Loss Of Coverage Research Articles

Exploring patient perspectives on the impact of resuming cost sharing: a qualitative analysis

IntroductionThe ACCESS trial showed that those who received a copayment elimination benefit had a modest improvement in their adherence to medications, but no improvement in clinical outcomes. This is consistent with other studies that have demonstrated that time-limited copayment elimination was welcomed by participants. However, the removal of such benefits can be problematic, as participants may have become accustomed to receiving the benefit, and made changes to their spending that would need to be reconsidered. We aimed to explore participants’ experience with resuming cost sharing for their medications at the end of the ACCESS trial and if this experience influenced their willingness to participate in future trials like ACCESS.MethodsWe conducted semi-structured interviews with 21 former participants of the ACCESS trial who were receiving the copayment elimination intervention, with discussions focused on the loss of the copayment elimination. The interviews were recorded, transcribed, and analyzed in duplicate using thematic analysis.ResultsFour primary themes emerged from the analysis, including emotionality regarding loss of benefits; notification of benefit termination, describing tangible losses from coverage ending, but resistance to acknowledging negative impacts; and acceptability of receiving a temporary financial benefit. Many participants described negative emotions around the loss of coverage and concern about affording care for their chronic diseases. Despite negative emotions about the end of their study benefit, participants generally had a positive view of the study and would participate again in a future study of this nature.ConclusionThe positive tangible and emotional benefits of the copayment elimination over 3 years outweighed the negative emotions and impacts associated with having to become reaccustomed to life without it.Patient and public contributionWithin the ACCESS trial, participants were involved in the design, modification, and implementation of the program using multiple focus groups. The current study aimed to engage patients to provide input on their experience and engagement with the copayment elimination program.

The Otoacoustic Emissions in the Universal Neonatal Hearing Screening: An Update on the European Data (2004 to 2024)

Background: The reported data on European universal neonatal hearing screening (UNHS) practices tend to be scarce, despite the fact that the European Union project, EUScreen, collected unofficial data from 38 collaborating European institutions. The objectives of this systematic review were as follows: (a) to identify the most recent (in a 20-year span) literature information about UNHS programs in Europe and (b) to provide data on the procedures used to assess the population, the intervention policies, and on the estimated prevalence of congenital hearing loss with emphasis on the bilateral hearing loss cases. Methods: Queries were conducted via the Pubmed, Scopus and Google Scholar databases for the time period of 2004–2024. The Mesh terms used were “OAE”, “Universal Neonatal Hearing Screening”, “congenital hearing loss” and “well babies”. Only research articles and review papers of European origin were considered good candidates. The standard English language filter was not used, in order to identify information from non-English-speaking scientific communities and groups. Results: Very few data and reports were identified in the literature search. Eleven manuscripts were identified corresponding to eight UNHS programs. Except in Poland, most of the data refer to regional and not national programs. The screening coverage estimates of all programs exceed 90%; infants were mostly assessed by a three-stage protocol (TEOAE + TEOAE + AABR), followed by a clinical ABR test. The average prevalence (i.e., from well babies AND NICU infants) of bilateral hearing loss ranged from 0.5 to 20.94 per 1000 (Zurich sample). Infants presenting unilateral or bilateral hearing losses were first rehabilitated by hearing aids and consequently (>15 mo) by cochlear implants. Conclusions: Even though UNHS programs are well-established clinical practices in the European States, the amount of information in the literature about these programs is surprising low. The existing data in the timespan 2004–2024 corroborate the international UNHS data in terms of coverage and bilateral hearing loss prevalence, but there is a strong need to supplement the existing information with the latest developments, especially in the area of hearing loss rehabilitation.

Resumption Of Medicaid Eligibility Redeterminations: Little Change In Overall Insurance Coverage.

