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Peterson on Health Care as a Voter Priority

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Public Policy Professor Mark Peterson spoke to NPR about the role that access to health care has played in the 2020 election. Republicans who previously pushed for repealing and replacing Obamacare have skirted the issue this year, as voters have expressed overwhelming support for protections such as guaranteed coverage for those with preexisting medical conditions. Opposing the Affordable Care Act is “political suicide” in this election cycle, Peterson said. “There doesn’t seem to be any real political advantage anymore.” He also called the latest effort to strike down the ACA, which is headed to the U.S. Supreme Court, an “extraordinary stretch, even among many conservative legal scholars.” Peterson was also cited in a Kaiser Health News story on the election’s impact on California’s progressive health care ambitions and in a piece by the Spanish news agency EFE comparing President Trump’s crowded campaign rallies to Democrat Joe Biden’s physically distant events.

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A Spotlight on Yin’s Research on Health Insurance Literacy

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The podcast Tradeoffs featured Public Policy Associate Professor Wesley Yin’s research into low enrollment rates in public health insurance plans, even when government subsidies are available. The study, which will be published in American Economics Review, noted that 60% of people who are uninsured and eligible for either Medicaid or Affordable Care Act premium tax subsidies choose to remain uninsured. In a randomized field experiment, researchers sent five types of letters to a group of uninsured, subsidy-eligible people in California. The letters contained escalating amounts of information, from merely announcing the start of open enrollment to specifying how much subsidy an individual could receive. Enrollment rates in this group increased about 16%, suggesting that this low-cost intervention increased their health insurance literacy and comfort level in navigating the system. In addition, the new enrollees were healthier, on average, than those already in the system, creating a more stable risk pool. Yin’s study is discussed in the second half of the podcast.

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Torres-Gil on Entrenched Disadvantages in Hispanic Community

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Fernando Torres-Gil, director of the Center for Policy Research on Aging at UCLA Luskin, co-authored an opinion piece for the Abilene Reporter News on the accumulated lifelong disadvantages experienced by the Hispanic community, which leave it particularly vulnerable to COVID-19. “Hispanics are more likely than non-Hispanic whites to experience health conditions tied to poverty, low levels of educational attainment and inadequate retirement income,” wrote Torres-Gil and co-author Jacqueline L. Angel. Eliminating these disparities should be a national priority, they said, arguing for a robust social safety net that ensures access to health care coverage, fair housing and an equitable education. They also called for the creation of “new and innovative community assets — like affordable adult day and child care services — that are critical resources to improve intergenerational relations, health and well-being, as well as the academic success of generations to come.”

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Sangalang on Culturally Sensitive Mental Health Care for Refugees

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Assistant Professor of Social Welfare Cindy Sangalang spoke to TimesOC for a report on the lack of culturally sensitive mental health care services for Orange County’s Vietnamese and Cambodian communities. Sangalang, whose research focuses on health and well-being in immigrant communities, said many Southeast Asian refugees have endured trauma at multiple points in their lives: before they migrated; when they arrived in the United States, adjusting to a new country; in the present, with a rise in deportations; and in moments throughout, amid continued socioeconomic insecurity. She added that it’s important to consider the U.S. role in the conflicts refugees fled. “For us to address the health, education and other needs of these populations, it’s really a way to think about the consequences of the war in that region and how it’s had these ripple effects, and why it’s important for us to address these needs.”

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Ong on High Stakes of Census Undercount

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A CNN report on the high stakes of an inaccurate census called on Paul Ong, director of the Center for Neighborhood Knowledge at UCLA Luskin, to provide analysis and expertise. A significant census undercount could have a sweeping impact: States could lose representatives in Congress. Children might miss out on needed funding for schools and other programs. Communities of color could get less funding for health care. Money for roads, bridges and transportation might fall short. Businesses might be stuck using flawed data for important decisions. The article cited an analysis, co-authored by Ong, that warned of a serious undercount of immigrants, low-income people and people of color. This could imperil funding for hospitals and health care clinics that serve these populations, as well as programs such as Medicaid and Medicare, Ong said. He added that census data also could be used to determine where to set up COVID-19 testing sites or how to prioritize vaccine distribution.

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Paid Sick Leave a Crucial Weapon During COVID-19 Era and Beyond Global study shows that gaps in coverage for ailing workers put nations’ health and economic security at risk

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By Mary Braswell

At a time when the world’s attention is focused on curbing the spread of infectious disease, new research by the UCLA WORLD Policy Analysis Center shows that strengthening guarantees of paid sick leave is crucial to protecting health and economic security around the globe.

Just published in the journal Global Public Health, the study found that almost every country (94%) mandates some form of paid sick leave at the national level. The United States is one of 11 countries that do not.

Yet, even in nations that guarantee paid time off for illness, the analysis showed critical gaps that undermined the ability of sick workers to follow public health advice and stay home from the very first day of illness. This was true in such countries as Italy and Iran, among the hardest hit in the early days of the COVID-19 pandemic, the study noted.

