The Impact of Medicaid Expansion on the Healthfulness of Non-Alcoholic Beverage Choices among Low-Income Households

2019 ◽  
Author(s):  
Xi He ◽  
Rigoberto A. Lopez ◽  
Rebecca Boehm
Keyword(s):  
Low Income ◽  
Alcoholic Beverage ◽  
Medicaid Expansion ◽  
The Impact ◽  
Low Income Households

Medicaid expansion and non‐alcoholic beverage choices by low‐income households

2020 ◽  
Vol 29 (11) ◽  
pp. 1327-1342
Author(s):  
Xi He ◽  
Rigoberto A. Lopez ◽  
Rebecca Boehm
Keyword(s):  
Low Income ◽  
Alcoholic Beverage ◽  
Medicaid Expansion ◽  
Low Income Households

Impact of Medicaid expansion on two-year mortality among stage IV breast cancer (BC) patients according to race.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6525-6525
Author(s):  
Catalina Malinowski ◽  
Xiudong Lei ◽  
Hui Zhao ◽  
Sharon H. Giordano ◽  
Mariana Chavez Mac Gregor
Keyword(s):  
Breast Cancer ◽  
Low Income ◽  
Stage Iv ◽  
Medicaid Expansion ◽  
Risk Of Death ◽  
Stage Iv Breast Cancer ◽  
Increased Risk ◽  
The Impact ◽  
Expansion Period ◽  
White Patients

6525 Background: Inadequate access to healthcare services is associated with worse outcomes. Disparities in access to cancer care are more frequently seen among racial/ethnic minorities, uninsured patients, and those with low socioeconomic status. A provision in the Affordable Care Act called for expansion of Medicaid eligibility in order to cover more low-income Americans. In this study, we evaluate the impact of Medicaid expansion in 2-year mortality among metastatic BC patients according to race. Methods: Women (aged 40-64) diagnosed with metastatic BC (stage IV de novo) between 01/01/2010 and 12/31/2015 and residing in states that underwent Medicaid expansion in 01/2014 were identified in the National Cancer Database. For comparison purposes, 2010-2013 was considered the pre-expansion period and 2014-2015 the post-expansion period. We calculated 2-year mortality difference-in-difference (DID) estimates between White and non-White patients using multivariable linear regression models. Results are presented as adjusted differences (in % points) between groups in the pre- and post-expansion periods and as adjusted DID with 95%CI. Covariates included age, comorbidity, BC subtype, insurance type, transfer of care, distance to hospital, region, residence area, education, income quartile, facility type and facility volume. In addition, overall survival (OS) was evaluated in pre- and post-expansion periods via Kaplan-Meier method and Cox proportional hazards models; results are presented as 2-year OS estimates, hazard ratios (HRs), and 95% CIs. Results: Among 7,675 patients included, 4,942 were diagnosed in the pre- and 2,733 in the post-expansion period. We observed a reduction in 2-year mortality rates in both groups according to Medicaid expansion. Among Whites 2-year mortality decreased from 42.5% to 38.7% and among non-Whites from 45.4% to 36.4%, resulting in an adjusted DID of -5.2% (95%CI -9.8 to -0.6, p = 0.027). A greater reduction in 2-year mortality was observed among non-Whites in a sub-analysis of patients who resided in the poorest quartile (n = 1372), with an adjusted DID of -14.6% (95%CI -24.8 to -4.4, p = 0.005). In the multivariable Cox model, during the pre-expansion period there was an increased risk of death for non-Whites compared to Whites (HR 1.14, 95% CI 1.03 to 1.26, P = 0.04), however no differences were seen in the post-expansion period between the two groups (HR 0.93, 95% CI 0.80 to 1.07, P = 0.31). Conclusions: Medicaid expansion reduced racial disparities by decreasing the 2-year mortality of non-White patients with metastatic breast cancer and reducing the gap when compared to Whites. These results highlight the positive impact of policies aimed at improving equity and increasing access to health care.

The Impact of the COVID-19 Pandemic on Low Income Households in the Philippines

10.1596/35260 ◽  
2021 ◽  
Author(s):  
Yoonyoung Cho ◽  
Jorge Avalos ◽  
Yasuhiro Kawasoe ◽  
Douglas Johnson ◽  
Ruth Rodriguez
Keyword(s):  
Low Income ◽  
The Philippines ◽  
The Impact ◽  
Low Income Households

Linking a sugar-sweetened beverage tax with fruit and vegetable subsidies: A simulation analysis of the impact on the poor

2021 ◽  
Author(s):  
Pourya Valizadeh ◽  
Barry M Popkin ◽  
Shu Wen Ng
Keyword(s):  
Low Income ◽  
Simulation Analysis ◽  
Fruit And Vegetable ◽  
Sugar Sweetened Beverage ◽  
Subsidy Rate ◽  
Sweetened Beverage ◽  
Financial Gain ◽  
Households With Children ◽  
The Impact ◽  
Low Income Households

