Levels of Employment and Community Engagement among Low-Income Adults: Implications for Medicaid Work Requirements.

CONTEXT: Twenty states are pursuing community engagement requirements ("work requirements") in Medicaid, though legal challenges are ongoing. While most nondisabled low-income individuals work, it is less clear how many engage in the required number of hours of qualifying community engagement activities and what heterogeneity may exist by race/ethnicity, age, and gender. The authors' objective was to estimate current levels of employment and other community engagement activities among potential Medicaid beneficiaries. METHODS: The authors analyzed the US Census Bureau's national time-use survey data for the years 2015 through 2018. Their main sample consisted of nondisabled adults between 19 and 64 years with family incomes less than 138% of the federal poverty level (N = 2,551). FINDINGS: Nationally, low-income adults who might become subject to Medicaid work requirements already spent an average of 30 hours per week on community engagement activities. However, 22% of the low-income population-particularly women, older adults, and those with less education-would not currently satisfy a 20-hour-per-week requirement. CONCLUSIONS: Although the majority of potential Medicaid beneficiaries already meet community engagement requirements or are exempt, 22% would not currently satisfy a 20-hour-per-week requirement and therefore could be at risk for losing coverage.

"A rising tide floats all boats": The role of neighborhood collective efficacy in responding to child maltreatment.

BACKGROUND: Nearly one-quarter of the approximately 400,000 reports to child protective services originating from non-mandated reporters come from neighbors. Understanding factors leading non-mandated reporters to contact authorities is important because if modifiable, they might serve as intervention targets to promote reporting of suspected maltreatment. OBJECTIVE: Investigate associations between neighbors' reported responses to scenarios involving children in need, child/teen misbehavior, and suspected maltreatment with individual and neighborhood characteristics, including neighborhood collective efficacy, fear of victimization, and fear of retaliation. HYPOTHESIS: Increased collective efficacy would be associated with increased likelihood of neighbors taking action in response to the situation. PARTICIPANTS & SETTING: 400 caregivers of minors in Cleveland, OH, USA living in 20 census tracts. METHODS: Generalized linear mixed-effects modeling. RESULTS: Analyses adjusted for covariates confirmed our primary hypothesis: a 1-unit increase in the collective efficacy measure was associated with a 64% increase in the odds of neighbors taking action compared to doing nothing (odds ratio = 1.64, 95th percentile confidence interval 1.41-1.92). Also, participants with less than a high-school education had 36% greater odds of reporting their neighbors taking action compared to more educated participants. An interaction effect between participants' fear of victimization in their neighborhood, but not fear of retaliation, was also observed: the effect of collective efficacy on the odds of neighbors taking action was substantially greater among residents expressing moderate and high fear of victimization. CONCLUSION: Enhancing collective efficacy may be an effective strategy for fostering community response to suspected child maltreatment and other situations of a child in need because it may catalyze a variety of positive responses to these situations.

Employment-based retirement plan participation: geographic differences and trends, 2010.

LATEST DATA: This Issue Brief examines the level of participation by workers in public- and private-sector employment-based pension or retirement plans, based on the U.S. Census Bureau's March 2011 Current Population Survey (CPS), the most recent data currently available (for year-end 2010). SPONSORSHIP RATE: Among all working-age (21-64) wage and salary employees, 54.2 percent worked for an employer or union that sponsored a retirement plan in 2010. Among full-time, full-year wage and salary workers ages 21-64 (those with the strongest connection to the work force), 61.6 percent worked for an employer or union that sponsors a plan. PARTICIPATION LEVEL: Among full-time, full-year wage and salary workers ages 21-64, 54.5 percent participated in a retirement plan. TREND: This is virtually unchanged from 54.4 percent in 2009. Participation trends increased significantly in the late 1990s, and decreased in 2001 and 2002. In 2003 and 2004, the participation trend flattened out. The retirement plan participation level subsequently declined in 2005 and 2006, before a significant increase in 2007. Slight declines occurred in 2008 and 2009, followed by a flattening out of the trend in 2010. AGE: Participation increased with age (61.4 percent for wage and salary workers ages 55-64, compared with 29.2 percent for those ages 21-24). GENDER: Among wage and salary workers ages 21-64, men had a higher participation level than women, but among full-time, full-year workers, women had a higher percentage participating than men (55.5 percent for women, compared with 53.8 percent for men). Female workers' lower probability of participation among wage and salary workers results from their overall lower earnings and lower rates of full-time work in comparison with males. RACE: Hispanic wage and salary workers were significantly less likely than both white and black workers to participate in a retirement plan. The gap between the percentages of black and white plan participants that exists overall narrows when compared across earnings levels. GEOGRAPHIC DIFFERENCES: Wage and salary workers in the South and West had the lowest participation levels (Florida had the lowest percentage, at 43.7 percent) while the upper Midwest, Mid-Atlantic, and Northeast had the highest levels (West Virginia had the highest participation level, at 64.2 percent). OTHER FACTORS: White, more highly educated, higher-income, and married workers are more likely to participate than their counterparts.

