Journal of Health Politics Policy and Law最新文献_第2页

Policy Feedbacks and Medicaid on Its 60th Anniversary. 政策反馈和医疗补助计划 60 周年。

IF 3.3 3区医学

Journal of Health Politics Policy and Law Pub Date : 2025-04-01 DOI: 10.1215/03616878-11567676

Andrea Louise Campbell

{"title":"Policy Feedbacks and Medicaid on Its 60th Anniversary.","authors":"Andrea Louise Campbell","doi":"10.1215/03616878-11567676","DOIUrl":"10.1215/03616878-11567676","url":null,"abstract":"Context: Despite early skepticism about Medicaid's ability to withstand retrenchment as a program of \"welfare medicine,\" it has proved remarkably durable. Existing analyses explain durability from a policy feedbacks perspective-how program provisions affect the subsequent political environment and policy-making options. This article updates earlier feedback accounts to the Affordable Care Act (ACA) era.Methods: The article examines extant findings on policy feedbacks in Medicaid at the elite and mass levels since the 2010 passage of the ACA.Findings: Mass feedbacks have been modest. Medicaid expansion under the ACA only slightly increased beneficiary political participation, if at all. Medicaid attitudes among beneficiaries and the larger public have become somewhat more supportive. Elite-level feedbacks are the most powerful, with the federal contribution-increased for expansion populations under the ACA-inexorably shaping state incentives. However, continued rejection of Medicaid expansion and attempts to add conditions to Medicaid eligibility in Republican-led states with large shares of Black residents demonstrate that federalism, race, and the program's welfare medicine image continue to threaten the program.Conclusion: Medicaid survives as the nation's largest health insurance program by enrollment, and it is deeply woven into the health care system. However, it remains chronically vulnerable and variable across states despite robust aggregate enrollment and spending.","PeriodicalId":54812,"journal":{"name":"Journal of Health Politics Policy and Law","volume":" ","pages":"165-188"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Entrenched Opportunity: Medicaid, Health Systems, and Solutions to Homelessness. 根深蒂固的机会：医疗补助、医疗系统和无家可归问题的解决方案。

IF 3.3 3区医学

Journal of Health Politics Policy and Law Pub Date : 2025-04-01 DOI: 10.1215/03616878-11567700

Charley E Willison, Naquia A Unwala, Katarzyna Klasa

{"title":"Entrenched Opportunity: Medicaid, Health Systems, and Solutions to Homelessness.","authors":"Charley E Willison, Naquia A Unwala, Katarzyna Klasa","doi":"10.1215/03616878-11567700","DOIUrl":"10.1215/03616878-11567700","url":null,"abstract":"Context: As inequality grows, politically powerful health care institutions-namely Medicaid and health systems-are increasingly assuming social policy roles, particularly related to solutions to homelessness. Medicaid and health systems regularly interact with persons experiencing homelessness who are high users of emergency health services and who experience frequent loss of or inability to access Medicaid services because of homelessness. This research examines Medicaid and health system responses to homelessness, why they may work to address homelessness, and the mechanisms by which this occurs.Methods: The authors collected primary data from Medicaid policies and the 100 largest health systems, along with national survey data from local homelessness policy systems, to assess scope and to measure mechanisms and factors influencing decision-making.Findings: Nearly one third of states have Medicaid waivers targeting homelessness, and more than half of the 100 largest health systems have homelessness mitigation programs. Most Medicaid waivers use local homelessness policy structures as implementing entities. A plurality of health systems rationalizes program existence based on the failure of existing structures.Conclusions: Entrenched health care institutions may bolster local homelessness policy governance mechanisms and policy efficacy. Reliance on health systems as alternative structures, and implementing entities in Medicaid waivers, may risk shifting homelessness policy governance and retrenchment of existing systems.","PeriodicalId":54812,"journal":{"name":"Journal of Health Politics Policy and Law","volume":" ","pages":"307-336"},"PeriodicalIF":3.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medicare in Treacherous Markets: From Community Bake Sales to Private Equity. 险恶市场中的医疗保险：从社区烘焙销售到私募股权。

