Coverage Expansions and Utilization of Physician Care: Evidence From the 2014 Affordable Care Act and 1966 Medicare/Medicaid Expansions.

To evaluate the effects of the 2 major coverage expansions in US history-Medicare/Medicaid in 1966 and the Affordable Care Act (ACA) in 2014-on the utilization of physician care. Using the National Health Interview Survey (1963-1969; 2011-2016), we analyzed trends in utilization of physician services society-wide and by targeted subgroups. Following Medicare/Medicaid's implementation, society-wide utilization remained unchanged.

High-Deductible Health Plans and Healthcare Access, Use, and Financial Strain in Those with Chronic Obstructive Pulmonary Disease.

Medical treatment can improve quality of life and avert exacerbations for those with chronic obstructive pulmonary disease (COPD). High-deductible health plans (HDHPs) can increase exposure to medical costs, and might compromise healthcare access and financial well-being for patients with COPD. To examine the association of HDHPs with healthcare access, utilization, and financial strain among individuals with COPD.

The Effects on Hospital Utilization of the 1966 and 2014 Health Insurance Coverage Expansions in the United States.

Background: Persons with comprehensive health insurance use more hospital care than those who are uninsured or have high-deductible plans. Consequently, analysts generally assume that expanding coverage will increase society-wide use of inpatient services. However, a limited supply of beds might constrain this growth.

Implications of Changing Public Charge Immigration Rules for Children Who Need Medical Care.

Importance: In October 2018, the Trump administration published a proposed rule change that would increase the chance of an immigrant being deemed a "public charge" and thereby denied legal permanent residency or entry to the United States. The proposed changes are expected to cause many immigrant parents to disenroll their families from safety-net programs, in large part because of fear and confusion about the rule, even among families to whom the rule does not technically apply.

Objective: To simulate the potential harms of the rule change by estimating the number, medical conditions, and care needs of children who are at risk of losing their current benefits, including Medicaid and Children's Health Insurance Program (CHIP) and Supplemental Nutrition Assistance Program (SNAP).

The Incidence of Diabetic Ketoacidosis During "Emerging Adulthood" in the USA and Canada: a Population-Based Study.

Background: As children with diabetes transition to adulthood, they may be especially vulnerable to diabetic ketoacidosis (DKA). Cross-national comparisons may inform efforts to avoid this complication.

Objective: To compare DKA hospitalization rates in the USA and Manitoba, Canada, during the vulnerable years known as "emerging adulthood.

The Cancer Prevention Project of Philadelphia: preliminary findings examining diversity among the African diaspora.

Cancer mortality inequity among persons of African Ancestry is remarkable. Yet, Black inclusion in cancer biology research is sorely lacking and warrants urgent attention. Epidemiologic research linking African Ancestry and the African Diaspora to disease susceptibility and outcomes is critical for understanding the significant and troubling health disparities among Blacks.

Analysis of Work Requirement Exemptions and Medicaid Spending.

This study estimates the number of Medicaid enrollees at risk of losing coverage if work requirements are implemented and calculates current Medicaid spending for those enrollees at the national level and among states with approved or pending waivers.

Disparities in pulmonary fibrosis care in the United States: an analysis from the Nationwide Inpatient Sample.

Background: Idiopathic pulmonary fibrosis is a disease with high morbidity and mortality. Care for these patients, including lung transplantation, may provide significant benefits, but is resource-intensive and expensive. Disadvantaged patients with IPF may hence be at risk for receiving inferior care.

Peripheral blood clinical laboratory variables associated with outcomes following combination nivolumab and ipilimumab immunotherapy in melanoma.

Both the combination of nivolumab + ipilimumab and single-agent anti-PD-1 immunotherapy have demonstrated survival benefit for patients with advanced melanoma. As the combination has a high rate of serious side effects, further analyses in randomized trials of combination versus anti-PD-1 immunotherapy are needed to understand who benefits most from the combination. Clinical laboratory values that were routinely collected in randomized studies may provide information on the relative benefit of combination immunotherapy.

Out-of-Pocket Spending and Premium Contributions After Implementation of the Affordable Care Act.

Importance: The Affordable Care Act (ACA) was associated with a reduced number of Americans who reported being unable to afford medical care, but changes in actual health spending by households are not known.

Objectives: To estimate changes in household spending on health care nationwide after implementation of the ACA.

Design, Setting, And Participants: Population-based data from the Medical Expenditure Panel Survey from January 1, 2012, through December 31, 2015, and multivariable regression were used to examine changes in out-of-pocket spending, premium contributions, and total health spending (out-of-pocket plus premiums) after the ACA's coverage expansions on January 1, 2014.

The Effects of Household Medical Expenditures on Income Inequality in the United States.

Objectives: To assess the effect of households' outlays for medical expenditures on income inequality and changes since the implementation of the Affordable Care Act (ACA).

Methods: We analyzed data from the US Current Population Surveys for calendar years 2010 through 2014. We calculated the Gini index of income inequality before and after subtracting households' medical outlays (including insurance premiums and out-of-pocket costs) from income, the financial burden of medical outlays for each income decile, and the number of individuals pushed below poverty by medical outlays.

The Affordable Care Act: How Nixon's Health Reform Proposal Became Democrats' Albatross.

President Obama's signature health care reform, the Affordable Care Act (ACA), was passed in 2010 and fully implemented in 2014. Two years later, Republicans' attacks on the ACA as a failed reform helped fuel their recent electoral victory. The legislation significantly expanded insurance coverage.

Racial disparities in neurologic health care access and utilization in the United States.

Objective: To evaluate racial and ethnic differences in the utilization of neurologic care across a wide range of neurologic conditions in the United States.

Methods: We analyzed nationally representative data from the 2006-2013 Medical Expenditure Panel Survey (MEPS), including information on demographics, patient-reported health conditions, neurology visit rates, and costs. Using diagnostic codes, we identified persons with any self-identified neurologic disorder except back pain, as well as 5 subgroups (Parkinson disease, multiple sclerosis, headache, cerebrovascular disease, and epilepsy).

Racial and Ethnic Disparities in Mental Health Care for Children and Young Adults: A National Study.

Psychiatric and behavior problems are common among children and young adults, and many go without care or only receive treatment in carceral settings. We examined racial and ethnic disparities in children's and young adults' receipt of mental health and substance abuse care using nationally representative data from the 2006-2012 Medical Expenditure Panel Surveys. Blacks' and Hispanics' visit rates (and per capita expenditures) were about half those of non-Hispanic whites for all types and definitions of outpatient mental health services.

Holistic Nursing in the Genetic/Genomic Era.

Holistic nursing practice is an ever-evolving transformative process with core values that require continued growth, professional leadership, and advocacy. Holistic nurses are required to stay current with all new required competencies, such as the Core Competencies in Genetics for Health Professional, and, as such, be adept at translating scientific evidence relating to genetics/genomics in the clinical setting. Knowledge of genetics/genomics in relation to nursing practice, policy, utilization, and research influence nurses' responsibilities.

The beauty of metaphors.

Metaphors are a way of describing an experience or a perceived notion as a personal expression of thought. The metaphoric understanding of what practicing as a holistic nurse means is discussed with reference to the personal, emotional, and spiritual components of being a holistic nurse.