Public Policy Commons^™

The Impact Of Medicaid Expansion Under The Affordable Care Act On Accessibility And Availability Of Primary Health Care, Aaron Amaning Boaitey

All Graduate Theses, Dissertations, and Other Capstone Projects

The Affordable Care Act (ACA) sought to provide universal health insurance coverage for Americans through a combination of Medicaid expansions, insurance market policies, advance premium tax credits, among other reforms. Lawmakers intended to enforce Medicaid expansion through the ACA at the federal level. However, the June 2012 United States (U.S.) Supreme Court decision in National Federation of Independent Business v. Sebelius allowed states to opt-out of Medicaid expansion. As a result, states took different approaches to expand Medicaid eligibility. This study uses data from the Inter-university Consortium for Political and Social Research (ICPSR) to analyze how opting in or out …

Three Essays On Health Economics And Policy Evaluation, Shishir Shakya

Graduate Theses, Dissertations, and Problem Reports (ETD)

This dissertation consists of three essays on the U.S. Health care policy. Each paragraph below refers to the three abstracts for the three chapters in this dissertation, respectively. I provide quantitative evidence on how much Prescription Drug Monitoring Programs (PDMPs) affects the retail opioid prescribing behaviors. Using the American Community Survey (ACS), I retrieve county-level high dimensional panel data set from 2010 to 2017. I employ three separate identification strategies: difference-in-difference, double selection post-LASSO, and spatial difference-in-difference. I compare how the retail opioid prescribing behaviors of counties, that are mandatory for prescribers to check the PDMP before prescribing controlled substances …

Redefining Trauma: Utilizing Restorative Justice To Repair Care Systems, Emebet Aklilu

Master's Projects and Capstones

This project examined the ways in which restorative justice programming can improve trauma informed care among the African American population in Oakland, CA. With 23% of African American men and women living at or below the poverty line in the United States, this project assesses gaps in current trauma informed care practices as evident in the literature. Following a rigorous document review the author coded and organized key programming components following six factors detailed by Rowher, Schoones, and Young (2014). Further examination of these program components was conducted using Bloom’s taxonomy levels to assess program outcomes associated with specific modules …

Single Versus Multi-Center Surgeons' Risk-Adjusted Mitral Valve Repair Procedural Outcomes, Anne Bennett, Thomas Bogue, Samuel Greenberg, Joshua Zhu, Samantha Novotny, Joseph Pizzuti, Lee A. Santore, Robert H. Habib, Annie Laurie Laurie Shroyer, Jonathan Price, Henry Tannous, Thomas Bilfinger

Department of Surgery Faculty Publications

The purpose of this study is to explore strategies to improve mitral valve repair (MVr) outcomes. This research explores postoperative outcomes of patients undergoing MVr surgery by single center surgeons versus patients of multicenter surgeons. Specific outcomes of interest include 30-day operative mortality, major operative complications (e.g., deep sternal wound infection, permanent stroke, renal dysfunction requiring dialysis, reoperation, and prolonged ventilation), length of stay, and 30-day readmissions.

In brief, the serisk-adjusted outcome rates for surgeons that perform mitral valve repair procedures will be compared for surgeons that operate at a single center [i.e. SC surgeons] versus multiple centers [i.e. MC …

Examining Racial & Ethnic Disparities In The Reach Of The Medicare Shared Savings Program, Lindsey Arneson

Capstone Experience: Master of Public Health

It is important to understand the quality of health care for racial and ethnic minorities covered under the largest U.S. government-run insurance program, Medicare, because the demographics of the U.S. are becoming older and more diverse. A new value-based program under Medicare is the Shared Savings Program (MSSP), which creates incentives to improve care quality and health outcomes for Medicare beneficiaries with a specific focus on increasing the provision of preventive care services. This capstone project aims to understand the representation of racial/ethnic minority Medicare beneficiaries, namely African Americans/Blacks and Hispanics/Latinxs, that receive care from providers or facilities (i.e., Accountable …

Snap At The Community Scale: How Neighborhood Characteristics Affect Participation And Food Access, Nevin Cohen

Publications and Research

Cities are spatially diverse, with enclaves of particular demo- graphic groups, clusters of businesses, and pockets of low-income individuals living amid affluence.