Abstract Background US individuals, particularly from low-income subpopulations, have very poor diet quality. Policies encouraging shifts from consuming unhealthy food towards healthy food consumption are needed. Objectives We simulate the differential impacts of a national sugar-sweetened beverage (SSB) tax and its combination with fruit and vegetable (FV) subsidies targeted to low-income households, on SSB and FV purchases of lower and higher SSB purchasers. Design We considered a one-cent-per-ounce SSB tax and two FV subsidy rates of 30% and 50% and used longitudinal grocery purchase data for 79,044 urban/semiurban US households from 2010-2014 Nielsen Homescan. We used demand elasticities for lower and higher SSB purchasers, estimated via longitudinal quantile regression, to simulate policies’ differential effects. Results Higher-SSB purchasing households made larger reductions (per adult equivalent) in SSB purchases than lower SSB purchasers due to the tax (e.g., 4.4 oz/day at SSB purchase percentile 90 vs. 0.5 oz/day at percentile 25; p < 0.05). Our analyses by household income indicated low-income households would make larger reductions than higher-income households at all SSB purchase levels. Targeted FV subsidies induced similar, but nutritionally insignificant, increases in FV purchases of low-income households regardless of their SSB purchase levels. Subsidies, however, were effective in mitigating the tax burdens. All low-income households experienced a net financial gain when the tax was combined with a 50% FV subsidy, but net gains were smaller among higher SSB purchasers. Further, low-income households with children gained smaller net financial benefits than households without children and incurred net financial losses under a 30% subsidy rate. Conclusions SSB taxes can effectively reduce SSB consumption. FV subsidies would increase FV purchases, but nutritionally meaningful increases are limited due to low purchase levels pre-policy. Expanding taxes beyond SSBs, larger FV subsidies, or subsidies beyond FVs, particularly for low-income households with children, may be more effective.

Impact of Medicaid expansion on pancreatic cancer care: A difference-in-difference analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18567-e18567
Author(s):  
Ahmad Hamad ◽  
Mariam Eskander ◽  
Yaming Li ◽  
Oindrila Bhattacharyya ◽  
James L Fisher ◽  
...  
Keyword(s):  
Low Income ◽  
Early Stage ◽  
Ductal Adenocarcinoma ◽  
Control Group ◽  
Medicaid Expansion ◽  
Difference In Difference ◽  
Post Surgery ◽  
Number Of Patients ◽  
The Impact ◽  
Expansion Period

e18567 Background: The Affordable Care Act (ACA) increased insurance coverage for low-income individuals, which should potentially lead to better access to care and improved oncological outcomes. This study seeks to evaluate the impact of Medicaid expansion (ME) on care for pancreatic ductal adenocarcinoma (PDAC). Methods: Patients who were uninsured or on Medicaid and diagnosed with PDAC between 2004 and 2017 were queried from the National Cancer Database (NCDB). Two different expansion cohorts were included: early expansion states and 2014 expansion states. For early expansion states, the time period of pre-expansion was 2004-2009 and post-expansion was 2010-2017. As for the 2014 expansion states, the pre-expansion period was from 2004-2013 and post-expansion period was from 2014-2017. Patients in non-expansion states formed the control group. A difference-in-difference (DID) analysis was used to assess the association of ME with stage of diagnosis, treatment and survival for each expansion cohort. Results: In both early and January 2014 expansion states, there was an increase in overall Medicaid coverage (Early: DID = 0.29, 2014: DID = 0.37; P < 0.001), in particular for non-Hispanic Black and Hispanic Black patients (Non-Hispanic Black: Early: DID = 0.11, 2014: DID = 0.11; P < 0.001, Hispanic-Black: 2014: DID = 0.20; P = 0.003). There were no differences in early stage diagnosis (Early: DID = 0.02, 2014: DID = -0.02; P > 0.05). There was an increase in the number of patients receiving surgery (Early: DID = 0.05; P = 0.001, 2014: DID = 0.03; P = 0.029) but no difference in time to surgery among patients receiving surgery upfront (Early: DID = 1.75, 2014: DID = 0.38; P > 0.05). There was no difference in 30-day readmission post-surgery (Early: DID = 0.003; 2014: DID = -0.00007; P > 0.05) or 90-day mortality (Early: DID = -0.007, 2014: DID = -0.035; P > 0.05). Moreover, there was no difference in receipt of chemotherapy (Early: DID = 0.01, 2014: DID = 0.005; P > 0.05) or time to chemotherapy for patients receiving neoadjuvant chemotherapy (Early: Early: DID = 9.62, 2014: DID = 0.01; P > 0.05). Finally, there was no difference in receipt of palliative care among stage IV patients in both cohorts (Early: DID = -0.004, 2014: DID = 0.004; P > 0.05). Conclusions: This study suggests that after ME, PDAC patients were more likely to be insured and had increased access to surgical care. Future, studies should evaluate the implications of improved surgical access on clinical outcomes such as mortality.