In anticipation of the end of the COVID-19 public health emergency, Congress ended the Medicaid continuous coverage requirement on March31, 2023, allowing states to terminate coverage for ineligible people and resume eligibility determinations through a process known as unwinding. Although administrative data have documented substantial declines in Medicaid enrollment since April2023, the impact on uninsurance is unknown. Using data from the Census Bureau's Household Pulse Survey, we estimated the early effect of Medicaid unwinding on insurance coverage among people ages19-64. We found that within the first three months of unwinding, the number of people self-reporting Medicaid coverage declined by approximately two million, and there was a much smaller, statistically insignificant decline in overall coverage of approximately 467,000 people. It appears that for many people, the availability of employer-sponsored insurance and other private coverage offset Medicaid coverage loss. These results suggest that the resumption of redeterminations has had less impact on uninsurance than was initially feared. Our findings highlight the importance of tracking coverage transitions during unwinding. By identifying populations at risk for uninsurance after Medicaid loss, these data could enhance the effectiveness of state outreach and enrollment assistance for people eligible for Marketplace coverage and subsidies.

Validity of GPS data in driving cycles

AbstractThere is continuous research into driving cycles (DCs) as researchers across the globe seek to define driving characteristics, energy consumption, and emissions in a local context. For decades, data collection for the development of DCs has been conducted in three ways: chase car, instrumented vehicle, or a combination of both. Many studies have moved on to cheap and easily available global positioning system (GPS) technology, while others record vehicle data directly through the on‐board diagnostics (OBD) port. However, there are major limitations to GPS data collection such as frequent inaccuracies and loss of coverage in urban environments. For this reason, both OBD and GPS vehicle speed data have been collected. Then, the recorded data has been analysed to capture any differences in sampling rates and dropping data. Finally, basic DCs were created from smoothed GPS and OBD data and compared. DCs were developed with a microtrip‐based method, and a relative error term was used to compare candidate DCs to the collected data. DCs were compared based on kinematic characteristic parameters that are most used in the field. The results of this study could be used to assess the validity of GPS‐based DCs compared to OBD cycles using low‐cost devices.

A large reverse-genetic screen identifies numerous regulators of testis nascent myotube collective cell migration and collective organ sculpting.

Collective cell migration is critical for morphogenesis, homeostasis, and wound healing. During development migrating mesenchymal cells form tissues that shape some of the body's organs. We have developed a powerful model for examining this, exploring how Drosophila testis nascent myotubes migrate onto the testis during pupal development, forming the muscles that ensheath it and also creating its characteristic spiral shape. To define genes that regulate this process, we have carried out RNAseq to define the genes expressed in myotubes during migration. Using this dataset, we curated a list of 131 ligands, receptors and cytoskeletal regulators, including all Rho-family GTPase GAPs and GEFs, as candidates. We then used the GAL4/UAS system to express 279 shRNAs targeting these genes, using the muscle specific driver dMef2>GAL4, and examined the adult testis. We identified 29 genes with diverse roles in testis morphogenesis. Some have phenotypes consistent with defects in collective cell migration, while others alter testis shape in different ways, revealing some of the underlying logic of testis morphogenesis. We followed up one of these genes in more detail-that encoding the Rho-family GEF dPix. dPix knockdown leads to a drastic reduction in migration and a substantial loss of muscle coverage. Our data suggest different isoforms of dPix play distinct roles in this process, reveal a role for its protein partner Git. We also explore whether cdc42 activity regulation or cell adhesion are among the dPix mechanisms of action. Together, our RNAseq dataset and genetic analysis will provide an important resource for the community to explore cell migration and organ morphogenesis.

Investigation of interfractional range variation owing to anatomical changes with beam directions based on water equivalent thickness in proton therapy for pancreatic cancer.