This essay presents data from New York City to illustrate the importance of measuring and addressing neighborhood characteristics that affect Sup- plemental Nutrition Assistance Program (SNAP) participation and the purchasing power of SNAP benefits: pockets of “eligible-but-not-enrolled” in- dividuals, proximity between SNAP participants and jobs, and variations in food prices across neighborhoods.

It concludes with 5 exam- ples of how addressing these community-scale issues can increase SNAP participation and food access.

Boomers And Fraudsters: A Closer Look At The Financial Elder Abuse Cycle In America, Ryan E. Brown

Marriott Student Review

In 2011, a landmark study was published by the Metlife Mature Market Institute claiming that nearly $3 billion disappears from the wallets and bank accounts of senior citizens annually. More surprising is that a similar study reported that figure could be as high as $36 billion. Because so many seniors let incidents of fraud or financial deceit go unreported, there is a huge discrepancy in annual reporting. This contributes to the overall lack of understanding we have of elder financial abuse, or why seniors continue to lose to fraudsters and scam artists. In a brief overview of financial elder abuse …

Using A Role-Driven Race Equity Reform Approach To Mitigate The Effects Of America's History Of Racism On Food Insecurity, Kenya N. Washington, Darryl E. Williams Jr.

Professional Agricultural Workers Journal

Abstract

Food insecurity, or the lack of reliable access to sufficient quantities of nutritious food, affects African Americans and other minorities disproportionately. This paper examines how America’s history of racism created and sustains the Nation’s racially disparate food system. Food insecurity contributes to hunger. This paper contemplates disparities in other American systems, including education and criminal justice, as exemplars of the broader ramifications of hunger. Finally, the paper examines the potential of individual action to address problems in any system. It champions the adoption of a role-driven race equity reform strategy as a tool to confront the current food insecurity. …

Sociodemographic And Health Status Characteristics Of Maine's Newly Eligible Medicaid Beneficiaries [Data Brief], Zachariah T. Croll Mph, Erika C. Ziller Phd, Barbara Leonard Mph

Medicaid

This data brief identifies key characteristics of groups who will gain access through MaineCare expansion. Researchers Croll and Ziller at the University of Southern Maine, along with Leonardson of the Maine Health Access Foundation present a statistical analysis of uninsured non-elderly adults age 18 – 64 with no children and lower incomes, the population newly eligible for MaineCare through expansion. Drawing from five years of data from Maine’s Behavioral Risk Factor Surveillance System, the report addresses sociodemographic characteristics, health status, and access to care. The survey indicates that those who are likely eligible for expanded MaineCare coverage are twice as …

Factors Associated With Participation In The Oregon Summer Food Program: A Mixed Methods Analysis, Alethea Chiappone, Teresa M. Garvin, Casey Blaser, Hollyanne E. Fricke, Lisa Weissenburger-Moser Boyd, Tom Barnard, Amy L. Yaroch

Journal of Health Disparities Research and Practice

The Summer Food Service Program (SFSP) was established to ensure children eligible for the National School Lunch Program (NSLP) continue to receive meals outside of the school year. However, participation in SFSP is relatively low (2.8 million annually) when compared with NSLP participation (30.4 million annually), suggesting that challenges exist in reaching children. Using a mixed methods approach, this study explored factors associated with SFSP participation. A secondary data analysis of the Oregon SFSP identified factors associated with SFSP participation at the Oregon SFSP-, sponsor-, and site-levels. Semi-structured interviews with SFSP sponsors explored barriers and facilitators to SFSP participation. Results …

Have You Seen The Poop Fairy?, Sergio Lozoya

Architecture and Planning ETDs

This research seeks to understand the effectiveness of the There is no Poop Fairy campaign through a public survey of dog owners. The There Is No Poop Fairy campaign was initiated in Albuquerque, New Mexico, in 2014, with the goal of getting dog owners to pick up and properly dispose of their dogs’ waste. The Rio Grande is contaminated with E. coli bacteria that originates in part from dog waste, which is carried to the river through storm water. Levels of E. coli in the Rio Grande have decreased dramatically within the past few years, coincident with the campaign. The …

Reexamining The Impact Of Medicaid Expansion In A Post-Affordable Care Act Environment From A Critical Race Perspective, Ty Price Dooley

