Five million families and children will now sleep a little easier. How will the new Latino/Hispanic immigrant status impact healthcare policy?

Being “in the shadows” has long been a healthcare access issue.  The broken healthcare system has been aggravated by a broken immigration system. Immigration and healthcare are tied together in many ways, especially for the economically disadvantaged.

According to the New York Times:

What Is President Obama’s Immigration Plan?

President Obama announced on Thursday evening a series of executive actions to grant up to five million unauthorized immigrants protection from deportation. The president is also planning actions to direct law enforcement priorities toward criminals, allow high-skilled workers to move or change jobs more easily, and streamline visa and court procedures, among others. NOV. 20, 2014 RELATED ARTICLE

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Who could be affected?

The president’s plan is expected to affect up to five million of the nation’s unauthorized immigrant population, currently 11.4 million according to the Migration Policy Institute. It would create a new program of deferrals for approximately 3.7 undocumented parents of American citizens or legal permanent residents who have been in the country for at least five years. Deferrals would include authorization to work and would be granted for three years at a time.

It would also expand a program created by the administration in 2012 called Deferred Action for Childhood Arrivals, or DACA, which allows young people who were brought into the country as children to apply for deportation deferrals and work permits. The plan would extend eligibility to people who entered the United States as children before January 2010 (the cutoff is currently June 15, 2007). It would also increase the deferral period to three years from two years and eliminate the requirement that applicants be under 31 years old. About 1.2 million young immigrants are currently eligible, and the new plan would expand eligibility to approximately 300,000 more.

It would not provide a path to full legal status or benefits under the Affordable Care Act. Officials have said that the president’s plan will not provide specific protection for farm workers or parents of DACA-eligible immigrants.

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Filed under: ACA and Medicaid, Blogosphere, Data Trends - American Demographics and Public Opinion, Family Policy, Feminization of Poverty, Health Literacy, Health Policy, Healthcare Reform, Immigration, Latinos, Maternal and Child Health, Medicaid, News, Public Health, Public Policy, census; immigration; births; fertility; Latinos; Hispanics; Mexican Americans; child health

Gap in Diet Quality Between Wealthiest and Poorest Americans Doubles, Study Finds

Healthy food is not easy to prepare, does not have a very long shelf life, and is more expensive than cheaper canned and mass produced “food” that contains fillers and other ingredients that return adequate profits, facilitate transportation, refrigeration, and distribution.

America’s food consumption and health connection problem goes well beyond socioeconomic issues of lack of cash and proximity and access to healthy food.  Our society’s economy produces commodities and commodities are distributed based on market forces of supply and demand.  Supply and demand pressures have thus far overpowered the traditional forces on the side of promoting community health.  The loosing forces are:

• Social do-gooders

• Philanthropy

• Public health officials

• Conscientious parents

• Suburban focused and lead prevention efforts

In short, economic forces have thus far trumped social ideas and groups aiming to undo what are basically the macro and micro consequences of food production and distribution.

Any successful efforts in this area will have to have for-profit corporations at the table with philanthropy and government officials providing public policy leadership and incentives that appeal to corporate America’s economic interests and social responsibility (good corporate citizen) commitments.

More via Gap in Diet Quality Between Wealthiest and Poorest Americans Doubles, Study Finds.

Filed under: ACA and Medicaid, Behavioral Health Outcomes, Blogosphere, Health Literacy, Health Policy, Healthcare Reform, News, Parenting, Philanthropy, Policy ThinkShop Comments on other media platforms, Public Health, Public Policy

RWJF Initiative on the Future of Nursing | The information from the experts has been published. What are you and other community stakeholders doing about it?

Are you familiar with the RWJ report titled “The Future of Nursing: Leading Change, Advancing Health” by the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Penn Medicine (University of Pennsylvania Health System)?

As we know, initiatives like the one that produced this report, as recent as 2011, come and go.  What remains is the report and what committed professional like yourself and our colleagues do with the information.

We at The Policy ThinkShop were inspired by a nurse colleague not only to pullout this report but to post a comment on our blog for your benefit.