IF 3.3 3区医学

Journal of Health Politics Policy and Law Pub Date : 2025-02-28 DOI: 10.1215/03616878-11825378

James A Morone

{"title":"Medicare in Treacherous Markets: From Community Bake Sales to Private Equity.","authors":"James A Morone","doi":"10.1215/03616878-11825378","DOIUrl":"https://doi.org/10.1215/03616878-11825378","url":null,"abstract":"Medicare's 60th birthday marks a shocking milestone for social democrats: More than half of all beneficiaries are signed up with private insurance plans that routinely deny payments. This paper flips the focus from the government program itself to the broader health care markets in which Medicare operates. I show how Medicare has lived through four very different health market eras. Each involves new kinds of medical institutions, new financial logics, and new thinking about what markets are and what role they ought to play in the program. First, during the long battle over Medicare, government programs and markets were (quite mistakenly) viewed as simple opposites. Second, in the 1970s, a new view emerged: Competition between HMOs would provide enrollees choice of providers, enhancing quality and lowering costs. Third, in the 1980s, Republicans pressed market choices into Medicare - drawing on rhetorical images from a bygone era; as conservatives were imagining medical markets, corporations arrived, asserted vast controls over medicine, and redirected consumer choice itself -- from selecting health providers to picking between insurance plans. Finally, beginning in the 2000s, private equity poured into health care and, once again, transformed the market. By Medicare's 60th birthday, enrollees found themselves in turbulent new era as health care in America was growing increasingly monetized.","PeriodicalId":54812,"journal":{"name":"Journal of Health Politics Policy and Law","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Consequences of Medicare Advantage for Beneficiaries and Politics: Revisiting The Delegated Welfare State. 医疗保险优势对受益人和政治的影响：重新审视委托福利国家。

IF 3.3 3区医学

Journal of Health Politics Policy and Law Pub Date : 2025-02-28 DOI: 10.1215/03616878-11825370

Andrea Louise Campbell, Kimberly J Morgan

{"title":"Consequences of Medicare Advantage for Beneficiaries and Politics: Revisiting The Delegated Welfare State.","authors":"Andrea Louise Campbell, Kimberly J Morgan","doi":"10.1215/03616878-11825370","DOIUrl":"https://doi.org/10.1215/03616878-11825370","url":null,"abstract":"The Delegated Welfare State (Morgan and Campbell 2011) explored the causes and possible consequences of the 2003 Medicare reform boosting private managed care plans in the delivery of Medicare benefits. In this paper, we review scholarship on beneficiary experience (access, costs, outcomes) and political feedbacks arising from the delegated governance reform to evaluate whether predictions about consumer behavior and policy entrenchment have manifested. We find that beneficiary experiences and satisfaction do not differ significantly between Medicare Advantage and traditional Medicare, and MA plans' managed care techniques have cut per beneficiary spending. However, MA remains costlier to the federal government, per beneficiary, because of the outsized payments received by plan providers. Officials have failed to rectify these overpayments because of policy feedback effects - the empowerment of lobbying groups with a stake in the program and beneficiary support for it. Growing dependence on private plans to deliver health insurance for a large and politically influential constituency, senior citizens, has rendered government officials and elected politicians reluctant to imperil this market and the happiness of beneficiaries.","PeriodicalId":54812,"journal":{"name":"Journal of Health Politics Policy and Law","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medicare at 60: A Popular Program Facing Challenges. 60岁的医疗保险：一个面临挑战的受欢迎计划。

IF 3.3 3区医学

Journal of Health Politics Policy and Law Pub Date : 2025-02-28 DOI: 10.1215/03616878-11825362

