Automating benefits delivery: lowering health insurance costs for unemployment insurance recipients.

To provide financial relief to those affected by the COVID-19 pandemic, from July to December 2021, the American Rescue Plan Act temporarily expanded eligibility for cost-sharing reduction (CSR) silver 94 plans that cover 94% of medical costs for unemployment insurance (UI) recipients enrolled in the Affordable Care Act (ACA) Marketplaces. In June 2021, California's ACA Marketplace automatically redetermined eligibility and enrollment for 79 645 UI recipients so the enhanced subsidies would be applied without any action required among program participants. Using administrative data from California and a difference-in-differences design, we found that enrollees automatically moved to CSR silver 94 plans for the second half of 2021 saved $295 in premiums and $180 in out-of-pocket expenses (or $475 in total). These findings can inform state and federal policymakers exploring ways of automating benefits delivery for consumers already engaging with other safety-net programs to increase health insurance affordability.

The Affordability Of Individual-Market Health Insurance In California Under The American Rescue Plan Act, 2021.

In 2021 the American Rescue Plan Act increased premium subsidies for people purchasing insurance from the Affordable Care Act Marketplaces and provided zero-premium Marketplace plans that covered 94 percent of medical care costs (silver 94 plans) to recipients of unemployment compensation. Using data on adult enrollees in on- and off-Marketplace individual plans in California in 2021, we found that 41 percent reported incomes at or below 400 percent of the federal poverty level and that 39 percent reported living in households receiving unemployment compensation. Overall, 72 percent of enrollees reported having no difficulty paying premiums, and 76 percent reported that out-of-pocket expenses did not affect their seeking of medical care. The majority of enrollees eligible for plans with cost-sharing subsidies were enrolled in Marketplace silver plans (56-58 percent). Many of these enrollees, however, may have missed opportunities for premium or cost-sharing subsidies: 6-8 percent enrolled in off-Marketplace plans and were more likely to have difficulty paying premiums than those in Marketplace silver plans, and more than one-quarter enrolled in Marketplace bronze plans and were more likely to delay care because of cost than those in Marketplace silver plans. In the coming era of expanded Marketplace subsidies under the Inflation Reduction Act of 2022, helping consumers identify high-value and subsidy-eligible plans could mitigate remaining affordability problems.

The effects of the American Rescue Plan Act on racial equity in health insurance coverage.

OBJECTIVE: To evaluate the effects on racial disparities in health insurance coverage from the changes in the Premium Tax Credit (PTC) implemented in March 2021 as part of the American Rescue Plan Act (ARPA). DATA SOURCES AND STUDY SETTING: We use nationally representative individual-level data from the Household Pulse Survey (HPS), which provides demographic, economic, and health insurance information for United States residents during the period April 2020-August 2022. STUDY DESIGN: While the PTC changes applied to all states, the 14 states that did not expand Medicaid received substantially more benefits than the expansion states since they had more uninsured individuals eligible for the PTC than the expansion states. In our analysis, the treatment (control) group includes all Medicaid nonexpansion (expansion) states. We use a difference-in-difference regression analysis to estimate the increase in the probability of insurance coverage after the expansion of the PTC. Furthermore, we conduct sensitivity and heterogeneity analyses. DATA COLLECTION/EXTRACTION METHODS: We focus on survey respondents ages 18-64. PRINCIPAL FINDINGS: The expanded PTC increased the probability of an individual having coverage through the Health Insurance Exchange (HIX) in a nonexpansion state by 0.95 (95% CI: 0.6136, 1.2900), 1.75 (95% CI: 1.1795, 2.3291), and 1.75 (95% CI: 1.1815, 2.3269) percentage points among White, Black, and Hispanic respondents, respectively. It also increased overall health insurance coverage among all groups. CONCLUSIONS: The expanded PTC boosted HIX and overall health insurance coverage and reduced racial disparities.

Nursing home infection control strategies during the COVID-19 pandemic.

BACKGROUND: The American Rescue Plan Act of 2021 awarded $500 million toward scaling "strike teams" to mitigate the impact of Coronavirus Disease 2019 (COVID-19) within nursing homes. The Massachusetts Nursing Facility Accountability and Support Package (NFASP) piloted one such model during the first weeks of the pandemic, providing nursing homes financial, administrative, and educational support. For a subset of nursing homes deemed high-risk, the state offered supplemental, in-person technical infection control support. METHODS: Using state death certificate data and federal nursing home occupancy data, we examined longitudinal all-cause mortality per 100,000 residents and changes in occupancy across NFASP participants and subgroups that varied in their receipt of the supplemental intervention. RESULTS: Nursing home mortality peaked in the weeks preceding the NFASP, with a steeper increase among those receiving the supplemental intervention. There were contemporaneous declines in weekly occupancy. The potential for temporal confounding and differential selection across NFASP subgroups precluded estimation of causal effects of the intervention on mortality. CONCLUSIONS: We offer policy and design suggestions for future strike team iterations that could inform the allocation of state and federal funding. We recommend expanded data collection infrastructure and, ideally, randomized assignment to intervention subgroups to support causal inference as strike team models are scaled under the direction of state and federal agencies.

Changes in Food Security, Healthfulness, and Access During the Coronavirus Disease 2019 Pandemic: Results From a National United States Survey.

Background: Coronavirus disease 2019 (COVID-19) disrupted access to food and adequate nutrition and the types of foods consumed. However, little empiric data exists on the changes in American's food and nutrition habits 2 y into the pandemic. Objectives: To assess current and altered food choices ∼2 y into the COVID-19 pandemic in the months after historic public pandemic relief. Methods: A national sample of 1878 United States adults balanced by age, sex, race/ethnicity, and income completed a one-time, online, semi-quantitative, 44-item questionnaire in Fall 2021 asking about the demographics, COVID-19 food choice changes (including free-text), and consumer priorities. This analysis investigates COVID-19 impacts on food security, healthfulness, and access. Results: More than 35% of respondents reported improved food security and >45% reported improved food healthfulness compared with prepandemic status. Improvement was reported in more than 30% of Black/African-American and Hispanic/Latinx adults, adults with lower annual income, and female sex, despite over 75% reporting reduced choice of where to eat or buy food. The pandemic offered occasion for many to improve diet, but a similar number expressed that the pandemic destabilized healthy habits. Conclusions: Our novel findings suggest that by late 2021, most Americans had improved food security and food choice healthfulness, despite reduced access to food service and retail, although with worsening among a meaningful proportion of Americans as well as heterogeneity in these changes. Vigorous federal, state, city, and community responses to the pandemic may have played a role in improving the food security and food choice healthfulness during the COVID-19 pandemic. Health crises differently impact health behaviors, but when accompanied by vigorous civic and community response, food security, and food healthfulness can be fortified.

Amplifying Advocacy for Student Health and School Nursing Services.

Annually, the National Association of School Nurses (NASN) sets advocacy goals, including legislative and policy priorities. Activities this past year continued to focus on assistance for school nurses to manage the ongoing pandemic by providing for additional school nurses and supplies. In addition, NASN advocated for legislation to provide grants for school nurses in Title 1 schools, to reduce tobacco use, and to address social determinants of health. This article provides a brief summary of NASN's 2021-2022 national advocacy efforts.