To assess the interfractional anatomical range variations (ARVs) with beam directions and their impact on dose distribution in intensity modulated proton therapy, we analyzed water equivalent thickness (WET) from 10 patients with pancreatic cancer. The distributions of the interfractional WET difference ($\Delta{\mathrm{WET}}^{\theta }$) across 360° were visualized using polar histograms. Interfractional ARVs were evaluated using the mean absolute error and ΔWET pass rate, indicating the percentage of $\Delta \mathrm{WE}{\mathrm{T}}^{\theta }$ < thresholds. The impact on dose distribution in proton therapy was evaluated based on two treatment plans for 40Gy(RBE)/5 fractions: 'Plan A', using two beam angles, in which the target was closest to the body surface among four perpendicular directions; and 'Plan B', using two beam angles with small ARVs. Analysis revealed individual variations in angular trends of interfractional ARVs. Three distinct trends were identified: Group 1 exhibited small ARVs around posterior directions; Group 2 exhibited small ARVs except ~60°; Group 3 demonstrated minimal ARVs only ~90°. In dose evaluation, while 150° and 210° were selected in Plan B for 9 out of 10 patients, for the remaining patient, 60° and 90° were chosen. Comparing dose volume histogram parameters for all patients, Plan B significantly reduced target coverage loss while maintaining organ-at-risk sparing comparable to Plan A. These results demonstrated that selecting beam angles with small interfractional ARVs for each patient enhances the robustness of dose distribution, reducing target coverage loss.

Graphene nanocoating on titanium maintains structural and antibiofilm properties post-sterilization

ObjectiveTo evaluate the impact of sterilization methods on the structural integrity and antimicrobial properties of graphene nanocoating on titanium (GN). MethodsGN was transferred to titanium using wet (WT) or dry transfer (DT) techniques and sterilized using an autoclave (AC), glutaraldehyde (GA), or ethylene oxide (EtO). The GN structure was characterized using Raman spectroscopy before and after sterilization. Additional specimens were characterized by Raman after AC and water jetting. Biofilm formation was assessed before and after AC using colony-forming units (CFU), biofilm biomass, and SEM (uncoated titanium was the control). Three independent samples were used for structural characterization and biofilm quantification. Statistical analyses were conducted using one-way analysis of variance (ANOVA) and Tukey's test (α = 0.05). ResultsWT and DT demonstrated high structural stability after sterilization and water jetting, with negligible coating quality or coverage loss. GN exhibited lower biofilm formation even after AC sterilization, as shown by the reduction in CFU counts, biofilm biomass, and SEM images compared to the control. SignificanceGN demonstrated high resistance to the stresses imposed by all sterilization methods tested, maintaining its structural integrity, resistance to water-jet cleaning, and antibiofilm potential. The findings suggest that standard industrial practices can effectively sterilize highly resilient GN on titanium implants and possibly other biomaterials.

Combining 5G New Radio, Wi-Fi, and LiFi for Industry 4.0: Performance Evaluation.

Fifth-generation mobile networks (5G) are designed to support enhanced Mobile Broadband, Ultra-Reliable Low-Latency Communications, and massive Machine-Type Communications. To meet these diverse needs, 5G uses technologies like network softwarization, network slicing, and artificial intelligence. Multi-connectivity is crucial for boosting mobile device performance by using different Wireless Access Technologies (WATs) simultaneously, enhancing throughput, reducing latency, and improving reliability. This paper presents a multi-connectivity testbed from the 5G-CLARITY project for performance evaluation. MultiPath TCP (MPTCP) was employed to enable mobile devices to send data through various WATs simultaneously. A new MPTCP scheduler was developed, allowing operators to better control traffic distribution across different technologies and maximize aggregated throughput. Our proposal mitigates the impact of limitations on one path affecting others, avoiding the Head-of-Line blocking problem. Performance was tested with real equipment using 5GNR, Wi-Fi, and LiFi -complementary WATs in the 5G-CLARITY project-in both static and dynamic scenarios. The results demonstrate that the proposed scheduler can manage the traffic distribution across different WATs and achieve the combined capacities of these technologies, approximately 1.4 Gbps in our tests, outperforming the other MPTCP schedulers. Recovery times after interruptions, such as coverage loss in one technology, were also measured, with values ranging from 400 to 500 ms.

