Loss Of Health Insurance Research Articles

Government Risk Management Priorities: A Comparison of the Preferences of Asian Indian Americans and Other Americans

A survey was conducted of approximately 200 Asian Indian Americans and 200 other residents of New Jersey in order to understand the risk management priorities that they want government to have. We found that Asian Indian Americans, especially younger women, focused on personal/family risks, such as alcohol and drug abuse, sexual abuse, and domestic violence. The New Jersey comparison group, in contrast, placed war/terrorism and loss of health care services and insurance at the top of their priorities for government. These results suggest stressful acculturation-related issues within the Asian Indian community. Both populations want more risk management from government than they believe government is currently providing. Respondents who wanted more from government tended to dread the risk, be fearful of the consequences, trust government, and have a feeling of personal efficacy. Within the Asian Indian American sample, wide variations were observed by language spoken at home and religious affiliation. Notably, Muslims and Hindi language speakers tended not to trust government and hence wanted less government involvement. This study supports our call for studies of recent migrant populations and Johnson's for testing ethnic identity and acculturation as factors in risk judgments.

Meeting Report: Genetics at the Community Level

Francis Collins, director of the National Human Genome Research Institute (NHGRI), picked up a guitar and sang to close out the Seattle community genetics forum. To the tune of the 1961 rock-and-roll song “Runaway” and enthusiastic audience response, he imagined the thoughts of a person in 2015 upon seeing their personal genomic data for the first time: “As I walk the bases/in all three billion places/I wonder/am I built for strong endurance or loss of health insurance?” Ethical, legal, and social issues were a primary focus of the 21 May 2005 community forum, held at the University of Washington (UW). “This is a historic time for our species,” said Collins during his keynote address. “We have, for the first time, the ability to read our own instruction book. We have the responsibility to do so in ways that don’t injure people.” About 300 students, teachers, and community members attended the event, which was organized by the UW Center for Genomics and Health Care Equality (with funding from NHGRI) and the UW Center for Ecogenetics and Environmental Health (with funding from the NIEHS). The centers were assisted by an advisory committee of UW genomics experts. Advances in genomic science—such as genetic testing to determine optimal medication dosing—are making “personalized medicine” a reality, said Collins. At the same time, the increasing ability to collect genetic information about individuals raises concerns about how that knowledge may be used, perhaps by potential employers. Collins also raised larger issues: “Will knowledge of human variations reduce prejudice or increase it? Will we succumb to genetic determinism, neglecting the role of the environment and undervaluing the human spirit?” High school students at the forum included winners from the 18 March 2005 Student Biotech Expo, sponsored by the nonprofit Washington Biotechnology and Biomedical Foundation. Several students reprised prize-winning performances. A rap called “Doggin’ Genes,” written and performed by Heather Earp and Hana Fallisgaard of Shorecrest High School, described the sequencing the dog genome. A two-person play about genetic testing, written and performed by Maya Sugarman and Rhiannon Bronstein of Garfield High School, explored the quandaries of undergoing genetic testing for a disease for which there is no cure. Staff from throughout NHGRI attended the forum to hear community concerns and take them back to institute programs, said Vence Bonham, chief of the NHGRI Education and Community Involvement Branch. Forum presentations and breakout sessions focused on topics including medical uses of genetic information, racial profiling and DNA evidence, behavior and genetics, and genetic discrimination related to employment and insurability. Panel discussions covered a wide range of additional topics including the cost and availability of genomic medicine. “Most Native American people don’t have access to available treatments that could make them better,” said speaker Ralph Forquera, executive director of the Seattle Indian Health Board. Until access to basic care is improved, he said, advances such as genome-based personalized medicine are “fluff,” and will benefit only affluent people. Makani Themba-Nixon, executive director of the nonprofit Praxis Project, wondered if an overemphasis on genomic research could obscure the importance of sociopolitical considerations such as links between environmental pollutants and health. Collins said that large-scale studies that include data on environmental exposures as well as genetics are needed to better understand genetic effects on health. “It would be expensive,” he said. “It would have to be a political priority.” Speakers and meeting participants also discussed the need for better understanding of genomic science among community members and health care providers. Sharon Terry, president of the nonprofit Genetic Alliance, commented that, until her sons were diagnosed with a genetic disorder, she “didn’t know a gene from a hubcap.” Added Forquera, “We need to find a way to make genomic information interesting, engaging, and accessible.” Presenters gave several examples of effective nonlecture formats for conveying genomic information, including the use of individual case studies in discussing genetic testing. Elaine Armstrong, a high school teacher from Battle Ground, Washington, said case studies are useful in the classroom, because they grab the students’ attention. “I was pleased to talk with such a diverse range of participants representing many different communities,” said Collins after the meeting. “What I am most excited about is to see what happens next, and to find ways to continue to actively engage members of the public in this dialogue.”