The link to the report follows:

http://www.thefutureofnursing.org/sites/default/files/Future%20of%20Nursing%20Report_0.pdf

According to the report:

“In 2008, The Robert Wood Johnson Foundation (RWJF) approached the Institute of Medicine (IOM) to propose a partnership to assess and respond to the need to transform the nursing profession. Recognizing that the nursing profession faces several challenges in fulfilling the promise of a reformed health care system and meeting the nation’s health needs, RWJF and the IOM established a 2-year Initiative on the Future of Nursing. The cornerstone of the initiative is this committee, which was tasked with producing a report containing recommendations for an action-oriented blueprint for the future of nursing, including changes in public and institutional policies at the national, state, and local levels (Box S-1). Following the report’s release, the IOM and RWJF will host a national conference on November 30 and December 1, 2010, to begin a dialogue on how the report’s recommendations can be translated into action. The report will also serve as the basis for an extensive implementation phase to be facilitated by RWJF.”

The report explains the committee of experts charge in producing the study and report as follows:

The committee may examine and produce recommendations related to the following issues, with the goal of identifying vital roles for nurses in designing and implementing a more effective and efficient health care system:

• Reconceptualizing the role of nurses within the context of the entire workforce, the shortage, societal issues, and current and future technology;

• Expanding nursing faculty, increasing the capacity of nursing schools, and redesigning nursing education to assure that it can produce an adequate number of well prepared nurses able to meet current and future health care demands;

• Examining innovative solutions related to care delivery and health professional education by focusing on nursing and the delivery of nursing services; and

• Attracting and retaining well prepared nurses in multiple care settings, including acute, ambulatory, primary care, long term care, community and public health.

“In 2008, the Robert Wood Johnson Foundation approached the Institute of Medicine (IOM) to propose a partnership between the two organizations. The resulting collaboration became the two-year Robert Wood Johnson Foundation Initiative on the Future of Nursing at the IOM. The committee was chaired by former U.S. Secretary of Health and Human Services Donna Shalala, and the goal was to look at the possibility of transforming the nursing profession to meet the challenges of a changing health care landscape. The report produced by the committee, The Future of Nursing: Leading Change, Advancing Health, makes specific and directed recommendations in the areas of nurse training, education, professional …”

More on the initiative via About | RWJF Initiative on the Future of Nursing.

Filed under: ACA and Medicaid, Blogosphere, Health Literacy, Health Policy, Healthcare Reform, Leadership, Maternal and Child Health, News, Philanthropy, Policy ThinkShop Comments on other media platforms, Public Health, Public Policy, Nursing

A toolbox for promoting and supporting a healthier lifestyle for all Americans: Ideas, Activities and Outcomes | LinkedIn

Suggestions, resources and ongoing support to help you understand and address ongoing changes in our healthcare system for you, your family and your community:

We all want to improve our health, the wellbeing of our families and of our community.

Much of what is needed to fix our healthcare system has already been talked about, written and read. We know so much but so few of us act on it.

What remains to be done is to build coalitions and groups that understand how to go about educating their friends, families and communities on how to create a healthier environment that helps people live healthier lives and to take action to improve our community’s quality of life. We must do this one community at a time. Where do we start and what are the tools we will need to get the job done?

The Policy ThinkShop is an internet link and resource rich website (blog) that is dedicated to helping you learn and teach others about improving your family and community. After you read this article go to The Policy ThinkShop to get the rest of the information you may need:

https://policyabcs.wordpress.com

Other popular healthcare reform information links:

https://policyabcs.wordpress.com/2014/06/24/the-policy-thinkshop-brings-your-attention-to-the-latest-resources-on-the-aca-reform-survey-of-non-group-health-insurance-enrollees-the-henry-j-kaiser-family-foundation/

https://policyabcs.wordpress.com/2014/06/01/find-out-how-your-state-is-doing-on-aca-implementation-health-policy-center-at-the-urban-institute-independent-research-for-better-health-policy/

https://policyabcs.wordpress.com/2014/01/25/will-those-with-cancelled-insurance-policies-be-better-off-in-aca-marketplaces/

https://policyabcs.wordpress.com/2013/10/12/a-simple-list-to-keep-you-on-top-of-the-current-healthcare-battle-a-very-quick-guide-to-health-insurance-exchanges-kaiser-health-news/

Health ThinkShop recommended reading on healthcare change and healthcare system challenges we face:

http://books.google.com/books?The SAGE Handbook of Interpersonal Communication fourth edition

http://books.google.com/books Health Behavior Theory for Public Health PRINCIPLES, FOUNDATIONS, AND APPLICATIONS

More via A toolbox for promoting and supporting a healthier lifestyle for all Americans: Ideas, Activities and Outcomes | LinkedIn.

