Life in Obamacare’s Dead Zone – The New York Times

A PHS 795 student writes about an article in the NYT about working, low-income Americans who are eligible for neither Medicaid nor subsidized insurance on the ACA exchanges:

Yesterday, an article was published on the New York Times regarding the coverage gap between Obamacare and Medicaid. I was moved by this poignant article, as it discusses the personal ramifications of being uninsured. This article discusses the innovative ways providers had adapted to the overwhelming demands of treating the uninsured and medically isolated, where the coverage gap exists. This article reemphasizes the fact that being uninsured is still costly. It is costly on the uninsured mental health, it is costly on community contributions, and it is costly to treat potentially preventable diseases that could have been managed if the uninsured had been able to see a physician on a regular basis.


Hypertension: It’s not just a rich men’s problem…

A PHS 795 student does something excellent — corrects an incorrectly held impression by observing data. They write:

I came across this article a while ago on a recent study – saying that more than 1 billion people are living with high blood pressure. Since the world has 7 billion, about 14% of the entire population! While I have had a(n incorrect…) perception that high blood pressure was more of a rich men’s problem, this latest study suggests that it is a condition of poverty, showing a completely inverse relationship with national income. On top of the well-known factors (e.g. high levels of salt and potassium in diet, lead exposure and pollution, lack of diagnosis and treatments), children who are undernourished are more likely to have higher blood pressure as they grow older. The researchers suggest that the global community take it as a condition of poverty – especially focus on the intake of healthy calories and not just enough calories! I have a mixed feeling of ‘relief’ that we have discovered a problem to be resolved for global health improvement as well as ‘frustration’ that we have ANOTHER problem on the endless list…..

Stigma and mental health: not just a US issue.

A PHS 795 student writes about a recent piece on NPR:

This article touches on a health issue that we mentioned in an earlier lecture by Dr. Elizabeth Jacobs on health care disparities and cultural competency. In it, the article discusses how cultural awareness of what mental health is often ignored. In particular, it draws on an anecdotal story from an individual from Nepal and how they were not aware what depression was, let alone how to seek help for many years. Additionally, “in Nigeria,… only a third of those with depression knew they had a problem and that something could be done about it”. I found this very interesting because even talking to older adults in the U.S., it seems like there is still a large stigma about mental health and a gross misunderstanding as the causes and effects, particularly of depression. The individual in the article, Jagannath Lamichhane, even states “‘People believe that depression is the result of personal weaknesses…'”, and from my knowledge, this seems to be a misunderstanding across different parts of the world and different cultures. This relates back to the lecture on cultural competency and the burden that medical professionals, researchers, and policy-makers all have to continue raising awareness on mental health, the biopsychological factors related to mental health, and of course, services available. I’m not certain as to how much training people in these three spheres receive, but it certainly seems to be a global public frame of mind and cultural attitude that needs to be further developed and conversations that need to be had.

Gender equity and the “repeal/replace” question.

A PHS 795 student raises important questions about gender equity and intergenerational effects from potential repealing and replacing of the ACA:

In our past few lectures, we discussed the criteria for assessing health insurance policy as well as the Trump Administration’s impact on health care reform. A brief article from Kaiser Health News suggests that women may incur a disproportionate cost as a result of ACA reform (or dismantlement) because of foreseen policy changes regarding the coverage of maternity care.


According to the article, an estimated 13% of women who purchased health insurance on the individual market (not public insurance or employer-provided insurance) had coverage for maternity care in 2009. The ACA mandated that all plans must cover maternity care, endorsing it as an essential preventive service. With an incoming administration reevaluating what qualifies as preventive care, women who purchase health care in the post-ACA individual market may find few plans that cover maternity care.

We talked about “fairness” as a criterion for health insurance policy, and this piece raises questions on whether these potential changes in coverage are fair to women. I had one question that wasn’t addressed by this article: Is it fair to future children, and should we consider future children in evaluating health policy changes. If we recall Dr. Ehrenthal’s lecture on the life-course trajectory of health, early interventions when a child is in utero can affect birth outcomes and may impact early childhood development. When we evaluate health insurance policy changes, should we consider those affected aside from the single patient? If so, how do we evaluate “secondary” (non-patient) players in policy?

(Note: When I refer to a child in utero, I assume that the mother intends to carry the child to full term.)

CBPP: Medicare is Not “Bankrupt”

In a followup to our lectures on Medicare and Medicaid, a PHS student refers us to a useful posting on the Center for Budget and Policy Priorities blog about predictions of Medicare costs for the next generation. Notably, patterns of cost growth are sensitive to policy (including Obamacare, which has contributed to lower long-run cost forecasts).

Medicare has grown somewhat stronger financially in both the short and long term but continues to face long-run financing challenges

Source: Medicare Is Not “Bankrupt” | Center on Budget and Policy Priorities

It will be important to keep these projections in mind as policy alternatives affecting Medicare, Medicaid and Obamacare are rolled out under the Trump Administration.


What constitutes a “health emergency”

A PHS 795 student makes an important point about the importance of clear communication in population health (and indeed all science of public interest):


I initially was looking through NPR and what was in the headlines when this article caught my eye. I was going to summarize on the update of Zika that the article mentions, but as I read it, I actually noticed two larger populations health issues. In the first part of the course, multiple lecturers touched on the responsibility of researchers to make their work clearly understood to the public and our “academic oath” in doing good research that helps the greater good, or population health as the case may be. So when I read an article titled “Zika No Longer Global ‘Health Emergency,’ WHO Declares”, I assumed it meant that Zika had finally stopped spreading or was no longer as much of a crisis as it had been. So I was very surprised that when I kept reading, the third paragraph is:

“‘It is really important that we communicate this very clearly: We are not downgrading the importance of Zika,’ Salama says. ‘In fact, by placing this as a longer term program of work, we’re sending the message that Zika is here to stay. And WHO’s response is here to stay, in a robust manner.’ One thing is clear: Zika is still spreading. And microcephaly cases are still growing. ”

To me, these two things are contradictory. It appears the researchers made an effort to clarify their statements, but somehow it was still lost in the headline.  With respect to population health, when headlines like these make the news (that are somewhat the opposite of what the research says), public support for health programs often diminishes which just exacerbates the health issues in the first place. These leads to the second issue: when support for public health programs declines, it is often people who are most at risk that feel the effects first.

The article mentions that pregnant women are most at risk and from my prior knowledge, I believe it is often women from poorer areas So then people with low socio-economic status are the ones who will first and foremost feel the adverse effects of misreporting research. I believe this is one example of how there needs to be better communication between research and the rest of the world.

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

I would like to share the next article with the rest of the class:

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 …