ACA Medicaid Expansion Associated With Increased Medicaid Participation and Improved Health Among Near-Elderly: Evidence From the Health and Retirement Study.

The Affordable Care Act (ACA) dramatically expanded health insurance, but questions remain regarding its effects on health. We focus on older adults for whom health insurance has greater potential to improve health and well-being because of their greater health care needs relative to younger adults. We further focus on low-income adults who were the target of the Medicaid expansion.

Evidence of Racial and Geographic Disparities in the Use of Medicare Observation Stays and Subsequent Patient Outcomes Relative to Short-Stay Hospitalizations.

Purpose: To examine racial and geographic disparities in the use of-and outcomes associated with-Medicare observation stays versus short-stay hospitalizations.

Methods: We used 2007-2010 fee-for-service Medicare claims, including 3,555,994 observation and short-stay hospitalizations for individuals over age 65. We estimated linear probability models with hospital fixed effects to identify within-facility disparities in observation stay use, and estimated in-hospital mortality, and 30- and 90-day post-discharge mortality, return ED visits, and hospital readmissions as a function of placement in observation using linear probability models, propensity-score matching, and interaction terms.

Costs of a Staff Communication Intervention to Reduce Dementia Behaviors in Nursing Home Care.

Context: Persons with Alzheimer's disease and other dementias experience behavioral symptoms that frequently result in nursing home (NH) placement. Managing behavioral symptoms in the NH increases staff time required to complete care, and adds to staff stress and turnover, with estimated cost increases of 30%. The Changing Talk to Reduce Resistivenes to Dementia Care (CHAT) study found that an intervention that improved staff communication by reducing elderspeak led to reduced behavioral symptoms of dementia or resistiveness to care (RTC).

The Increasing Use of Cannabis Among Older Americans: A Public Health Crisis or Viable Policy Alternative?

Cannabis use among older Americans is increasing. Although much of this growth has been attributed to the entry of a more tolerant baby boom cohort into older age, recent evidence suggests the pathways to cannabis are more complex. Some older persons have responded to changing social and legal environments and are increasingly likely to take cannabis recreationally.

Prescription drug coverage and chronic pain.

Chronic pain is one of the most common chronic conditions affecting more than 50 % of older adults. While pain management can be quite complex, prescription drugs are the most commonly used treatment modality. In this study, I examine whether increased access to prescription drugs due to the introduction of the Medicare Part D program in 2006 led to better management of pain among the elderly.

The Role of Medical Expenditure Risk in Portfolio Allocation Decisions.

Economic theory suggests that medical spending risk affects the extent to which households are willing to accept financial risk, and consequently their investment portfolios. In this study, we focus on the elderly for whom medical spending represents a substantial risk. We exploit the exogenous reduction in prescription drug spending risk because of the introduction of Medicare Part D in the U.

Outcomes associated with observation versus short-stay admission among chest pain patients in the Veterans Health Administration.

Background: To determine the extent to which 30- and 90-day hospital readmission and mortality rates differ as a function of whether a chest pain patient is placed in observation status or admitted to the hospital for a short-stay (<48 h).

Methods: Using 114,043 observation stays and short-stay admissions for chest pain at Veterans Health Administration hospitals between 2005 and 2013, we estimated event-level logistic regression models using a generalized estimating equation framework to predict 30 and 90-day readmissions and mortality as a function of whether the patient had an observation stay or a short-stay admission. We also adjusted for a variety of patient characteristics and unobserved time-invariant hospital factors.

Chest Pain Patients at Veterans Hospitals Are Increasingly More Likely to Be Observed Than Admitted for Short Stays.

Observation stays are an outpatient service used to diagnose and treat patients for extended periods of time while a decision is made regarding inpatient admission or discharge. Although the use of observation stays is increasing, little is known about which patients are observed and which are admitted for similar periods of time as inpatients. The aim was to identify patient characteristics associated with being observed rather than admitted for a short stay (<48 hours) within the Veterans Health Administration (VHA).

Patient, hospital, and local health system characteristics associated with the use of observation stays in veterans health administration hospitals, 2005 to 2012.

Recent studies have documented that a significant increase in the use of observation stays along with extensive variation in patterns of use across hospitals.The objective of this longitudinal observational study was to examine the extent to which patient, hospital, and local health system characteristics explain variation in observation stay rates across Veterans Health Administration (VHA) hospitals.Our data came from years 2005 to 2012 of the nationwide VHA Medical SAS inpatient and enrollment files, American Hospital Association Survey, and Area Health Resource File.

Medicare Part D and Portfolio Choice.

This study evaluates the impact of medical expenditure risk on portfolio choice among the elderly. The risk of large medical expenditures can be substantial for elderly individuals and is only partially mitigated by access to health insurance. The presence of deductibles, copayments, and other cost-sharing mechanisms implies that medical spending risk can be viewed as an undiversifiable background risk.

The Impact of Medicare Part D on Emergency Department Visits.

The Medicare Part D program introduced prescription drug coverage for seniors in 2006. We examine the impact of this program on the use of emergency department (ED) care. Using a difference-in-differences model, we find declines in the number of ED visits for non-emergency care but not for emergency care, suggesting that Part D may have led to better management of health and reduced unnecessary use of EDs.

Continued Gains in Health Insurance but Few Signs of Increased Utilization: An Update on the ACA's Dependent Coverage Mandate.

Objectives: To evaluate the Affordable Care Act's dependent coverage mandate impact on insurance take-up and health services use through the second full year of implementation.

Data: Medical Expenditure Panel Survey from 2006 to 2012.

