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Abstract Background The Affordable Care Act (ACA) established the health insurance marketplaces to provide people the opportunity to obtain healthcare coverage. Assisters have worked with people who may have difficulty understanding the new system and selecting the right plan. This study aims to describe the local availability of assister programs, and examine the factors influencing assister provision. Methods The 2016 Small Area Health Insurance Estimates data and a database of assister programs constructed using healthcare.gov were analyzed at the county level. Bivariate analysis by assister provision was performed to determine the differences between the two groups, and the hierarchical generalized linear model was used to examine the factors predicting assister availability. Results The study analyzed 2260 counties nested within 35 states. Assister availability largely varied across counties and states. About half of the counties did not provide assisters at all, and the assister provision rate at state level ranged between 19 - 100%. Counties in metropolitan areas were more likely to provide assister programs than rural areas, and so were counties with higher adult uninsured rate or higher uninsured rate among the people with incomes between 138 - 400% of federal poverty level (FPL). Conclusions Despite the important role of in-person assistance in plan enrollment, no previous study has examined the local variability of assister program. Our study found a large geographical variation in assister availability, raising concerns about the disparity in access to assister service.

The response patterns of youth who witness bullying have potential to influence future occurrence and persistence of bullying behaviors. Prevention efforts have included an increased focus on bystander interventions; however, the majority of adolescents rarely intervene in bullying situations. When they do, they often display of mixed pattern of behaviors. To better understand factors related to adolescent responses to witnessing bullying, the current study drew upon school climate survey data reported by 57,314 middle and high school students. Logistic regression analyses demonstrated higher odds of bully assisting behavior among those with higher externalizing symptoms and higher odds of defending the targets among those with elevated internalizing symptoms. Prior victimization was associated with higher odds of all bystander-behavior response types. These findings highlight the salient role of youth's prior victimization and mental health in youth responses to witnessing bullying. Implications for bystander-focused bullying prevention efforts are considered. [ABSTRACT FROM AUTHOR]

Assisters provide in-person and phone-based support to help consumers narrow their plan options on the Affordable Care Act's health insurance Marketplaces. We elicited the perspectives of a national sample of thirty-two assisters from ten states on consumer plan selection and available Marketplace decision support tools (for example, total cost estimators and provider network look-up tools). Assisters identified several shortcomings that limited their use of decision support tools, such as nonspecific cost estimates and inaccurate provider network data. Assisters instead provided individualized cost estimates, called provider offices to verify network coverage, and found innovative strategies to help consumers access care affordably under their chosen plan. Two priorities emerged for optimizing consumers' Marketplace insurance selection process: improve the quality of data used in decision support tools and invest in assister programs. Assister strategies should be a benchmark for improving decision support tools, with lessons to be learned for future tool development.