Search

A growing body of public policy literature examines how welfare retrenchment reform produces attitudinal and behavioral feedback effects. This study adds to the literature on welfare reforms by exploring how different policy designs, combined with individual proximity to reform, produce heterogeneous feedback effects. Bridging the theories of policy feedback and policy design, we theorize how different policy designs shape individuals' self‐interest or sociotropic considerations when they form opinions on welfare reform. The feedback effects of these different policy designs are channeled by individual proximity to the reform, resulting in heterogeneous responses to proposed policy change. Seizing an opportune time window when the Chinese government undertook a public consultation program in 2020 regarding the proposed reform reallocating financial resources in individuals' medical savings accounts, we conducted a survey experiment to examine if two different policy designs led to varying feedback effects. We find that the moderate de facto retrenchment reform indeed triggered public opposition. Unlike previous research that emphasizes partisanship as a major source of heterogeneous feedback effects, our study reveals different sources of heterogeneity—public opposition to the proposed reform varies by the specific policy designs and individuals' past experiences with the existing health insurance policy. [ABSTRACT FROM AUTHOR]

Numerous studies have established a correlation between social anxiety and poor cognitive control. However, little is known about the cognitive control pattern of individuals with high social anxiety (HSAs) and the underlying mechanisms. Based on the Dual Mechanisms of Control framework and the Expected Value of Control theory, this study explored whether HSAs have an impaired cognitive control pattern (Experiment 1) and whether motivational deficiencies underlie the impaired control pattern (Experiment 2). In Experiment 1, 21 individuals with low social anxiety (LSAs) and 21 HSAs completed an AX‐Continuous Performance Task. Results showed that HSAs had a smaller P3b amplitude than LSAs, indicating their weakened proactive control in the cue processing stage, but a larger contingent negative variation (CNV) on cue B as compensation for the negative effects of anxiety in the response preparation stage. No group difference was found in N2 and P3a amplitude on probes, suggesting that reactive control in HSAs was not affected compared to LSAs. In Experiment 2, 21 LSAs and 21 HSAs completed a cued‐flanker task, where the likelihood of proactive control engagement was manipulated. The results revealed that HSAs exhibited motivation deficiencies in engaging in proactive control, as evidenced by P3b, CNV amplitude, and response times. These findings shed light on the impaired cognitive control pattern of HSAs and suggest that motivational deficiencies may be the crucial underlying factor. This current study confirmed that individuals with high social anxiety (HSAs) are associated with the impaired cognitive control patterns characterized by weakened proactive control and provide electrophysiological evidence. This is the first study that found HSAs have motivational deficiencies to engage in proactive control, which supports the Expected value of control theory and provides a new intervention direction. [ABSTRACT FROM AUTHOR]

This article discusses the impact of expanding pre-deductible coverage in HSA-eligible health plans on medication adherence. The study found that there was evidence of increased medication adherence in 2022, particularly for enrollees with diabetes using insulin and enrollees with heart disease or diabetes using statins. However, the overall increase in adherence was relatively small. The lack of a larger increase may be due to the fact that adherence rates were already relatively high for most medications. The study acknowledges that the findings may be influenced by how employers implemented the changes in response to IRS notice 2019-45. A 2021 survey found that three-quarters of health plans expanded pre-deductible coverage as a result of an IRS notice. Studies have shown that the impact of expanding pre-deductible coverage on premiums is small, with estimated increases ranging from virtually zero to 1.5 percent. The notice has also led to increased use of certain medical services and prescription drugs among enrollees in HSA-eligible health plans. However, there is still uncertainty about the overall impact of the notice on premiums and cost sharing. The study suggests that adopting more flexible benefit designs in HSA-eligible health plans can improve health management and reduce costs. [Extracted from the article]

This study investigated why individuals change their health insurance plans, factors that influence their health insurance plan choices and information sources used to compare and select their desired plans. Semi-structured interviews and card sorting exercises with state university employees in the Midwest region were performed. Saving money was the main reason for switching health insurance plans. Health insurance plan coverage and cost, past experiences with the plans and coverage, health saving accounts, personal and/or family health status and forecasting health care demands for the upcoming year determined their choice of health insurance plan. Human Resource departments, printed materials, health insurance companies, online tools for comparing plans and interpersonal communications were the primary information sources for comparing and selecting health insurance plans. The study suggests that although individuals evaluate various factors and refer to multiple information sources when choosing a plan, they still experience uncertainty regarding selected plans for the coming year. [ABSTRACT FROM AUTHOR]

The article explores the trends and statistics regarding flexible spending accounts (FSAs), focusing on the increase in forfeitures observed in 2022. It also discusses the different features of FSAs, such as rollover options and grace periods, and how accountholder behavior varies based on age and account type, including limited-purpose FSAs.

