Aaron E. Carroll's Blog, page 17

Climate Change and the Air We Breathe

We’re back with another episode on climate change and health, and this time we’re looking at some of the indirect health effects, with a focus on how things like air pollution and allergens arise from a warming planet and make us sick, particularly affecting our respiratory system.

 



The post Climate Change and the Air We Breathe first appeared on The Incidental Economist.

Arkansas should press pause on its Medicaid unwinding process

Last week, Marlee Stark and I published an op-ed in the Arkansas Democrat Gazette on why the Arkansas Department of Human Services (DHS) should press pause on its Medicaid unwinding process. Earlier this month, DHS released its first report laying out how many people lost coverage in April, as the state resumed its redetermination process.

As we write,

According to DHS’ recent report, over 50,000 people were disenrolled for procedural reasons, like failure to return paperwork or requested information, or because the state didn’t have their correct address on file. Only 15 percent of those who were disenrolled were confirmed truly ineligible or said they no longer needed their coverage, likely because they acquired another source of coverage during the pandemic.

In our piece, we argue that DHS should take a look at why so many people are losing coverage even though they may still be eligible—and outline some of the consequences the state may face if it chooses not to do so.

Read the full piece here.

Research for this piece was supported by Arnold Ventures.

The post Arkansas should press pause on its Medicaid unwinding process first appeared on The Incidental Economist.

Is ChatGPT Nicer than Your Doctor?

Is the ChatGPT artificial intelligence chatbot more empathetic than your doctor? And does it deliver higher quality information? A recent study suggest that might be the case. At first glance we figured, sure, a chatbot never gets bored or impatient, so maybe at some point it outperforms a lot of burnt-out doctors. But there’s a lot of detail to consider here – so it’s a good thing that’s what we do here!

 



The post Is ChatGPT Nicer than Your Doctor? first appeared on The Incidental Economist.

Why the unwinding of the Medicaid continuous coverage requirement hasn’t received more national attention

During the pandemic, Congress did something unprecedented: it guaranteed continuous health insurance coverage for low-income individuals. Now that pandemic-related policies are ending, this guarantee is also ending, and states are clearing out their Medicaid rolls. But this change isn’t getting enough attention—and that’s because the program is functioning as intended.

Medicaid has been far more generous than ever during the pandemic. The usual process of determining whether a Medicaid enrollee still qualifies for coverage was paused for the past three years. The program has grown by over 20 million enrollees (representing a 30 percent increase), largely due to this temporary change. Normally, if an enrollee is ineligible for coverage or if the state cannot verify eligibility, then the enrollee is disenrolled from the program. As of April 1, the program started to return to this pre-pandemic form.

Estimates suggest that 15–18 million people could lose Medicaid coverage as the program “returns to normal.” Not all of those people are projected to lose coverage entirely—the Urban Institute estimates that about just over 20 percent of these enrollees will become uninsured, with the remaining transitioning to another coverage source. But that’s still four million people at risk.

Medicaid was never intended to provide continuous coverage, nor was it designed to serve all poor people. (This is not a normative statement, just a statement of historical and political fact.) Tracing the evolution of the program can help us understand its limited reach. Medicaid was initially only available to those who received cash assistance, a program built upon explicitly racist prior law. Aid to Families with Dependent Children (AFDC), the country’s original cash assistance program, gave states control over who was eligible—and who was not. Many states implemented eligibility rules that were explicitly designed to exclude Black people, particularly in the South.

While President Clinton’s 1996 Welfare Reform delinked Medicaid from AFDC, Medicaid’s origin story reveals the program’s intentionally constrained reach. And while the Affordable Care Act eliminated categorical eligibility in most states, the program’s reach is still limited—even in states that did expand their programs.

The program’s decentralized structure challenges advocacy organization. Unlike federalized programs like Medicare, Medicaid does not have a strong voting bloc. And, as the privatization of Medicaid has grown (70 percent of enrollees receive their government-financed benefits from private insurers, like United Healthcare), research suggests it may be harder for enrollees to recognize the role of the government in the provision of Medicaid. This could affect the role people see the government playing in their lives, and thus how they support (or don’t) the program.

