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Reports

April 2019

Blue Shield of California Foundation (San Francisco, CA)

Blue Shield of California Foundation released a new report on domestic violence. Domestic violence negatively impacts every community in the United States, affecting one in three women and one in four men, with profound and enduring consequences. In addition, one in five children witnesses parental assault, leading to increased risk of experiencing or perpetrating domestic violence as adults, and continuing the cycle of violence.

This new report uses a life course analysis—which is based on the premise that health is a consequence of multiple determinants and contexts that change as a person develops—to focus on the risk factors for domestic violence perpetration and to highlight opportunities for prevention.

The foundation commissioned this research based on our belief that an increased understanding of the root causes of domestic violence will lead to appropriate interventions to effectively prevent violence and end the cycle.

Contact: Christine Maulhardt Vaughan
Phone: 415.229.6145
Email: christinevaughan@blueshieldcafoundation.org


HealthSpark Foundation (Colmar, PA)

A new report was released on racial disparities in the homeless system in Montgomery County, PA. With funding from HealthSpark Foundation, Your Way Home Montgomery County hired The Center for Social Innovation to understand racial demographics in the county’s homeless population and identify ways to better serve people of color. The resulting report included some startling statistics including that African Americans make up a much greater portion of the homeless population (51 percent) than the county population in total (10 percent). The report also provides 27 recommendations for Your Way Home to reduce racial disparities and better serve people of color who experience homelessness.

Contact: Tamela Luce, MPA
Phone: 215.716.5400
Email: tluce@healthspark.org


Kentucky Voices for Health (Louisville, KY)

The University of Louisville’s Commonwealth Institute of Kentucky released a report on the Affordable Care Act (ACA)’s impact on Kentucky’s health and economy since 2014. The report documents Kentucky’s numerous health and economic gains that largely hang in the balance of the federal court case Stewart v. Azar, brought by sixteen Kentuckians against the Centers for Medicare & Medicaid Services (CMS), which re-approved Governor Bevin’s 1115 Medicaid waiver, called Kentucky HEALTH, on November 20, 2018.

As Kentucky weathers numerous threats to its health care safety net, this report offers a new baseline to measure changes in insurance coverage, access to care, health outcomes, and economic impact.

Baseline Highlights

  • Insurance coverage for Kentuckians increased dramatically under the ACA, largely due to the state’s decision to implement Medicaid Expansion for those living at or below 138 percent of the Federal Poverty Level. Kentucky’s uninsured rate fell from 20.4 percent in 2013 to 7.8 percent in 2016–the largest decline in the country.
  • Access to care increased dramatically under the ACA due to expanded Medicaid, protections for pre-existing conditions, new individual plan offerings with more comprehensive coverage, and income-based tax credits.
  • Each Medicaid dollar spent in the health care system generates a return of $1.35 to $1.80 to Kentucky’s economy.
  • More than 16,000 jobs have been created in the health care and social services sectors since 2014.
  • Expansion states have increased Medicaid budgets; however, benefits such as reduced uncompensated care and job growth in health and social services offset the increase.

The report found that numerous studies associate expanded coverage with improved overall health, increased access to care, higher rates of preventive care, less reliance on emergency room care, better chronic disease management, and a decrease in self-report of psychological distress and poor mental health days. More affordable access to care has also led to a decrease in health care related debt, which used to be the number one cause of personal bankruptcy.

Other states, such as Indiana and Arkansas, have implemented similar waivers with disastrous results. In Indiana, 55 percent of those subject to premium payments failed to meet the requirement, and more than 18,000 in Arkansas lost coverage for failing to meet reporting requirements in 2018. In both states, beneficiaries cited confusion and lack of awareness as reasons for their inability to comply.

InsureKY is a statewide coalition of nonprofits formed to promote more affordable health insurance, better care, and stronger consumer protections for all Kentuckians, including Homeless and Housing Coalition of Kentucky, Kentucky Center for Economic Policy, Kentucky Equal Justice Center, Kentucky Voices for Health, and Mental Health America of Kentucky. 

Contact: Emily Beauregard
Phone: 502.882.0584
Email: emily.beauregard@kyvoicesforhealth.org


NYS Health (New York, NY)

Following a hospitalization for an illness or injury, one in five patients need additional health care services for their recovery, typically in a nursing home or rehabilitation facility, through outpatient therapy, or at home. For patients and their families, however, choosing where to seek post-hospital care can be among the hardest decisions they have to make. Although there may be resources available, many patients aren't aware of their options or feel rushed in their decisionmaking.

A new report by the United Hospital Fund (UHF), supported by NYSHealth, is the final installment in UHF's four-part "Difficult Decisions" series, based on a yearlong inquiry to better understand why hospital discharge planning can fall short despite well-intentioned efforts by hospital staff. The new report explores how fragmented care settings and payment systems, unclear regulations, and information gaps all play a role in limiting the guidance hospital staff can provide patients and their families in arranging post-acute care. It also outlines strategies for change in six key areas: engaging patients and families; improving discharge planning; bridging health system silos; addressing regulatory and payment policy barriers; enhancing public information and transparency; and increasing public awareness.

Email: info@nyshealth.org


RCHN Community Health Foundation (New York, NY)

Community health centers today serve more than one in five people in the United States living with HIV/AIDS and receiving care for their condition. As a critical part of the HIV/AIDS prevention and treatment system, health centers will need sustained funding and additional resources to support the Trump Administration’s recent initiative to stop new HIV infections in the United States by 2030. In Medicaid non-expansion states, health centers will face an especially great challenge, given Medicaid’s role in funding health care for people with or at risk for HIV. These are the key findings from an analysis published by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University Milken Institute School of Public Health.

The Trump Administration’s newly announced initiative calls for a significant expansion of health care, including outreach to at-risk populations, services aimed at preventing new infections, and ongoing care and treatment for people living with an HIV diagnosis. In order to strengthen HIV-related care, community health centers nationwide will need to increase prevention, treatment, and management services and remain sustainable, the researchers write.

The administration’s initiative calls for targeting high-burden states, counties, rural areas, and cities, including seven states with substantial rural HIV burden, 48 counties in 19 states, Washington, DC, and San Juan, Puerto Rico. While all community health centers will face some challenges in ramping up services, sustainable expansion will be especially difficult in the 10 high-burden states that have not adopted the Affordable Care Act Medicaid expansion, the authors of the analysis conclude.

In Alabama, Florida, Georgia, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, and Texas, thousands of low-income, at-risk people may not be covered by Medicaid, which increases the risk of inadequate care and places additional burdens on health centers to identify sources of sustainable financing to support expanded care. The analysis recommends a 10-year reauthorization of the Health Center Fund, with additional funding targeted to HIV/AIDS prevention and treatment efforts, as well as expanded Medicaid coverage in the 10 high-burden, non-expansion states.

To read the analysis, “Community Health Centers and the President’s HIV Initiative: Issues and Challenges Facing Health Centers in High-Burden States and Communities,” click here.

Contact: Kathy Fackelmann
Phone: 202.994.8354
Email: kfackelmann@gwu.edu