Impacts of Expanding Health Care Coverage on the Employment and Earnings of Participants in the SSI Work Incentive Program - Policy Brief

While people with disabilities often say that a loss of public health insurance is a deterrent to work, it is rare to find situations in which they might actually exhibit such a behavioral response to a change in access. Expansions in the income threshold for SSI work incentives program (Sections 1619(a) and (b)) provide an opportunity to observe such a response. Section 1619(b) allows SSI recipients to maintain Medicaid eligibility even if their income is above the level that makes them ineligible for SSI payments. If earnings increase beyond the 1619(b) threshold, however, the person loses their SSI and Medicaid eligibility. Section 1619(b) income thresholds vary significantly across states and over time. Stapleton and Tucker (2000) use the variation in Section 1619(b) income thresholds to examine the employment, earnings and program participation patterns of SSI recipients who have incomes near the threshold level for their state. They find strong evidence that many SSI recipients restrain their earnings to stay below the 1619(b) threshold. It is important to note, however, that the findings only provide evidence on the behavior of a small portion of the population with disabilities (i.e., SSI recipients who work). Nonetheless, this evidence seems to provide strong empirical support for the hypothesis that lack of access to health insurance is an important work disincentive for people with disabilities. They also find that 1619(b) participation varies significantly from month to month. Consequently, cross-sectional estimates on the share of SSI recipients participating in 1619(b) significantly understate the share of SSI recipients who ever participate. These findings are consistent with previous findings that cross-sectional estimates of employment tend to understate multi-period employment patterns for the broader population with disabilities.

Welfare Reform and Health Insurance: Consequences for Parents

We assessed the relation between the work promotion, welfare reduction, and marriage goals of welfare reform and the stability of health insurance of parents in transition from welfare to work. We analyzed a panel survey (1999-2002) of a stratified random sample of Illinois families receiving welfare in 1998 (n=1363). Medicaid remains the foremost source of health insurance despite a significant decline in the proportion of parents with Medicaid. Regardless of work/welfare status in year 1, transitioning to work only or no work/no welfare increased the likelihood of having unstable health insurance in years 2 and 3 compared with those who remained on welfare only. Parents who meet the welfare reform goals of work promotion and reduction of welfare dependence experience significant loss and instability of health insurance.

Perceived barriers to employment among persons living with HIV/AIDS

This study examined factors associated with contemplating returning to work among unemployed persons living with HIV/AIDS (PLHA) in a large urban city in the United States. A mailed, self-administered survey gathered information from 757 unemployed PLHA. Chi-square and logistic regression analyses were used to determine associations between contemplating returning to work and sociodemographic characteristics, health factors and perceived barriers to employment. We found that most unemployed PLHA (74%) were thinking of returning to work, but perceived significant barriers such as loss of disability income benefits (73%), loss of publicly-funded health insurance (67%) and workplace discrimination (66%). Univariate analyses indicated that contemplating returning to work was significantly associated with sociodemographic characteristics, health factors and perceived barriers to employment in the following areas: (1) availability of health insurance, (2) personal health and physical ability, (3) health concerns related to working and the work environment, and (4) current job skills. Multivariate analyses indicated that: gender, age, race/ethnicity, health insurance type, health status and the belief that health will improve if employed were independently associated with contemplating returning to work. In summary, a substantial proportion of unemployed PLHA may contemplate re-entering the workforce. Assistance is needed to help PLHA address perceived barriers that may prevent them from seeking employment.