Filed under: ACA and Medicaid, Behavioral Health Outcomes, Blogosphere, Civic Engagement, Health and Exercise, Health Literacy, Health Policy, Healthcare Reform

American unions membership declines as public support fluctuates | Pew Research Center

The Polity ThinkShop brings you this important report on the State of our American State

Have unions been dealt yet another blow, now ironically by the well intentioned ACA reform?  

If the federal government mandates that business and individuals obtain insurance is this setting a president for the federal government to regulate and mandate worker gains without the use of union muscle?

These are provocative questions, at least for people who still remember the sacrifices that were made to create unions and the horrible conditions that preceded them.

“Last week’s vote by workers at Volkswagen’s Chattanooga, Tenn. plant against joining the United Auto Workers union — despite VW’s tacit encouragement — points up the challenges faced by U.S. organized labor. Even though unions retain much public support, the share of American workers who actually belong to one has been falling for decades and is at its lowest level since the Great Depression.

In a Pew Research Center survey conducted in June 2013, about half (51%) of Americans said they had favorable opinions of labor unions, versus 42% who said they had unfavorable opinions about them. That was the highest favorability rating since 2007, though still below the 63% who said they were favorably disposed toward unions in 2001. In a separate 2012 survey, 64% of Americans agreed that unions were necessary to protect working people (though 57% also agreed that unions had “too much power”).”

More via American unions membership declines as public support fluctuates | Pew Research Center.

Filed under: ACA and Medicaid, Blogosphere, Civic Engagement, consumers, Government Works?, Health Policy, Healthcare Reform, Job Sector, News, Policy ThinkShop Comments on other media platforms, Public Health, Public Policy, Public Sector

Our experience of health is mediated by culture, language and values

If we are going to be successful in improving our healthcare system, we are going to have to make a difference in the quality of healthcare provided, access to care, health literacy on the part of consumers of care; and we will have to make it easier to live a healthier lifestyle for those most at risk.  But how can we do this and where do we start?

Any effort that seeks to address healthcare quality and costs, both categories that seem to top the chart for both consumers, payers, political leaders, and policy makers, must address the continuum of prevention, intervention, followup, evaluation, and implementation of findings.  The process of true healthcare reform must begin with each individual and the social and economic context in which he or she must navigate (health literacy) to achieve an optimal health lifestyle.  The most significant challenge for a culturally diverse society like ours in the area of supporting and addressing lifestyle with the goal of improving health is communication.  In the area of healthcare this means optimal interpersonal health communication between provider and service recipient.  What do patients who experience communication dissonance in the healthcare encounter think of the physician – patient encounter?  That’s where we need to begin.

“Patient-reported experiences of care are an important focus in health disparities research. This study explored the association of patient-reported experiences of care with race and acculturation status in a primary care setting. 881 adult patients (African-American 34%; Hispanic–classified as unacculturated or biculturated–31%; Caucasian 33%; missing race 2%), in outpatient Family Medicine clinics, completed a written survey in Spanish or English. Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group (CAG) Survey Adult Primary Care instrument was used for experiences of care and Short Form-12 survey for health status. Controlling for other variables, race and acculturation were significantly associated with several CAG subscales. Hispanic patients gave significantly higher ratings for care experiences and expressed greater interest in shared decision making. Selected patient-reported measures of care are associated with patients’ race and acculturation status (for Hispanic patients). We discuss implications for both provision and measurement of quality care.”

More via Differences in patient-reported experi… [J Immigr Minor Health. 2013] – PubMed – NCBI.

