Health disparities quiz 2

life on a conveyor belt

moving to act

By 2013, it was reported that 43 million people lacked healthcare coverage.

the ACA mandated healthcare coverage and imposed tax penalties for those without health insurance

Gentrification

Arrival of wealthier people into an existing neighborhood or geographic area

Mechanisms by which SES Impacts Health

Researchers agree that there is a link betweenSES and health outcomes/mortality No clear consensus regarding how SES affects health, but many hypotheses exist Health disparities research Dr. Donald Barr categorizes these ideas of what causes the link between SES and health into two overarching categories: • Material deprivation • Psychological and biological effects of perceiving less privilege

only 9% of uninsured individuals reported that they would rather pay the fine

46% reported that they tried to get coverage but it was too expensive.

Lyndon B. Johnson

36th president of the United States he is known for finding the right time to advocate the Great Society initiatives in 1964 and 65 that addressed education, medical care, urban problems, and transportation

steps to be anti-racist

1. name racism 2. how racism is acting here 3. organize with people like

key ACA replacement provisions

1. retain the tax preference for employer-paid premiums, with an upper limit 2. provide refundable tax credits to households without access to employer coverage 3. allow states to regulate insurance offerings and to establish mechanisms consumer choice of plans 4. provide "continues coverage protection" for persons with preexisting conditions 5. allow states to adopt a default enrollment program 6. allow for a gradual transition from ACA subsides

global poverty

10.7% live on less than $2 a day 767 million people subsaharan africa

Poverty in the United States

2015 U.S. Poverty Rate: 13.5% • 43.1 million people • Across ages and demographic groups poverty decreased from 2014 to 2015 • Poverty rates still disproportionately affect particular populations

Socioeconomic Status (SES)

A composite measure that typically incorporates economic, social, and work status. Economic status is measured by income. Social status is measured by education, and work status is measured by occupation Low education + lower status occupation + low income = Poor health High education + high status occupation + high income = Better health

2010:

A new Patient's Bill of Rights goes into effect, protecting consumers from the worst abuses of the insurance industry. Cost-free preventive services begin for many Americans.

Access to care and distribution of resources

Access to care impacted by SES Decisions must be made regarding distribution of resources This phenomenon exists domestically and in other developed countries Access to care alone does not fully explain how SES impacts health

2012:

Accountable Care Organizations and other programs helped doctors and health care providers work together to deliver better care.

Patient Protection and Affordable Care Act (PPACA)

Affordable Care Act (ACA) and nicknamed Obamacare United States federal statute enacted by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act amendment, it represents the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965. Under the act, hospitals and primary physicians would transform their practices financially, technologically, and clinically to drive better health outcomes, lower costs, and improve their methods of distribution and accessibility.

2014:

All Americans had access to affordable health insurance options. The Marketplace allowed individuals and small businesses to compare health plans on a level playing field. Middle and low- income families received tax credits that covered a significant portion of the cost of coverage. And the Medicaid program was expanded to cover more low-income Americans. All together, these reforms meant that millions of people who were previously uninsured would gain coverage, thanks to the Affordable Care Act.

The Legislative Branch: Congress

Congress makes state laws Congress is divided into 2 parts. One part is called the Senate. There are 40 State Senators. Another part is called the House of Representatives. There are 120 State Representatives Both senators and representatives are elected by the eligible voters in their districts.

Over 17 million more people have health coverage in 2016 compared to 2013

Corresponding with implementation of the ACA's coverage provisions, the total number of nonelderly uninsured individuals nationally dropped from 44 million in 2013 to 27 million in 2016, with the biggest decline in the first two years of ACA implementation. Because the expansions are largely targeted to adults, who have historically had higher uninsured rates than children, nearly the entire decline in the number of uninsured people under the ACA has occurred among adults.

statistics of coverage gain

Coverage gains from 2013 to 2015 were particularly large among groups targeted by the ACA, including adults and poor and low-income individuals. The uninsured rate among nonelderly adults dropped from 20.4% in 2013 to 12.8% in 2015, representing a 7.6 percentage point drop, or a 37% decline. In addition, between 2013 and 2015, the uninsured rate declined by more than 10 percentage points for poor and near-poor nonelderly individuals. People of color, who had higher uninsured rates than non-Hispanic Whites prior to 2014, had larger coverage gains than non- Hispanic Whites. Though uninsured rates dropped across all states, they dropped more in states that chose to expand Medicaid.