Journal of Public Management & Social Policy

The passage of the Patient Protection and Affordable Care Act (ACA) in 2010 drastically transformed the health care system in the United States. This paper examines the factors influencing state decisions relative to Medicaid expansion in a post-ACA environment through the lens of Critical Race Theory. This study incorporates economic, geographic and health variables into a model of post-ACA-Medicaid decision-making by using logistic regression to examine State Medicaid expansion from 2010 to 2014. The size of the minority population in state, tobacco use and southern distinctiveness are significant predictors of decision making relative to Medicaid expansion. Findings support that racialized …

Gambling-Related Harms: Developing Priorities For Harm Reduction Policy Setting, Judith Glynn Msc, Margo Hilbrecht Phd

International Conference on Gambling & Risk Taking

As jurisdictions worldwide have overseen gambling expansion, most have implemented regulatory and public policy regimes to reduce harm. This study was conducted to specify the nature and extent of gambling-related harm that public policy efforts could prevent or mitigate in Ontario, Canada.

Research has historically operationalized harm from gambling as cases of disordered gambling; and policy work has focused on the prevalence and treatment of these cases. Recent work to fully conceptualize and measure gambling-related harm in individual gamblers, their families, and communities (Blaszczynski et al, 2015, Browne et al., 2016, 2017; Langham et al., 2016,) dovetailed with the desire …

The Health Care Costs Of Financial Exploitation In Maine, Kimberly I. Snow Mhsa, Yvonne Jonk Phd, Deborah Thayer Mba, Catherine Mcguire Bs, Stuart Bratesman Mpp, Charles A. Smith Phd, Erika C. Ziller Phd

Disability & Aging

This study sought to determine the Medicare and Medicaid costs experienced by dual eligible older adults in Maine for whom Maine Adult Protective Services (APS) substantiated allegations of elder financial exploitation and to compare them to those of Maine’s general older population. The analysis is an important step forward in estimating the medical costs associated with elder abuse.

Elder financial exploitation may result in significant public burden on Medicare and Medicaid, shouldered by taxpayers. Efforts to detect, investigate, prosecute, and mitigate this abuse will benefit not only the victims, but also the financial stewardship of these public programs.

Preventive Health Service Use Among Rural Women, Erika C. Ziller Phd, Jennifer D. Lenardson Mhs, Nathan Paluso Mph, Jaclyn Janis Bsn, Rn

Access / Insurance

Preventive health services and screenings are an important component in the continuum of care provided to individuals across all ages. Yet, research has shown that rural residents generally use fewer preventive health services and screenings. This study used the National Health Interview Survey to examine receipt of preventive health services (cholesterol check, fasting blood sugar test, mammogram, pap smear, and receipt of the HPV vaccine) by rural and urban women over the age of 18. Findings indicate that rural women were less likely than their urban peers to receive preventive health services, and that some of the differences may be …

British Government Information Resources, Bert Chapman

Libraries Faculty and Staff Creative Materials

Provides an overview of British Government information resources. Contents include basic British economic and political background and information from British Government websites including the Department of Environment, Food, and Rural Affairs (DEFRA), Brexit related material produced by British government agencies such as the Department for Exiting the European Union,, the Ministry of Defence, the National Museum of the Royal Navy, the Home Office Visas and Immigration Section, the Office of National Statistics, Her Majesty's Treasury, the British Parliament including parliamentary committees and research agencies, the website of Member of Parliament (MP) Jacob Rees-Mogg (Conservative-North East Somerset), a webcast of House …

How Do Changing Financial Circumstances Relate To Financial Well-Being? Evidence From A National Survey, Sam Bufe, Sicong Sun, Stephen P. Roll, Olga Kondratjeva, Michal Grinstein-Weiss

Social Policy Institute Research

This brief is the third and final brief in a series exploring the financial well-being of low- and moderate-income (LMI) households in the United States. The first brief in this series explored how financial well-being differed between LMI households and the general population.¹ The second in the series examined how financial well-being changed over time in a sample of LMI respondents.² This brief uses longitudinal survey data paired with administrative tax data to assess how different household experiences—including the use of alternative financial services, the experience of material and medical hardship, and improvements in physical and financial health—correspond …

Assessing The Short-Term Stability Of Financial Well-Being In Low- To Moderate-Income Households, Sicong Sun, Stephen P. Roll, Olga Kondratjeva, Sam Bufe, Michal Grinstein-Weiss