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]

Several states have implemented limits or caps on out-of-pocket (OOP) costs for insulin, but the effectiveness of these caps is uncertain. This observational study examines the potential effect of the caps on the OOP cost and use of insulin among a sample of commercially insured persons with diabetes. Visual Abstract. Association of State Insulin Out-of-Pocket Caps With Insulin Cost-Sharing and Use Among Commercially Insured Patients With Diabetes: Several states have implemented limits or caps on out-of-pocket (OOP) costs for insulin, but the effectiveness of these caps is uncertain. This observational study examines the potential effect of the caps on the OOP cost and use of insulin among a sample of commercially insured persons with diabetes. Background: Twenty-five states have implemented insulin out-of-pocket (OOP) cost caps, but their effectiveness is uncertain. Objective: To examine the effect of state insulin OOP caps on insulin use and OOP costs among commercially insured persons with diabetes. Design: Pre–post study with control group. Setting: Eight states implementing insulin OOP caps of $25 to $30, $50, or $100 in January 2021, and 17 control states. Participants: Commercially insured persons with diabetes and insulin users younger than 65 years. Subgroups of particular interest included members from states with insulin OOP caps of $25 to $30, enrollees with health savings accounts (HSAs) that require high insulin OOP payments, and lower-income members. Measurements: Mean monthly 30-day insulin fills and OOP costs. Results: State insulin caps were not associated with changes in insulin use in the overall population (relative change in fills per month, 1.8% [95% CI, −3.2% to 6.9%]). Insulin users in intervention states saw a 17.4% (CI, −23.9% to −10.9%) relative reduction in insulin OOP costs, largely driven by reductions among HSA enrollees; there was no difference in OOP costs among nonaccount plan members. More generous ($25 to $30) state insulin OOP caps were associated with insulin OOP cost reductions of 40.0% (CI, −62.5% to −17.6%), again primarily driven by a larger reduction in the subgroup with HSA plans. Limitations: Single national insurer; 9-month follow-up. Conclusion: Insulin OOP caps were associated with reduced insulin OOP costs but no overall increases in insulin use. A proposed national insulin cap of $35 for commercially insured persons might lead to meaningful insulin OOP savings but have a limited effect on insulin use. Primary Funding Source: Centers for Disease Control and Prevention and National Institute of Diabetes and Digestive and Kidney Diseases. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Stephen Beck Jr. Achieving a Better Life Experience Act of 2014 (ABLE Act) authorized state-administered tax-preferred savings programs for individuals with a disability called ABLE accounts. OBJECTIVE: Examine ABLE account participation rates and amounts held by Supplemental Security Income (SSI) recipients who are eligible for ABLE accounts and use the findings to identify methods to improve ABLE account participation. METHODS: Descriptive analysis using Social Security program data on the population of SSI recipients eligible for ABLE accounts to quantify: the prevalence of ABLE account use; participation rates among those eligible for ABLE accounts by demographic and socio-economic characteristics, state of residence, and state-level tax incentives; and amounts accumulated in ABLE accounts. RESULTS: As of December 2021, 36,610 SSI recipients owned ABLE accounts with a median value of $3,222, and the participation rate is 1.1 percent among SSI recipients whose disability occurred before age 26. We document substantial differences in participation rates by demographic and socioeconomic characteristics, across states, and by the availability of state-level tax incentives. CONCLUSION: ABLE account use among SSI recipients is relatively low. Differences in participation rates indicate that evidence-based methods to increase participation can improve savings and economic well-being. [ABSTRACT FROM AUTHOR]

Poverty is often characterized not only by low and unstable income, but also by heavy debt burdens. In a randomized field experiment with more than 3,500 low-income micro-entrepreneurs in Chile, we find that providing access to free savings accounts decreases participants' short-term debt. In addition, participants who experience an economic shock have less need to reduce consumption, and subjective well-being improves significantly. Precautionary savings and credit therefore act as substitutes in providing self-insurance, and participants prefer borrowing less when a free formal savings account is available. Take-up patterns suggest that requests by others for participants to share their resources may be a key obstacle to saving. [ABSTRACT FROM AUTHOR]