Tony Iton

Education is the single most important modifiable social determinant of health. Income and education are the two big ones that correlate most strongly with life expectancy and most health status measures income, education, and occupation

Current Research Trends

Further explain the mechanisms behind how SES impacts health outcomes Utilization of life course framework to examine the effects of SES across the lifespan Examining measures of SES, rather than merely controlling for them

Measuring SES

Individually measuring income, education, or occupation Composite measures of SES: tools that take in many contributors • Economic • Social • Work

inequity

Increase in disparities based on placement on the spectrum Resources are inequitable, causing both material deprivation and the psychosocial concept of things not being fair The larger the gap between the rich and the poor the more this inequity is perceived Here the Gini index is often used by researchers to determine the degree of inequality in a particular geographic area

Gini index

Most common measure of household income inequality

potential repeal aspects

Most obvious are the rates of the uninsured Nationally: 29.8 million would lose coverage by 2019 Statewide here in Florida: 2.2 million would lose coverage in 2019 Less obvious, but carrying a direct impact on USF, are the numbers of jobs that will be lost with the repeal, and without sounds replacement policies, of premium tax credits and Medicaid expansion Nationally: 2.6 million jobs lost (2019-2023) (that's ranging from 334,000 jobs lost in California to 4,000 jobs lost in Wyoming) Statewide here in Florida: 181,000 jobs would be lost healthcare jobs account for 35% of the loss. Construction, Real Estate, Retail trade, Finance and Insurance, and the public sector account for the other 65% of jobs lost

2013:

Open enrollment in the Health Insurance Marketplace began on October 1st.

stress vulnerability

Repeated periods of stress in a short period of time allows little room for recuperation: • Weakened physical and mental states • Immunological response • Ability to cope with other health conditions.

2011:

People with Medicare got key preventive services for free, and also received a 50% discount on brand-name drugs in the Medicare "donut hole."

Poverty

Poverty describes a condition in which basic human needs cannot be met by a person or group - including access to clean water, nutrition, health care, education, clothing, or shelter absolute poverty: does not have access to basic human needs relative poverty: has less access then those in the community geography, culture, neighborhood structure

Executive Branch

President of the United States administers the branch enforces the laws of the legislative (congress) branch

Another option is the Unleashing of States

Section 1332 of the ACA permits states to apply for waivers to jettison core elements of the ACA, including the individual and employer mandates, exchanges, and components of the required benefit package, as long as financial protections for families stay in place. The Obama administration did little to encourage states to apply for 1332 waivers, and interpreted the law narrowly. Trump could do the opposite, allowing states to propose their own replacement for major parts of the ACA. Building on Section 1332 to begin a fundamental shift in the health care relationship between Washington, DC, and the states. Under this vision of federalism, Congress would set the broad coverage objectives and themes of the system, including a regulatory framework of protections and minimum benefits, and would legislate a redesigned set of subsidies, Medicaid funds, and tax benefits for families. States could propose their own repeal-and-replace plans for federal approval, which could include alternative insurance regulation to accomplish federal goals.

Other mechanisms

Social support and social capital

Redesigning Subsidies

Tax credits for the purchase of health insurance, including "refundable" credits that are within the same species as ACA subsidies. Medicaid and subsidy redesign: This involves waivers to use the Medicaid expansion funds under the ACA to craft consumer-driven subsidies for working families, including prefunding HSA accounts or purchasing private insurance (states like Indiana have done something similar).

Three branches of government

The Legislative Branch inclusive of Congress The Judicial Branch, inclusive of the supreme court The Executive Branch, inclusive of the President of the United States.

State Government

The Legislative Branch: Congress The Judicial Branch: supreme court The Executive Branch: governor

challenges with current policy

The requirement that most individuals have health insurance beginning in 2014; and • The penalties to employers that do not offer affordable coverage to their employees, with exceptions for small employers.

Under the ACA, the uninsured rate has declined to a historic low.