Moreover, research has shown that the composition of a program’s beneficiaries can determine its political support. While the majority of people with Medicaid coverage are white, racially marginalized groups are disproportionately represented among the program’s beneficiaries. Ideas of deservingness are highly racialized. Consider the likely outrage that would ensue if millions of seniors with Medicare were projected to lose coverage.

Onerous renewal processes that drive coverage loss are a result of politics and policy choices. One way states can reduce Medicaid spending is by imposing limits on eligibility, or construct burdens that make it more difficult to enroll in or maintain coverage. States can rely on administrative burdens—and, thus, people being unable to access and maintain their benefits—as a tool to manage the costs of Medicaid programs. Medicaid enrollees frequently experienced gaps in coverage (or “churn”) because of challenges navigating the renewal process well before the pandemic. It’s just that these coverage disruptions weren’t all happening at the same time.

One could argue that because of the state variation in the program, it makes more sense to just talk about unwinding at the state and local level. A part of this is true—unwinding plans and capacity to facilitate renewals are really state-specific. You could also attribute the lack of attention to uncertainty surrounding how many people will be affected—and exactly who will fall through the cracks.

But the unwinding—and the lack of national attention from media and policymakers—points to the other political reality that seems to be absent from (this particular) policy discussion: the US does not guarantee universal coverage, and Medicaid was most certainly never conceptualized to fill this role.

Research for this piece was supported by Arnold Ventures.

The post Why the unwinding of the Medicaid continuous coverage requirement hasn’t received more national attention first appeared on The Incidental Economist.

HSR Special Issue: Commemorating the 25th Anniversary of the Veterans Affairs Quality Enhancement Research Initiative and Evolution of Learning Health Systems

Sponsored by: Health Services Research and Development (HSR&D) Quality Enhancement Initiative, Veterans Health Administration, U.S. Department of Veterans Affairs

Submission deadline for abstracts: July 17, 2023

Health Services Research (HSR) and the U.S. Department of Veterans Affairs (VA) Quality Enhancement Research Initiative (QUERI) are partnering to publish a Special Issue to commemorate the 25th Anniversary of the QUERI, with a particular focus on the evolution of improvement science and evidence-based policy methods in a learning health system. The special issue will be edited by Melissa Garrido, PhD, and Amy Kilbourne, PhD.

QUERI was created in 1998 to support the VA’s goal of establishing a learning health system by accelerating the implementation of research into real-world practice. In the 25 years of the QUERI program, initiatives have evolved from implementation of guideline-based care for specific conditions to the conduct of system-wide quality improvement and implementation science efforts. Most recently, QUERI is supporting evidence-based policymaking in the VA through embedded science and policy evaluation.

This special issue aims to highlight scientific contributions and real-world impacts emanating from 25 years of initiatives stemming from QUERI and other learning health systems in the U.S. and abroad that reflect the more rapid translation of research into practice. Submissions are encouraged that highlight empirical implementation, evaluation, or policy research involving health systems; implementation and evaluation of multisite or national programs and policies; emerging translational methods; and new endeavors to train and mentor the future learning health system workforce. Papers must report the results of original investigations. Framework, review, summary, and commentary articles will be solicited separately.

Examples of topic areas of interest include but are not limited to:

Studies involving regional or national implementation and/or evaluation of effective innovations in partnership with leaders, providers, Veterans, and/or other interested parties, including their impact on quality of careNational evaluations of program or policies affecting Veterans, patients, caregivers, consumers, or frontline providers, with a focus on at-risk and marginalized populations, that inform evidence-based policy goalsNovel implementation, policy evaluation, and quality improvement initiatives involving under-represented scientists or study settingsStudies of initiatives to support the future health services research and learning health system workforce, including novel socio-technical infrastructures that promote a learning health systemStudies that develop or apply novel scientific methods in the context of implementation, quality improvement or program and policy evaluation initiatives, including new technologies and tools to assess implementation, sustainment, lived experiences, and patient and community outcomesApplication or adaptation of QUERI initiatives in non-VA settings

Abstracts may not exceed 300 words and must be formatted as indicated in Section 2.4.2.2 of the HSR Author Instructions (keywords not necessary).

Abstracts will be evaluated by a multidisciplinary review panel. Evaluation criteria include: (1) quality, rigor, and originality; (2) relevance to the special issue theme; and (3) clarity of writing and presentation. Authors of abstracts that most closely match the criteria will be invited to submit full manuscripts.

