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To assess post-COVID-19 changes in insurance coverage, health behaviors, and self-assessed health among low-income, non-elderly adults by state Medicaid expansion status.We used nationally representative survey data from the 2016 through 2020 Behavioral Risk Factor Surveillance System (BRFSS). The sample was restricted to adults aged 19-64 with household income below 138 percent of the federal poverty level (N = 179,135).We examined a broad set of outcomes related to coverage, health behaviors, and self-assessed health available in the BRFSS. We used a difference-in-differences model to compare changes in outcomes for individuals living in the 35 states and DC that expanded Medicaid under the Affordable Care Act to those in the 15 non-expansion states before and after the COVID-19 pandemic commenced in March 2020.N/A.We found that the expansions provided some protection for low-income people during the pandemic. In 2020, relative to earlier years, people in expansion states were more likely to report very good or excellent health (4.9 percentage points, 95%CI = 0.022, 0.076; p 0.01) and physical health (-0.393 days of poor physical health in the past month, 95%CI = -0.714, -0.072; p 0.05), lower rates of smoking (-1.9 percentage points, 95%CI = -0.041, 0.004; p 0.10) and heavy drinking (-1.4 percentage points, 95%CI = -0.025, -0.004; p 0.01), and higher flu vaccination rates (2.8 percentage points, 95%CI = 0.005, 0.051; p 0.05) than those in non-expansion states. These benefits were particularly salient for Black and Hispanic individuals. We found no significant differences in insurance coverage, exercise, obesity, and self-assessed mental health between expansion and non-expansion states for the overall low-income sample. However, the expansion was associated with greater insurance coverage for Hispanic adults during the pandemic.Investments in public health through expanding Medicaid may shield low-income populations from some of the health ramifications of public health emergencies.

Context: Twenty states are pursuing community engagement requirements (“work requirements”) in Medicaid, though legal challenges are ongoing. While most nondisabled low-income individuals work, it is less clear how many engage in the required number of hours of qualifying community engagement activities and what heterogeneity may exist by race/ethnicity, age, and gender. The authors' objective was to estimate current levels of employment and other community engagement activities among potential Medicaid beneficiaries. Methods: The authors analyzed the US Census Bureau's national time-use survey data for the years 2015 through 2018. Their main sample consisted of nondisabled adults between 19 and 64 years with family incomes less than 138% of the federal poverty level (N = 2,551). Findings: Nationally, low-income adults who might become subject to Medicaid work requirements already spent an average of 30 hours per week on community engagement activities. However, 22% of the low-income population—particularly women, older adults, and those with less education—would not currently satisfy a 20-hour-per-week requirement. Conclusions: Although the majority of potential Medicaid beneficiaries already meet community engagement requirements or are exempt, 22% would not currently satisfy a 20-hour-per-week requirement and therefore could be at risk for losing coverage.

This study examines the longer term relationship between public health insurance expansions and health behaviors. I leverage geographic and temporal variation in the implementation of the Affordable Care Act-facilitated Medicaid expansions and provide the first estimates of the expansions' behavioral impacts during their first 5 years. Using national survey data from the 2010 to 2018 Behavioral Risk Factors Surveillance System and a difference-in-differences regression design, I show that the Medicaid expansions increase utilization of certain forms of preventive care, while reducing heavy drinking. I also find suggestive evidence that the expansions reduce smoking and increase the probability of exercise. These results stand in contrast with earlier studies that used only 2 or 3 years of postexpansion data and found no detectable effect of the Medicaid expansions on health behaviors in the short run. My results, combined with evidence from previous studies, suggest that public insurance expansions may not prompt an immediate change in health behaviors, but newly eligible populations do increase investments in healthy behaviors over time. In the long run, Medicaid expansions may help reduce engagement in risky behaviors like drinking and smoking among low-income people.

A growing body of literature examining the effects of the Affordable Care Act (ACA) on nonelderly adults provides promising evidence of improvements in health outcomes through insurance expansions. Our review of forty-three studies that employed a quasi-experimental research design found encouraging evidence of improvements in health status, chronic disease, maternal and neonatal health, and mortality, with some findings corroborated by multiple studies. Some studies further suggested that the beneficial effects have grown over time and thus may continue to grow if the ACA insurance expansions remain in force. However, not all studies reported a significant positive relationship between ACA provisions that expanded insurance coverage and health status. We highlight the challenges facing researchers, including the importance of nonmedical factors in determining individual health and the use of outcome data predominantly drawn from self-reports. In closing, we identify opportunities to enhance researchers' understanding of the relationship between the ACA insurance expansions and health outcomes using new data sources, including electronic health records.