Health Insurance Costs and Early Retirement Decisions

The loss of health insurance may be an important component of the cost of retirement, especially for workers without retiree health insurance coverage. The authors find that insurance costs significantly reduce retirement rates for full-time wage and salary workers ages 51 to 61. Simulations suggest that a $1,000 increase in the net present value of health insurance premium costs reduces the probability of early retirement by 0.17 percentage points for men and by 0.24 percentage points for women, corresponding to elasticities of −0.22 and −0.24, respectively. The authors' models predict that expanding the Medicare program to cover those aged 62–64 would increase retirement rates for workers with employer-sponsored coverage who lack retiree benefits, if the government subsidizes their coverage. However, the impact would be small, increasing overall retirement rates by only 7%.

Health Insurance Costs and Early Retirement Decisions

The loss of health insurance may be an important component of the cost of retirement, especially for workers without retiree health insurance coverage. The authors find that insurance costs significantly reduce retirement rates for full-time wage and salary workers ages 51 to 61. Simulations suggest that a $1,000 increase in the net present value of health insurance premium costs reduces the probability of early retirement by 0.17 percentage points for men and by 0.24 percentage points for women, corresponding to elasticities of -0.22 and -0.24, respectively. The authors' models predict that expanding the Medicare program to cover those ages 62 to 64 would increase retirement rates for workers with employer-sponsored coverage who lack retiree benefits, if the government subsidizes their coverage. However, the impact would be small, increasing overall retirement rates by only 7%.

Widowhood, Divorce, and Loss of Health Insurance Among Near Elderly Women: Evidence from the Health and Retirement Study

We have found modest effects of widowhood events on loss of health insurance. There are also modest effects of widowhood on labor supply, which we have not as yet attempted to attribute to insurance demand. Even new widowhood events, however, are not random with respect to initial conditions. Both initial health insurance status and risk of future widowhood are related to basic characteristics observed when married at baseline. When these confounding variables are controlled for in models of the effect of widowhood events on uninsurance, there is no longer statistical evidence of an independent effect of husband's death on risk of losing insurance. Part of the reason why the measured independent effect of widowhood appears small is that there are events within marriage that can also affect insurance coverage, such as retirement or health events. Even though the number of uninsured women whose lack of coverage can be attributed to widowhood is therefore small, and not a distinct major policy motive for changes in age of eligibility for Medicare, uninsurance rates overall among the near elderly, and the potential public burden of cost-shifting from years just before 65 to years just after gaining Medicare coverage, suggest that Medicare eligibility policies should be a focus of continued research.

Loss of health insurance and the risk for a decline in self-reported health and physical functioning.

Millions of Americans are intermittently uninsured. The health consequences of this are not known. National survey. Six thousand seventy-two participants in the Health and Retirement Study (HRS) age 51 to 61 years old with private insurance in 1992. Loss of insurance coverage between 1992 and 1992 and development of a major decline in overall health or a new physical difficulty between 1994 and 1996. In 1994, 5768 (95.0%) people continued to have private insurance, 229 (3.8%) reported having lost all insurance, and 75 (1.2%) converted to having only public insurance. Over the subsequent 2 years (1994-1996), the risk for a major decline in overall health was 15.6% for those who lost all insurance versus 7.2% for those with continuous private insurance (P <0.001). After adjusting for baseline sociodemographics, health behaviors, and health status, the adjusted relative risk for a major decline in health for those who lost coverage was 1.82 (95% CI, 1.25-2.59) compared with those with continuous private insurance. Those who lost insurance also had a higher risk for developing a new mobility difficulty compared with those with continuous private insurance (28.5% vs. 20.4%, respectively; P= 0.02), but this was not significant in multivariate analysis (adjusted RR, 1.26; 95% CI, 0.90-1.68). Loss of insurance has adverse health consequences even within 2 years after becoming uninsured. Studies of insurance coverage should routinely measure the number of Americans uninsured at any time over the preceding 2 years as a more accurate measure of the population at risk from being uninsured.