Social Policy Institute Research

A growing body of research demonstrates that U.S. households experience a high degree of volatility in their finances. This volatility can take the form of large swings in month-to-month income, spells of unemployment, and incurring unexpected expenses.1 Beyond being difficult to predict, these income and expense shocks are costly as well, with one survey finding that the most expensive shock experienced by the median U.S. household cost roughly half of one month’s income.2This financial volatility disproportionately affects low- to moderate-income (LMI) households;3 a population that often lacks the resources to manage this volatility. For example, research from the Survey of …

How Do Changing Financial Circumstances Relate To Financial Well-Being? Evidence From A National Survey, Sam Bufe, Stephen P. Roll, Olga Kondratjeva, Michal Grinstein-Weiss

Social Policy Institute Research

This brief is the third and final brief in a series exploring the financial well-being of low- and moderate-income (LMI) households in the United States. The first brief in this series explored how financial well-being differed between LMI households and the general population. The second in the series examined how financial well-being changed over time in a sample of LMI respondents. This brief uses longitudinal survey data paired with administrative tax data to assess how different household experiences—including the use of alternative financial services, the experience of material and medical hardship, and improvements in physical and financial health—correspond to the …

Making Dependent Care Fsaa Work For Low- To Moderate-Income Families 5 Action Steps For Employers, Sophia Fox-Dichter, Ellen Frank-Miller, Sloane Wolter

Social Policy Institute Research

Dependent Care Flexible Spending Accounts (DCFSAs) can help workers save money on child care expenses by using pre-tax dollars, but few employees actually use the accounts, particularly low- to moderate-income (LMI) employees, because:

• DCFSAs are difficult to understand; figuring out if they are possible to use and worth the trouble is a complex task for families.

• Families face a “double-hit” if they use the accounts – they have to set aside pre-tax dollars for child care expenses and then pay out-of-pocket before getting reimbursed.

• Using a DCFSA may require certainty about a year’s worth of child care …

Dependent Care Fsas: Policy Proposals To Level The Playing Field For Low- To Moderate-Income Parents, Ellen Frank-Miller, Sophia Fox-Dichter, Sloane Wolter

Social Policy Institute Research

This research was funded by the Annie E. Casey Foundation. We thank them for their support but acknowl-edge that the findings and conclusions presented in this report are those of the authors alone, and do not necessarily reflect the opinions of the Foundation.The authors are grateful to Don Baylor at the Annie E. Casey Foundation for his guidance and support throughout the project. We are also grateful to Elaine Maag at the Urban Institute for offering her expertise related to interactions between the Earned Income Tax Credit and dependent care flexible spending ac-counts. Finally, we extend our sincere thanks to …

Healthcare Spending Mandate Modeling Report, Northwest Economic Research Center, Peter Hulseman, Adam Rovang, Devin Bales, Nicholas Chun

Northwest Economic Research Center Publications and Reports

Governor Brown’s health care financing package, which was released with the 2019-21 recommended budget included several revenue components which provide broad-based, sustainable revenue for health care coverage in Oregon for the next six years. One component of that package is the Subsidized Employer Participation Program, which would be similar to the San Francisco Health Care Security Ordinance (HCSO). The new requirement would compel employers of a certain size who otherwise do not qualify for any exemption to contribute to their employees’ health care costs. An employer’s contribution could be in one of three ways: (1) in the form of directly …

The Socio-Economic Impact Of The Disproportionate Occurrence Of Asthma In The State Of Mississippi: Should Reporting Be Mandated?, Lolita D. Gray, Jahniah Grimsley, Jabria Pearson

Journal of Health Ethics

The state of Mississippi continues to experience a disproportionate occurrence of asthma among its citizens and various associated socioeconomic impacts. The objective of this study seeks to gauge the perception of the participants in regards to this asthma disparity. Specifically, research questions seek responses to following: 1) Will mandated, systematic reporting of asthma occurrences among socioeconomically disadvantaged communities effectively address the asthma disparity and lead to a better quality of life? and 2) Will mandated, systematic reporting of asthma increase the socioeconomic impact among these communities? This cross-sectional study employs a case study methodology utilizing various research techniques, i.e. interviews, …

Dependent Care Fsas: The Uneven Playing Field For Employers And Workers, Ellen Frank-Miller, Sophia Fox-Dichter, Sloane Wolter