The federal individual mandate of the Affordable Care Act, which required people to pay a tax penalty if they did not have health insurance, was repealed in 2019. However, some states implemented state-level insurance mandates which essentially replaced the federal mandate. I use nationally representative survey data from the 2015-19 Annual Social and Economic Supplement to the Current Population Survey to compare the probability of becoming newly uninsured among people living in states without state-level insurance mandates versus states with a mandate, before and after the 2019 repeal. In a sample of 214,821 lower-income, nonelderly adults, the repeal of the federal mandate was associated with a 0.5% point, or 24%, increase in the year-over-year probability of becoming newly uninsured. These results suggest that people respond to financial incentives when making insurance enrollment decisions. In the absence of a federal mandate, state-level mandates may reduce transitions to uninsurance.

Most US workers receive their health insurance through employers due to its favorable tax treatment, improved bargaining power, and reduced adverse selection concerns. This institutional structure, however, favors large employers and full-time workers; thus, not all segments of the workforce enjoy the benefits of this system. Artists are especially disadvantaged relative to other sectors in the employment-based health insurance system as they tend to be self-employed workers and/or work on contractual bases. Theory suggests that the Affordable Care Act (ACA), by expanding options for health insurance to those without offers from employers, should represent an improvement, particularly for occupations that favor independent work, such as artists. We use large-scale survey data that identifies occupations and contains sufficient numbers of artists to study the impact of the ACA on the health insurance of these workers. We find that the 2010 Young Adult mandate of the ACA increases employment-related health insurance by 10.7 percentage points (ppts) (and any coverage by 6.6 ppts) for 21–25 year-old artists and that the Medicaid coverage rate of artists below the poverty level increases by 12.4 ppts (although its effects on any coverage are statistically imprecise) due to the state Medicaid expansion component of the ACA in 2014. Both these effects are significantly larger than for other workers. Our results thus indicate that recent health reforms have important and larger effects on artist occupations than other worker populations.

Over the past four decades, more than 2,300 people have been the victims of mass shootings involving a firearm in the United States. Research shows that mass shootings have significant detrimental effects on the direct victims and their families. However, relatively little is known about the extent to which the impacts of these tragedies are transmitted into communities where they occur, and how they influence people beyond those directly affected. This study uses nationally representative data from the Gallup-Healthways survey to assess the spillover effects of mass shootings on community wellbeing and emotional health outcomes that capture community satisfaction, sense of safety, and levels of stress and worry. We leverage differences in the timing of mass shooting events across counties between 2008 and 2017. We find that mass shootings reduce both community wellbeing and emotional health. According to our results, a mass shooting is associated with a 27 percentage point decline in the likelihood of having excellent community wellbeing and a 13 percentage point decline in the likelihood of having excellent emotional health four weeks following the incident. The effects are stronger and longer lasting among individuals exposed to deadlier mass shootings. Furthermore, the reductions in wellbeing are greater for parents with children below age 18. Our findings suggest that mass shootings have significant societal costs and create negative spillover effects that extend beyond those immediately exposed.

The field of text mining which deals with the providing of answers to the questions of the users is also one of the hot topics for researchers. The difficulty seen in the proper answering of the questions needs to be resolved. The large variety of questions fails in the QA system. In this paper, Natural Language Processing (NLP) has been used which deals with the processing of the data that comes in any form like text, video, image, or audio. This NLP comes under the field of artificial intelligence (AI), which is used in the field of question answering (QA) system. Here proposed work for designing a system that works for factoid QA which will answer the questions that are asked by the users. Lexical Chain and Keyword analysis are used in our system for the answering of questions from a given set of articles. The reasoning system is used for the validity of the answering. The experiment here is done with the SQUAD dataset. In our experiment, the accuracy obtained for the passage retrieval using TFIDF is 69.69%. The overall average of the correct prediction of the answer is 69.93%.

A growing body of literature examining the effects of the Affordable Care Act (ACA) on nonelderly adults provides promising evidence of improvements in health outcomes through insurance expansions. Our review of forty-three studies that employed a quasi-experimental research design found encouraging evidence of improvements in health status, chronic disease, maternal and neonatal health, and mortality, with some findings corroborated by multiple studies. Some studies further suggested that the beneficial effects have grown over time and thus may continue to grow if the ACA insurance expansions remain in force. However, not all studies reported a significant positive relationship between ACA provisions that expanded insurance coverage and health status. We highlight the challenges facing researchers, including the importance of nonmedical factors in determining individual health and the use of outcome data predominantly drawn from self-reports. In closing, we identify opportunities to enhance researchers' understanding of the relationship between the ACA insurance expansions and health outcomes using new data sources, including electronic health records.