The effect of dynamic changes in vegetation coverage on the mechanism of organic carbon loss in inter-rill erosion

The intricate effects of dynamic variations in vegetation coverage, representing different vegetation growth states and erosion conditions, on properties (content, enrichment and loss) of sediment and soil organic carbon (SOC) fraction in inter-rill erosion have not yet been fully elucidated. By setting micro-plots with different vegetation coverage ranges (0 %, 15 ∼ 35 %, 25 ∼ 55 % and 35 ∼ 70 %), the interaction mechanisms between vegetation coverage and inter-rill erosion, particle size distribution and SOC fractions properties during the vegetation growing period were studied. The average sediment yield, runoff yield and sediment concentration were highest under the bare plot, and diminished progressively with increased vegetation coverage. The effective clay content decreased with the increasing coverage, while ultimate clay was highest in the vegetation coverage range of 25 ∼ 55 %. Clay particle was transported as aggregates, with enrichment for all treatments except for the vegetation coverage range of 35 ∼ 70 %, providing transportation potential for SOC fractions loss. The content of SOC and mineral-associated organic carbon, as well as their enrichment ratio, decreased and then increased with coverage, which is the opposite of particulate organic carbon, and the loss of all fractions decreased with increasing vegetation coverage. Mineral-associated organic carbon dominated change in SOC, with proportion in SOC content and loss decreasing first and then increasing with vegetation coverage. The structural equation model showed the impact of vegetation coverage on SOC fraction loss was mainly achieved through indirect regulation of inter-rill erosion and particle size distribution. Our results provide new insights into the complex relationship between natural slope vegetation coverage and SOC loss, particularly from a fractions perspective, as well as understanding the ultimate fate of SOC in such environments.

“No room for error”: a qualitative interview study of experiences with health insurance coverage loss and COVID-19 pandemic relief policies among people with asthma

Objectives The COVID-19 pandemic led to unemployment and associated health insurance loss, prompting an unprecedented adoption of emergency policies, including economic relief efforts and health insurance coverage expansion. We sought to understand pandemic-related challenges for people with asthma and how emergency policies served families facing both chronic disease management and health insurance loss. Study design Qualitative interview study. Methods In 2021, we conducted semi-structured telephone interviews with 21 adults who had asthma and lost employment and employer-sponsored health insurance coverage during the COVID-19 pandemic. We used thematic analysis to assess how health and economic policies affected participants’ ability to access care and manage their asthma. Results Participants reported reduced access to care, as well as worry about heightened susceptibility to COVID-19 due to their asthma. While insurance loss exacerbated these challenges, participants indicated that economic relief efforts, including direct stimulus payments, helped them afford needed asthma care. Participants were more critical of enhancements to existing coverage policies such as the Affordable Care Act (ACA) Marketplace and Consolidated Omnibus Budget Reconciliation Act (COBRA) due to difficulty understanding, accessing, and affording such coverage. Conclusions Our findings underscore that people affected by asthma and health insurance loss benefit from policies that provide flexible and easy-to-use assistance, such as direct payments, for meeting the diverse challenges posed by living with a chronic disease. Although policies that expand health insurance coverage are critical, more attention is needed to help people with chronic conditions access these programs in a timely way.

Navigating coverage: A qualitative study exploring the perceived impact of an insurance company policy to discontinue coverage of antiobesity medication

IntroductionObesity rates continue to rise in the United States. Treatment includes modification of diet, exercise, behavioral modification and medical consideration including anti-obesity medications. However, multiple highly effective anti-obesity medications are expensive and with that we see insurers opting out of coverage of these medications. This has led to patients having to abruptly stop treatment with these medications. The purpose of this study is to explore the impact of non-medical discontinuance of obesity medication among patients in medical weight management programs. MethodsThis is a qualitative descriptive study. Semistructured interviews were completed with participants in an academic medical weight management clinic. Interviews were recorded and transcribed. Themes were identified by members of the study team through qualitative content analysis. Participants were on or about to start anti-obesity medications and were from a single insurance company which cut coverage to all anti-obesity medications. ResultsTwenty-two insured patients from across the state either currently taking or intending to take anti-obesity medications, participated. All participants were female. Few participants said they could afford the cost of the medication. Four main themes emerged: 1) Feelings of hope replaced by hopelessness upon loss of medication coverage, 2) Anger regarding the perceived injustice of anti-obesity medication coverage termination, 3) Perceptions of past and present stigma within the healthcare system and insurance company, 4) Generational influences on obesity treatment. ConclusionPatients perceive the discontinuation of anti-obesity medication coverage as stigmatizing and unjust, leading to feelings of hopelessness and fear. With more insurance companies denying coverage for these costly medications more information is needed to identify best ways to address the loss of coverage with patients. Clinical management of these patients should incorporate evidence-based obesity treatments while navigating insurance constraints.