Filed under: ACA and Medicaid, access to education, Aging, Behavioral Health Outcomes, Blogosphere, Cancer Treatment & Success, Children and Poverty, Civic Engagement, consumers, Culture, Culture Think, Feminization of Poverty, Health and Exercise, Health Literacy, Health Policy

What Is the Result of States Not Expanding Medicaid?

Half the country seems to be moving along with ACA reform and the other half are paying a price for not fully participating.  According to an Urban Institute report released this month, the nearly half of states that have not expanded medicaid under ACA implementation may have missed an important economic boost during these tough economic times.

“In the 24 states that have not expanded Medicaid, 6.7 million residents are projected to remain uninsured in 2016 as a result. These states are foregoing $423.6 billion in federal Medicaid funds from 2013 to 2022, which will lessen economic activity and job growth. Hospitals in these 24 states are also slated to lose a $167.8 billion (31 percent) boost in Medicaid funding that was originally intended to offset major cuts to their Medicare and Medicaid reimbursement.

A review of state-level fiscal studies found comprehensive analyses from 16 diverse states. Each analysis concluded that expansion helps state budgets. State savings and new state revenues exceeded increased state Medicaid expenses, with the federal government paying a high share of expansion costs. Even if future lawmakers reduce federal Medicaid spending, high federal matching rates are likely to remain at the ACA’s enhanced rates, given historic patterns. Facing bipartisan gubernatorial opposition, Congress lowered the federal share of Medicaid spending just once since 1980, while cutting Medicaid eligibility, services, and provider payments more than 100 times. Medicaid expansion thus offers significant state-level fiscal and economic benefits, along with increased health coverage.”

The Policy ThinkShop provides you with this link to the full report: http://www.urban.org/UploadedPDF/413192-What-is-the-Result-of-States-Not-Expanding-Medicaid.pdf

Filed under: ACA and Medicaid, Blogosphere, consumers, Health Policy, Healthcare Reform

The Policy ThinkShop brings your attention to the latest resources on the ACA reform: Survey of Non-Group Health Insurance Enrollees | The Henry J. Kaiser Family Foundation

The Kaiser Family Foundation has released its first survey of the population finding new health coverage under the recently implemented ACA reform.  The survey delineates two main groups taking advantage of the increased access to health insurance: those who had non-group coverage and those who had no insurance at all.  The experiences of these two groups may prove important, the report goes on to say, with significant implications on how the success of the ACA reform is judged.

Apparently, the success of the ACA reform in brining people into the insured fold may be limited by financial literacy, insurance literacy, and health literacy deficits evident in the Kaiser Family Foundation survey.

A preliminary read of the survey report findings by The Policy ThinkShop points to an emergent need to address health literacy in the newly covered group in order to ensure that coverage recipients understand how to take advantage of their presumed efficacy in the insurance market and in their presumed increased access to healthcare itself and cost saving prevention health services.  According to the survey:

“Health insurance is complicated, and many previous studies have documented gaps in health insurance literacy among consumers. The survey finds evidence of this among those who purchase their own coverage, with many respondents unable to answer some basic questions about their plans. For example, nearly one in five non-group enrollees (18 percent) say they don’t know the amount of their monthly premium and almost four in ten (37 percent) don’t know the amount of their annual deductible. Among those with ACA-compliant plans, three in ten (30 percent) say they don’t know the metal level of their plan (platinum, gold, silver or bronze), and among those who report getting a government subsidy to defray their premium cost, nearly half (47 percent) couldn’t say what the amount of the subsidy is.”

The survey report goes on to highlight the segment of the population surveyed who are more privileged because of their prior experience obtaining insurance:

 

“Some groups are more knowledgeable than others, including college graduates, those with higher incomes, and small business owners. Plan switchers, who likely have more experience buying coverage in the non-group market, are also more likely than those who were previously uninsured to be able to report the metal level of their plan and their premium and deductible amounts.”