Gaps in employer coverage: lack of supply or lack of demand?

According to data from the May 1988 Current Population Survey, 18 percent of workers are in firms that do not offer health insurance. The question explored here is whether the absence of insurance in these firms is related to lack of supply (that is, a failure of the firm to offer the benefit because the price it faces is too high or the benefit too low) or lack of demand (that is, employees in these firms would not purchase the insurance even if it were offered). Characteristics hypothesized to affect the supply of insurance by firms (size, rate of turnover, and union status) are found to distinguish whether or not firms offer insurance. The data show near-universal acceptance of group insurance among employees offered the opportunity to participate. Both of these factors suggest a failure of supply. However, employees in firms that do not offer insurance are young, low-wage earners who work part time. These are also characteristics of workers who do not purchase group insurance even when it is offered, suggesting that many of the workers who are not offered group insurance would not participate in a plan even if the supply failure were corrected. These findings have implications for the effectiveness of voluntary strategies to improve access, but they also raise concern over the fairness to workers of mandates requiring that they purchase coverage.

Kentucky physicians and politics.

Approximately 19% of Kentucky Physicians are KEMPAC members or contribute to state legislative and Gubernatorial candidates. This limited study of political activity indicates that a small percentage of physicians participate in the political process. Despite the small number of contributors to state legislative candidates, KMA's legislative and lobbying effort is highly effective and members receive high quality service and representation in the political arena.

Retirement plan participation and features and standard of living of Americans 55 or older.

This Issue Brief is the third in a series of Employee Benefit Research Institute (EBRI) publications based on data collected in 1998 and released in 2002 as the Retirement and Pension Plan Coverage Topical Module of the 1996 Survey of Income and Program Participation (SIPP). This report completes the series by examining the survey's more detailed questions concerning workers' employment-based retirement plans. Specifically, it examines the percentage of workers who are participating in a plan, and also workers' reasons for not participating in a plan when working in a job where a plan is sponsored; the features of, or decisions made concerning salary reduction plans; historical participation in employment-based retirement plans; and a comparison of the standard of living of individuals age 55 or older with their living standard in their early 50s. As of June 1998, 64.3 percent of wage and salary workers age 16 or older worked for an employer or union that sponsored any type of retirement plan (defined contribution or defined benefit) for any of its employees or members (the "sponsorship rate"). Almost 47 percent of these wage and salary workers participated in a plan (the "participation rate"), with 43.2 percent being entitled to a benefit or eligible to receive a lump-sum distribution from a plan if their job terminated at the time of survey (the "vested rate"). The predominant reason for choosing not to participate in a retirement plan was that doing so was unaffordable. The eligible participation rate for salary reduction plans was 81.4 percent. Fifty-six percent of all workers have participated in some type of retirement plan sometime during their work life through 1998. For those ages 51-60, almost 72 percent have ever participated in a plan. The median account balance in salary reduction plans in 1998 was $14,000. In 1998, 12.9 percent of salary reduction plan participants eligible to take a loan had done so, and the average outstanding loan balance was $5,196. Nearly 80 percent of those age 55 or older reported that their standard of living is about the same or better now than it was when they were in their early 50s. The incidence of both pension income and health insurance from a former employer had a significant impact on retirees' ability to maintain their standard of living. In addition, those who spent their entire most recent lump-sum distribution were more likely to have a much worse standard of living in retirement than those who rolled over their entire most recent distribution.

Consumer-directed health care for persons under 65 years of age with private health insurance: United States, 2007.

Data from the National Health Interview Survey. In 2007, 17.3% of persons under 65 years of age with private health insurance were enrolled in a high deductible health plan (HDHP), 4.5% were enrolled in a consumer-directed health plan (CDHP), and 14.8% were in a family with a flexible spending account for medical expenses (FSA); Persons with directly purchased private health insurance were more likely to be enrolled in a high deductible plan than those who obtained their private health insurance through an employer or union; Higher incomes and higher educational attainment were associated with greater uptake and enrollment in HDHPs, CDHPs, and FSAs. National attention to consumer-directed health care has increased following the enactment of the Medicare Prescription Drug Improvement and Modernization Act of 2003 (P.L. 108-173), which established tax-advantaged health savings accounts (1). Consumer-directed health care enables individuals to have more control over when and how they access care, what types of care they use, and how much they spend on health care services. This report includes estimates of three measures of consumer-directed private health care. Estimates for 2007 are provided for enrollment in high deductible health plans (HDHPs), plans with high deductibles coupled with health savings accounts also known as consumer-directed health plans (CDHPs), and the percentage of individuals with private coverage whose family has a flexible spending account (FSA) for medical expenses, by selected sociodemographic characteristics.