It is surprisingly complicated to ascertain the amount of Social Security benefits that your clients must include in their taxable income. The good news is that at least 15 percent of Social Security retirement benefits are excluded from tax, and in some cases, Social Security benefits are totally exempt. In addition, clients who are able to lower their adjusted gross income (e.g., by taking tax-free Roth or health savings account (HSA) distributions instead of taxable retirement distributions) may decrease or eliminate the amount of their Social Security income that is subject to taxation. The bad news is that tax-exempt bonds and harvested capital gains lose some of their luster if the taxation of Social Security benefits is a concern for your client. [ABSTRACT FROM AUTHOR]

The cost of care is shifting to the individual in the form of high-deductible health plans and health savings accounts. The public demands and expects innovation in health care and health delivery and is using quality and cost data to make purchasing decisions. Public expectations for convenience are demonstrated in the use of walk-in clinics, telemedicine, and other technologies. As a result of the responsibility for paying and managing one's own health, consumerism involves a curated approach to selecting health services. This Health Policy Perspectives column examines how consumerism influences health care policy, in particular occupational therapy service delivery. Issues that consumerism creates include (1) a lack of publicly shared cost and quality data about occupational therapy; (2) confusion in measurement of client-centered care, patient satisfaction, and patient experience; (3) inadequate incorporation of patient shared decision-making throughout the occupational therapy process; and (4) payment model restrictions in service delivery. Occupational therapy practitioners must help consumers learn, through patient shared decision-making, that occupational therapy is evidence based and produces desired outcomes, thereby both improving the quality and lowering the cost of health care. Occupational therapy practitioners must advocate for lower cost and convenient service options in the community through an array of technologies. Practice scholarship of the clinical doctorate in occupational therapy must focus on conducting consumer research related to patient experience; enhancing service delivery through quality improvement; and innovating practice for new sites and methods of service delivery, including the use of technology. This Health Policy Perspectives column examines how consumerism influences health care policy, in particular occupational therapy service delivery. [ABSTRACT FROM AUTHOR]

Customers in sales processes increasingly encounter automated sales agents that complement or replace human sales agents. Yet, little is known about whether, how, and why customers respond to automated agents in contrast to human agents across successive decision stages of the same sales process. Even less is known about customer responses to combinations where both agents assume distinct roles and focus on complementary tasks that are traditionally performed by only one single agent. Against this backdrop, this paper explores the influence of increasingly common sales representative types on customer decisions across sales stages. Our findings demonstrate that customer responses to automated (versus human) sales agents are not stable in sales processes and instead, shift as customers move across sales stages. What is more, the paper shows that combinations of sales agents versus single sales agents do matter, yet their differential effects depend on contextual features of the sales setting. These insights are important because vendors may assume that a certain type of sales agent is always more appreciated by customers, whereas in fact, different sales agent types bring distinct attributes to the table, and customers' appreciation of these attributes shifts across sales stages. Customers in sales processes increasingly encounter automated sales agents (ASAs) that complement or replace human sales agents (HSAs). Yet, little is known about whether, how, and why customers respond to ASAs in contrast to HSAs across successive decision stages of the same sales process. Even less is known about customer responses to HSA-ASA combinations, where both agents assume distinct roles and focus on complementary tasks that are traditionally performed by only one single sales agent. Against this backdrop, this paper explores the influence of increasingly common sales representative (rep) types (i.e., ASA, HSA, and HSA-ASA) on customer decisions across sales stages. Drawing on information processing theory and the literature on hedonic-utilitarian decision making, we investigate customer responses to text-based ASAs from vendor companies in two common early stages of email sales processes (i.e., sales initiation stages) when customers successively decide whether to indicate their initial interest in an offer and then, whether to provide their contact information. Specifically, we conducted two complementary multi-decision experiments, namely (1) a randomized field experiment in a high-stakes sales initiation setting (n = 325) and (2) a subsequent randomized online experiment to complement the real-world insights (n = 408). Our core findings reveal reversing effect patterns of sales rep types across stages: although customers are more likely to indicate their initial interest to HSAs (versus ASAs) because of HSAs' higher levels of social presence, they are less likely to provide contact information to HSAs because of HSAs' lower levels of performance expectancy and effort expectancy. We also show that HSA-ASA combinations can be reasonable options for single ASAs, yet contextual features of the sales setting may affect differential customer responses to HSA-ASA combinations (versus ASAs) in each sales stage. Taken together, we uncover shifting effect patterns in customer responses to sales rep types across successive sales stages and shed light on the consecutive underlying mechanisms that explain these shifts. These findings have significant implications for vendor companies seeking to allocate HSAs and/or ASAs effectively across various decision stages in sales processes and beyond. History: Wonseok Oh, Senior Editor and Khim Yong Goh; Associate Editor. Funding: This work was supported by the Center for Responsible Digitality (ZEVEDI) and the German Research Foundation (DFG) [Grant 471168026]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/isre.2022.1171. [ABSTRACT FROM AUTHOR]