Policy ThinkShop Policy Resources for you –

You can read the entire survey report at:

http://kaiserfamilyfoundation.files.wordpress.com/2014/06/survey-of-non-group-health-insurance-enrollees-findings-final1.pdf

Report Executive Summary

“January 1, 2014 marked the beginning of several provisions of the Affordable Care Act ACA making significant changes to the non-group insurance market, including new rules for insurers regarding who they must cover and what they can charge, along with the opening of new Health Insurance Marketplaces also known as “Exchanges” and the availability of premium and cost-sharing subsidies for individuals with low to moderate incomes. Data from the Department of Health and Human Services and others provide some insight into how many people purchased insurance using the new Marketplaces and the types of plans they picked, but much remains unknown about changes to the non-group market as a whole. The Kaiser Family Foundation Survey of Non-Group Health Insurance Enrollees is the first in a series of surveys taking a closer look at the entire non-group market. This first survey was conducted from early April to early May 2014, after the close of the first ACA open enrollment period. It reports the views and experience of all non-group enrollees, including those with coverage obtained both inside and outside the Exchanges, and those who were uninsured prior to the ACA as well as those who had a previous source of coverage non-group or otherwise.”

via Survey of Non-Group Health Insurance Enrollees | The Henry J. Kaiser Family Foundation.

Filed under: ACA and Medicaid, access to education, Aging, Behavioral Health Outcomes, Blogosphere, Children and Poverty, Civic Engagement, consumers, Health Literacy, Health Policy, Healthcare Reform, Maternal and Child Health, Medicaid, Medicaid Expansion, News, Philanthropy, Policy ThinkShop Comments on other media platforms, Public Health, Public Policy

Addressing health problems in your community takes more than understanding what causes them or who they impact most. | ‘A Starting Point for Change’: Fifth Edition of the County Health Rankings Released Today – Robert Wood Johnson Foundation

Addressing health problems in communities takes more than understanding what causes them or who they impact most.  It takes a motivated network of stakeholders to define policies, bring resources, and build appropriate programs.  What can you do to successfully convene and motivate local thought leaders to help you in your public health cause?

Motivating others to work with you requires a command of the relevant facts to build a reasonable conversation.  Commanding local data, defining local health problems (in terms of needed policies, plans and programs) will help you form a team of local stakeholders that can support your vision of a healthier community.

This year the RWJF released its fifth edition of its county health ranking report.  The report focuses on the relationship between how you feel and where you live.   The website provides a user friendly set of online tools for understanding demographic variables and performing health analysis that can help you increase your “health literacy” as a community member, stakeholder, policy maker and leader with a focus on addressing community health challenges.

The following resources will help you make progress on the health issues impacting your community.

 

The Policy ThinkShop provides you with the following summary of the findings and user friendly links to the website where you can plugin your state, county, etc., and get your data:

http://www.countyhealthrankings.org

Also, you can search the site for best practice programs and policies:

http://www.countyhealthrankings.org/roadmaps/what-works-for-health

 

“This year’s County Health Rankings report shows some important trends, including:

Teen birth rates have decreased about 25 percent since 2007.

The rate of preventable hospital stays decreased about 20 percent from 2003 to 2011.

Smoking rates dropped from 21 percent in 2005 to 18 percent in 2012.

Completion of at least some college attendance increased slightly from 59 percent in 2005 to 64 percent in 2012.

This year’s report also features several new measures:

Housing:

Almost 1 in 5 households are overcrowded, pose a severe cost burden, or lack adequate facilities to cook, clean, or bathe.

These problems are greatest on the East and West coasts, in Alaska, and in parts of the South.

Transportation:

More than three-quarters of workers drive to work alone and among them 33 percent drive longer than a half hour each way.

Driving contributes to physical inactivity, obesity and air pollution.

Food Environment:

People in many parts of the country face food insecurity or the threat of hunger and limited access to healthy foods, especially in counties in the Southwest, across parts of the South and in the Western United States.

Mental Health:

Amid growing attention to mental health care, the availability of mental health providers in the healthiest counties in each state is 1.3 times higher than in the least healthy counties.

The west and northeast regions of the country have the best access to mental health providers.

Injury-Related Deaths:

The third-leading cause of death in the United States, injury death rates are 1.7 times higher in the least healthy counties than in the healthiest counties.

These rates are particularly high in the Southwest, part of the Northwest including Alaska and in the East South Central and Appalachian regions.

Exercise Opportunities:

Access to parks or recreational facilities in the healthiest counties is 1.4 times higher than in the least healthy counties.”