Sistema de salud de El Salvador / The health system of El Salvador

En este artículo se describen las condiciones de salud de la población salvadoreña y, con mayor detalle, el sistema de salud de El Salvador, incluyendo su estructura y cobertura, sus fuentes de financiamiento, los recursos físicos, materiales y humanos con los que cuenta, las actividades de rectoría que desarrolla el Ministerio de Salud Pública y Asistencia Social, y la participación de los usuarios de los servicios de salud en la evaluación del sistema. Asimismo se discuten las más recientes innovaciones implantadas por el sistema salvadoreño de salud, dentro de las que destacan la aprobación de la Ley de Creación del Sistema Nacional de Salud que busca ampliar la cobertura, disminuir las desigualdades y mejorar la coordinación de las instituciones públicas de salud.

This paper describes the health conditions in El Salvador and the main característics of the Salvadoran health system, including its structure and coverage, its financial sources, the physical, material and human resources available, the stewardship functions developed by the Ministry of Public Health, and the participation of health care users in the evaluation of the system. It also discusses the most recent policy innovations including the approval of the Law for the Creation of the National Health System, which intends to expand coverage, reduce health inequalities and improve the coordination of public health institutions.

Participação, controle social e exercício da cidadania: a (des)informação como obstáculo à atuação dos conselheiros de saúde / Participation, social control and exercise of citizenship: (dis)information as an obstacle to health counselors

Para fortalecer o exercício do controle social na política de saúde, é necessário o efetivo conhecimento do SUS; da legislação; da realidade epidemiológica, assistencial, financeira, política, etc. Neste sentido, o presente estudo objetivou dimensionar o nível de informação e conhecimento dos Conselheiros Municipais de Saúde de Viçosa - MG, em relação a suas atribuições e funções. Os elementos de análise do estudo foram: entrevistas semiestruturadas, no período de abril a julho de 2006, e a observação direta das reuniões. Do total de 44 conselheiros, 34 (77,3 por cento) foram entrevistados; destes, 17 (50 por cento) são representantes dos usuários, oito (23,5 por cento) são representantes do Governo Municipal, sete (20,6 por cento) são representantes dos prestadores de serviço e dois (5,9 por cento) são representantes dos profissionais de saúde. Observa-se que 41,2 por cento de conselheiros desconhecem o Regimento Interno, o que poderia estar dificultando o exercício de suas competências. O Plano Municipal de Saúde não é utilizado como um instrumento de consulta para avaliação das ações e serviços de saúde pelos conselheiros, pois a maioria (73,5 por cento) afirma não o ter lido. A possibilidade de os conselheiros contribuírem para fiscalizar as execuções financeiras e orçamentárias do Fundo de Saúde Municipal se torna restrita, pois 67,6 por cento dos entrevistados não sabem analisar o Relatório de Gestão; 79,4 por cento dos conselheiros nunca receberam capacitação e 85 por cento relataram sentir necessidade de ser capacitados para atuar no conselho. A participação e o controle social conferem transparência ao bem público e, partindo do pressuposto que só se pode controlar aquilo que se conhece, justifica-se a necessidade contínua de cursos de capacitação para os conselheiros.

To strengthen the exercise of social control in health politics, it is really necessary to know the Unified Health System; the legislation; the epidemiological reality, assistance, financial, political, and so on. In this sense, this paper aims to analyze the level of information and knowledge of the Municipal Health Counselors in the city of Viçosa, Minas Gerais State, concerning their attributions and functions. The elements of analysis of the study were semi-structured interviews conducted from April to July 2006, and the direct observation of meetings. From 44 counselors, 34 (77.3 percent) were interviewed, 17 (50 percent) are users' representatives; eight (23.5 percent) are representatives of the municipal government; seven (20.6 percent) are representatives of the service; and two (5.9 percent) are representatives of health professionals. It can be noticed that 41.2 percent of counselors ignore the Internal Regiment, what could hinder the fulfillment of their competences. The health plan is not used for evaluation of health actions and services for the counselors, because most of them (73.5 percent) declared not having read it. The possibility of counselors helping supervise the financial and budgetary executions of the Municipal Health Fund restrains it, since 67.6 percent of the interviewees cannot analyze the administration report; 79.4 percent of the counselors never received training and 85 percent told need being qualified to act in the council. Participation and social control provide transparence to the public good and, based on the premise that one can only control what one knows, the need of continuing training courses for counselors is confirmed.