ACA Policy Diffusion
David K. Jones, Julianna Pacheco, and Colleen M. Grogan, special issue editors Duke University Press, 2017
The contributors to this issue investigate the complex ways that policies of the Affordable Care Act (ACA) have diffused through the states over seven years of implementation. When the ACA was passed in 2010, states were given the option to set up their own health care exchanges, expand their Medicaid programs, and reform both their local public health and their health care delivery systems. These reforms significantly impacted citizens’ access to insurance. Contributors examine how local conditions account for variation in enrollment across states, analyze the evolution of Medicaid waivers in Republican-led states, show how early-adopting states affected later adopters, explore the role of public opinion in the diffusion of ACA policies, and argue for the importance of rhetorical framing when advocating in favor of the ACA.
Contributors. Frederick J. Boehmke, Timothy Callaghan, Rena Conti, Bruce A. Desmarais, Colleen M. Grogan, Jeffrey J. Harden, Lawrence Jacobs, David K. Jones, Andrew Karch, Elizabeth Maltby, Julianna Pacheco, Aaron Rosenthal, Abigail A. Rury, Phillip McMinn Singer, Craig Volden
Concerns about access to behavioral health care for military service members and their dependents living in geographically remote locations prompted research into how many in this population are remote and the effects of this distance on their use of behavioral health care. The authors conducted geospatial and longitudinal analyses to answer these questions and reviewed current policies and programs to determine barriers and possible solutions.
Completion of the Human Genome Project will make possible a staggering array of new medical technologies, including new diagnostic and screening tests for inherited disorders, gene therapies, and the ability to manipulate a person's inherited, non-disease traits. Most of the attention given to the social implications of these technologies has focused on their potential to harm the individual, for example, by denying employment or insurance.
This book explores instead the potential harm to society if we unfairly distribute the enormous benefits of genetic technologies. The resulting division of society into genetic haves and have-nots would undermine the basic foundation of Western democratic society—the belief in equality of opportunity.
This book explains, in terms that can be understood by the general reader, how DNA works, what the Human Genome Project is, what these genetic technologies are and what they promise, and how they could disrupt our democratic society.
In an original contribution to the literature, the book then discusses the alternatives for avoiding the creation of a genetic underclass, ranging from halting the Human Genome Project itself to making genetic technologies available without regard to ability to pay. The authors' provocative conclusion is that a lottery in which everyone has a chance to obtain access to these technologies is the only feasible option.
This book will be of interest to anyone who wishes to learn more about the Human Genome Project and the genetic revolution that it will create, as well as those who already are familiar with the project and are concerned about the social consequences of its scientific developments.
Affirmative action programs have significantly changed American medicine for the better, not only in medical school admissions and access to postgraduate training but also in bringing a higher quality of health care to all people. James L. Curtis approaches this important transition from historical, statistical, and personal perspectives. He tells how over the course of his medical education and career as a psychiatrist and professor--often as the first or only African American in his cohort--the status of minorities in the medical professions grew from a tiny percentage to a far more equitable representation of the American population.
Advancing arguments from his earlier book, Blacks, Medical Schools, and Society, Curtis evaluates the outcomes of affirmative action efforts over the past thirty years. He describes formidable barriers to minority access to medical-education opportunities and the resulting problems faced by minority patients in receiving medical treatment. His progress report includes a review of two thousand minority students admitted to U.S. medical schools in 1969, following them through graduation and their careers, comparing them with the careers of two thousand of their nonminority peers. These samples provide an important look at medical schools that, while heralding dramatic progress in physician education and training opportunity, indicates much room for further improvement.
A basic hurdle continues to face African Americans and other minorities who are still confined to segregated neighborhoods and inferior school systems that stifle full scholastic development. Curtis urges us as a nation to develop all our human resources through an expansion of affirmative action programs, thus improving health care for everyone.
James L. Curtis is Clinical Professor Emeritus of Psychiatry, Columbia University College of Physicians and Surgeons.