The share of the nonelderly population that lacked insurance coverage hovered around 16% between 1995 and 2007, then peaked during the ensuing economic recession. As early provisions of the ACA went into effect in 2010, and as the economy improved, the uninsured rate began to drop. With the implementation of the major ACA coverage provisions in 2014, the uninsured rate dropped dramatically and continued to fall in 2015 and early 2016. In 2016, the nonelderly uninsured rate was 10.0%, the lowest rate ever recorded.

windows of opportunity

These included governmental programs such as the Civil Rights Act started by JFK, The Economic Opportunity Act of 1964 attacking American poverty, The Social Security Act of 1965 that brought about Medicare, then Title XIX of this act that brought on Medicaid and Welfare.

The ACA's coverage provisions built on and attempted to fill gaps in a piecemeal insurance system that left many without affordable coverage

This system had built up over time and included employer-based coverage for many-but not all-workers and their families, public coverage for some low-income people, and directly-purchased coverage for a small number of people who bought policies on the non-group market. (Medicare covers most people over age 65 as well as some younger people with disabilities.) Under this system, many were ineligible for coverage or could only access coverage that was too costly for them to afford. In 2013, 44.3 million nonelderly people in the U.S. lacked health insurance. Poor and low-income adults were particularly likely to lack coverage, and the main reason that most people said they lacked coverage was inability to afford the cost.

President Donald Trump

Trump pushed the secretary of Health and Human Services (HHS) and other federal agencies to begin weakening the law to minimize the unwarranted economic and regulatory burdens of the ACA, and prepare to afford the States more flexibility and control to create a more free and open healthcare market. Remembering the checks and balances system, most of the provisions in the ACA can't just be changed by HHS or the president; they require action from Congress or a lengthy period involving public comment. Which is why it's reasonable to assume this line is targeted at the things HHS can change, like the individual mandate. The individual mandate, which requires most people to have health insurance or face a tax penalty, has always been the most contentious part of the law.

How a per capita cap works.

Under a Medicaid per capita cap, the federal government would set a limit on how much to reimburse states per enrollee. Unlike a block grant approach, which provides a set amount of federal spending regardless of enrollment, payments to states would reflect changes in enrollment. A per capita cap model would not account for changes in the costs per enrollee beyond the growth limit. To achieve federal savings, the per capita growth amounts would be set below the projected rates of growth under current law. Key design challenges. Key challenges in designing a per capita cap proposal include determining the base per enrollee amounts, setting the annual growth rates, and making decisions about new state flexibility versus maintaining federal core requirements and state accountability.

Block grants

Unlike with the per capita cap, the plan does not provide any details on how a state's block grant amount would initially be set or be adjusted annually. But as with the per capita cap, the block grant amounts would certainly be designed to provide significantly less federal funding than under current law. For example, past block grants have been based on state's historical spending in a base year, adjusted annually for population growth and general inflation. As noted above, however, health care costs rise faster than inflation. And with the aging of the population, Medicaid enrollment is expected to grow faster than the rate at which the overall population increases.

policy making process

a continuous cycle with three phases in which all decisions are subject to change

What is racism

a system of structuring opportunities and assigning value based on the social interpretation on how we look (which is what we call "race") -unfairly disadvantages some individuals and communities -unfairly advantages other individuals and communities -saps the strength of the whole society through the waste of human resources

internalized

acceptance by the stigmatized "races" of negative messages about our own abilities and intrinsic worth examples: self devaluation white mans ice is colder syndrome resignation, helplessness, hopelessness accepting limitations to our full humanity

The Executive Branch: governor

administers the Executive Branch enforces the laws that the Legislative Branch (Congress) makes The Governor is elected by state citizens, 18 years of age and older, who vote in the election in their states

four subspecies of humans

african black american red asian yellow european white oceania (new category)

1995-2016

all time low of 10% uninsured rate among the noneldery population

benefits of the ACA

benefits for women: providing insurance options, covering preventive services and lowering costs young adult coverage: coverage available to children up to age 26 strengthening medicare: yearly wellness visits and many free preventive services for some seniors with medicare holding insurance companies accountable: insures must justify any premium increase of 10% or more before the rate takes effects