scholarly journals Accessibility of summer meals and the food insecurity of low-income households with children

2016 ◽  
Vol 19 (11) ◽  
pp. 2079-2089 ◽  
Author(s):  
Daniel P Miller
Keyword(s):  
Food Security ◽  
Food Insecurity ◽  
Low Income ◽  
Urban Areas ◽  
California Health Interview Survey ◽  
Lower Probability ◽  
Geographic Accessibility ◽  
Households With Children ◽  
The Impact ◽  
Low Income Households

AbstractObjectiveAlmost no previous research has examined the impact of the US Department of Agriculture’s (USDA) Summer Food Service Program and related Seamless Summer Option, which provide meals and snacks to low-income children over the summer. The present study investigated whether geographic accessibility of summer meals programme sites (a proxy for programme participation) was associated with food insecurity for low-income households.DesignThe study used data from the California Health Interview Survey (CHIS) and administrative data on summer meals sites in California. Geocoding was used to calculate driving time between CHIS households and nearby summer meals sites. Geographic accessibility was measured using a gravity model, which accounted for the spatially distributed supply of and demand for summer meals. Food insecurity and very low food security were measured using a standard six-item measure from the USDA.SubjectsLow-income families with children (n5394).SettingA representative surveillance study of non-institutionalized households in California.ResultsGeographic accessibility was not associated with food insecurity. However, geographic accessibility was associated with a significantly lower probability of very low food security in the full sample and among households with younger children and those living in less urban areas.ConclusionsThe USDA’s summer meals programme may be effective at reducing the most severe form of food insecurity for low-income households with children. Expanding the number of summer meals sites, the number of meals served at sites and sites’ hours of operation may be effective strategies to promote nutritional health over the summer months.

Low Income Households: Casualties of the Boom, Casualties of the Bust?

2011 ◽  
Vol 11 (1) ◽  
pp. 81-91 ◽  
Author(s):  
Grahame Whitfield ◽  
Chris Dearden
Keyword(s):  
Economic Growth ◽  
Financial Institutions ◽  
Low Income ◽  
Rapid Change ◽  
Credit Crunch ◽  
Low Incomes ◽  
Economic Boom ◽  
The Uk ◽  
The Impact ◽  
Low Income Households

This article reflects on research undertaken with low income households over a 12 month period following the ‘credit crunch’, a period characterised by rapid change to the financial landscape in the UK. It argues that people living on persistent low incomes were casualties of the economic ‘boom’ as they did not benefit from economic growth and of the ‘bust’ in that they most keenly felt the impact of the recession and the reaction of financial institutions to the new financial landscape. It concludes by arguing that, reflecting on the complexity of people's lives, addressing indebtedness requires a multi-faceted approach.

scholarly journals The impact of financial incentives and restrictions on cyclical food expenditures among low-income households receiving nutrition assistance: a randomized controlled trial

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Sruthi Valluri ◽  
Susan M. Mason ◽  
Hikaru Hanawa Peterson ◽  
Simone A. French ◽  
Lisa J. Harnack
Keyword(s):  
Low Income ◽  
Financial Incentives ◽  
Fruits And Vegetables ◽  
The United States ◽  
Assistance Program ◽  
Added Sugar ◽  
Food Expenditures ◽  
Nutrition Assistance ◽  
The Impact ◽  
Low Income Households

Abstract Background The Supplemental Nutrition Assistance Program (SNAP) is the largest anti-hunger program in the United States. Two proposed interventions to encourage healthier food expenditures among SNAP participants have generated significant debate: financial incentives for fruits and vegetables, and restrictions on foods high in added sugar. To date, however, no study has assessed the impact of these interventions on the benefit cycle, a pattern of rapid depletion of SNAP benefits that has been linked to worsening nutrition and health outcomes over the benefit month. Methods Low-income households not currently enrolled in SNAP (n = 249) received benefits every 4 weeks for 12 weeks on a study-specific benefit card. Households were randomized to one of four study arms: 1) incentive (30% incentive for fruits and vegetables purchased with study benefits), 2) restriction (not allowed to buy sugar-sweetened beverages, sweet baked goods, or candy using study benefits), 3) incentive plus restriction, or 4) control (no incentive or restriction). Weekly household food expenditures were evaluated using generalized estimating equations. Results Compared to the control group, financial incentives increased fruit and vegetable purchases, but only in the first 2 weeks after benefit disbursement. Restrictions decreased expenditures on foods high in added sugar throughout the benefit month, but the magnitude of the impact decreased as the month progressed. Notably, restrictions mitigated cyclical expenditures. Conclusions Policies to improve nutrition outcomes among SNAP participants should consider including targeted interventions in the second half of the month to address the benefit cycle and attendant nutrition outcomes. Trial registration ClinicalTrial.gov, NCT02643576. Retrospectively registered December 22, 2014.

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