Beginning with the colonial era, Western biomedicine has radically transformed African medical beliefs and practices. Conversely, in using Western biomedicine, Africans have also transformed it. The African Transformation of Western Medicine and the Dynamics of Global Cultural Exchange contends that contemporary African medical systems—no less “biomedical” than Western medicine—in fact greatly enrich and expand the notion of biomedicine, reframing it as a global cultural form deployed across global networks of cultural exchange.
The book analyzes biomedicine as a complex and dynamic sociocultural form, the conceptual premises of which make it necessarily subject to ongoing change and development as it travels the globe. David Baronov captures the complexities of this cultural exchange by using world-systems analysis in a way that places global cultural processes on equal footing with political and economic processes. In doing so, he both allows the story of Africa’s transformation of “Western” biomedicine to be told and offers new insights into the capitalist world system.
Lucid and compellingly written, Patricia Siplon has immersed herself in the history and ongoing firestorms of how AIDS policies are influenced, fought over, and enacted in the United States. AIDS and the Policy Struggle in the United States is equally as engrossing and as revealing in its own way as And the Band Played On. With an initial chapter that clearly follows the tangled historical string from the first realizations of a medical emergency to today's overwhelming worldwide epidemical crisis, she goes on to look at how medical treatments have changed and grown; how blood policies were formed; how value-based debates raged and continue to rage over prevention; how communities developed to first respond to the crisis, and later organized to fight for health care; and finally-now that AIDS is recognized for the global crisis it is-how foreign policy is being shaped.
Invaluable for activists and anyone involved in fighting for the humane treatment of people with HIV/AIDS around the world, this is also an important and insightful guide to the how and what of public policy as it is fashioned out of the clay of U.S. democratic institutions.
In Ailing in Place, Michele Morrone explores the relationship between environmental conditions in Appalachia and health outcomes that are too often ascribed to individual choices only. She applies quantitative data to observations from environmental health professionals to frame the ways in which the environment, as a social determinant of health, leads to health disparities in Appalachian communities. These examples—these stories of place—trace the impacts of water quality, waste disposal, and natural resource extraction on the health and quality of life of Appalachian people.
Public Health is inextricably linked to place. Environmental conditions such as contaminated water, unsafe food, and polluted air are as important as culture, community, and landscape in characterizing a place and determining the health outcomes of the people who live there. In some places, the state of the environment is a consequence of historical activities related to natural resources and cultural practices. In others, political decisions to achieve short-term economic objectives are made with little consideration of long-term public health consequences.
In the United States, the entanglement of sports and education has persisted for over a century. Multimillion-dollar high school football stadiums, college coaches whose salaries are many times those of their institutions’ presidents, psychological and educational tolls on student-athletes, and high-profile academic scandals are just symptoms of a system that has come under increasing fire. Institutions large and small face persistent quandaries: which do they value more, academic integrity or athletic success? Which takes precedence: prioritizing elite teams and athletes, or making it possible for all students to participate in sports? How do we create opportunities for academic—not just athletic—development for players?
In Alternative Models of Sports Development in America, B. David Ridpath—a leading sports development researcher who has studied both the US system and the European club model—offers clear steps toward creating a new status quo. He lays out four possible alternative models that draw various elements from academic, athletic, and European approaches. His proposals will help increase access of all young people to the benefits of sports and exercise, allow athletes to also thrive as students, and improve competitiveness. The result is a book that will resonate with sports development professionals, academic administrators, and parents.
This report summarizes analysis in which the COMPARE microsimulation model was used to estimate how several potential changes to the Affordable Care Act, including eliminating the individual mandate and eliminating the law’s tax-credit subsidies, might affect 2015 individual market premiums and overall insurance coverage. The report also presents estimate how changes in young adult enrollment might affect 2015 individual market premiums.
The U.S. Department of Defense is considering a change in policy to allow transgender military personnel to serve openly. A RAND study examined the health care needs of transgender personnel, the costs of gender transition–related care, and the potential readiness implications of a policy change. The experiences of foreign militaries that permit transgender service members to serve openly also point to some best practices for U.S. policymakers.