Rates of Poverty in the United States by Key Demographic Factors

black no high school diploma south america under 18 gender: male 12.2% female 15.8% male $1 women $0.80

President is elected by

by United States citizens, 18 years of age and older, who vote in the presidential elections in their states votes are tallied by states and form the Electoral College system States have the number of electoral votes which equal the number of senators and representatives they have It is possible to have the most popular votes throughout the nation and NOT win the electoral vote of the Electoral College

Japanese lanterns

colored perception

Race

complex relationship between race and SES SES alone does not explain the race differences in health incomes

Legislative branch

congress makes laws two parts: -senate: (100 Senators-2 from each of our states) -House of Representatives: (Representatives meet together to discuss ideas and decide if these ideas (bills) should become laws. There are 435 Representatives. The number of representatives each state gets is determined by its population) Both senators and representatives are elected by the eligible voters in their states Florida has 27 Congressional representatives

education attainment level

correlates well with life expectancy

institutionalized

differential access to the goods, services, and opportunities of society by race examples: housing, education, employment, income medical facilities clean environment information, resources, voice acts of doing as well as acts of not doing and often shows up as inaction in the face of need why we even see an association between social class and race in this country

personally mediated

differential assumptions about the abilities, motives, and intents of others, by race differential actions based on those assumptions prejudice and discrimination

restaurant saga

dual reality

The Judicial Branch: supreme court

includes the Supreme Court and 7 Justices special judges who interpret laws according to the Constitution pertain to issues related to the Constitution they are the highest court in our state All three parts of our state government have their main headquarters in the city of Tallahassee, FL.

Judicial branch

includes the Supreme Court and 9 Justices special judges who interpret laws according to the Constitution These justices only hear cases that pertain to issues related to the Constitution highest court in our country The federal judicial system also has lower courts located in each state to hear cases involving federal issues All three parts of our federal government have their main headquarters in the city of Washington D.C.

levels of racism

institutionalized personally mediated internalized

we need to address the

institutionalized racism

Phase 1, policy formulation

involves agenda setting and the development of legislation. This phase results in new public laws or changes to existing laws. Not every problem that receives policy maker attention will necessarily result in the development of legislation. Consider that in the absence of researcher involvement at this stage, policy makers are more likely to rely on vested interests (e.g., industry advocacy groups) or nonscientists for information.

Phase 2, policy implementation

involves rulemaking and operational decisions that come after the passage of new legislation. Rulemaking establishes formal regulations (in this context, regulations is used interchangeably with rules) and is necessary to carry out the intent of public laws. At the national level, proposed rules are published in the Federal Register, and interested parties can submit comments before the regulations are finalized. The operation stage involves the actual running of the programs created by new legislation. Usually, appointees and civil servants are responsible for operational activities.

gardeners tail

levels of racism

Phase 3, policy modification

occurs when the consequences of existing policies result in further policy making. Even policy decisions that are correct when made must adjust to accommodate changing circumstances. As the feedback loop in the model shows, policy modification can occur anywhere in the process. Individuals, organizations, or interest groups who benefit from a policy may seek modifications that increase or maintain these benefits over time. The flip side is also true: Those who are negatively affected will seek to minimize these effects. Researchers may reach out to policy makers to provide research that supports legislation or that indicates that changes are needed for legislation.

What matters most, Politics or Policies?

policies. Because policies take the public health's to a level that medicine alone may never reach.

gardener in story

power to decide power to act control of resource dangerous when: allied with one group not concerned with equity

Jodi Ray

responsible for bringing in the 2nd largest HHS navigator award nationwide. $4.2 million dollars was awarded to the University of South Florida to specifically help eligible uninsured individuals get health care.

action steps

share stories of impact of coverage engage in meaningful dialogue, discussing issues and impact contact local and congressional representatives become more informed

In its nearly 2000 pages, the ACA established quite a few changes to healthcare. Most notably are:

• The increased Medicaid eligibility to 138% of the Federal Poverty Level for all children up to age 19 • Provision of Medicaid coverage to children aging out of foster care up to age 26 as of 2014 and • Strengthened the Children's Health Insurance Program. • The law also lowered healthcare costs for Medicare recipients and prescription drug costs. • The ACA also established guidelines to cover preventive services such as routine screenings.