Effect Of Mandate Research Articles

Evidence on the Effects of the Federal COVID-19 Vaccine Mandate on Nursing Home Staffing Levels.

To assess the federal COVID-19 vaccine mandate's effects on nursing homes' nurse aide and licensed nurse staffing levels in states both with and without state-level vaccine mandates. Cross-sectional study using data from Centers for Medicare and Medicaid Services, Centers for Disease Control and Prevention, and Economic Innovation Group. Including nursing home facility fixed effects provides evidence on the intertemporal effects of the federal vaccine mandate within nursing homes. The sample contains 15,031 nursing homes, representing all US nursing homes with available data. On January 13, 2022, the US Supreme Court upheld the federal COVID-19 vaccine mandate for health care workers in Medicare- and Medicaid-eligible facilities, with workers generally required to be vaccinated by March 20, 2022 (ie, the compliance date). We examined actual nursing home staffing levels in 3 time periods: (1) pre-Court decision; (2) precompliance date; and (3) postcompliance date. We separately examined staffing levels for nurse aides and licensed nursing staff. Because 28% of nursing homes were in states with state-imposed vaccine mandates that predated the Supreme Court's ruling, we divided the sample into 2 groups (nursing homes in mandate states vs nonmandate states) and performed all analyses separately. Staff vaccination rates and staffing levels were higher in mandate states than nonmandate states in all 3 time periods. After the Court's decision, staff vaccination rates increased 5% in nonmandate states and 1% in mandate states (on average). We find little evidence that the Court's vaccine mandate ruling materially affected nurse aide and licensed nurse staffing levels, or that nursing homes in mandate states and nonmandate states were differentially affected by the Court's ruling. Staffing levels over time were generally flat, with some evidence of a modestly greater increase for nurse aide staffing in mandate states than nonmandate states, and a modestly smaller decrease for licensed nurse staffing in mandate states than nonmandate states. Finally, regression results suggest that for both nurse aides and licensed nurses, staffing levels were lower in rural and for-profit nursing homes, and higher in Medicare-only, higher quality, and hospital-based nursing homes. Results suggest the federal COVID-19 vaccine mandate has not caused clinically material changes in nursing home's nurse aide and licensed nurse staffing levels, which continue to be primarily associated with factors that are well-known to researchers and practitioners.

The ACA's Individual Mandate In Retrospect: What Did It Do, And Where Do We Go From Here?

The Affordable Care Act required most people to obtain health insurance or pay a tax penalty. Legislation enacted in December2017 effectively repealed that requirement, starting in 2019. This article reviews recent research on the mandate's effects, concluding that the mandate meaningfully increased insurance coverage, but likely by less than was projected before implementation. These coverage gains are likely to erode as mandate repeal takes hold. Looking ahead, policy makers have many options for expanding insurance coverage without restoring an individual mandate. However, achieving universal coverage without some form of mandatory individual contribution to health insurance would have a very large fiscal cost.

93. Certificate-of-Need state laws and elective posterior lumbar fusions: a Medicare trends, costs and outcomes analysis

BACKGROUND CONTEXT Certificate-of-Need (CON) state laws have been a major mandate of health policies aimed at forming centralized health planning as a key-core of the US health care system. Though the federal CON mandate was repealed in 1986, several states still continue to use it as a means of limiting health care resource utilization while attempting to provide quality care in high-volume facilities. PURPOSE The current study aimed to utilized a national Medicare claims dataset to assess whether elective posterior lumbar fusions (PLFs) performed in CON vs No CON states had lower utilization rates, lower costs, and better quality of care. STUDY DESIGN/SETTING Retrospective review of administrative claims from the 100% Medicare Standard Analytical Files (SAF100). PATIENT SAMPLE The 2005-2014 100% Medicare Standard Analytical File (SAF100) was queried to identify patients undergoing elective 1-to-3 level PLF. OUTCOME MEASURES Trends in utilization during the study period (2005-2014), average 90-day costs/reimbursements, 90-day complications and 90-day readmissions. METHODS Patients were categorized into ‘CON’ and ‘No CON’ based on existing state laws where they received the procedure. For each group (CON vs No CON), differences in per-capita utilization, 90-day reimbursements and proportion of high-volume facilities (>150 procedures/year) vs low-volume facilities (≤50 procedures/year) have been reported. Multivariate analyses were used analyze 90-day complication/readmission rates between the two groups. RESULTS A total of 188,687 patients underwent an elective 1- to 3-level PLF in a CON state and 167,642 patients received the procedure in a No CON state from 2005 to 2014. The average per capita utilization of PLFs was lower in CON states as compared to No CON states (14.5 vs 15.4 per 10,000 population; p CONCLUSIONS While the presence of CON laws was associated with lower utilization of elective 1-to-3 level PLFs, and a greater presence of high-volume facilities, the mandate's effect on enhancing quality-of-care, by reduction of 90-day readmissions and 90-day complications is minimally significant. Future research, involving other surgical subspecialties, is needed before health policy makers may consider the removal or alteration of these laws. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Effects of the Affordable Care Act's Dependent Coverage Mandate on Private Health Insurance Coverage in Urban and Rural Areas.

To evaluate the impact of the Affordable Care Act's (ACA) dependent coverage mandate on insurance coverage among young adults in metropolitan and nonmetropolitan areas. A cross-sectional analysis was conducted using data from 2006-2009 and 2011 waves of the Medical Expenditure Panel Survey. A difference-in-difference analysis was used to compare changes in full-year private health insurance coverage among young adults aged 19-25 years with an older cohort aged 27-34 years. Separate regressions were estimated for individuals in metropolitan and nonmetropolitan areas and were tested for a differential impact by area of residence. Full-year private health insurance coverage significantly increased by 9.2 percentage points for young adults compared to the older cohort after the ACA mandate (P = .00). When stratifying the regression model by residence area, insurance coverage among young adults significantly increased by 9.0 percentage points in metropolitan areas (P = .00) and 10.1 percentage points in nonmetropolitan areas (P = .03). These changes were not significantly different from each other (P = .82), which suggests the ACA mandate's effects were not statistically different by area of residence. Although young adults in metropolitan and nonmetropolitan areas experienced increased access to private health insurance following the ACA's dependent coverage mandate, it did not appear to directly impact rural-urban disparities in health insurance coverage. Despite residents in both areas gaining insurance coverage, over one-third of young adults still lacked access to full-year health insurance coverage.