Modeling lung endothelial dysfunction in sepsis-associated ARDS using a microphysiological system.

Endothelial dysfunction is a critical feature of acute respiratory distress syndrome (ARDS) associated with higher disease severity and worse outcomes. Preclinical invivo models of sepsis and ARDS have failed to yield useful therapies in humans, perhaps due to interspecies differences in inflammatory responses and heterogeneity of human host responses. Use of microphysiological systems (MPS) to investigate lung endothelial function may shed light on underlying mechanisms and targeted treatments for ARDS. We assessed the response to plasma from critically ill sepsis patients in our lung endothelial MPS through measurement of endothelial permeability, expression of adhesion molecules, and inflammatory cytokine secretion. Sepsis plasma induced areas of endothelial cell (EC) contraction, loss of cellular coverage, and luminal defects. EC barrier function was significantly worse following incubation with sepsis plasma compared to healthy plasma. EC ICAM-1 expression, IL-6 and soluble ICAM-1 secretion increased significantly more after incubation with sepsis plasma compared with healthy plasma. Plasma from sepsis patients who developed ARDS further increased IL-6 and sICAM-1 compared to plasma from sepsis patients without ARDS and healthy plasma. Our results demonstrate the proof of concept that lung endothelial MPS can enable interrogation of specific mechanisms of endothelial dysfunction that promote ARDS in sepsis patients.

Racial and Ethnic Disparities in Medicaid Disenrollment After the End of the COVID-19 Public Health Emergency

This survey study reports the proportions of and reasons for Medicaid coverage loss among racially and ethnically minoritized individuals.

Selecting Invalid Instruments to Improve Mendelian Randomization with Two-Sample Summary Data.

Mendelian randomization (MR) is a widely-used method to estimate the causal relationship between a risk factor and disease. A fundamental part of any MR analysis is to choose appropriate genetic variants as instrumental variables. Genome-wide association studies often reveal that hundreds of genetic variants may be robustly associated with a risk factor, but in some situations investigators may have greater confidence in the instrument validity of only a smaller subset of variants. Nevertheless, the use of additional instruments may be optimal from the perspective of mean squared error even if they are slightly invalid; a small bias in estimation may be a price worth paying for a larger reduction in variance. For this purpose, we consider a method for "focused" instrument selection whereby genetic variants are selected to minimise the estimated asymptotic mean squared error of causal effect estimates. In a setting of many weak and locally invalid instruments, we propose a novel strategy to construct confidence intervals for post-selection focused estimators that guards against the worst case loss in asymptotic coverage. In empirical applications to: (i) validate lipid drug targets; and (ii) investigate vitamin D effects on a wide range of outcomes, our findings suggest that the optimal selection of instruments does not involve only a small number of biologically-justified instruments, but also many potentially invalid instruments.

