Research Roundup: Medicaid Wellness Programs; Preexisting Conditions; Changes In Subsidies

Health Affairs: Iowa’s Medicaid Expansion Promoted Healthy Behaviors But Was Challenging To Implement And Attracted Few Participants
As part of Iowa’s Medicaid expansion, the Healthy Behaviors Program was designed to provide members with incentives to complete specified healthy activities in return for waiving monthly premiums. We used claims data and interviews to document the first year (2014) of the program’s implementation. Healthy activities completion rates did not exceed 17 percent. Interviews with members and clinic managers revealed low levels of awareness of the program’s existence, deficits in knowledge about how the program works, and a variety of barriers to activity completion. ... The results suggest that efforts by federal and state governments to reform Medicaid by shifting responsibility onto program members for healthy behaviors are unlikely to succeed. (Askelson et al., 5/2)

JAMA: Trends And Patterns Of Geographic Variation In Cardiovascular Mortality Among US Counties, 1980-2014
In this study of small area estimation models applied to death records from the National Center for Health Statistics, the difference between county-level mortality rates declined substantially over the past 35 years for both ischemic heart disease and stroke; however, large differences remained in 2014. The largest concentration of counties with high cardiovascular disease mortality extended from southeastern Oklahoma along the Mississippi River Valley to eastern Kentucky, and several cardiovascular disease conditions were clustered substantially outside the South, including atrial fibrillation (Northwest), aortic aneurysm (Midwest), and endocarditis (Mountain West and Alaska). (Roth et al., 5/16)

The New England Journal of Medicine: Aerobic Or Resistance Exercise, Or Both, In Dieting Obese Older Adults
In this clinical trial involving 160 obese older adults, we evaluated the effectiveness of several exercise modes in reversing frailty and preventing reduction in muscle and bone mass induced by weight loss. Participants were randomly assigned to a weight-management program plus one of three exercise programs — aerobic training, resistance training, or combined aerobic and resistance training — or to a control group (no weight-management or exercise program). ... Of the methods tested, weight loss plus combined aerobic and resistance exercise was the most effective in improving functional status of obese older adults. (Villareal et al., 5/18)

JAMA Internal Medicine: Perceived Discrimination Experienced By Physician Mothers And Desired Workplace Changes
In a large cross-sectional survey of physician mothers, we found that perceived discrimination is common, affecting 4 of 5 respondents, including about two-thirds of the respondents who reported discrimination based on gender and more than a third who reported maternal discrimination. The overlap of groups reporting gender and maternal discrimination was less than half, suggesting that they are somewhat different phenomena. (Adesoye et al., 5/8)

International Journal of Health Services: Availability Of Outpatient Mental Health Care By Pediatricians And Child Psychiatrists In Five U.S. Cities
The authors sought to assess the availability of outpatient mental health care through pediatrician and child psychiatrist offices in the United States and to characterize differences in appointment availability by location, provider type, and insurance across five cities. To do so, the authors posed as parents of a 12-year-old child with depression, gave a predetermined insurance type, and asked to make the first available appointment with the specified provider. They called the offices of 601 individual pediatricians and 312 child psychiatrists located in five U.S. cities and listed as in-network by Blue Cross Blue Shield, one of the largest private insurers in the United States. Appointments were obtained with 40% of the pediatricians and 17% of the child psychiatrists. The mean wait time for psychiatry appointments was 30 days longer than for pediatric appointments. (Cama et al., 5/9)

The Kaiser Family Foundation: Gaps in Coverage Among People With Pre-Existing Conditions
The American Health Care Act (AHCA), which has passed the House of Representatives, contains a controversial provision that would allow states to waive community rating in the individual insurance market. In this brief we estimate the number of people with pre-existing conditions who might be affected by such a policy. ... Using the most recent National Health Interview Survey (NHIS), we estimate that 27.4 million non-elderly adults nationally had a gap in coverage of at least several months in 2015. This includes 6.3 million people (or 23% of everyone with at least a several-month gap) who have a pre-existing condition that would have led to a denial of insurance in the pre-ACA individual market and would lead to a substantial premium surcharge under AHCA community rating waiver. (Levitt et al., 5/17)

Urban Institute: Premium Tax Credits Tied To Age Versus Income And Available Premiums: Differences By Age, Income, And Geography
This paper compares tax credits offered through the Affordable Care Act (ACA) with those in the American Health Care Act (AHCA). They examined the premium levels in 10 cities, five of which have relatively low premiums and five of which have relatively high premiums. The authors find that younger people typically receive larger insurance premium tax credits under the AHCA, while older adults typically receive larger premium tax credits under the ACA. The analysis also shows that lower-income older adults currently receive higher tax credits under the ACA than they would under the AHCA regardless of where they live. (Holahan, Blumberg and Wengle, 5/17)