8 results on '"Zewde, Naomi"'
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2. Improving estimates of Medicaid's effect on poverty: Measures and counterfactuals
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Zewde, Naomi, Remler, Dahlia, Hyson, Rosemary, and Korenman, Sanders
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Poverty -- Prevention -- Laws, regulations and rules -- United States ,Medicaid -- Influence -- Laws, regulations and rules ,Health care disparities -- Economic aspects ,Medically uninsured persons -- Health aspects -- Economic aspects ,Government regulation ,Business ,Health care industry - Abstract
Objective: To re-evaluate the effect of Medicaid on poverty using a poverty measure that accounts for health insurance needs and benefits and an evaluation approach that reflects disparities in access to alternative coverage. Data Sources: The Current Population Survey (CPS) for calendar year 2015. Study Design: We estimate the effect of losing Medicaid on poverty, combining two previous approaches: (1) A propensity impact, which simulates a no-Medicaid coun-terfactual incorporating changes to health insurance and medical out-of-pocket spending, using the Supplemental Poverty Measure (SPM). This measure does not reflect a need for health care access nor how health benefits meet that need. (2) An accounting impact, which assumes that those losing Medicaid remain uninsured and does not incorporate any behavioral changes, using the health-inclusive poverty measure (HIPM). This measure includes a need for health insurance in the threshold and health insurance benefits in resources. Data Collection/Extraction Methods: Not applicable. Principal Findings: Using the propensity-matched approach, we attributed a 2.5 percentage point reduction in health-inclusive poverty among those younger than age 65 to the Medicaid program, between the 1.0-point SPM propensity-match impact and the 3.9-point HIPM accounting impact. Medicaid's antipoverty impact and HIPM-SPM differences are greater among those who would become uninsured. HIPM propensity-matched estimates reveal much larger impacts of Medicaid on poverty disparities linked to race/ethnicity and single parenthood than SPM-based propensity estimates. Conclusions: Both the poverty measure and the method used to estimate the counterfactual make substantial, policy-relevant differences to estimates of Medicaid's impact on poverty. A poverty measure that fails to incorporate health insurance needs and benefits substantially underestimates Medicaid's effect. Failing to consider adjustments in insurance coverage and out-of-pocket spending substantially overestimates Medicaid's effect and underestimates its reduction of disparities. KEYWORDS health expenditures, healthcare disparities, Medicaid, poverty, single-parent family, What is known on this topic * Uninsured households frequently delay or forgo needed care. * If health care coverage is considered a need, then households who have no health [...]
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- 2021
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3. Erasing the Red Line? National Lessons from a New York Homeowner Policy.
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Zewde, Naomi, Edwards, Raz, and Bacchus, Erinn
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BLACK people ,HOUSING policy ,HOUSEHOLD budgets ,INCOME ,REAL estate sales - Abstract
The centrality of home equity to the balance sheets of American households, and the oppressive legacy of racial exclusion from mortgage markets, compel the design of intentionally anti-racist housing policy capable of building lasting wealth for Black families. In this study, we compare the home-mortgage terms offered to middle-income Whites in the New Deal era, with a contemporary New York City policy offered in formerly redlined districts. The city's Housing Development Fund Corporation policy is for limited-income households but does not limit down payments nor qualify for federal home loans. Using mined listing data and the 2017 Panel Study of Income Dynamics, we find more than 80% of income-eligible urban Black households lack the wealth to purchase the median listing, versus 51% of Whites. Moreover, the policy's market exclusions preclude access to what is now substantial accumulated equity. Unit owners face wide-scale housing-code violations and property seizure, highlighting the limitations of "limited equity" ownership, which counteracts wealth creation. We draw two primary lessons. First, anti-racist policy cannot demand substantial financial assets. Second, financing schemes for building improvement or climate-responsive adaptation, in addition to initial purchase, should be well-tailored to family budgets and designed to deliver equity to the formerly excluded. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Racial Wealth Inequality and Access to Care with High-Deductible Health Insurance.
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ZEWDE, NAOMI
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RACIAL inequality ,WEALTH inequality ,HEALTH services accessibility ,MEDICAL savings accounts ,HEALTH insurance ,COPAYMENTS (Insurance) ,CONSUMER behavior - Abstract
This article discusses the relationship between racial wealth inequality and access to care with high-deductible health insurance (HDHP). The study focuses on the impact of this trend on Black consumers, who may face affordability barriers due to income constraints and historical wealth disparities. The findings suggest that Black enrollees in HDHPs are more likely to have lower incomes and fewer assets compared to White enrollees. However, the study does not establish a causal link between racial wealth inequality and affordability disparities. The analysis finds that racial disparities in access to care are greater among high-deductible plan holders, but the inclusion of economic covariates, such as income and wealth, reduces these disparities. The study suggests that income and wealth play a larger role in explaining racial disparities in access to care among high-deductible plan holders. [Extracted from the article]
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- 2024
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5. Basic Health Programs: An Alternative to Public Options?