Tricia Neuman, Jean Fuglesten Biniek, Juliette Cubanski

{"title":"Medicare at 60: A Popular Program Facing Challenges.","authors":"Tricia Neuman, Jean Fuglesten Biniek, Juliette Cubanski","doi":"10.1215/03616878-11825362","DOIUrl":"https://doi.org/10.1215/03616878-11825362","url":null,"abstract":"As Medicare approaches its 60th anniversary, it almost goes without saying that the program is both popular and successful. Medicare provides health insurance coverage to 67 million older adults and people with disabilities. Medicare is viewed favorably by Democrats, Republicans, and Independents. Medicare has also helped to extend life expectancy and, in conjunction with the Civil Rights Act of 1964, narrow disparities in care. It is a vital source of revenue for hospitals, physicians and other health care providers, and health insurers and is an essential component of health and retirement security in the U.S. These are among the reasons why Medicare is often considered a third rail in politics. Medicare also faces challenges stemming from the growing role of private plans, demographic shifts, and rising health care costs. This paper examines these challenges by focusing on three fundamental questions. First, what are the implications of the transformation that is taking place with private insurers playing a more dominant role in providing Medicare benefits? Second, what changes may be important to address the gaps in covered benefits and related affordability challenges? Third, how can Medicare be sustained to finance care for current and future generations?","PeriodicalId":54812,"journal":{"name":"Journal of Health Politics Policy and Law","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Evolution of Medicare: Challenges, Responses, and Prospects. 医疗保险的演变：挑战、反应和前景。

IF 3.3 3区医学

Journal of Health Politics Policy and Law Pub Date : 2025-02-28 DOI: 10.1215/03616878-11830274

Sherry Glied, Richard Frank, Brendan Lui

{"title":"The Evolution of Medicare: Challenges, Responses, and Prospects.","authors":"Sherry Glied, Richard Frank, Brendan Lui","doi":"10.1215/03616878-11830274","DOIUrl":"https://doi.org/10.1215/03616878-11830274","url":null,"abstract":"The Medicare program has provided a near-universal source of health care coverage for America's elderly since 1965. Over its 60-year history, the program has evolved to cover a greater share of the population and pay for an increasing share of the nation's health care bills. As Medicare has grown, so too have its challenges. The traditional Medicare program has failed to keep pace with a rapidly changing health care sector and demographic shifts. Constrained by its own benefit design, Medicare has allowed privately-contracted health plans (Medigap, Medicare Advantage) to provide much needed yet inadequate remedies to the program's shortcomings. After briefly recounting Medicare's origins, we discuss how the program's founding statutes have hindered its ability to respond to new and growing challenges along the dimensions of cost-sharing, cost containment, and benefit design. We then propose a three-pronged approach to reforming Medicare's benefit structure. We argue that a simplified enrollment process, a single benefit that brings together the program's constituent parts (Part A, Part B, and Part D), and a new organizational structure for care delivery based on the program's experience with Accountable Care Organizations (ACOs), will together create a robust foundation that can sustain the Medicare program into the future.","PeriodicalId":54812,"journal":{"name":"Journal of Health Politics Policy and Law","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143528036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Medicare at 60: Many Successes but More Work to Do. 60岁的医疗保险：许多成功，但还有更多工作要做。

IF 3.3 3区医学

Journal of Health Politics Policy and Law Pub Date : 2025-02-28 DOI: 10.1215/03616878-11825354

Bowen Garrett, John Holahan, Stephen Zuckerman

引用次数: 0

Introduction: Medicare at 60. 简介：60岁的医疗保险。

IF 3.3 3区医学

Journal of Health Politics Policy and Law Pub Date : 2025-02-28 DOI: 10.1215/03616878-11834145

Jonathan Oberlander

引用次数: 0

Policy Feedback and the Politics of Childhood Vaccine Mandates: Conflict and Change in California, 2012-2019. 政策反馈与儿童疫苗任务的政治学：2012-2019 年加利福尼亚州的冲突与变化》（Conflict and Change in California, 2012-2019）。

IF 3.3 3区医学

Journal of Health Politics Policy and Law Pub Date : 2024-12-01 DOI: 10.1215/03616878-11377933

