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5.
Am J Law Med ; 45(2-3): 106-129, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31722633

RESUMO

Beginning on inauguration day, President Trump has attempted an executive repeal of the Affordable Care Act. In doing so, he has tested the limits of presidential power. He has challenged the force of institutional and non-institutional constraints. And, ironically, he has helped boost public support for the ACA's central features. The first two sections of this article respectively consider the use of the President's tools to advance and to subvert health reform. The final two sections consider the forces constraining the administration's attempted executive repeal. I argue that the most important institutional constraint, thus far, is found in multifaceted actions by states - and not only blue states. I also highlight the force of public voices. Personal stories, public opinion, and 2018 election results - bolstered by presidential messaging - reflect growing support for government-grounded options and statutory coverage protections. Indeed, in a polarized time, "refine and revise" seems poised to supplant "repeal and replace" as the conservative focus countering liberal pressure for a common option grounded in Medicare.


Assuntos
Pessoal Administrativo , Reforma dos Serviços de Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act/legislação & jurisprudência , Política , Governo Federal , Financiamento Governamental/legislação & jurisprudência , Financiamento Governamental/organização & administração , Regulamentação Governamental , Reforma dos Serviços de Saúde/história , História do Século XX , História do Século XXI , Humanos , Reembolso de Seguro de Saúde/legislação & jurisprudência , Jurisprudência , Medicaid/legislação & jurisprudência , Medicaid/organização & administração , Medicare/legislação & jurisprudência , Medicare/organização & administração , Patient Protection and Affordable Care Act/organização & administração , Cobertura de Condição Pré-Existente , Opinião Pública , Governo Estadual , Estados Unidos
11.
Anthropol Med ; 26(3): 280-295, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31550907

RESUMO

As immigration and health policy continue to be contentious topics globally, anthropologists must examine how policy creates notions of health-related deservingness, which may have broad consequences. This paper explores hidden relationships between immigration enforcement laws and the most recent health reform law in the United States, the Patient Protection and Affordable Care Act (ACA), which excludes immigrants from certain types of health services. Findings in this paper show how increasingly harsh immigration enforcement efforts provide health facilities a 'license to discriminate' against undocumented immigrants, resulting in some facilities 'dumping' undocumented patients or unlawfully transferring them from one hospital to another. Due to changes made through the ACA, patient dumping disproportionately complicates public hospitals' financial viability and may have consequences on public facilities' ability to provide care for all indigent patients. By focusing on the converging consequences of immigrant policing and health reform, findings in this paper ultimately show that examining deservingness assessments and how they become codified into legislation, which I call 'deservingness projects', can reveal broader elements of state power and demonstrate how such power extends beyond targeted populations. Exercises of state power can thus have 'spillover effects' that harm numerous vulnerable populations, highlighting the importance of medical anthropology in documenting the broad, hidden consequences of governmental actions that construct populations as undeserving of social services.


Assuntos
Emigração e Imigração/legislação & jurisprudência , Reforma dos Serviços de Saúde/legislação & jurisprudência , Hispano-Americanos/legislação & jurisprudência , Transferência de Pacientes/legislação & jurisprudência , Imigrantes Indocumentados/legislação & jurisprudência , Antropologia Médica , Direitos Humanos/legislação & jurisprudência , Humanos , Patient Protection and Affordable Care Act , Estados Unidos/etnologia
14.
Med Care ; 57(9): 710-717, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31295167

RESUMO

BACKGROUND: The State Innovation Models (SIM) Initiative invested $254 million in 6 states in Round 1 to accelerate delivery system and payment reforms. OBJECTIVE: The objective of this study was to examine the association of early SIM implementation and diagnosed diabetes prevalence among adults and hospitalization rates among diagnosed adults. RESEARCH DESIGN: Quasi-experimental design compares diagnosed diabetes prevalence and hospitalization rates before SIM (2010-2013) and during early implementation (2014) in 6 SIM states versus 6 comparison states. County-level, difference-in-differences regression models were estimated. SUBJECTS: The annual average of 4.5 million adults aged 20+ diagnosed with diabetes with 1.4 million hospitalizations in 583 counties across 12 states. MEASURES: Diagnosed diabetes prevalence among adults and hospitalization rates per 1000 diagnosed adults. RESULTS: Compared with the pre-SIM period, diagnosed diabetes prevalence increased in SIM counties by 0.65 percentage points (from 10.22% to 10.87%) versus only 0.10 percentage points (from 9.64% to 9.74%) in comparison counties, a difference-in-differences of 0.55 percentage points. The difference-in-differences regression estimates ranged from 0.49 to 0.53 percentage points (P<0.01). Regression results for ambulatory care-sensitive condition and all-cause hospitalization rates were inconsistent across models with difference-in-differences estimates ranging from -5.34 to -0.37 and from -13.16 to 0.92, respectively. CONCLUSIONS: SIM Round 1 was associated with higher diagnosed diabetes prevalence among adults after a year of implementation, likely because of SIM's emphasis on detection and care management. SIM was not associated with lower hospitalization rates among adults diagnosed with diabetes, but the SIM's long-term impact on hospitalizations should be assessed.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Diabetes Mellitus/diagnóstico , Reforma dos Serviços de Saúde/legislação & jurisprudência , Implementação de Plano de Saúde/estatística & dados numéricos , Adulto , Idoso , Assistência à Saúde/legislação & jurisprudência , Diabetes Mellitus/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Inovação Organizacional , Prevalência , Governo Estadual , Estados Unidos/epidemiologia , Adulto Jovem
15.
Int J Equity Health ; 18(1): 106, 2019 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272460

RESUMO

Overcoming continuing polarization regarding judicial enforcement of health rights in Latin America requires clarifying divergent normative and political premises, addressing the lack of reliable empirical data, and establishing the conditions for fruitful inter-sectoral, inter-disciplinary dialogue.


Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Equidade em Saúde/legislação & jurisprudência , Prioridades em Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , América Latina , Programas Nacionais de Saúde/legislação & jurisprudência , Fatores Socioeconômicos
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