Introduction Health insurance expansions may increase early detection of cancer and reduce late-stage cancer incidence. The study assesses the effects of the Affordable Care Act Medicaid expansions on rates of early- and late-stage cancer diagnosis up to 3 years after implementation. Methods Population-based quasi-experimental analysis of nonelderly adults was conducted in 732 counties from the 2010–2016 Surveillance, Epidemiology, and End Results Program cancer registry data. Multivariate event study regressions were estimated to compare annual changes in county-level rates of cancer diagnoses in states that expanded Medicaid with those that did not. Data analysis was performed from May to October 2019. Results Medicaid expansion was associated with an increase in early-stage cancer diagnoses of 21.3 per 100,000 population (95% CI=2.9, 35.2) or 9.14% of population in its first year; estimates for Years 2 and 3 were also positive but smaller and not statistically significant. There was a marginally significant reduction in late-stage diagnoses of 8.7 per 100,000 population (95% CI= −25.0, 3.4) or 5.7% of population relative to baseline, 3 years after Medicaid expansion. There was no detectable effect of expansion on total diagnoses. Conclusions Medicaid expansions increased early-stage cancer diagnosis in the first year of expansion, but effects dissipated in subsequent years, suggesting a response to pent-up patient demand for screening and diagnostic services immediately after expansion. There was also suggestive evidence of reductions in late-stage diagnosis in the third year of Medicaid expansion, highlighting the potential role of public health insurance in improving cancer outcomes among nonelderly adults.

Little is known about how the Affordable Care Act might have differentially affected insurance coverage for self-employed workers, wage earners with and without offers of employer-sponsored insurance, and people not employed. We found that the self-employed and wage earners without employer coverage offers had coverage gains equal to or greater than those of people not employed.

Purpose To analyze the differential rural-urban impacts of the Affordable Care Act Medicaid expansion on low-income childless adults’ health insurance coverage. Methods Using data from the American Community Survey years 2011-2015, we conducted a difference-in-differences regression analysis to test for changes in the probability of low-income childless adults having insurance in states that expanded Medicaid versus states that did not expand, in rural versus urban areas. Analyses employed survey weights, adjusted for covariates, and included a set of falsification tests as well as sensitivity analyses. Findings Medicaid expansion under the Affordable Care Act increased the probability of Medicaid coverage for targeted populations in rural and urban areas, with a significantly greater increase in rural areas (P < .05), but some of these gains were offset by reductions in individual purchased insurance among rural populations (P < .01). Falsification tests showed that the insurance increases were specific to low-income childless adults, as expected, and were largely insignificant for other populations. Conclusions The Medicaid expansion increased the probability of having “any insurance” for the pooled urban and rural low-income populations, and it specifically increased Medicaid coverage more in rural versus urban populations. There was some evidence that the expansion was accompanied by some shifting from individual purchased insurance to Medicaid in rural areas, and there is a need for future work to understand the implications of this shift on expenditures, access to care and utilization.

The U.S. population receives suboptimal levels of preventive care and has a high prevalence of risky health behaviors. One goal of the Affordable Care Act (ACA) was to increase preventive care and improve health behaviors by expanding access to health insurance. This paper estimates how the ACA-facilitated state-level expansions of Medicaid in 2014 affected these outcomes. Using data from the Behavioral Risk Factor Surveillance System, and a difference-in-differences model that compares states that did and did not expand Medicaid, we examine the impact of the expansions on preventive care (e.g., dental visits, immunizations, mammograms, cancer screenings), risky health behaviors (e.g., smoking, heavy drinking, lack of exercise, obesity), and self-assessed health. We find that the expansions increased insurance coverage and access to care among the targeted population of low-income childless adults. The expansions also increased use of certain forms of preventive care, but there is no evidence that they increased ex ante moral hazard (i.e., there is no evidence that risky health behaviors increased in response to health insurance coverage). The Medicaid expansions also modestly improved self-assessed health.