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Zewde, Naomi, Drake, Coleman, and Biener, Adam
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HEALTH programs ,MEDICAID ,SAFETY-net health care providers ,GOVERNMENT policy ,MEDICAL care costs ,INCOME ,PATIENT Protection & Affordable Care Act - Abstract
Issue: “Public option” health plans, particularly as enacted in Washington State, have had difficulty meeting their goals of improving affordability for patients and reducing overall health care costs. Some states have instead created a Basic Health Program (BHP), an alternative form of coverage authorized by the Affordable Care Act that replaces marketplace coverage for residents with low incomes who are eligible for premium subsidies. Goals: Analyze the evolution of Washington’s public option and policy changes made in other states in response to initial rollout challenges and compare these with the policy goals and outcomes of BHPs. Key Findings and Conclusion: Washington’s public option initially struggled with provider network participation and price competitiveness. Without sufficient network participation and robust enrollment, public options have few means to improve affordability or lower health care costs. BHPs are unlikely to face the same challenges. They contract with safety-net providers at Medicaid-like rates to cover all households with incomes between 138 percent and 200 percent of the federal poverty level who would otherwise be eligible for marketplace subsidies. A BHP can provide robust affordability with minimal out-of-pocket spending at a low cost to states and the federal government. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Does Private Insurance Provide More Care?
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Zewde, Naomi
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HEALTH services accessibility ,PRIVATE sector ,INCOME ,HEALTH insurance ,DESCRIPTIVE statistics ,RESEARCH funding ,MEDICAID ,MEDICAL appointments ,DEMOGRAPHIC characteristics ,INSURANCE - Abstract
Medicaid provides virtually no-cost coverage to millions of low-income Americans. This study examines whether its beneficiaries realize similar health care access as their counterparts with private insurance. We draw on the 2014–2017 Medical Expenditure Panel Survey and control for observable confounding factors across coverage types by estimating and applying entropy weights. Medicaid beneficiaries were moderately more likely to report a usual source of care (74.5% vs 68.1%, p<.01) and approximately equally as likely to report a checkup in the past year as the privately insured (43.5% vs 44.5%, p>.1), each significantly more likely than the uninsured. Medicaid beneficiaries had significantly more prescription fills (12.6 vs 8.2) and emergency-care visits (.26 vs.15) annually than the privately-insured on average, with similar numbers of physician visits. On balance, we did not find evidence that Medicaid was associated with diminished access or utilization relative to private insurance, while both had more access than the uninsured. [ABSTRACT FROM AUTHOR]
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- 2023
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7. Impact of the 2008 Recession on Wealth-Adjusted Income and Inequality for U.S. Cohorts.
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Zewde, Naomi and Crystal, Stephen
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ASSETS (Accounting) , *RECESSIONS , *INCOME , *SOCIOECONOMIC factors , *EMPLOYMENT , *LABOR market , *FINANCIAL management - Abstract
Objective To examine the distributional effects of the 2008 recession and subsequent recovery across generational cohorts. Methods Using data from the Survey of Consumer Finances (2007–2016), we constructed a measure of economic well-being accounting for income, household size, and annuitized value of assets. We examine trajectories of adjusted income and inequality, using Gini coefficients and income shares by decile, for the overall population and by cohort during the recession and recovery. Results Inequality declined temporarily during the recession, but reached new highs during the recovery. During recovery, population-level increases in economic resources were not reflected among below-median households, as the more concentrated financial assets rose while broader-based home equity and employment fell or remained stagnant. Inequality measures increased for cohorts in their primary working years (Generation-X and Baby Boomers), but not among the younger Millennials, who were at early stages of education, workforce entry, and household formation. Discussion The study illustrates an integrative approach to analyzing cumulative dis/advantage by considering interactions between historically consistent macrolevel events, such as economic shocks or policy choices affecting all cohorts, and the persistent life-course processes that tend to increase heterogeneity and inequality as cohorts age over time. Although recovery policies led to rapid recovery of financial asset values, they did not proportionately reach those below the median or their economic resource types. Results suggest that in a high-inequality environment, recovery policies from economic shocks may need tailoring to all levels of resources in order to achieve more equitable recovery outcomes and prevent exacerbating cohort inequality trajectories. [ABSTRACT FROM AUTHOR]
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- 2022
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8. Incentives and Operations of Medicaid Managed Care Plans in New York State: Implications for Procurement Design and Market Evolution.
- Author
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Zewde N and Perez V
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- New York, United States, Humans, Motivation, Managed Care Programs economics, Managed Care Programs organization & administration, Medicaid economics
- Abstract
Several states are considering competitive procurement to help shape Medicaid managed care markets. In New York state, the focus of our study, regulators propose contracts that reward quality improvement and simplify state administration by rewarding plans that operate across several of the state's 62 counties. This case analysis uses novel regulatory data from New York state, obtained via public records request, to examine incentives underlying Medicaid markets and help inform contracting design. The data report plan enrollment by county and plan spending across administrative activities for all 16 Medicaid plans in New York state for 2018. We examine the counties in which plans operate, profitability, and administrative resource allocation. We compare outcomes by tertile of plan profitability, measured as net income per member-month. Plan profitability ranged widely, with the most profitable plan realizing nearly $30 per member-month while the least profitable 5 plans realized net negative earnings. Operational differences across plan profitability emerged most clearly in administrative spending. The most profitable plans reported greater spending on salaries overall and for executive management, and taxes, while the least profitable plans spent more on operational functions including utilization management/ quality improvement, claims processing, and informational systems. We observe modest differences in county rurality and little in geographic breadth. Procurement design that rewards capacity-building in key administrative functions might impact market evolution, given that on average, highly profitable firms spent less on these activities in New York's Medicaid managed care market in 2018., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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