health care

Catholic hospitals are a large and growing part of the U.S. health care system. Considerable public funding flows to these institutions, but they deny many reproductive health services and some kinds of end of life care to their patients. Catholic rules limit care in far-reaching ways, well beyond what many patients and health care providers understand or expect. These realities raise important issues about the future of religious restrictions in U.S. health care.

Restricted Care in a Growing Sector

Between 2001 and 2011, the number of Catholic hospitals increased by 16%, while public and secular not-for-profit hospitals decreased. One in six patients in the United States is cared for in a Catholic hospital, and in 2015, seven of the country’s 12 largest nonprofit hospital systems were Catholic. Although Catholic hospitals provide the same amount of charity care as non-Catholic hospitals, in terms of the percent of total revenues, they provide less care to Medicaid recipients than other kinds of hospitals.

Like other hospitals, Catholic institutions receive considerable public funding, yet they limit patient care to fit the Ethical and Religious Directives for Catholic Health Care Services written by the U.S. Conference of Catholic Bishops. As a condition of employment or medical privileges, doctors, nurses, and other clinical personnel are required to follow these directives when caring for patients in Catholic facilities.Legal rights mean little without practical access to reproductive health services. more...

The Affordable Care Act of 2010 promises to extend health insurance coverage to tens of millions of uninsured people across the United States – but not to everyone. Non-citizens are among those most likely to lack health insurance coverage, yet large segments of the immigrant population have been excluded from the benefits of health reform – and may face greater barriers in the future than in the past. more...

In 2006, the Massachusetts legislature passed and Governor Mitt Romney signed into law a health care reform with subsidized health insurance coverage for low-income people, a health insurance exchange to help people not otherwise covered choose among available plans, an individual mandate requiring residents to obtain coverage if affordable, and an expansion of Medicaid to include children and long-term unemployed adults. The reform in Massachusetts turned out to be a blueprint for the Affordable Care reforms passed by Congress and signed by President Barack Obama in 2010. ObamaCare, as the federal reform law is sometimes called, is only now going into full effect, as debate continues to swirl about its provisions and its likely effects. No one can tell what the national reform’s impact on Americans’ health will turn out to be, but we can get an idea of possible benefits by looking at what is known so far about the aftermath of the earlier Massachusetts reforms. more...

The Affordable Care Act aims to extend health insurance to tens of millions more Americans through two major routes: by giving people information and in many cases tax credits to help them purchase private insurance plans offered on state or national “exchanges,” or online marketplaces; and by giving the fifty U.S. states plus the District of Columbia additional federal funds to expand their Medicaid programs to insure all low-income people just above as well as below the federal poverty line. States have a key role in implementing health reform. Each state can choose to run its own exchange marketplace and help its residents learn about their options for purchasing affordable plans. Each state also decides whether or not to accept new federal subsidies to expand Medicaid (covering 93% of the costs from 2014 through 2022). What states do—or refuse to do—makes a big difference, as a comparison of the nation’s two largest states, California and Texas, makes clear. California is leading the way in showing that Affordable Care can work, while authorities in Texas are obstructing implementation with gusto. more...

Stuck in a corporate job he called “not exactly fulfilling,” a 35-year-old man in Austin, Texas, told an NBC News reporter in September 2013 that he looked forward to the advent of Affordable Care reforms on January 1, 2014, because he will be able to quit and start working as an independent consultant. He couldn’t move on earlier because his wife has rheumatoid arthritis, a pre-existing health problem that made his employer benefits indispensable. Insurance companies would have charged him very high premiums for any plan he tried to buy on his own.

About three-quarters of Americans who work full time get health insurance through their employers, so the Austin man is not alone in experiencing what experts call “job lock” – a reluctance to change jobs for fear of losing employer health benefits. It’s a problem not just for would-be entrepreneurs but also for employees who just want to consider changing jobs. more...

