Also of interest in the January issue:
Impact Of Violence On Mexico's Life Expectancy.
Examining life expectancy trends in Mexico between 2000 and 2010 led researchers to find that homicide rates in the second half of the decade caused male life expectancy to stagnate. Although homicide has typically been associated with Mexican states linked to drug cartel operations, these results highlight increasing rates of male homicide in states with historically low levels of homicide. José Manuel Aburto, a fellow at the Max Planck Institute for Demographic Research; Hiram Beltrán-Sánchez, at the University of California, Los Angeles; and coauthors, used data from vital statistics files available through the Mexican National Institute of Statistics and Geography. The authors suggest that approaches such as epidemiological surveillance can strengthen polices to reduce violence. Evidence from other countries such as Colombia suggests that it is possible to reduce homicide mortality rates by implementing community programs that focus on lessening risk factors (for example, alcohol use and firearm possession).
Many Working-Age Cancer Survivors Suffer Financial Hardship.
According to an Institute of Medicine study, cancer care costs in the United States are rising at two to three times the rate of other health care costs. To assess the financial burden of these expenses, Matthew Banegas of the Kaiser Permanente Center for Health Research and coauthors used data from a 2012 LIVESTRONG online survey of 4,719 cancer survivors, ages 18-64. According to the survey, 33.6 percent of respondents reported that they had to borrow money or go into debt to pay for their care; 39.7 percent had to make other kinds of financial sacrifices; and 3.1 percent had to file for bankruptcy. The ACA contains several provisions that may assist patients with high medical costs. The authors speculate that for low-income households especially, improved insurance availability and caps on out-of-pocket expenses contained in the ACA could ease the financial burden of cancer treatment. They recommend that future research should assess the impact of the ACA on barriers to access to care, costs of care for cancer survivors, and the associated financial hardship of cancer.
Some Substance Use Disorders Not Associated With Higher Hospitalization Rates.  
Substance abuse creates its own health problems while exacerbating others.  Jan Gryczyski of the Friends Institute and coauthors examine hospitalization rates and costs across different categories of users of alcohol, marijuana, and other illicit drugs, using 2009-13 data from the National Surveys on Drug Use and Health, conducted annually by the Substance Abuse and Mental Health Services Administration (SAMHSA). The authors found no significant association between alcohol or marijuana use disorders and hospitalization. However, they did find a strong link between other drug use disorders and hospitalization: people with those disorders had 2.2 times higher odds of hospitalization relative to abstainers. Notably, marijuana users who do not have a marijuana use disorder have lower hospitalization rates than those who abstain from the drug completely--a finding that warrants additional exploration, given the loosening of restrictions on marijuana use occurring in states around the country.