This article provides a rank ordering of the most tax-efficient financial moves an employee should make when beginning a career. Ideally, the first two moves should be made together: put the maximum into a health savings account if the employee has high-deductible health insurance and put enough into a 401(k) account to obtain the maximum employer match. The next step is to pay down and ultimately pay off all high-interest-rate debts. The fourth step is to contribute to a Roth IRA annually since the contributions can be used for emergency spending needs tax free. [ABSTRACT FROM AUTHOR]

The article focuses on the impact of expanding pre-deductible coverage in Health Savings Account (HSA) eligible health plans on plan choice and cost sharing. Topics include the increase in enrollees with relevant health conditions, the shift in cost sharing from deductibles, and the negligible impact on overall cost sharing.

Background: High-deductible health plans (HDHPs) are becoming increasingly common, but their financial implications for enrollees with and without chronic conditions and the mitigating effects of health savings accounts (HSAs) are relatively unknown. Objective: Our aim was to compare financial hardship between non-HDHPs and HDHPs with and without HSAs, stratified by enrollees' number of chronic conditions. Design: We used data from 2015 to 2018 Medical Expenditure Panels Surveys (MEPS) to compare rates of financial hardship across individuals with HDHPs and non-HDHPs using linear and logistic regression models. Participants: A nationally representative sample of 30,981 adults aged 18–64 enrolled in HDHPs and non-HDHPs. Main Measures: We examined several measures of financial hardship, including total yearly out-of-pocket medical spending as well as rates of delaying medical care or prescriptions in the past year due to cost, forgoing medical care or prescriptions in the past year due to cost, paying medical bills over time, or having problems paying medical bills. We compared rates using the non-HDHP as the control. Key Results: On most measures, HDHPs are associated with greater financial hardship compared to non-HDHPs, including average annual out-of-pocket spending of $637 for non-HDHPs, $939 for HDHPs with HSAs, and $825 for HDHPs without HSAs (p < 0.01). However, for HDHP enrollees with multiple chronic conditions, having an HSA was associated with less financial hardship (p < 0.05). Conclusions: Our findings suggest that HSAs may be most beneficial for those with chronic conditions, in part due to the tax benefits they offer as well as the fact that those with chronic conditions are more likely to take advantage of their HSAs than their younger, healthier counterparts. However, as HDHPs are more likely to be correlated with worse financial outcomes regardless of health status, recent trends of increasing participation may be a reason for concern. [ABSTRACT FROM AUTHOR]

Objective. To assess the influence of being both poor and sick on the association of high-deductible health plans (HDHPs) with delayed/forgone care. Findings. In this cross-sectional study that included 14,203 respondents, representing 120 million Americans, individuals insured by HDHPs had 2.23 times the odds of delayed/foregone care compared with non-HDHP insureds. When examined across strata of income and health status, the association yielded similar odds of delayed/foregone care. Additionally, the interaction of being poor and sick on the association of HDHPs to delayed/foregone care was not statistically significant. Meaning. Being insured on a HDHP affected delayed/foregone care largely consistently, regardless of health, income, or combined health/income category. [ABSTRACT FROM AUTHOR]

15 Tso v. Comm'r, 40 T.C.M. (CCH) 1277 (T.C. 1980) (allowing the deduction for traditional Navajo medical treatment performed by Navajo medicine men, where the IRS conceded without arguing that the treatments counted as medical). [11] O'Donnabhain resembles a normal medical case, in that the IRS questioned whether the taxpayer pursued her therapy due to constraint or pretext. That question makes no sense when the proposed treatment is medical in nature: if there were no illness, of course the taxpayer would not have undertaken the treatment. Between 1982 and 2010, OTC medicines have generally not been eligible for the medical care deduction, but they technically were eligible for purchase from HRAs, Health FSAs, Archer MSAs, and HSAs.[30] This is because these arrangements incorporated section 213(d)'s definition of "medical care", but not section 213(b)'s ban on claiming the medical care deduction for OTC medicines. [Extracted from the article]

