Worth Reading: Flame retardants, avian flu, and the next labor fight

Pump Handle - 13 hours 8 min ago

A few of the recent pieces I’ve liked:

Robin Marantz Henig in the New York Times Magazine: The Last Day of Her Life

David Heath at the Center for Public Integrity: American Chemistry Council lied about lobbying role in flame retardants, consultant says

Maryn McKenna at Germination: The Avian Flu Epidemic: Massive Impact, Uncertain Future

Lydia DePillis in the Washington Post’s Wonkblog: The next labor fight is over when you work, not how much you make

Adam Gopnik in The New Yorker: The Plot Against Trains

Categories: Health

Interview: A Grassroots Effort to Save Africa’s Most Endangered Ape

Yale Environment 360 - 17 hours 17 min ago
The Cross River gorilla population, with fewer than 300 individuals, has been pushed to the brink of extinction in equatorial Inaoyom Imong Africa. At the center of the fight to save this beleaguered ape population is Nigerian scientist Inaoyom Imong, who comes from the region and knows its forests — and its people — intimately. In a Yale e360 interview, Imong describes the various pressures that have reduced populations of this gorilla subspecies and explains how a few thousand people living in rural Nigeria and Cameroon hold the key to saving this magnificent ape.
Read the interview.
Categories: Environment, Health

Researchers find food assistance program is linked with better mental health

Pump Handle - May 20, 2015

Do food assistance programs deliver more than food and nutrition? Can relieving the stress of food insecurity provide positive psychological benefits as well? A new study says yes it can.

In a study published in the June issue of the American Journal of Public Health, researchers set out to examine whether participating in the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as food stamps, was associated with better overall well-being and specifically, lower rates of psychological distress. In analyzing data from the SNAP Food Security survey, the largest longitudinal survey of SNAP beneficiaries to date, they found participating in the food assistance program did indeed decrease levels of psychological distress. Study authors Vanessa Oddo and James Mabli write:

Although research is limited, participation in food assistance programs may be particularly effective in modifying the relationship between food insecurity and mental illness. Certain nutrients, overall diet quality, and patterns of dietary intake may be important in reducing the prevalence of adverse mental health outcomes. By reducing households’ exposure to food insufficiency, federal nutrition programs, such as SNAP, may improve well-being by reducing the public health burden of mental illness among vulnerable populations.

In particular, the study found that psychological distress was less common among heads of households who had participated in SNAP for at least six months than among those who had just enrolled in the program — the percentages were 15.3 percent versus just more than 23 percent. Overall, the findings suggest that SNAP is associated with a 38 percent reduction in psychological distress among participating households.

In addition to improving food security, the researchers wrote that SNAP likely alleviates psychological distress by allowing beneficiaries to direct their limited incomes on basic needs outside of food, such as housing, utilities and health care. In other words, SNAP can help lessen a family’s financial strain and often provides a vital stepping stone for families struggling to get by in the current economy. The authors noted that their findings align with previous research on food assistance programs and improved mental health among adults.

“In light of the sizable variation in the monthly allotment of SNAP benefits across households, future studies should explore the role of benefit size on improving the well-being of program participants,” the study authors wrote. “In addition, a better understanding of the most effective pathways through which SNAP affects mental health and thus well-being in subpopulations of interest, including households with children or elderly persons, is warranted to inform future policy and intervention strategies.”

In 2014, SNAP helped more than 46 million low-income Americans struggling with food insecurity and hunger, with about 70 percent of SNAP participants living in families with children. Unfortunately, even though SNAP remains the country’s most critical anti-hunger initiative and has a solid track record of improving health outcomes and keeping people out of poverty, it’s regularly targeted for funding cuts. Just recently, members of the House proposed spending reductions that could cut off millions of families from food assistance.