Katie Attwell, Adam Hannah, Shevaun Drislane, Mark Christopher Navin

{"title":"Policy Feedback and the Politics of Childhood Vaccine Mandates: Conflict and Change in California, 2012-2019.","authors":"Katie Attwell, Adam Hannah, Shevaun Drislane, Mark Christopher Navin","doi":"10.1215/03616878-11377933","DOIUrl":"10.1215/03616878-11377933","url":null,"abstract":"Context: In 2012, California instituted a new requirement for parents to consult with a clinician before receiving a personal belief exemption (PBE) to its school entry vaccine mandate. In 2015, the state removed this exemption altogether. In 2019, legislators cracked down on medical exemptions to address their misuse by vaccine refusers and supportive clinicians. This article uses \"policy feedback theory\" to explore these political conflicts, arguing that PBEs informed the emergence and approaches of two coalitions whose conflict reshaped California's vaccination policies.Methods: The authors analyzed legal, policy, academic, and media documents; interviewed 10 key informants; and deductively analyzed transcripts using NVivo 20 transcription software.Findings: California's long-standing vaccination policy inadvertently disseminated two fundamentally incompatible social norms: vaccination is a choice, and vaccination is not a choice. Over time, the culture and number of vaccine refusers grew, at least in part because the state's policy sanctioned the norm of vaccine refusal.Conclusions: The long-term consequences of California's \"mandate + PBE\" policy-visible, public, and socially sanctioned vaccine refusal-undermined support for it over time, generating well-defined losses for a large group of people (the vaccinating public) and specifically for the provaccine parent activists whose experiences of personal grievance drove their mobilization for change.","PeriodicalId":54812,"journal":{"name":"Journal of Health Politics Policy and Law","volume":" ","pages":"1075-1110"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Explaining Political Differences in Attitudes to Vaccines in France: Partisan Cues, Disenchantment with Politics, and Political Sophistication. 解释法国人对疫苗态度的政治差异：党派线索、对政治的失望和政治智慧。

IF 3.3 3区医学

Journal of Health Politics Policy and Law Pub Date : 2024-12-01 DOI: 10.1215/03616878-11373758

Jeremy K Ward, Sébastien Cortaredona, Hugo Touzet, Fatima Gauna, Patrick Peretti-Watel

{"title":"Explaining Political Differences in Attitudes to Vaccines in France: Partisan Cues, Disenchantment with Politics, and Political Sophistication.","authors":"Jeremy K Ward, Sébastien Cortaredona, Hugo Touzet, Fatima Gauna, Patrick Peretti-Watel","doi":"10.1215/03616878-11373758","DOIUrl":"10.1215/03616878-11373758","url":null,"abstract":"Context: The role of political identities in determining attitudes to vaccines has attracted a lot of attention in the last decade. Explanations have tended to focus on the influence of party representatives on their sympathizers (partisan cues).Methods: Four representative samples of the French adult population completed online questionnaires between July 2021 and May 2022 (N = 9,177). Bivariate and multivariate analyses were performed to test whether partisan differences in attitudes to vaccines are best explained by partisan cues or by parties' differences in propensity to attract people who distrust the actors involved in vaccination policies.Findings: People who feel close to parties on the far left, parties on the far right, and green parties are more vaccine hesitant. The authors found a small effect of partisan cues and a much stronger effect of trust. More importantly, they show that the more politically sophisticated are less vaccine hesitant and that the nonpartisan are the biggest and most vaccine hesitant group.Conclusions: The literature on vaccine attitudes has focused on the case of the United States, but turning attention toward countries where disenchantment with politics is more marked helps researchers better understand the different ways trust, partisanship, and political sophistication can affect attitudes to vaccines.","PeriodicalId":54812,"journal":{"name":"Journal of Health Politics Policy and Law","volume":" ","pages":"961-988"},"PeriodicalIF":3.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141249079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0