#2011 Reduced hospitalisation or emergency department visits with long- versus short-term SZC in patients with history of hyperkalaemia: GALVANIZE Outcomes

Abstract Background and Aims Hyperkalaemia is associated with increased healthcare resource use and often requires long-term management. The GALVANIZE Outcomes study is a comparison of hyperkalaemia-related and all-cause hospitalisations or emergency department visits between matched patients treated with long- or short-term sodium zirconium cyclosilicate (SZC), using real-world data. This analysis evaluated outcomes in patients with a history of hyperkalaemia. Method A large US insurance claims database (from HealthVerity) was used to identify adults who initiated SZC (index date) in the outpatient setting between 1 January 2019 and 30 June 2022, with a diagnosis of hyperkalaemia within 6 months prior to the index date. Exclusion criteria included patients without either 6 months of continuous insurance coverage prior to index, or 30 days of continuous insurance coverage post-index. Patients were followed to the earliest of 6 months post-index, loss of coverage, end of the study period or (re) initiation of a potassium binder. Patients with short-term SZC use (≤30 days) were exact and propensity score–matched to patients with long-term SZC use (&amp;gt;90 days). Hyperkalaemia-related hospitalisations and emergency department visits were identified by the International Classification of Diseases (tenth revision) diagnosis code for hyperkalaemia. Rates of the composite outcomes of the number of hyperkalaemia-related hospitalisations or emergency department visits (primary endpoint) and all-cause hospitalisations or emergency department visits (exploratory endpoint) per person-year (PPY) were compared during follow-up using generalised estimating equations. Results Among 2088 eligible matched pairs with a history of hyperkalaemia, the mean age was 63.8 years and 41.4% of the population was female. Most patients (94.9%) had a diagnosis of chronic kidney disease, which mostly included stage 3 (27.3%), stage 4 (25.4%) and stage 5/end-stage (38.7%) kidney disease, while one-third (34.4%) had a diagnosis of heart failure irrespective of ejection fraction. The median (interquartile range) duration of follow-up was 183 (183, 183) days for long-term SZC and 169 (82, 183) days for short-term SZC. During follow-up, in patients with a history of hyperkalaemia, those with long-term SZC use had a 43% lower rate of hyperkalaemia-related hospitalisations or emergency department visits than matched patients with short-term SZC use (rate [95% confidence interval] PPY: 0.89 [0.79–0.98] vs 1.56 [1.35–1.76]; P&amp;lt;0.001) (Fig. 1). Similarly, patients with long-term SZC use had a 35% lower rate of all-cause hospitalisations or emergency department visits than those with short-term SZC use (2.63 [2.44–2.82] vs 4.05 [3.71–4.40]; P&amp;lt;0.001]) (Fig. 2). Conclusion In this real-world study of patients with hyperkalaemia, individuals treated with long-term SZC experienced significantly lower rates of hyperkalaemia-related and all-cause hospitalisations or emergency department visits compared with matched patients with short-term SZC use.

Loss of Medicaid Coverage During the Renewal Process

Medicaid beneficiaries must periodically redemonstrate their eligibility in a process that is called renewal, redetermination, or recertification. The number and characteristics of people who lose Medicaid coverage due to renewal requirements are not known. To measure the proportion of people who lose Medicaid coverage at the renewal deadline, overall and by enrollee characteristics, and time until regaining Medicaid coverage among those losing coverage at the deadline. This cohort study tracked the duration of Medicaid enrollment among Wisconsin Medicaid enrollees with a 12-month renewal deadline. Data were collected for all nonelderly (aged <65 years) new enrollees from January 2016 through January 2018, except those enrolled due to disability or pregnancy. Individuals were followed through January 2020 to provide at least 24 months of data on each enrollment spell. Data were analyzed from August 2023 to February 2024. The primary outcome was coverage loss during the renewal process, defined as a loss in Medicaid coverage from month 12 to month 13 for people who were still enrolled at the start of month 12. Secondary outcomes included coverage loss prior to the renewal deadline and the duration of the gap in Medicaid coverage among those who lost coverage during the renewal process. The study sample included 684 245 Medicaid enrollment spells across 586 044 people (51% female and 47% children 18 years or younger). Among enrollees, 20% lost Medicaid coverage at the renewal deadline. Of those who lost coverage, 37% regained Medicaid coverage within 6 months, and an additional 10% regained coverage within 12 months. Children younger than 12 years and people with more Medicaid-covered health care (top quartile of Medicaid-covered health care costs during the first 6 months of enrollment) were less likely than other groups to lose coverage during the renewal process (15% and 6% lost coverage at renewal, respectively) and more likely to regain Medicaid quickly. Personal characteristics such as gender and race and ethnicity remained associated with the risk of losing Medicaid at the renewal deadline after adjustment for baseline household income, enrollment group, and past use of Medicaid services. In this cohort study, the risk of coverage loss during the Medicaid renewal process was associated with age, past use of care, and other personal characteristics. These findings shed light on how renewal requirements shape access to Medicaid.