U.S. health care is in the midst of a major transformation. With the implementation of the Affordable Care Act, tens of millions of Americans are getting health insurance coverage for the first time. Expanded coverage will bring a tsunami of new demand, and current transformations underline the truth that insurance is not the same thing as access to appropriate health care. Across the nation, front-line providers of primary care – safety net providers – risk becoming overwhelmed by the arrival of millions of people newly insured or enrolled in Medicaid, including many vulnerable people with special needs. As happened after the start of Medicare in 1965, the United States faces the prospect of tremendous strain on the vital primary care infrastructure – with the risk that many people could still go without adequate care.

Bolstering safety net services will be essential to meet the needs of the newly insured – as well as the needs of millions who will still remain uninsured (either because Affordable Care does not include them or because they live in conservative states that refuse to expand Medicaid). more...

The debate over same-sex marriage – or “gay marriage” – has been contentious in national and state politics for nearly twenty years. After voters in many states rushed to ban same-sex unions, the tide turned. In recent years, sixteen states and the District of Columbia have legalized same-sex marriage and another three states have approved civil unions or domestic partnerships that include full spousal rights for lesbian, gay and bisexual couples. Despite this progress, as of the end of 2013, only 37% of Americans live in a state with marriage equality; and many lesbian, gay, and bisexual people still do not enjoy the full rights and benefits associated with marriage. This is unfortunate for moral and economic reasons. Equally important, a growing body of public health research documents the many health benefits associated with legal same-sex marriage. more...

The United States imprisons more of its people than any other nation – currently one out of every 31 Americans. Lots of prisoners naturally leads to a steady flow of people leaving prison. Each year more than 700,000 U.S. prisoners are released to their communities. These men and women often have little education and poor prospects for finding jobs or establishing stable homes – and to make things worse, their health often deteriorates right after they leave prison.

About four out of every five newly released people suffer from chronic medical, psychiatric or substance abuse problems – but only about one in five visits a physician outside of hospital emergency departments during the first year after release. Imprisoned patients are often released without adequate follow-up instructions, medications, or access to health insurance coverage. Many let problems fester until they end up in hospital emergency rooms – inflating costs in U.S. health care and forcing taxpayers or insured Americans to foot bills the ex-prisoners cannot pay. An obvious solution is to ensure continuous good health care for people leaving prison. more...

Over the last forty years, abortion has frequently taken center stage in American politics—as it did once again in 2012. This may seem only natural for an issue that speaks to deep values and the role of women in society. But abortion is at the margin of politics in most other rich countries, including our closest sister nations, Britain and Canada.

Why is U.S. politics different? Journalists and pundits point to the strong role of religion in American life. But Canada also has many Catholics and evangelical Protestants, and both Canada and Britain have strong antiabortion movements. In all three democracies, public opinion favors the right to an abortion in cases of rape or fetal abnormality or to protect a woman’s health, and is much less supportive when family size, poverty, or marital status are at issue.

Beyond religiosity and public opinion, national institutions play a crucial role. Abortion has become so politically explosive in the United States in significant part because we have an independently powerful Supreme Court, strong private medical professionals, weak political party elites, and a decentralized political system where controversies can live on and issues can be raised again and again. more...

Americans live in an aging society. As the Baby Boomers born after World War II retire, older people will become a larger segment of the U.S. population for at least the next two decades. Demand for federally funded Social Security and Medicare benefits will grow, and all fifty states will also face big challenges meeting the needs of elders. Our research shows that some states will do better than others in providing attractions and supports that matter for America’s graying citizens – and women serving in state legislatures will often be leaders in devising public policies that further care for the elderly in ways that improve the quality as well as length of life.

Previous research has documented that female state legislators are more interested than their male counterparts in supporting education and other public programs that meet the needs of families with children. To be sure, research to date leaves much more to be learned about the conditions that translate a female legislative presence into extra support for families. Democratic Party control of legislatures may magnify women’s influence, and so may an active women’s movement in any given state.

In addition to asking how women’s presence in legislatures translates into more support for families, we should also wonder about the extent of female legislative support. Does women’s legislative impact extend to policies that aim to help elders as well as younger families with children? And, if so, do states with more women in their legislatures actually prove to be better places for older people to live and flourish? We have investigated these issues as part of a broader project comparing state-level public policies that help people at various stages of aging. more...