BACKGROUND: The Affordable Care Act (ACA) of 2010 incentivized states to expand eligibility for their Medicaid programs. Many did so in 2014, and there has been great interest in understanding the effects of these expansions on access to health care, health care utilization, and population health. OBJECTIVE: To estimate the longer-term (three-year) impact of Medicaid expansions on insurance coverage, access to care, preventive care, self-assessed health, and risky health behaviors. DESIGN: A difference-in-differences model, exploiting variation across states and over time in Medicaid expansion, was estimated using data from the Behavioral Risk Factor Surveillance System (BRFSS) for 2010–2016. PARTICIPANTS: Low-income childless adults aged 19–64 years in the BRFSS. MAIN MEASURES: Outcomes included insurance coverage, access to care, several forms of preventive care (e.g., routine checkups, flu shots, HIV tests, dental visits, and cancer screening), risky health behaviors (e.g., smoking, alcohol abuse, obesity), and self-assessed health. KEY RESULTS: The previously documented benefits of Medicaid expansions on insurance coverage, access to care, preventive care, and self-assessed health have persisted 3 years after expansion. There was no detectable effect on risky health behaviors. CONCLUSIONS: The Affordable Care Act was motivated in part by a desire to increase health insurance coverage, improve access to care, and increase use of preventive care. The Medicaid expansions facilitated by the ACA are helping to achieve those objectives, and the benefits have persisted 3 years after expansion.

The problem with the Indian real estate industry was of the lack of information and data, as well as a coherent and credible location for accessing the data. Another issue that plagued the sector until recently was that the market was unregulated, in which malpractices were rife. The Real Estate Regulation Act 2016 enacted by the government was a gamechanger in the real estate sector to address these issues. With the regulator coming into play, the consumers could access much information collated and make an informed decision. However, there are still several issues persists, such the credible and quick data access, complex coordination of records and approvals among multiple government departments and statutory bodies, and data not updated promptly. Therefore, this study aims to check the feasibility of an Urban Land Data Repository, drawn from the Real Estate Regulation Act 2016, by taking into account Indian four states of Uttar Pradesh, Madhya Pradesh, Haryana, and Maharashtra to identify potential data points for the proposed repository. The paper details the data points and the rationale for taking them, closing with an analysis of the current data availability for the proposed repository through this policy analysis paper.

Importance The rate of opioid-related emergency department (ED) visits and inpatient hospitalizations has increased rapidly in recent years. Medicaid expansions have the potential to reduce overall opioid-related hospital events by improving access to outpatient treatment for opioid use disorder. Objective To examine the association between Medicaid expansions and rates of opioid-related ED visits and inpatient hospitalizations. Design, Setting, and Participants A difference-in-differences observational design was used to compare changes in opioid-related hospital events in US nonfederal, nonrehabilitation hospitals in states that implemented Medicaid expansions between the first quarter of 2005 and the last quarter of 2017 with changes in nonexpansion states. All-payer ED and hospital discharges from 45 states in the Healthcare Cost and Utilization Project FastStats were included. Exposures State implementation of Medicaid expansions between 2005 and 2017. Main Outcomes and Measures Rates of all opioid-related ED visits and inpatient hospitalizations, measured as the quarterly numbers of treat-and-release ED discharges and hospital discharges related to opioid abuse, dependence, and overdose, per 100 000 state population. Results In the 46 states and District of Columbia included in the study, 1524 observations of emergency department data and 2219 observations of opioid-related inpatient hospitalizations were analyzed. The post-2014 Medicaid expansions were associated with a 9.74% (95% CI, −18.83% to −0.65%) reduction in the rate of opioid-related inpatient hospitalizations. There appeared to be no association between the pre-2014 or post-2014 Medicaid expansions and the rate of opioid-related ED visits (post-2014 Medicaid expansions, −3.98%; 95% CI, −14.69% to 6.72%; and pre-2014 Medicaid expansions, 1.02%; 95% CI, −5.25% to 7.28%). Conclusions and Relevance Medicaid expansion appears to be associated with meaningful reductions in opioid-related hospital use, possibly attributable to improved care for opioid use disorder in other settings.

In the last decade, health care reform has dominated U.S. public policy and political discourse. Double-digit rate increases in premiums in the Health Insurance Marketplaces established by the Affordable Care Act (ACA) in 2018 make this an ongoing issue that could affect future elections. A seminal event that changed the course of policy and politics around health care reform is the 2016 presidential election. The results of the 2016 presidential election departed considerably from polling forecasts. Given the prominence of the Affordable Care Act in the election, we test whether changes in health insurance coverage at the county-level correlate with changes in party vote share in the presidential elections from 2008 through 2016. We find that a one-percentage-point increase in county health insurance coverage was associated with a 0.25-percentage-point increase in the vote share for the Democratic presidential candidate. We further find that these gains on the part of the Democratic candidate came almost fully at the expense of the Republican (as opposed to third-party) presidential candidates. We also estimate models separately for states that did and did not expand Medicaid and find no differential effect of insurance gains on Democratic vote share for states that expanded Medicaid compared to those that did not. Our results are consistent with the hypothesis that outcomes in health insurance markets played a role in the outcome of the 2016 presidential election. The decisions made by the current administration, and how those decisions affect health insurance coverage and costs, may be important factors in future elections as well.