To request a full copy of the SNAP and mental health study, visit the American Journal of Public Health.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

Categories: Health

Many Wind Turbines Being Installed in Critical Bird Habitat, Group Says

Yale Environment 360 - May 20, 2015
More than 30,000 wind turbines in the U.S. have been installed in areas critical to the survival of federally protected birds and

Whooping crane an additional 50,000 turbines are planned for similar areas, according to the advocacy group American Bird Conservancy (ABC). Those figures include 24,000 turbines in the migration corridor of the rare whooping crane and nearly 3,000 turbines in breeding strongholds for greater sage grouse, a species that has already declined by up to 80 percent in recent decades due to habitat loss, ABC says. The group is asking the federal government to regulate the wind industry with regard to its impacts on birds. Areas of "critical importance," where federally protected birds face the highest levels of risk, comprise just 9 percent of the land area of the U.S. and should be avoided in wind development, ABC says.
Categories: Environment, Health

Occupational Health News Roundup

Pump Handle - May 19, 2015

An injured worker who was featured in the ProPublica/NPR investigation on the dismantling of the workers’ compensation system recently testified before lawmakers in Illinois, cautioning them against making the same drastic workers’ comp cuts as his home state of Oklahoma. Michael Grabell, who co-authored the original investigation, writes that John Coffell, who lost his home after hurting his back at an Oklahoma tire plant, was part of an eight-hour hearing on workers’ comp before the entire Illinois state assembly. Grabell writes in ProPublica:

Coffell told the legislators that after injuring a disc in his back last summer, his pay dropped dramatically because Oklahoma had reduced the maximum wage-replacement benefits injured workers could receive from $801 a week to $561 a week.

Almost immediately, he said, his utilities were cut off, his truck was repossessed and his family was evicted from their rental home. Because no relative could accommodate all of them, Coffell sent his three children, aged 5 to 9, to live with grandparents. He and his wife only had enough gas money to see them on weekends. They’ve had to rely on food stamps to get by.

Asked by a legislator how it felt to not be able to support his family, Coffell said, “It’s indescribable, really. Pretty much if I was to give a crazy example, if you were to see your husband or child drowning in a pool, but not being able to get them out of it. Kind of the same feeling.”

Grabell reports that the hearing comes as Illinois Gov. Bruce Rauner puts forth a number of pro-business proposals that could roll back the state’s workers’ comp system, such as allowing workers’ comp judges to give equal weight to the opinions of doctors who are hired by insurance companies instead of giving deference to workers’ physicians. During the hearing, Grabell reports that participants repeatedly drew comparisons between Illinois and Indiana, which has the second cheapest insurance rates for employers in the country. Workers and their families exemplified the differences between the two states — Grabell reports:

Workers and their families praised Illinois’ law. Christine Fuller — who lived in Indiana, but whose father died from falling off a roof on a job in Illinois — said the survivor benefits she received from workers’ comp helped pay the mortgage and put her through college and graduate school.

Meanwhile, Laurie Summers — an Illinois nurse who dislocated her shoulder lifting a patient at a hospital in Indiana — said she had to drain her retirement savings and fight to get surgery.

“I believed with all my heart that my hospital would take care of me,” she said. “What I did not know, however, is that working in Indiana takes away that simple security.”

To read the full article, visit ProPublica.

In other news:

Houston Chronicle: Susan Carroll and Lise Olsen report that OSHA has proposed $99,000 in fines against DuPont for failing to prevent four worker deaths inside a pesticide unit in La Porte, Texas. OSHA also cited the company for 11 violations and identified a number of needed upgrades. The deadly workplace incident happened last year when workers were exposed to a toxic gas known as methyl mercaptan, an ingredient in a popular pesticide. Carroll and Lise report that the OSHA investigation found that workers weren’t properly trained to use the building’s ventilation system and in fact, according to documents obtained by the newspaper, the ventilation fans in the pesticide unit had been broken for months. In the article, Carroll and Lise quoted The Pump Handle’s own Celeste Monforton, who said the “penalities poked holes in DuPont’s ‘veneer’ of safety and represented ‘less than a  slap on the wrist for a billion dollar company. It illustrates why Congress needs to fix OSHA’s penalty system.’”