The U.S. Food & Drug Administration (FDA) has approved Opill® as the first daily over-the-counter (OTC) oral contraceptive. This approval marks a significant moment in reproductive health, as access to oral contraception has historically been limited to prescription-only policies. Opill® is a progestin-only pill that has been shown to be safe and effective, with a contraceptive efficacy similar to combination oral contraceptives (COCs) and a lower risk of venous thromboembolism (VTE). However, concerns have been raised about user compliance and the exclusion of populations with contraindicated medical conditions. While the approval of Opill® expands access to contraception, affordability remains a crucial issue that needs to be addressed through policy interventions. Currently, insurance coverage for OTC contraceptives is uncertain, and pricing regulations are needed to ensure reproductive justice. The Biden administration has issued Executive Orders to strengthen affordable contraception and family planning services, but a comprehensive approach, including federal funding for OTC contraceptives, may be necessary to remove barriers to reproductive healthcare. Federal agencies are expected to provide compliance guidance and coordinate with various stakeholders to standardize pricing and improve patient utilization. Overall, the approval of Opill® is a significant step towards increasing access to reproductive health, but further policy measures are needed to ensure affordability and equitable access for all. [Extracted from the article]

The article presents the discussion on policymakers understanding the strategies for improving employee financial wellness. Topics include examining trends in account balances, individual and employer contributions, distributions, invested assets, and account-owner demographics from 2011‒2021; and accountholder investing the HSA in assets other than cash.

The article discuses the research study conducted by the Employee Benefit Research Institute (EBRI) regarding how Health Savings Accounts (HSAs) are used by employees. It is reported that age and tenure play a major role in HSA utilization, with older accountholders having higher average contributions and balances than younger accountholders. It is further reported that only 12 percent of accountholders invested their HSAs in assets other than cash.

Families affected by asthma report difficulty adhering to care regimens because of high medication costs, coupled with increased cost sharing required by some insurance plans. To inform efforts to support adherence, we conducted a qualitative study to explore how families manage asthma care costs. We conducted phone interviews with commercially-insured, US adults (n = 59) who had asthma and/or a child with asthma. Our purposive sample included participants with high- and low/no-deductible health plans. We analyzed data using thematic content analysis to identify strategies for managing asthma care costs and to assess strategies' implications for adherence. Our analysis identified four overarching strategies for managing asthma care costs. First, participants used prevention strategies to avoid costly acute care by minimizing exposure to asthma triggers and adhering strictly to preventive medication regimens. Second, participants used shopping strategies to reduce costs, including by comparing medication prices across pharmacies, using medication coupons or free samples, and switching to lower-cost medications. Third, budgeting strategies involved putting aside funds, including in tax-exempt health savings accounts, or taking on debt to pay for care. Finally, some participants sought to reduce costs by forgoing recommended care, including by skipping medication doses or replacing prescribed medications with alternative therapies. Commercially-insured families use a wide range of strategies to manage asthma care costs, with both positive and negative implications for adherence. Our typology of asthma cost management strategies can inform insurance redesign and other interventions to help families safely reduce costs and maximize adherence to recommended care. [ABSTRACT FROM AUTHOR]

Individuals exhibiting high social anxiety (HSA) typically encounter challenges in identifying threatening stimuli with varying levels of intensity in different social scenes, ultimately affecting their social interactions. However, it is not well understood how social scenes, emotional intensity, and interaction influence the recognition of threat stimuli among HSA individuals (HSAs). To address this issue, a face recognition task was administered to 20 HSA participants and 22 individuals exhibiting low social anxiety (LSA) in this study. Results indicated that during the social scene presentation stage, HSAs produced larger P2 amplitude than LSA individuals (LSAs) no matter the valence of the scenes. During the face recognition stage, HSAs had smaller N170 amplitude than LSAs and exhibited lower recognition time for 2 % disgusted faces compared to LSAs. Furthermore, the consistency between scenes and faces led to faster recognition of disgusted faces in HSAs, but not in LSAs. Consequently, our findings suggested that HSAs exhibited unique cognitive processing patterns in social scenes, manifested by increased attention to scenes and decreased attention to faces. In addition, the emotional congruence between the scene and the faces could facilitate the recognition of faces by HSAs. • Individuals with high social anxiety displayed unique cognitive processing patterns: increased attention to scenes and decreased attention to faces. • The consistency of scene and facial emotion promoted the recognition of disgusted expressions in individuals with high social anxiety. • This study employed a single-trial analysis approach to process EEG data. [ABSTRACT FROM AUTHOR]