Rules that limit the duration of leave, set low rates of pay and exclude certain classes of employees put countries’ health and economic systems at risk, the study concluded. The global health emergency underscores the consequences.

‘The cost of providing paid sick leave is modest compared to the cost of reining in a pandemic.’ — Jody Heymann, founder of the WORLD Policy Analysis Center

“The cost of providing paid sick leave is modest compared to the cost of reining in a pandemic,” said Jody Heymann, founder of the WORLD Policy Analysis Center and a distinguished professor of public policy, health policy and management, and medicine at UCLA.

“This is particularly true once the more rapid spread of disease caused by workers going to work sick is factored in,” said study co-author Amy Raub, principal research analyst at WORLD. She pointed to previous studies showing that ill employees are 1.5 times more likely to go to work when they lack strong paid leave guarantees.

Heymann and Raub led the research team that analyzed government policies in all 193 U.N. member states to answer an array of questions: When do paid sick leave benefits begin and how long do they last? What is the rate of pay? Are self-employed and part-time workers covered? Are there exemptions for small businesses? The findings are based on long-term policies in place as of March 2019 and do not reflect temporary policy changes in response to the outbreak of the novel coronavirus.

“The pandemic provides a stark illustration that expanding sick leave protections to the world’s workers is urgently needed,” Raub said.

Recognizing that their paid sick leave policies left them ill-equipped to combat COVID-19, countries around the world put stronger protections in place. However, Heymann said, “these temporary changes do not ensure that countries are prepared for the next pandemic.”

“In the last 20 years, the world has battled a series of acute health emergencies,” said Heymann, citing severe acute respiratory syndrome (SARS) in 2002, the H1N1 influenza virus in 2009, and Middle East respiratory syndrome (MERS) in 2012, among other outbreaks. “And new and dangerous respiratory diseases are bound to emerge.”

“Well-designed paid sick leave is critical to ensure workers stay home when sick to prevent the spread of COVID-19 and other infectious pathogens — both when the economy is open and during an economic shutdown,” Raub said.

The new study found strong sick-leave policies in place in both low-income and affluent countries. In key areas, the United States’ record lagged far behind:

  • The U.S. has no permanent national sick leave policy, although some state and local governments have adopted protections.
  • Even if the nationwide emergency paid sick leave act adopted amid the coronavirus outbreak were made permanent, the U.S. would be the only country to exclude workers from the benefits based solely on the size of the business they work for.

Beyond the United States, there are critical global gaps:

  • 58% of countries do not explicitly guarantee paid sick leave to self-employed workers. This group makes up nearly half of the world’s work force, according to the United Nations’ International Labor Organization.
  • 65% of countries — including 54% of high-income countries — do not explicitly guarantee paid sick leave to part-time workers. This gap disproportionately impacts women, who are more likely to be employed part time than men in nearly every country.

To conduct the study, the multilingual research team analyzed the full texts of labor and social security legislation, as well as other resources. For each of the 193 countries, source materials were read independently by two researchers, who then compared and reconciled their assessments.

View a fact sheet and maps illustrating key findings from this report here. Questions about the study may be directed to Erin Bresnahan at the WORLD Policy Analysis Center.

The WORLD Policy Analysis Center at UCLA is a nonprofit policy research center that aims to improve the quantity and quality of globally comparative data on policies affecting human health, development, well-being and equity. With this data, WORLD informs policy debates and advances efforts to improve government transparency and accountability. The center’s founding director, Jody Heymann, is a distinguished professor at the Fielding School of Public Health, Luskin School of Public Affairs and David Geffen School of Medicine. She is also dean emeritus of the Fielding School.

Peterson on Strengths, Weaknesses of the Affordable Care Act

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Public Policy Professor Mark Peterson was featured in a virtual interview for the Journal of Health Politics, Policy and Law about his article “The ACA a Decade In: Resilience, Impact, and Vulnerabilities.” Peterson’s article highlighted the strengths and vulnerabilities of the Affordable Care Act 10 years after its enactment. In the interview, he pointed to the polarized political environment and the complexity of the bill as sources of weakness. Although the ACA started off as a Republican idea, he explained, stark partisanship prohibited modern Republicans from supporting it in the Senate. Peterson also mentioned that although almost everything in the bill was extremely popular, the public didn’t understand what was in it. “The strategy of building a health care reform plan not by replacing anything but by building on the existing structures resulted in an enormously complicated bill,” he said. “Most people did not know to what extent they were going to be affected by it.”

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What the Ebola Outbreak Could Teach Us About How to Contain the Novel Coronavirus New study underscores the importance of public engagement and trust during health crises

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A new research paper examining the 2014-15 Ebola outbreak in Africa could hold crucial insights for policymakers grappling with the novel coronavirus pandemic — namely, the importance of public engagement and trust during health crises.

The study, co-authored by Assistant Professor of Public Policy Darin Christensen of the UCLA Luskin School of Public Affairs, shows that where people lack confidence in their health providers, they are less likely to seek testing and treatment when they feel sick. This stymies efforts to identify, treat and isolate infected patients to limit further contagion.