BBC: Reporter Mark Lobel writes that he and a team of fellow BBC journalists were monitored, arrested and detained in Qatar while investigating the experiences of migrant laborers who are building accommodations for the 2022 FIFA World Cup. Lobel writes: “Mustafa Qadri, Amnesty International’s Gulf migrant rights researcher, told us the detentions of journalists and activists could be attempts ‘to intimidate those who seek to expose labour abuse in Qatar.’ Qatar, the world’s richest country for its population size of little more than two million people, is pouring money into trying to improve its reputation for allowing poor living standards for low-skilled workers to persist.” An article published late last year in the Guardian reported that Nepalese migrant workers building World Cup infrastructure in Qatar died at a rate of one every two days in 2014.

Salon: Katie McDonough writes about a new Human Rights Watch report that finds service members who report a sexual assault are 12 times more likely to experience some kind of retaliation than to see their attackers convicted. The report is based on interviews with more than 150 service members, both men and women. McDonough writes: “The consequences of the current climate are pretty straightforward: when reporting a rape is more likely to get you punished or kicked out of the military than raping someone, service members don’t report. And this will remain the case until current mechanisms in place to prevent retaliation are meaningfully enforced and other protections are added. But the United States may be a long way off from both.”

The New York Times: In the aftermath of a New York Times investigation into the working conditions at nail salons and the serious dangers to workers’ health, Gov. Andrew Cuomo announced that he would seek new rules to improve safety at nail salons and protect workers’ rights. However, reporter Jim Dwyer reminds readers that nail salon workers are just the tip of the iceberg when it comes to the exploitation of immigrant workers. He began his article with the story of Chitra KC, who worked at a gas station in Holbrook, New York, and is one of more than two-dozen immigrant workers with wage theft claims against the owner. Dwyer writes: “Immigrants are the pilings of the New York economy, the providers of low-cost, seamless comforts like 24-hour takeout food, cheap nail salons, all-night gas stations, nonunion construction workers. Some entered the United States legally; others did not. The ability of unscrupulous employers to steal wages can take your breath away.”

The Los Angeles Times: Lawmakers in Los Angeles are poised to vote on whether to raise the local minimum wage to $15. Reporter Emily Alpert Reyes writes that if Los Angeles goes forward with the wage hike, workers will experience an incremental increase in wages that will eventually reach $15 by 2020. Reyes writes: “The wage proposal would hike pay more slowly than some activists wanted. But leaders in the Raise the Wage Coalition nonetheless heralded it last week as a sound plan to improve the standard of living for low-income workers and their families.”

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

Categories: Health

Maps Depict China's Coasts Under Scenario of Dramatic Sea Level Rise

Yale Environment 360 - May 19, 2015
Roughly 43 percent of China's population lives near the coast — a region that is expected to experience dramatically


Shandong province after dramatic sea level rise rising sea levels if global warming continues along its current trajectory. What will China's coast look like far in the future if polar ice sheets and glaciers undergo extensive melting? Cartographer Jeffrey Linn has used projections from the Intergovernmental Panel on Climate Change (IPCC) to depict the impact of a 200-foot rise in global sea level. In this map, he shows the potential inundation of a portion of Shandong province near the town of Qingdao, home to 3.5 million people and the brewery that makes the widely distributed beer Tsingtao. Earlier, Linn drew up similar maps showing the inundation western North America's coastline under scenarios of extreme sea level rise.
Categories: Environment, Health

Thumbs up and down for House bill to reform toxics law

Pump Handle - May 18, 2015

Congress continues to take key legislative steps to reform the 40 year old Toxic Substances Control Act (TSCA). The latest move came last week in a subcommittee of the House Energy and Commerce Committee. In a bi-partisan unanimous vote (21-0) on May 14, the Subcommittee on Environment and Economy reported out the TSCA Modernization Act. It is now ready for action by the full Committee.

We’ve reported previously on The Pump Handle about a TSCA reform bill making its way in the Senate. The Vitter/Udall bill (S.697) has 39 co-sponsors, evenly split between Republicans and Democrats. Kim Krisberg (here, here) and Lizzie Grossman (here) have written about problems with S.697, including those identified by key environmental and health organizations. As for the TSCA Modernization Act gaining traction in the House, these groups’ critiques begin with “it’s better than Vitter/Udall.”