A Profile of the Population Enrolled in New York State's Child Health Plus

The recently enacted State Children's Health Insurance Program (SCHIP), designed to provide affordable health insurance for uninsured children, was modeled in part on New York State's Child Health Plus (CHPlus), which was implemented in 1991. All SCHIP programs involve voluntary enrollment of eligible children. Little is known about characteristics of children who enroll in these programs. To provide a profile of children enrolled in CHPlus between 1993 and 1994 in the 6-county upstate New York study area, and to estimate the participation rate in CHPlus. Methods. A parent interview was conducted to obtain information about children, 0 to 6.9 years old, who enrolled in CHPlus in the study area. Two school-based surveys and the Current Population Survey were used to estimate health insurance coverage. Enrollment data from New York State's Department of Health, together with estimates of the uninsured, were used to estimate participation rates in CHPlus. Most children enrolled in CHPlus in the study area were white. Although 17% of all children in the study area who were <13 years old and living in families with incomes below 160% of the federal poverty level were black, only 9% of CHPlus-enrolled children were black. Twenty-one percent of enrolled children were uninsured during the entire year before enrollment and 61% of children had a gap in coverage lasting >1 month. Children were generally healthy; only 4% had fair or poor health. Eighty-eight percent of parents of enrolled children had completed high school or a higher level of education. Parents reported that loss of a job was the main reason for loss of prior health insurance for their child. Most families learned about CHPlus from a friend (30%) or from their doctor (26%). The uninsured rate among children in the study area was approximately 4.1%. By 1993, the participation rate in CHPlus was about 36%. Blacks were underrepresented in CHPlus. Because the underlying uninsured rate was relatively low and parental education and family income were relatively high, the effects of CHPlus observed in this evaluation may be conservative in comparison to the potential effects of CHPlus for other populations of children. Participation rates during the early years of the program were modest.

A highly accurate, low cost test forBRCA1 mutations

The hereditary breast and ovarian cancer syndrome is associated with a high frequency of BRCA1mutations. However, the widespread use ofBRCA1 testing has been limited to date by three principal concerns:...

Cancer control in susceptible groups: opportunities and challenges.

Cancer mortality rates in the United States have risen throughout most of this century, and a downward trend has just emerged in recent years. Nevertheless, it is predicted that cancer will soon be the leading cause of death among Americans. To gain new knowledge of etiology, we have studied persons at highest risk as human models of cancer susceptibility. Clinical observations at the bedside are used to generate etiologic hypotheses that are tested in epidemiologic studies. Companion laboratory studies can identify biologic mechanisms of predisposition. Data show that inborn mutations in cancer-predisposing genes, such as BRCA1 and BRCA2, markedly increase the risk of cancers at unusually early ages. Increasing numbers of these highly penetrant genes are being identified. These discoveries have created new opportunities for genetic testing to identify cancer-prone individuals. Individuals found to be carriers can be offered counseling to avoid environmental exposures that further elevate risk, intensive medical surveillance for early detection, participation in chemoprevention trials, and prophylactic surgery to remove at-risk tissues. However, genetic knowledge can have adverse effects, including psychologic distress, social stigmatization, and loss of health insurance. Research is needed to maximize benefits and minimize risks to the susceptible populations. Professional and public education can promote appropriate use of genetic data, and legislation may be required to prevent discrimination. Knowledge of these highly penetrant genes can be extended to common polymorphisms that modify cancer risk associated with exposures to environmental carcinogens.

An Unusual View Of Health Economics

An Unusual View Of Health Economics

Living with mental illness: A personal experience

Having lived with a bipolar disorder for nearly 20 years, I discuss my personal struggles with the discrimination, blame, and guilt frequently associated with having a mental illness. I have experienced failed aspirations, feelings of self-depreciation, depression, and denial—all associated with stigma. Stigma has contributed to loss of jobs, loss of status in the community, and loss of health insurance. I have found that one way to cope with stigma is to fully disclose my illness to family, friends, and my employer. I have also found satisfaction in opposing stigma through mental health advocacy.

Supplemental Security Income (SSI), Disability Insurance (DI), and substance abusers.