Invited manuscripts must follow the Author Instructions and undergo the same HSR peer review process as regular manuscripts. However, due to the strict timeline for publishing the special issue, the process may be shorter. Authors must be prompt in returning revisions.

Invited articles that are accepted will be posted online after proofing. Some accepted articles might not be selected for the special issue but will be published in a regular issue. The special issue will be open access, with open access charges funded by the sponsor. The expected publication date for the special issue is December 2024.

To submit an abstract for consideration, please email it with the corresponding author’s contact information to hsr@aha.org. Include “25th Anniversary of the VA QUERI Program” in the email subject line.

Key dates for authors
Submission deadline for abstracts: 17 July 2023
Authors notified about manuscript invitation: 17 August 2023
Submission deadline for invited manuscripts: 1 November 2023
Special issue publication date: December 2024

Questions? Please email Kelly Teagle at hsr@aha.org.

The post HSR Special Issue: Commemorating the 25th Anniversary of the Veterans Affairs Quality Enhancement Research Initiative and Evolution of Learning Health Systems first appeared on The Incidental Economist.

Exploring the Future of Implantable Medical Devices on the Healthcare Triage Podcast

In the latest episode of the Healthcare Triage Podcast, Dr. Aaron Carroll talks with Hugh Lee, associate professor of biomedical engineering and director of the Center for Implantable Devices at Purdue University. They discuss how research translates into new implantable medical devices, including a device Lee is working on that can sense when the wearer is experiencing an opioid overdose and deliver a dose of life-saving Naloxone, as well as how engineers can collaborate with clinicians to drive further innovation in the field.

 

 

Transcript: bit.ly/3H3Qkjl

This Healthcare Triage podcast episode is co-sponsored by Indiana University School of Medicine, whose mission is to advance health in the state of Indiana and beyond by promoting innovation and excellence in education, research, and patient care, and the Indiana Clinical and Translational Sciences Institute, a three way partnership among Indiana University, Purdue University and the University of Notre Dame, striving to make Indiana a healthier state by empowering research through pilot funding, research education and training. More information on the Indiana CTSI can be found by visiting IndianaCTSI.org.

The post Exploring the Future of Implantable Medical Devices on the Healthcare Triage Podcast first appeared on The Incidental Economist.

A Vaccine for Breast Cancer?

Cancer prevention is a major goal in health research, and one major milestone was the HPV vaccine, which targets a virus that is responsible for different types of cancer, mainly cervical cancer. Now we’ve got some recent excitement in the news about a possible breast cancer vaccine. How does this vaccine work, how successful is it, and when might it be available?

 



The post A Vaccine for Breast Cancer? first appeared on The Incidental Economist.

Did All Those Masks Help with Covid or Not?

Headlines recently blared about the new review that looked at how effective masks are at preventing the transmission of flu-like disease. Cochrane reviews are well respected, and the media coverage about the recent review has been hard to parse. So is that it, end of story on masks? Not if you skip the media headlines and read the actual review!

 



The post Did All Those Masks Help with Covid or Not? first appeared on The Incidental Economist.

Was a Laboratory Leak Responsible for the Covid-19 Pandemic? The Many Confusing US Intelligence Reports

The Covid lab escape theory! This has been in the background for a while, but it came roaring to the forefront when a prominent news source claimed that the US Department of Energy concluded that Covid was the result of a laboratory leak in Wuhan, China. So, is that it? Now we know where it came from? Confidence is low on our end that we’re going to be able to answer definitively.

 



The post Was a Laboratory Leak Responsible for the Covid-19 Pandemic? The Many Confusing US Intelligence Reports first appeared on The Incidental Economist.

U.S. Water Problems

The current U.S. water system is falling apart. We have seen issues with lead poisoning and waterborne diseases, but the overall aging water infrastructure and fragmented government oversight is not as widely discussed.

On top of this, the price of water is increasing, resulting in unaffordable water for about 35% of U.S. households. Some spend less on other things like food, medicine, and health care to cover the water bill.

These problems hinder the accessibility to clean water, especially for minoritized communities. On the Public Health Post, my piece discusses the U.S. water access gap.

Read the full article here.

Research for this piece was supported by Arnold Ventures.

The post U.S. Water Problems first appeared on The Incidental Economist.