Following the House subcommittee’s action on May 14, Safer Chemicals Healthy Families, one of the leading public health and environmental coalitions monitoring the action, said

“The new draft is a significant step toward a version of TSCA reform that can enjoy broad support. It’s not there yet, however.”

The 450-member coalition, with groups as diverse as Autism Speaks, Natural Resources Defense Council and the United Auto Workers Union, has concerns with a number of provisions of the bill. They include:

  • Uncertainty about whether it fixes the problem with current law which obstructs EPA’s ability to restrict or ban deadly toxic substances, such as asbestos. We wrote about that problem here.
  • Use of the undefined phrase “unreasonable risk” as a trigger for EPA action, rather than a trigger such as “reasonable certainty of no harm.”
  • Likelihood that EPA will be unable to conduct chemical assessments on its high priority toxic substances because it will be overwhelmed with requests by industry to conduct assessments on their pet compounds. In the current version of the House bill, there’s no cap on the number of industry-requested reviews EPA must conduct, for example, in a given year.
  • Limits on EPA to take action to address health risks from a toxic substance if the proposed action is considered too pricey. Safer Chemicals Healthy Families argues:

“Cost considerations should be reserved for the question of how to mitigate the risk, not whether to mitigate it. As it stands, we believe the draft would allow a major risk – such as a chemical that causes cancer or birth defects – to remain unmitigated if it was deemed too expensive to do so. That is a very different outcome than mitigating the risk in a cost-effective way.”

Safer Chemicals Healthy Families, however, gives a thumbs up to the bill’s authors, for example, steps to preserve the authority of states to take action on chemical hazards. (Lizzie Grossman wrote about that issue here and Kim Krisberg (here.))  The coalition offers this caveat:

We’re still evaluating the bill and will likely communicate our position on the pros and cons more fully and formally to the Energy and Commerce Committee. At first blush, however, the movement is mostly in the right direction and it brings the bill within striking distance of meaningful, if limited, reform, if the Committee continues its work.

I gave up weeks ago trying to understand and digest the Senate’s Vitter/Udall bill. The 175 page document twisted my brain in knots as I tried to compare the current law to S.697’s proposed changes.  I’m still studying the 40-page House bill and will make my own judgement whether to give it a thumbs up or down.



Categories: Health

Low Snowpack Raising Drought Concerns in Oregon and Washington

Yale Environment 360 - May 18, 2015
While drought conditions in California and the southwestern U.S. have been dominating news headlines, Oregon and


Snowpack in May 2015 Washington could also soon be facing dangerously dry conditions due to low snowpack levels, as these photos show. Although the region has seen several months with average or just-below average precipitation, unusually warm temperatures on land and offshore led to most of that moisture arriving in the form of rain rather than snow. Like many parts of the western U.S. and Canada, the Pacific Northwest depends on mountain snowpack to melt and fill streams and rivers through warmer, drier summer months. According to state officials, snowpack in Washington was just 16 percent of normal as of May 15, and yearly runoff is predicted to be at its lowest in 64 years. Average snowpack in Oregon stood at just 11 percent of normal, its lowest level since 1992.
Categories: Environment, Health

Indonesia Extends Major Logging Moratorium, Which Critics Decry as Weak

Yale Environment 360 - May 15, 2015
Indonesia has extended a major logging moratorium aimed at preserving the archipelago's vast swathes

Deforestation for a palm oil plantation in Indonesia. of tropical rainforest, but environmentalists say the logging ban does not go nearly far enough. The country, home to some of the world's most biodiverse rain forests and endangered species such as tigers and elephants, first enacted the moratorium in 2011, banning new logging permits for primary and virgin forests and peatlands. The moratorium was first extended until 2015, and now has been extended again, to 2017. Environmental groups have criticized the moratorium, however, saying that it still allows deforestation for ventures deemed in the national interest, such as infrastructure projects and agricultural plantations. Indonesia is the largest economy in Southeast Asia and third-largest carbon emitter in the world. Huge swathes of its forests have been chopped down by palm oil, mining, and timber companies.
Categories: Environment, Health

