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Health Affairs' January Issue: Coverage, Medicaid, Nurses & More - Health Affairs

The January issue of Health Affairs, a variety issue, includes studies covering health care coverage, including Medicaid, and some of the ramifications of the COVID-19 pandemic on the nursing workforce. It also includes the Centers for Medicare Medicaid Services’  2020 national health expenditures report.

Featured articles highlighted and described below:

  • DATAWATCH: Nurse Employment During The First Fifteen Months Of The COVID-19 Pandemic; Peter Buerhaus of Montana State University and coauthors .
  • AGE-FRIENDLY HEALTH: Informal Caregivers Provide Considerable Front-Line Support In Residential Care Facilities And Nursing Homes; Norma Coe and Rachel Werner, both of the University of Pennsylvania.
  • The Impact Of Household Health Insurance Coverage Gains On Children’s Achievement In Iowa: Evidence From The ACA; George Wehby of the University of Iowa and National Bureau of Economic Research.  

D ATAWATCH: Nurse Employment During The First Fifteen Months Of The COVID-19 Pandemic

The onset of the COVID-19 pandemic brought about an economic shutdown in March 2020. To determine how this affected the US nursing workforce,  Peter  Buerhaus  of Montana State University and coauthors  examine aggregate data from the Bureau of Labor Statistics for the period from February 2020 through June 2021. The authors found unprecedented declines in the early months of the pandemic, most intensely in physician offices, outpatient care centers, and home health care. According to the authors, employment in most sectors gradually returned to near  prepandemic  levels over the course of 2020; however, overall unemployment rates stayed higher in nonhospital settings, particularly in nursing homes, with total employment 13.2 percent lower in June 2021 than in February 2020. (See exhibit below.) The authors also detected higher unemployment rates among registered nurses and nursing assistants who are members of racial and ethnic minority groups. For example, in the second quarter of 2021, unemployment rates for White registered nurses and nursing assistants were below what they had been in 2019, whereas unemployment rates for racial and ethnic minority groups were 1.6 and 2.7 percentage points higher, respectively, than they had been in 2019. These findings provide a snapshot of the pandemic’s effects on employment and earnings and shed light on some of the broader dynamics affecting this critical sector of the health workforce.

 

AGE-FRIENDLY HEALTH: Informal Caregivers Provide Considerable Front-Line Support In Residential Care Facilities And Nursing Homes

To a surprising degree, residents of nursing homes and other residential facilities (such as assisted living) continue to rely on family members and friends for help with mobility, household activities, and self-care. Together, these loved ones form an invisible workforce in these facilities, supplementing formal, paid care with hours of informal care each week. In one of the first studies focusing on residential care settings,  Norma Coe and Rachel Werner, both of the University of Pennsylvania,   analyze both private and government nationally representative surveys for 2015 and 2016 to measure caregiving. According to the authors, more than half of nursing home residents received help from family and friends, who provide, on average, more than one extra shift of care per week. Although residential care facility dwellers had less need for help, they also relied on informal care to a substantial degree when needs arose. The authors note that the importance of these caregivers in the lives of residents has been brought to the forefront during the COVID-19 pandemic, when visitor bans aimed at protecting residents and staff members from the spread of the virus prevented visitation, bringing with it elevated rates of depression and a host of behavioral problems. The authors recommend that informal caregivers be integrated into the care delivery system of these facilities through policies and practices that include paying them for their care and providing formal training.

The Impact Of Household Health Insurance Coverage Gains On Children’s Achievement In Iowa: Evidence From The ACA

More than half of US children live in households that earn less than 200 percent of the federal poverty level. Children living in low-income households such as these have lower school achievement than their peers, on average, as measured by school test performance. In one of the first studies of its kind,  George  Wehby of the University of Iowa and National Bureau of Economic Research  examined effects of the Affordable Care Act (ACA) health insurance expansions—which began in 2014 and increased access to health care for a growing number of lower-income individuals and families—on standardized school test scores of children in Iowa schools, focusing on reading and math tests. The study data were derived from test scores for academic years 2011–12 through 2017–18 and were linked to the birth certificates for the students who were tested. The data included information on maternal education. According to the author, for children whose mothers had a high school education or less at the child’s birth there was a statistically significant increase in reading scores in academic years 2016–17 and 2017–18, which coincided with the third and fourth years after implementation of the 2014 ACA expansions. The author did not find an increase in math scores. He concludes that the study provides novel evidence that the ACA insurance coverage expansions were associated with improved academic achievement of children in low-income Iowa households and that these findings complement those on changes in health care access and health status in low-income households and are particularly relevant for states that have not yet expanded Medicaid under the ACA.

Other studies discussing related topics include:

  • US Physicians’ Knowledge About The Americans With Disabilities Act And Accommodation of Patients With Disability; Lisa  Iezzoni  of Harvard Medical School and Massachusetts General Hospital and coauthors.
  • Louisiana Medicaid Expansion Associated With Reduced Travel For Care Among Minority Groups And Rural Residents; Dimitris  Karletsos  and Charles  Stoecker, both with Tulane University.
  • Understanding The Use of Medicare Procedure Codes For Advance Care Planning: A National Qualitative Study; Keren Ladin of Tufts University and coauthors.