Social Policy Institute Research

This research was funded by the Annie E. Casey Foundation. We thank them for their support but acknowl-edge that the findings and conclusions presented in this report are those of the authors alone, and do not necessarily reflect the opinions of the Foundation.The authors are grateful to Don Baylor at the Annie E. Casey Foundation for his guidance and support throughout the project. We extend our thanks to Elaine Maag at the Urban Institute for offering her expertise related to interactions between the Earned Income Tax Credit and dependent care flexible spending ac-counts.In this two-part series, we provide a field …

Financial Counseling For Low- And Moderate-Income Home Health Care Employees: An Assessment Of Take-Up, Engagement, And Outcomes, Ellen G. Frank-Miller Phd, Sophia R. Fox-Dichter Msw, Sloane Wolter Ab, Jenna Hampton Bsw

Social Policy Institute Research

Employee financial wellness programs (EFWPs) are gaining in popularity as a strategy to address workers' financial challenges and goals beyond offering health and retirement benefits. Most workers say they are stressed about their finances¹ and a third are less productive at work because of this stress.² Although employers are increasingly interested in offering EFWPs, little research has been conducted concerning these workplace financial products and services.

Workplace Credit-Building Counseling At A Midwest Employer: An Assessment Of Take-Up, Engagement, And Outcomes, Ellen G. Frank-Miller Phd, Sophia Fox-Dichter Msw, Sloane Wolter Ab, Jenna Hampton Bsw, Yingying Zeng Msw, Msp

Social Policy Institute Research

Employee financial wellness programs (EFWPs) are gaining in popularity as a strategy to address workers' financial challenges and goals beyond offering health and retirement benefits. Most workers say they are stressed about their finances¹ and a third are less productive at work because of this stress.² Although employers are increasingly interested in offering EFWPs, little research has been conducted concerning these workplace financial products and services.

Credit-Building Services For Employees: An Assessment Of Engagement And Outcomes, Yingying Zeng Msw, Msp, Mathieu Despard Phd, Msw

Social Policy Institute Research

Employee financial wellness programs (EFWPs) are gaining in popularity as a strategy to address workers' financial challenges and goals beyond offering health and retirement benefits. Most workers say they are stressed about their finances¹ and a third are less productive at work because of this stress.² Although employers are increasingly interested in offering EFWPs, little research has been conducted concerning these workplace financial products and services.

Put Your Money Where Your Mouth Is: Reforming Organized Dentistry To Address Persistent Oral Health Disparities In The U.S., Aparna Chintapalli

Pomona Senior Theses

The importance of oral health has been largely neglected from the conventional standards of healthcare in terms of public understanding & prioritization, the industrial infrastructure, and the scope of prevention & early-intervention services. Its adjunctive locus to the field of medicine has lead to the bifurcation of the oral cavity from the rest of the human body. As a result of this divide, there have been multiple factors that have allowed socially stratified oral health outcomes to manifest. This thesis examines the determinants of oral health disparities through a multidisciplinary lens (i.e. biology, public policy, infrastructure), and offers evidence of …

Dependent Care Fsas Work For Low- To Moderate-Income Families: 5 Action Steps For Policymakers, Sophia Fox-Dichter, Ellen Frank-Miller, Sloane Wolter

Social Policy Institute Research

Dependent Care Flexible Spending Accounts (DCFSAs) can help workers save money on child care expenses by using pre-tax dollars, but few employees actually use the accounts, particularly low- to moderate-income (LMI) employees, because:

• DCFSAs are difficult to understand; figuring out if they are possible to use and worth the trouble is a complex task for families.

• Families face a “double-hit” if they use the accounts – they have to set aside pre-tax dollars for child care expenses and then pay out-of-pocket before getting reimbursed.

• Using a DCFSA may require certainty about a year’s worth of child care …

Employer-Sponsored Small-Dollar Loans: An Assessment Of Take-Up, Engagement, And Outcomes, Ellen G. Frank-Miller Phd, Sophia Fox-Dichter Msw, Sloane Wolter Ab, Jenna Hampton Bsw, Mathieu Despard Phd, Msw, Geraldine Germain Msw

Social Policy Institute Research

Employees financial wellness program (EFWPs) are gaining in popularity as a strategy to address workers' financial challenges and goals beyond offering health and retirement benefits. Most workers say they are stressed about their finances¹ and a third are less productive at work because of this stress.² Although employers are increasingly interested in offering EFWPs, little research has been conducted concerning these workplace financial products and services.