Biologically Inspired Coating Will Improve Solar Panels, Researchers Say

Yale Environment 360 - May 14, 2015
Key characteristics of moths’ eyes, which are anti-reflective, and lotus leaves, which are water-repellant, inspired a new type of glass coating that could significantly improve the efficiency of solar panels, say researchers at Oak Ridge National Laboratory. The extremely durable coating can be customized to be fog-resistant, anti-reflective, and superhydrophobic — meaning it repels water drops so efficiently that they barely make contact with the solar panel surface, literally bouncing off and carrying away dirt and dust that hamper performance. The key component is a nanostructured layer of glass film that, under a microscope, has a porous texture resembling coral, which helps the solar cells absorb more light, the researchers say. Reflecting less sunlight means a 3 to 6 percent increase in light-to-electricity conversion efficiency and power output, studies show. The coating can be fabricated using standard industry techniques, the researchers say, making it easy and inexpensive to scale up and incorporate in current products.
Categories: Environment, Health

Not an “accident”: Selvin Lopez-Castillo, 43, suffers fatal work-related injury in Franklin Township, NJ

Pump Handle - May 14, 2015

Selvin Antulio Lopez-Castillo, 43, suffered fatal traumatic injuries on Monday, May 4, 2015 while working at a residential construction site in Franklin Township, NJ. ABCNews reports:

  • The incident occurred around 4 pm at a site where a home was under construction.
  • Five other workers were nearby when the incident occurred.

NBCNY reports:

  • “The worker was about 8 feet down when the walls of the hole gave way. The other workers attempted to get him out but were unsuccessful.”
  • “Firefighters from Community, East Franklin, Somerset Fire and Rescue and New Brunswick Fire responded to the scene. They worked for almost two hours to get the man out of the 3.5-foot-wide trench.

The Franklin Township Police Department noted:

  • “Upon arrival officers found several workers attempting to dig the victim out. …Due to the instability and fearing another collapse, the workers were order out of the trench.”
  • “The house was under construction and the workers were digging the trench for utilities. Firefighters were able to extricate Lopez-Castillo from trench at 5:43 PM.”
  • The township’s construction office reported “the sites did have valid permits at the time of the incident.”

Mr. Lopez-Castillo worked for Adonai Construction LLC. OSHA’s on-line enforcement database does not show any previous inspections listed under this employer’s name.

Each year, about 100 workers in New Jersey are fatally injured on-the-job. The Bureau of Labor Statistics reports 102 work-related fatal injuries in New Jersey during 2013 (most recent available.) Nationwide, at least 4,545 workers suffered fatal traumatic injuries in 2013.

The AFL-CIO’s annual Death on the Job report notes:

  • Federal OSHA has 59 inspectors in New Jersey to cover more than 228,000 workplaces.
  • The average penalty for a serious OSHA violation in New Jersey is $2,176. The  median OSHA penalty for citations related to a fatality is $6,000.

Federal OSHA has until early November 2015 to issue any citations and penalties related to the incident that stole Mr. Lopez-Castillo’s life. It’s likely they’ll determine that his death was preventable. It was no “accident.”

Categories: Health

A Remarkable Recovery for the Oysters of Chesapeake Bay

Yale Environment 360 - May 14, 2015
In the past century, more than 90 percent of the world’s oyster beds have been lost to pollution, overharvesting, disease, and

Wild oysters harvested from the Chesapeake Bay coastal development. The renowned oysters of the Chesapeake Bay experienced a similar decline, with production nearly disappearing a decade ago. Now, however, Chesapeake Bay oysters are undergoing a remarkable recovery thanks to a brilliant oyster geneticist, improved state and federal management, the expansion of private hatchery operations, the cleanup of the bay, and some help in the form of average rain years and excellent reproductive oyster classes.
Read more.
Categories: Environment, Health

HPV vaccine study highlights how health reform is driving patients toward prevention

Pump Handle - May 13, 2015

In a perfect example of how the Affordable Care Act is broadening access to relatively low-cost and potentially life-saving interventions, a new study finds that the health reform law likely led more than 1 million young women to seek out the human papillomavirus vaccine and protect themselves against cervical cancer.

