Future of the ACA in the Trump Administration

We now know that Rep. Tom Price has been tapped by Pres. Elect Trump to head the Department of Health and Human Services. This answers, in part, one of the questions raised by a PHS 795 student in commenting on a Health Affairs blog piece on the future of the ACA:

I’d like to point out, as the author does too, that Trump never actually refers to The Patient Protection and Affordable Care Act, just “Obamacare.” I think the fact that he doesn’t (or  can’t?) actually name the legislation is telling. The ability to talk about legislation in a specific and clear way is important, and will have implications for what happens next. If President Elect Trump can’t point to specific provisions to repeal either he’ll be unsuccessful in repealing anything, or he’ll create a mess of our health care system by derailing and defunding all of the new structures, federal offices, funding streams, and policy mechanisms that PPACA put in place.  I think this piece does an excellent job of outlining scenarios and showing that political leadership really matters. It really matters who control Congress. It matters who President Trump selects as his Sec. of Health and Human Services (as well as other cabinet positions).  Trump will almost certainly have enormous, and probably painful, impacts on the health system. And while interesting as a policy experiment, these changes will affect peoples’ lives in ways we probably can’t yet understand. 



Race, Class and Maternity

A PHS 795 student offers insights on an interesting article published on ebony.com:

I would like to share the next article with the rest of the class: http://www.ebony.com/wellness-empowerment/black-mothers-health-matters#axzz4OAcQXgss

I think “Black maternal health matters” is a great article for this class because it problematizes what we understand as the access to health and how it is mediated by class, race and gender. As we learned in professor Jacob´s lecture on health care disparities, this article shows that the physical and legal access to health is not enough to ensure the appropriateness of health care within socially disadvantaged communities as African-American women in this country. This article discuss the importance of race as a stressor that affects maternal health, and as a barrier for black women´s access to the resources needed to sustain their and their children´ best health. What can public health practitioners do in order to achieve equity in health care? How important is a reproductive justice framework in our practice?

An election day observation: health disparities may affect electoral outcomes…

A thought-provoking find from PHS 795 student Edward Vargas:

Dear all: In spirit of elections and health….Below is a paper by two colleagues ya’ll might find of interests that focuses on the impact of racial mortality differentials on political participation in the US.  They find that, “premature deaths among blacks have had a significant impact on the racial composition of America’s electorate and, during the study period, may have been a key influence on several state election outcomes. State level findings suggest that our estimated effects could have had political potency at the national level, as well, given that the predicted reversal of specific senate elections would have changed the controlling party in the Senate from 1986 to 2002.”


Black Lives Matter: Differential Mortality and the Racial …


Excess mortality in marginalized populations could be both a cause and an effect of political processes. We estimate the impact of mortality differentials between …

Health Affairs on the “New Era of Health Equity”

A PHS 795 student comments on a piece in the most recent issue of Health Affairs outlining the history of major policy initiatives on health equity in the US:

 a Ushering In The New Era Of Health Equity


Ushering In The New Era Of Health Equity | At the intersection of health, health care, and policy.

The author first outlines the  3 “eras” of health equity in the US. The first came in 2001 with the IOM’s Crossing the Quality Chasm and the book  Unequal Treatment, which highlighted the presence of disparities. The second era started with the passage of the ACA and the new emphasis on access to care, and attempts to achieve the Triple Aim. Finally, the third era is here, in part because of the passage of MACRA (Medicare Access and CHIP Re-Authorization Act, which he calls the best ABC of health yet—an acronym with in an acronym).

Interestingly, some of the alternative payment and delivery mechanism are reproducing disparities. ACO are less likely to recruit doctors who take care of minority patients and MIPS (merit-based incentive programs) are less likely to exist in minority communities.Betancourt argues that in order to achieve equity in the third era, we have to ensure that some patients are not benefiting from reforms more than others. 

This article highlighted many of the themes discussed in Dr. Dugoff and Dr. Jacob’s lectures. It is interesting to examine who has access to alternative payment models, the impact on both the quality of care they have access to and their subsequent health outcomes. As we’ve talked about in class, even where health outcomes are improving, health disparities persist. This article makes it clear that access to health insurance/ providers is not enough to end health disparities. Given how much care delivery is changing, access to these new innovative models may make a huge difference in both outcomes and either perpetuating or combatting health disparities.

Something to think about as we kick off OE4. (for the non-health policy nerds, today is the beginning of the 4th open enrollment period for the ACA marketplaces)