In The Affordable Care Act’s Shadow: The Fate Of The Children’s Health Insurance Program

UNC Libraries · 2025-09-18

The Children's Health Insurance Program (CHIP) is a success story. CHIP has contributed greatly to ensuring affordable insurance and access to medical services for millions of children. The 2015 two-year extension of CHIP funding appeared to confirm its longstanding status as a bipartisan program. Yet that appearance obscures important changes in CHIP politics. In recent years, there have been calls to end the program, and its bipartisan coalition has frayed. In this article we analyze CHIP's funding extension, explore its shifting political environment, and discuss the implications for the program's future.

Changes to Depression-Related Health Care Encounters and Telehealth Adoption in the COVID-19 Era

Telemedicine Journal and e-Health · 2025-11-05

OBJECTIVE: This study aimed to explore changes in the incidence of depression-related health care encounters following the COVID-19 pandemic among patients diagnosed with depressive disorders and characterized those who had transitioned their care largely to telehealth. METHODS: This retrospective study included adults diagnosed with depressive disorders in the 2018-2021 Medical Expenditure Panel Survey (MEPS). We assessed encounter rates and telehealth use in depression-related care. Encounter rates were compared through zero-truncated negative-binomial models. Weighted logistic regression models were used to explore factors associated with the transition of depression-related care to telehealth. RESULTS: We found a statistically significant increase in depression-related encounters following the COVID-19 pandemic (incident rate ratios: 1.42, 95% confidence interval: 1.20-1.68). Logistic regression results showed no statistically significant differences in telehealth transitions among the included sociodemographic variables. CONCLUSIONS: Patients with depressive disorders had significant increase in depression-related encounters. The odds of transitioning to telehealth for depression-related care were not statistically different among common sociodemographic groups.

Elections and Voter Turnout

2025-01-01 · 1 citations

Draining the Swamp: The Local Governance of Mosquito Borne Diseases in Florida

Urban Affairs Review · 2025-05-08 · 4 citations

Public health capacity can be placed in local public health departments or alternative bureaucracies. Provision of local services through special district (SD) governments has been widely studied in local politics. What have not been examined are the implications of SD governance for the provision of public health services. Public health services are often categorically different from other types of local government services because they address problems affecting the entire local population. Siloing public health governance may influence not only agency capacity to carry out tasks, but the effectiveness and equity of public health solutions. We examine SD governance of local mosquito control in Florida, to analyze differences in policy-design and implementation between SDs and non-SDs across counties. SDs are primarily located in wealthy districts, have substantially greater resources, and provided over limited, sub-county, service-areas. Jurisdictions outside of SD service-provision often have no local mosquito control governance, relying on intergovernmental services.

Implementing automated Medicaid eligibility renewals was not associated with higher levels of program participation

Health Affairs Scholar · 2024-05-22 · 3 citations

Increasing participation in Medicaid among eligible individuals is critical for improving access to care among low-income populations. The administrative burdens of enrolling and renewing eligibility are a major barrier to participation. To reduce these burdens, the Affordable Care Act required states to adopt automated renewal processes that use available databases to verify ongoing eligibility. By 2019, nearly all states adopted automated renewals, but little is known about how this policy affected Medicaid participation rates. Using the 2015-2019 American Community Survey, we found that participation rates among nondisabled, nonelderly adults and children varied widely by state, with an average of 70.8% and 90.7%, respectively. Among Medicaid-eligible adults, participation was lower among younger adults, males, unmarried individuals, childless households, and those living in non-expansion states compared with their counterparts. State adoption of automated renewals varied over time, but participation rates were not associated with adoption. This finding could reflect limitations to current automated renewal processes or barriers to participation outside of the eligibility renewal process, which will be important to address as additional states expand Medicaid and pandemic-era protections on enrollment expire.

Governance and health policy

Edward Elgar Publishing eBooks · 2024-04-09 · 1 citations

Governance is a difficult topic in health care systems, focused on how decisions are made and implemented rather than the choice of policy, and shaped by many contextual factors. It is nonetheless crucial for explaining and changing what systems do and how they affect people. This chapter presents a broad governance framework for identifying governance aspects of health policies and systems and for further recognizing challenges associated with governance. It then, to show how governance can be understood in a contextual sense, focuses on a case study of the territorial politics of health policy making in multi-level and federal political systems.

Advocating for patients with skin disease: Federal dermatology lobbying and expenditure activity by the American Academy of Dermatology Association and SkinPAC from 2008 to 2021

Journal of the American Academy of Dermatology · 2023-01-21 · 1 citations

Denmark, the United States and Canada: Before, during and post vaccination rollout

Health Policy and Technology · 2023-08-25 · 2 citations

Pivot: partisan policy responses to COVID-19 health disparities

Health Affairs Scholar · 2023-10-21 · 4 citations

How did partisanship influence rhetoric about, public opinion of, and policies that prioritize racial and ethnic health disparities of COVID-19 during the first wave of the pandemic between March and July 2020? In this retrospective, mixed-methods analysis using national administrative and survey data, we found that the rhetoric and policy of shared sacrifice diminished and partisan differences in pandemic policy increased once it became clear to political elites that there were major racial disparities in COVID-19 cases and deaths. We trace how first disparities emerged in data and then were reported in elite, national media, discussed in Congress, and reflected in public opinion. Once racial disparities were apparent, partisan divides opened in media, public opinion, and legislative activity, with Democrats foregrounding inequality and Republicans increasingly downplaying the pandemic. This temporal dimension, focusing on how the diffusion of awareness of inequalities among elites shaped policy in the crucial months of early 2020, is the principal novel finding of our analysis. Overall, there is a clear, partisan policy response to addressing COVID-19 racial disparities across media, public opinion, subnational legislative activity, and congressional deliberations.

State Attorneys General and their Challenges to Federal Policies: Insights from the <i>Texas v. California</i> Litigation Regarding the Affordable Care Act

Publius The Journal of Federalism · 2023 · 3 citations

• Political Science
• Sociology
• Political Science

Abstract This article explains a rising trend in American politics: the increasingly prominent role the state attorneys general (AGs) play in challenging federal policies. It focuses on one particularly important case—Republican efforts to overturn the Affordable Care Act in Texas v. California. We consider how state AGs and solicitors general (SGs) drive policy efforts through litigation and the factors that contribute to their participation. We find, first, that although members of the out-of-power party in Washington are the ones who typically bring state lawsuits, the Texas litigation demonstrates that these lawsuits are also a vehicle by which members of the party in power try to achieve goals that are otherwise unattainable through the legislative process. Second, Republican AGs submerge partisan arguments in “constitution-talk” with the aim of achieving a policy goal that was defeated democratically. We reach these conclusions through content analysis of AG press releases and semi-structured interviews with litigators and other elite actors.