Federal legislation repealed Supplemental Security Income (SSI) and Disability Insurance (DI) for alcohol and drug abusers as of January 1997. This article outlines the context in which the legislation was passed and summarizes concerns resulting from the legislation. We discuss the effects of the legislation on treatment participation, financing, and availability, and the legislation's impact on individuals with dual mental health and substance abuse problems. We also consider the individual and societal implications of substance abusers' loss of monthly income and health insurance.

Middle class too feels loss of health insurance

Middle class too feels loss of health insurance

Middle Class Too Feels Loss of Health Insurance

ABSTRACT FOR ONE reason or another, some 2.25 million Americans, on average, have their health insurance policies canceled every month, according to a new report, How Americans Lose Health Insurance. The report was released at a press conference on Capitol Hill by Families USA Foundation, a Washington, DC—based consumer group working for health system reform.The majority of the people who lose their insurance manage to reacquire health insurance coverage, but their new policy may not provide the same benefits as the old one. In any event, there is an interim period when they go bare. It takes about 5 months or less for half of those who lost their health insurance coverage to get it back, says the report.The report is based primarily on data from the 1990 Survey of Income Program Participation conducted by the Bureau of the Census. Health insurance status is reported for five types of

Reluctance to undergo predictive testing: the case of Huntington disease.

The development of a presymptomatic test for Huntington Disease (HD) has enabled some persons at risk to determine whether or not they are gene carriers. The purpose of this study was to explore the reasons why those at risk choose not to be tested in a situation where testing is available and most of the test-associated costs are covered by state funding. Subjects were also asked their levels of knowledge about testing, attitudes towards aspects of the testing protocols, and intentions towards testing once the gene for HD is found. Sixty-six individuals at risk for HD who had chosen not to be tested completed a mailed questionnaire. The most important reasons for not being tested were increased risk to children if one was found to be a gene carrier, absence of an effective cure, potential loss of health insurance, financial costs of testing, and the inability to "undo" the knowledge. Individuals comprising this sample were quite knowledgeable about predictive testing. Most supported the availability of testing despite the lack of a cure, the need for special counseling prior to testing, and the idea that testing should be a voluntary decision. Most said they would take the test if a treatment was available, if the mechanics of the test were simplified, or if the test was 100% accurate. The risk to relatives, lack of treatment or cure, fear of losing one's health insurance, and the accuracy of the information to be gained from testing are important factors in the decision not to be tested.

SOCIAL REHABILITATION AND RETURN TO WORK AFTER CARDIAC TRANSPLANTATION—A MULTICENTER SURVEY 1

As the medical results of heart transplantation steadily improve, the social rehabilitation of patients, in particular, their ability to return to some form of employment, is becoming increasingly important. Two-hundred fifty patients were therefore surveyed at 7 heart transplant centers (5 of which were Medicare certified) from different geographic regions in the U.S.A. Over all, 45% were employed, 36% were unemployed, 13% were medically disabled, and 6% were retired. Of those employed, 87% had returned to their previous employment, and only 13% had secured new employment. Of the unemployed, 16% had made job applications, and no fewer than 63% had no current plan to seek employment. Factors found to negatively influence a return to work included the following: (1) length of medical disability prior to transplantation; (2) a patient's self-perception of being physically unable to work; and (3) the potential loss of health insurance and/or disability income. At 2 centers, where there was a definite policy of not supporting a patient's claim for medical disability in the absence of an absolute indication, there were significantly increased numbers who (1) secured new employment and (2) planned to seek employment. More serious attention must be paid to aspects of employment if heart transplant recipients are to become fully productive members of the community.

Physician Use of the HIV Antibody Test

IN 1985,I was the primary physician for a young man whose life was ruined by the inappropriate disclosure of a positive human immunodeficiency virus (HIV)—antibody test. A physician ordered the test without consent and notified the local health department of the positive result. The health department notified the individual's employer and he was promptly fired. These events became common knowledge at his workplace and in his rural Midwestern town and he was shunned. His landlord asked him to move. Ten days after testing, the life he had known for the past ten years was permanently ruined and he left town. With the loss of his job came loss of health insurance and insurability; he has been unable to obtain health or life insurance since then. See also p 229. In this case, no purpose was served by obtaining the HIV-antibody test. The patient had been diagnosed with acquired immunodeficiency syndrome