As a new financial planner, take the time to help your clients through periods of transition by educating them on how their employer- provided benefits package creates stability. The purpose of this column is to highlight common life events clients face and to offer the new planner advice and guidance about how employee benefits are intertwined with these events. [ABSTRACT FROM AUTHOR]

Higher education can lead to economic mobility, but cost is a barrier for low-income families. Children's savings account (CSA) programs for higher education increase educational aspirations. Early Bird, a novel health system–integrated CSA program being assessed through a randomized control trial could greatly influence families' outcomes. Three preliminary lessons have emerged. [ABSTRACT FROM AUTHOR]

On‐demand home service applications (HSAs) have revolutionized the service industry and are gaining high popularity. By using the innovation resistance theory in HSA context, the present study aimed to (a) examine the relationships of consumer barriers with trust and word of mouth (WOM) and (b) analyze how country context moderates the relationships of consumer barriers with trust. Survey data were gathered from 343 respondents (India = 216, The USA = 127) and analyzed using SmartPLS 3 software. The results showed that value barrier, risk barrier, and image barrier negatively affect trust and WOM. While the tradition barrier is insignificantly associated with trust and WOM, and usage barrier negatively relates to WOM only. The study also discovered the positive association of trust with WOM. The study further found that the country context moderates the relationship of value barrier, risk barrier, and image barrier with trust. Finally, implications for theory and practice are presented. [ABSTRACT FROM AUTHOR]

Little is known about health care spending variation across the US for recent years. To estimate health spending by state and payer, we combined data from the government's State Health Expenditure Accounts, which have estimates through 2014, with other primary data on spending. In 2019 state-specific per person spending ranged from $7,250 to $14,500. After adjustment for inflation, annualized per person spending growth for each state ranged from 1.0 percent in Washington, D.C., to 4.2 percent in South Dakota between 2013 and 2019. The factors that explained the most variation across states were incomes (25.3 percent) and consumer prices (21.7 percent). Medicaid expansion was associated with increases in total spending per person, although the median of spending in expansion states showed slower growth in out-of-pocket spending than the median in nonexpansion states. Contemporary estimates of state health spending are valuable for tracking divergent expenditure trajectories in the US and assessing the associated factors. [ABSTRACT FROM AUTHOR]

Cancer genomic heterogeneity presents significant challenges for understanding oncogenic processes and for cancer's clinical management. Variation in driver mutation frequency between patients with the same tumor type as well as within an individual patients' cancer can shape the use of mutations as diagnostic, prognostic, and predictive biomarkers. We have characterized genomic heterogeneity between and within canine splenic hemangiosarcoma (HSA), a common naturally occurring cancer in pet dogs that is similar to human angiosarcoma (AS). HSA is a clinically, physiologically, and genomically complex canine cancer that may serve as a valuable model for understanding the origin and clinical impact of cancer heterogeneity. We conducted a prospective collection of 52 splenic masses from 43 dogs (27 HSA, 15 benign masses, and 1 stromal sarcoma) presenting for emergency care with hemoperitoneum secondary to a ruptured splenic mass. Multi-platform genomic analysis included matched tumor/normal targeted sequencing panel and exome sequencing. We found candidate somatic cancer driver mutations in 14/27 (52%) HSAs. Among recurrent candidate driver mutations, TP53 was most commonly mutated (30%) followed by PIK3CA (15%), AKT1 (11%), and CDKN2AIP (11%). We also identified significant intratumoral genomic heterogeneity, consistent with a branched evolution model, through multi-region exome sequencing of three distinct tumor regions from selected primary splenic tumors. These data provide new perspectives on the genomic landscape of this veterinary cancer and suggest a cross-species value for using HSA in pet dogs as a naturally occurring model of intratumoral heterogeneity. [ABSTRACT FROM AUTHOR]

The article presents the discussion on quantifying the effect of expanding pre-deductible coverage to 116 drug classes used for managing chronic conditions. Topics include medical cost offsets as well as other forms of cost sharing reducing the impact of expanding predeductible coverage on premiums; and bicameral legislation providing HSAeligible health plans additional flexibility providing pre-deductible coverage for services managing chronic conditions.

The article discusses that Medicaid expansion falls within adaptive accumulation in which profit streams can be secured. It presents a policy case in which the neoliberal image of an increasingly minimalist government should be modified as corporate players and state actors seek an enlargement of the healthcare domain. It focuses on the rules of reproduction for social actors, which affect the political party's historical disposition to bipartisanship, social inclusion, and social policy.