Mortality and morbidity ramifications of proposed retractions in healthcare coverage for the United States

In the absence of universal healthcare in the United States, federal programs of Medicaid and Medicare are vital to providing healthcare coverage for low-income households and elderly individuals, respectively. However, both programs are under threat, with either enacted or proposed retractions. Specifically, raising Medicare age eligibility and the addition of work requirements for Medicaid qualification have been proposed, while termination of continuous enrollment for Medicaid was recently effectuated. Here, we assess the potential impact on mortality and morbidity resulting from these policy changes. Our findings indicate that the policy change to Medicare would lead to over 17,000 additional deaths among individuals aged 65 to 67 and those to Medicaid would lead to more than 8,000 deaths among those under the age of 65. To illustrate the implications for morbidity, we further consider a case study among those people with diabetes who would be likely to lose their health insurance under the policy changes. We project that these insurance retractions would lead to the loss of coverage for over 700,000 individuals with diabetes, including more than 200,000 who rely on insulin.

Medicaid Eligibility Loss Among Dual-Eligible Beneficiaries Before and During COVID-19 Public Health Emergency

Medicaid coverage loss can substantially compromise access to and affordability of health care for dual-eligible beneficiaries. The extent to which this population lost Medicaid coverage before and during the COVID-19 public health emergency (PHE) and the characteristics of beneficiaries more at risk for coverage loss are currently not well known. To assess the loss of Medicaid coverage among dual-eligible beneficiaries before and during the first year of the PHE, and to examine beneficiary-level and plan-level factors associated with heightened likelihood of losing Medicaid. This repeated cross-sectional study used national Medicare data to estimate annual rates of Medicaid loss among dual-eligible beneficiaries before (2015 to 2019) and during the PHE (2020). Individuals who were dual eligible for Medicare and Medicaid at the beginning of a given year and who continuously received low-income subsidies for Medicare Part D prescription drug coverage were included in the sample. Multivariable regression models were used to examine beneficiary-level and plan-level factors associated with Medicaid loss. Data analyses were conducted between March 2023 and October 2023. Onset of PHE. Loss of Medicaid for at least 1 month within a year. Sample included 56 172 736 dual-eligible beneficiary-years between 2015 and 2020. In 2020, most dual-eligible beneficiaries were aged over 65 years (5 984 420 [61.1%]), female (5 868 866 [59.9%]), non-Hispanic White (4 928 035 [50.3%]), full-benefit eligible (6 837 815 [69.8%]), and enrolled in traditional Medicare (5 343 537 [54.6%]). The adjusted proportion of dual-eligible beneficiaries losing Medicaid for at least 1 month increased from 6.6% in 2015 to 7.3% in 2019 and then dropped to 2.3% in 2020. Between 2015 and 2019, dual-eligible beneficiaries who were older (ages 55-64 years: -1.4%; 95% CI, -1.8% to -1.0%; ages 65-74 years: -2.0%; 95% CI, -2.5% to -1.5%; ages 75 and older: -4.5%; 95% CI, -5.0% to -4.0%), disabled (-0.8%; 95% CI, -1.1% to -0.6%), and in integrated care programs were less likely to lose Medicaid. In 2020, the disparities within each of these demographic groups narrowed significantly. Notably, while Black (0.6%; 95% CI, 0.2% to 0.9%) and Hispanic (0.7%; 95% CI, 0.3% to 1.2%) dual-eligible beneficiaries were more likely to lose Medicaid than their non-Hispanic White counterparts between 2015 and 2019, such gap was eliminated for Black beneficiaries and narrowed for Hispanic beneficiaries in 2020. During the PHE, Medicaid coverage loss declined significantly among dual-eligible beneficiaries, and disparities were mitigated across subgroups. As the PHE unwinds, it is crucial for policymakers to implement strategies to minimize Medicaid coverage disruptions and racial and ethnic disparities, especially given that loss of Medicaid was slightly increasing over time before the PHE.