In a study published this month in Health Affairs, researchers studied the impact of two ACA provisions: one requiring insurance providers to extend dependent coverage through age 26 and another that required insurers to offer a range of preventive services, such as immunizations, without cost-sharing. The study noted that prior to the ACA, young adults had the lowest rate of insurance coverage among all age groups, and few states required private health plans to cover vaccines for adults. Plus, the HPV vaccine, which protects against two strains of HPV responsible for 70 percent of cervical cancers, isn’t cheap to pay for out of pocket — it cost upward of $400 for all three doses. Federal health officials recommend that all boys and girls should receive the three doses at ages 11 or 12, though young women can get the vaccine through age 26 and young men through age 21. Study authors Brandy Lipton and Sandra Decker write:

While general measures of health care use are usually a logical starting point in analyses of the effects of health insurance expansions, most young adults have few health problems. This fact may explain why previous studies have not found a positive effect of the dependent coverage provision on the percentage of young adults having at least one health care visit in the past year or the percentage having obtained a flu shot in the past year, a service that is low cost and may be obtained without a physician office visit. The HPV vaccine, on the other hand, is a service with a high out-of-pocket cost that is recommended for young women in the age group targeted by the dependent coverage provision of the ACA. This makes the vaccine an especially strong example to consider in examining the effects of coverage provisions under the ACA.

To examine whether more young women were seeking out the potentially life-saving vaccine post-ACA, researchers examined data from the National Health Interview Survey between 2008 and 2012, with the final data sample consisting of just more than 10,000 women ages 18 to 26. They found that women ages 19 to 25 were more likely to report receiving the HPV vaccine after the ACA policies went into effect compared to before the policies took effect. In particular, the study found that among that age group, the ACA provisions increased the likelihood of HPV vaccine initiation by 7.7 percentage points and vaccine completion (receiving all three doses) by 5.8 percentage points. In simpler terms, that means 1.1 million young women began the HPV vaccine series and 854,000 young women completed the vaccine series.

The study authors noted that there was no “detectable” difference in women’s awareness of the HPV vaccine before and after the ACA polices were enacted, and so it is unlikely that a new awareness, as opposed to insurance changes, is responsible for the uptick in HPV immunization. The study also estimated that because a large percentage of the study sample was insured both before and after implementation of the two ACA policies, most of the increase in HPV vaccine initiation was likely due to more generous health benefits and cost sharing.

“By increasing the percentage of young women with any source of insurance and decreasing the out-of-pocket cost of the vaccine among those who would have been insured in the absence of the ACA, implementation of the ACA provisions may have facilitated uptake of the HPV vaccine among adult women,” the study stated.

To request a full copy of the study, visit Health Affairs.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

Categories: Health

Car Travel Is Six Times More Expensive Than Bicycling, Analysis Finds

Yale Environment 360 - May 13, 2015
Traveling by car costs society and individuals six times more than traveling by bicycle, according to a study of

Bicycles parked in downtown Copenhagen transportation trends in Copenhagen, one of the planet's most heavily bicycled cities. The analysis considered how much cars cost society and how they compare to bicycles in terms of air pollution, climate change, noise, road wear, public health, and congestion in Copenhagen. If the costs to society and the costs to private individuals are added together, the study found, the economic impact of a car is 0.50 euros per kilometer, whereas the cost of a bicycle is 0.08 euros per kilometer. Looking only at costs and benefits to society, one kilometer by car costs 0.15 euros, whereas society earns 0.16 euros on every kilometer cycled because of improvements in the public's health.
Categories: Environment, Health

Report: Expanded Medicaid programs are saving states millions of dollars

Pump Handle - May 12, 2015

More than $30 million in Arkansas, $25.8 million in Kentucky, $105.5 million in Washington and $180 million in Michigan. That’s how much money just four states during just one fiscal year saved under their newly expanded Medicaid programs.