Overdose deaths from prescription opioids are on the rise, and policymakers seek solutions to curb opioid misuse. Recent proposals call for price-based solutions, such as opioid taxes and removal of opioids from insurance formularies. However, there is limited evidence on how opioid consumption responds to price stimuli. This study addresses that gap by estimating the effects of prices on the utilization of opioids as well as other prescription painkillers. I use nationally representative individual-level data on prescription drug purchases to exploit the introduction of Medicare Part D in 2006 as an exogenous change in out-of-pocket drug prices. I find that new users have a relatively high price elasticity of demand for prescription opioids, and that consumers treat over-the-counter painkillers as substitutes for prescription painkillers. My results suggest that increasing out-of-pocket prices of opioids, through formulary design or taxes, may be effective in reducing new opioid use.

Smart City, as this chapter proves, is the one that adapts to its dynamic structural changes in the economy within a shortest possible time without causing pitfalls. Vijayawada–Guntur–Mangalagiri–Tenali (VGTM) area, which has been identified as the capital region of the newly created state of Andhra Pradesh with its capital Amaravati in Guntur District, is fast adjusting to this structural change and plans to bring in technology to boost its economic dynamism. From that of a ‘rice bowl’, the region is transforming itself into a major service sector region, servicing not only the region, but is emerging as a major node in the eastern coast.

To analyze the differential rural-urban impacts of the Affordable Care Act Medicaid expansion on low-income childless adults' health insurance coverage.Using data from the American Community Survey years 2011-2015, we conducted a difference-in-differences regression analysis to test for changes in the probability of low-income childless adults having insurance in states that expanded Medicaid versus states that did not expand, in rural versus urban areas. Analyses employed survey weights, adjusted for covariates, and included a set of falsification tests as well as sensitivity analyses.Medicaid expansion under the Affordable Care Act increased the probability of Medicaid coverage for targeted populations in rural and urban areas, with a significantly greater increase in rural areas (P.05), but some of these gains were offset by reductions in individual purchased insurance among rural populations (P.01). Falsification tests showed that the insurance increases were specific to low-income childless adults, as expected, and were largely insignificant for other populations.The Medicaid expansion increased the probability of having "any insurance" for the pooled urban and rural low-income populations, and it specifically increased Medicaid coverage more in rural versus urban populations. There was some evidence that the expansion was accompanied by some shifting from individual purchased insurance to Medicaid in rural areas, and there is a need for future work to understand the implications of this shift on expenditures, access to care and utilization.

The U.S. population receives suboptimal levels of preventive care and has a high prevalence of risky health behaviors. One goal of the Affordable Care Act (ACA) was to increase preventive care and improve health behaviors by expanding access to health insurance. This paper estimates how the ACA-facilitated state-level expansions of Medicaid in 2014 affected these outcomes. Using data from the Behavioral Risk Factor Surveillance System, and a difference-in-differences model that compares states that did and did not expand Medicaid, we examine the impact of the expansions on preventive care (e.g. dental visits, immunizations, mammograms, cancer screenings), risky health behaviors (e.g. smoking, heavy drinking, lack of exercise, obesity), and self-assessed health. We find that the expansions increased insurance coverage and access to care among the targeted population of low-income childless adults. The expansions also increased use of certain forms of preventive care but there is no evidence that they increased ex ante moral hazard (i.e., there is no evidence that risky health behaviors increased in response to health insurance coverage). The Medicaid expansions also modestly improved self-assessed health.

Transition of Indian economy from an inward looking, public sector dominated developmental state to a more market oriented one through an increased integration with the outside world is bringing newer challenges. Planners require new skills, especially in the areas of urban governance to play their rightful role in shaping Indian cities. To do that, there is an urgent need to revisit the way planning is taught in the country. In this chapter, we suggest specific changes to be effected in the syllabus and the course structure through incorporation of new analytical and conceptual frameworks and also closer integration between theory and studio exercises.

This analysis uses SEER Medicaid data to quantify changes in health insurance coverage under the Affordable Care Act among nonelderly patients newly diagnosed with cancer.