Coherence of recurring fires and land use change in South America

AbstractFire events in South America are becoming more extensive and frequent as climate extremes and human pressures increase, and even repeatedly occurring in some areas within decades. However, the relationship between recurring fires and vegetation dynamics remains unclear. Here, we extracted the number of fire occurrences using burned area satellite product and analysed the relationship between recurring fires and vegetation dynamics with remote sensing land use and vegetation index datasets in South America. We show that approximately 1.39 × 106 km2 of burnt area has experienced recurring fires during 2001–2020. More than half of burnt area of recurring fires occurred in savannahs with remaining burnt area in grasslands, forests and croplands. Although forests tended to be less susceptible to recurring fires among all vegetation types, their coverage loss with recurring fires was the greatest. The greater proportion of forest conversion to croplands concurred with more recurring fires. Conversely, the coverage of croplands and grasslands gained the most with recurring fires. In the areas without vegetation conversion, more frequent recurring fires further suppressed canopy greenness and density, even in fire‐adapted savannahs and grasslands. Our results suggest that recurring fires and land use change are generally coincident, reflecting the intense pressure of human activities on natural vegetation in South America. Thus, coordinated efforts on vegetation conservation and sustainable management of human‐induced burning in the region are urgently needed.

Survey-Reported Coverage in 2019-2022 and Implications for Unwinding Medicaid Continuous Eligibility

Policy changes and the COVID-19 pandemic affected health coverage rates, and the "unwinding" of Medicaid's continuous coverage provision in 2023 and 2024 may cause widespread coverage loss. Recent coverage patterns in national survey and administrative data can inform these issues. To assess national and state changes in survey-based Medicaid, private insurance, and uninsured rates between 2019 and 2022, as well as how these changes compare with administrative Medicaid enrollment totals. This cross-sectional study analyzes nationally representative survey data for all US residents in the American Community Survey (ACS) from 2019 to 2022 compared with administrative data on Medicaid and the Children's Health Insurance Program from the Centers for Medicare & Medicaid Services (CMS). Data analysis was conducted between June 2023 and January 2024. The COVID-19 pandemic, the Medicaid continuous coverage provision, and policy efforts to increase Marketplace coverage. Medicaid coverage (self-reported [ACS] and administratively recorded [CMS]), survey-reported uninsured, Medicare, and private insurance status. A nationally representative sample consisted of 12 506 584 US residents of all ages (survey-weighted 59.7% aged 19-64 years and 50.6% female). CMS statistics showed an increase in Medicaid coverage of 5.2 percentage points as a share of the population from 2019 to 2022. However, changes in the uninsured rate and survey-reported Medicaid were smaller: -1.2 (95% CI, -1.3 to -1.2) percentage points and 1.3 (95% CI, 1.2-1.4) percentage points, respectively. There was a 3.9 percentage point increase in the ACS's "undercount" of Medicaid enrollment, compared with CMS data, from 2019 to 2022. This undercount was larger among children than adults but smaller in states that recently expanded Medicaid. Rates of additional forms of coverage (such as private insurance) among those in Medicaid also grew during this time. In this cross-sectional study, the uninsured rate declined considerably from 2019 to 2022 but was just one-fourth as large as the growth in administrative Medicaid enrollment under the pandemic continuous coverage provision. Survey-based Medicaid growth was far smaller than administrative growth. This suggests that many people who remained enrolled in Medicaid during the pandemic did not realize that their coverage had continued. These findings have implications for projecting uninsured changes during unwinding, as well as the effect of continuous coverage policies on continuity of care.