By the end of the Ebola outbreak in early 2016, the U.S. Centers for Disease Control and Prevention estimated there were more than 28,000 cases of the disease in West Africa — with roughly half coming from Sierra Leone. Simple interventions that encouraged people to seek treatment increased reporting of Ebola cases by 60%, which the authors estimate reduced the virus’ reproduction rate by 19%.

‘Strengthening ties between health providers and the communities they serve could bolster containment efforts as the current pandemic spreads to poorer countries,’ researcher Darin Christensen says.

“The epidemic generated tremendous fear, and families faced tough choices about whether to care for loved ones at home or report to clinics for testing and, if needed, isolation,” said Christensen, a political economist who holds a joint appointment with UCLA’s department of political science. “That choice may seem obvious in a rich country. But in poorer countries, like Sierra Leone, citizens often have little confidence that health providers will treat them with compassion or deliver effective care. Interventions that build that trust encourage timely testing — exactly what was needed to contain Ebola and, now, COVID-19.”

Conducted across 254 government-run health clinics covering approximately 1 million people — more than 15% of Sierra Leone’s population — the research tested the effects of two interventions aimed at increasing public involvement with, and trust in, the country’s health system.

Under the first intervention, community members participated in meetings with local health clinics, and articulated complaints and suggestions designed to improve health services.

The clinic staff also shared public health advice with community members, like encouraging women to come into the clinic to give birth. This experiment turned patients into “accountability agents who hold health system actors to account,” according to the paper.

The other intervention was an incentive program that gave out awards to health care workers at clinics that were doing a good job of providing services. The intent was to motivate providers to encourage their clinics to provide a higher quality of care.

The study found that these accountability interventions prior to the Ebola outbreak spurred a vast increase in testing and the reporting of Ebola cases — including those who tested both positive and negative for the virus. The reporting did not reflect higher rates of disease in the areas that benefited from the interventions. The higher rates of testing resulted in more effective containment, and ultimately, there were 30% fewer deaths among Ebola patients in the areas that benefited from the interventions.

As governments, particularly in less-developed countries, seek to contain the spread of COVID-19, “there has rightfully been a lot of focus on the test kits and other equipment needed to fight this virus,” Christensen said. “But it’s also important to think about how we encourage people to change their behavior — to get tested, to self-quarantine. Our research suggests that strengthening ties between health providers and the communities they serve could bolster containment efforts as the current pandemic spreads to poorer countries.

“Many governments don’t have the capacity or mandate to enforce strict restrictions on travel or gatherings,” Christensen concluded. “They must appeal to their citizens to voluntarily change behavior. The Ebola epidemic demonstrates that public engagement and confidence help determine whether people heed those calls.”

The study was co-authored by Christensen and Oeindrila Dube of the University of Chicago, Johannes Haushofer of Princeton University, Bilal Siddiqi of UC Berkeley and the Center for Effective Global Action, and Maarten Voors of Wageningen University. The research team also has a forthcoming companion piece that underscores the effectiveness of crisis-response measures that emphasize community engagement.

 

Peterson Evaluates Health of Decade-Old ACA

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The state of the 10-year-old Affordable Care Act is the subject of a new article by Public Policy Professor Mark A. Peterson in a special two-issue publication of the Journal of Health Politics, Policy and Law. The advance publication of Peterson’s study, “The ACA a Decade In: Resilience, Impact, and Vulnerabilities,” is included in the first issue of the Duke University Press journal. Peterson, former editor of the journal, writes that in the decade since its enactment, the political health of the ACA — popularly known as Obamacare — has looked precarious. “It decidedly lacked the popular acclaim of the sort that arose to undergird programs like Social Security and Medicare,” Peterson says, but he adds that it has remained “viable and consequential despite Republican efforts to end it.” He also points out that, while the impact on insurance coverage has been substantial, it remains distant from universal coverage. “The ACA has revealed perhaps surprising resilience, put insurance cards into the hands of millions previously outside the system, and even contributed to some degree of reduced financial burdens,” Peterson argues. “At the same time, all of these gains have been incomplete, remain vulnerable and are threatened by underlying forces in the political economy.” Assessing the strengths and vulnerabilities of the act in its first 10 years, Peterson cautions that a path to a more secure future for either the ACA — or a more ambitious successor — is far from clear.

 

Peterson Weighs In on Sanders’ ‘Medicare for All’ Plan

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Public Policy Professor Mark Peterson was cited in a New York Times article discussing the prospects for Sen. Bernie Sanders’ “Medicare for All” proposal. Even if elected president, Sanders would probably not have sufficient support in Congress to achieve universal health coverage, the article noted. In the past 70 years, no legislation to advance universal health care has succeeded without Democratic control of all three branches of government and a supermajority in the Senate, which Sanders would be unlikely to have. Peterson pointed out that even if the rules were changed to require a simple majority to pass the legislation, “there is not any guarantee that the 51st Democrat would be willing to support Medicare for All or anything close to it.” Many Democrats in the House and Senate oppose Medicare for All, advocating instead for improving the Affordable Care Act or pursuing a new government-run “public option” that would compete with private insurance.

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