A recent report from the Center on Budget and Policy Priorities (CBPP) summarizes the benefits of Medicaid expansions on uninsurance rates, state health care spending and uncompensated care, finding that “contrary to critics’ claims that Medicaid expansion is financially unsustainable for states, there is increasing evidence that expansion has saved states money, and these savings are expected to grow over time.” First, here’s a little background on health reform and Medicaid.

The 2010 passage of the Affordable Care Act required states to expand Medicaid eligibility to Americans younger than 65 with incomes up to 133 percent of the federal poverty level. However, in 2012, the Supreme Court ruled that states could choose not to expand Medicaid without jeopardizing federal funding. Fast forward to 2015 and so far, 29 states and Washington, D.C., have expanded their Medicaid programs. Under the ACA, the federal government pays 100 percent of the cost of expanding Medicaid through 2016; the rate falls incrementally down through 2020, at which point the feds will pay 90 percent of the cost from then on.

Still, the high federal matching rate hasn’t been enough to entice all state policymakers to put people’s health before politics. (NPR published a piece just today on what’s happening in some states as they consider expanding Medicaid.) The recent CBPP report, authored by policy analyst Jesse Cross-Call, illustrates why the 21 states without an expanded Medicaid program are missing an opportunity to truly bend the health care spending curve in the long run, while many of their poorest residents remain cut off from affordable and comprehensive health care coverage.

According to the report, states that expanded Medicaid have experienced the greatest gains in insurance coverage. For example, in just one year, uninsurance rates in Arkansas and Kentucky dropped in half, from 22.5 percent to 11.4 percent and from 20.4 percent to 9.8 percent, respectively. In fact, nine of the 10 states with the biggest drop in residents without insurance were Medicaid expansion states. Because the ACA was designed under the assumption that states would expand Medicaid, residents in non-expansion states now fall into a gap in which they don’t qualify for Medicaid and don’t qualify for subsidies in the new health insurance marketplace. That means millions of Americans still can’t access affordable health care.

In addition to declining uninsured numbers, expanding Medicaid comes with serious financial benefits for state budgets too, as newly insured residents no longer depend on state-funded uncompensated care, Medicaid programs pull in more federal matching dollars, and states collect more tax revenue. Here are just a few examples from the CBPP report:

  • Arkansas’ decision to expand Medicaid saved the state $30.8 million in fiscal year 2014, and the state estimates it’ll save an additional $88.8 million in fiscal year 2015.
  • In addition to the $25.8 million Kentucky saved in fiscal year 2014 thanks to Medicaid expansion, the state predicts it will save an additional $83.1 million in fiscal year 2015.
  • As a result of Medicaid expansion, New Jersey policymakers expect to save nearly $3 billion through 2020 thanks to an increase in federal Medicaid funds.
  • New Mexico is on course to save $60 million between 2014 and 2016. The state also collected $30 million in new revenue in 2014 via taxes on managed care plans that serve the new Medicaid population.
  • In Washington state, the Medicaid expansion saved $105.5 million in fiscal year 2014, and the state expects to save an additional $286.6 million in fiscal year 2015.

Of course, increasing access to affordable health insurance has also led to big declines in uninsured and uncompensated care at hospitals. For example, the CBPP report notes that the Arkansas Hospital Association reported that admissions of uninsured patients fell by more than 46 percent between 2013 and 2014, while the Arizona Hospital Association reported a 31 percent drop in uncompensated care.

“Health reform’s Medicaid expansion has proven successful for the states that have taken the option, reducing both their uninsured populations and their health care-related costs and producing budgetary savings,” writes Cross-Call. “Meanwhile, policymakers in non-expansion states — many of which have high uninsurance rates, limited Medicaid eligibility for parents, and no eligibility for poor adults without children — have forgone significant savings and have placed the burden from their decision not to expand on their poorest residents.”

To read a full copy of “Medicaid Expansion Is Producing Large Gains in Health Coverage and Saving States Money,” visit the Center on Budget and Policy Priorities.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.

Categories: Health
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