Study Design: Difference-in-difference regressions comparing pre-/postpolicy-outcome changes between 19- to 25-year-olds and 27- to 34-year-olds.

Observation Rates At Veterans' Hospitals More Than Doubled During 2005-13, Similar To Medicare Trends.

When neither inpatient admission nor prompt discharge is clearly indicated for a patient in the emergency department, physicians place the patient under observation in a hospital for diagnosis and treatment. The increasing prevalence of observation stays at hospitals reimbursed by Medicare is receiving considerable attention, but the prevalence remains unexplored in Veterans Health Administration (VHA) hospitals, which are subject to different payment policies. Using VHA data for fiscal years 2005-13, we identified trends and variations in observation rates across twenty-one Veteran Integrated Service Networks and 128 VHA hospitals nationwide.

The Business Case for Tele-emergency.

Background: Tele-emergency is an expanding telehealth service that provides real-time audio/visual consultation delivered by an emergency medicine team to a remote, often rural, emergency department (ED). Financial analyses of tele-emergency in the literature are limited. This article expands the tele-emergency literature to describe the business case for tele-emergency.

Does prescription drug coverage improve mental health? Evidence from Medicare Part D.

The introduction of the Medicare Prescription Drug program (Part D) in 2006 resulted in a significant increase in access to coverage for older adults in the U.S. Several studies have documented the impact of this program on prescription drug utilization, expenditures and medication adherence among older adults.

Spillover Effects of the Affordable Care Act? Exploring the Impact on Young Adult Dental Insurance Coverage.

Objectives: To assess whether the Affordable Care Act's (ACA) dependent coverage health insurance mandate had a spillover impact on young adult dental insurance coverage and whether any observed effects varied by household income.

Data: Medical Expenditure Panel Surveys from 2006 through 2011.

Study Design: We employed a difference-in-difference regression approach comparing changes in insurance rates for young adults ages 19-25 years to changes in insurance rates for adults ages 27-30 years.

Will health care reform reduce disparities in insurance coverage?: Evidence from the dependent coverage mandate.

Objectives: We used data from the Medical Expenditure Panel Survey to assess the impact of the Affordable Care Act's dependent coverage mandate on disparities in health insurance coverage rates and evaluated whether non-Hispanic blacks and Hispanics gained coverage at the same rates as non-Hispanic whites.

Methods: To estimate changes in insurance rates, we employed a difference-in-difference regression approach comparing 7962 young adults aged 19-25 to 9321 adults aged 27-34. Separate regressions were estimated for non-Hispanic blacks, Hispanics, and non-Hispanic whites to understand whether the mandate had differential effects by race/ethnicity.

Lower extremity function trajectories in the African American Health Cohort.

Background: We addressed two understudied issues in estimating lower extremity functional trajectories in older adults-incorporating the effect of mortality and evaluating heterogeneity among African Americans.

Methods: Data were taken from the 998 participants in the African American Health cohort. A highly reliable and valid 8-item lower extremity function scale was used at baseline and at the 1-, 2-, 3-, 4-, 7-, and 9-year follow-up interviews.

Self-rated health trajectories in the African American health cohort.

Background: Self-rated health taps health holistically and dynamically blends prior health histories with current illness burdens and expectations for future health. While consistently found as an independent predictor of functional decline, sentinel health events, physician visits, hospital episodes, and mortality, much less is known about intra-individual changes in self-rated health across the life course, especially for African Americans.

Materials/methods: Data on 998 African American men and women aged 50-64 years old were taken from a probability-based community sample that was first assessed in 2000-2001 and re-assessed 1, 2, 3, 4, 7, and 9 years later.

Understanding heterogeneity in price elasticities in the demand for alcohol for older individuals.

This paper estimates the price elasticity of demand for alcohol using Health and Retirement Study data. To account for unobserved heterogeneity in price responsiveness, we use finite mixture models. We recover two latent groups, one is significantly responsive to price, but the other is unresponsive.

The effect of job loss on overweight and drinking.

This paper examines the impact of job loss due to business closings on body mass index (BMI) and alcohol consumption. We suggest that the ambiguous findings in the extant literature may be due in part to unobserved heterogeneity in response and in part due to an overly broad measure of job loss that is partially endogenous (e.g.

Education and health: evidence on adults with diabetes.

Although the education-health relationship is well documented, pathways through which education influences health are not well understood. This study uses data from a 2003-2004 cross sectional supplemental survey of respondents to the longitudinal Health and Retirement Study (HRS) who had been diagnosed with diabetes mellitus to assess effects of education on health and mechanisms underlying the relationship. The supplemental survey provides rich detail on use of personal health care services (e.

Job loss and depression: the role of subjective expectations.

Although the importance of expectations is well documented in the decision-making literature, a key shortcoming of the empirical research into effects of involuntary job loss on depression is perhaps its neglect of the subjective expectations of job loss. Using data from the US Health and Retirement Study surveys we examine whether the impact of job loss on mental health is influenced by an individual's subjective expectations regarding future displacement. Our results imply that, among older workers in the age range of 55-65 year, subjective expectations are as significant predictors of depression as job loss itself, and ignoring them can bias the estimate of the impact of job loss on mental health.

The Impact of Job Stress on Smoking and Quitting: Evidence from the HRS.

Job-related stress might affect smoking behavior because smoking may relieve stress and stress can make individuals more present-focused. Alternatively, individuals may both self-select into stressful jobs and choose to smoke based on unobserved factors. We use data from the Health and Retirement Study to examine how job stress affects the probability that smokers quit and the number of cigarettes smoked for current smokers.