More via ‘A Starting Point for Change’: Fifth Edition of the County Health Rankings Released Today – Robert Wood Johnson Foundation.

Filed under: ACA and Medicaid, Aging, Behavioral Health Outcomes, Blogosphere, Civic Engagement, Data Trends - American Demographics and Public Opinion, Health Literacy, Health Policy, Healthcare Reform, Medicaid Expansion, News, Policy ThinkShop Comments on other media platforms

Is your doctor happy? With Poll from: Gallup.Com

When you visit your doctor does (s)he look happy?  At the end of the day healthcare is a one on one personal experience.  All the insurance coverage or fancy machines in the world won’t improve medical care if the doctor patient relationship is not optimal.

So what is our healthcare system doing to address physician happiness?  The Gallup organization took a closer look at hospitals, one place where physician practice is defined and sustained–for better or for worse…

“When doctors are frustrated, patient care and hospital revenues suffer. Heres how hospitals can engage their physicians — and make a positive impact on patients and the bottom line.”

via Gallup.Com – Daily News, Polls, Public Opinion on Politics, Economy, Wellbeing, and World.

Filed under: ACA and Medicaid, Behavioral Health Outcomes, Blogosphere, Cancer Treatment & Success, Health Literacy, Health Policy, Healthcare Reform, Maternal and Child Health, Medicaid, Medicaid Expansion, Medical Research, Medicare, New American Electorate, Polls and pollsters, Public Health

Find out how your state is doing on ACA implementation. Health Policy Center at the Urban Institute | Independent research for better health policy

One of the most important differences between states in their ACA implementation experience is each state’s policy perspective on the social safety net.  Some states tend to be more liberal regarding healthcare.  Others see all safety net issues the same–they don’t want to pay for them and they certainly don’t want to expand them.  The details of how each state is faring and the comparison between various states you may be interested in follows …

The Policy ThinkShop facilitates your access to the complete Policy Brief update on state comparisons of ACA implementation at:

http://www.urban.org/uploadedpdf/413129-Eligibility-for-Assistance-and-Projected-Changes-in-Coverage-Under-the-ACA-Variation-Across-States.pdf

 

“The authors estimate that in 2014, 56 percent of the uninsured became eligible for financial assistance with health insurance coverage through Medicaid, CHIP, or subsidized marketplace coverage.  In states that expanded Medicaid eligibility, 68 percent of the uninsured became eligible for assistance, compared with only 44 percent in states that did not.  Because of this difference in eligibility, the ACA is projected to reduce the number of uninsured people by 56 percent in states that expanded Medicaid, compared with only 34 percent in states that did not.  The authors also provide estimates of what would happen if states that have not yet expanded Medicaid were to do so. Read more …”

More via Health Policy Center at the Urban Institute | Independent research for better health policy.

Filed under: ACA and Medicaid, Blogosphere, Children and Poverty, consumers, Health Literacy, Health Policy, Healthcare Reform

Addressing Deep and Persistent Poverty: A Framework for Philanthropic Planning and Investment

Given the last decade of a deep and lingering economic downturn, mortgage failures, Wall Street scandals and scams that brought much misfortune to the otherwise fortunate, poverty is no longer a controversial topic that afflicts the few and shakes the policy corridors of Washington.  The new poverty, according to most experts, affects families and children, the hard to employ and many struggling families who face their at home kids’ college loan bills without the benefit of Jr.’s paycheck.

Perhaps now is a good “quiet and tranquil” time to study the issue of the less fortunate without the cacophony of stakeholder voices drowning out reason.  Perhaps now that Occupy this and that has all but disappeared, the issue of poverty can occupy the voices of reason …

To be sure, the JPB foundation and the Urban Institute have recently partnered to produce an intelligent overview and analytical tools for looking, not only at poverty, but at what they term “deep poverty.”

The Policy ThinkShop provides you with the following link at an article to peruse the issue or the following downloadable report which will give you a deeper look at the deep poverty issue:

http://www.urban.org/UploadedPDF/412983-addressing-deep-poverty.pdf

“The JPB Foundation engaged the Urban Institute to provide background on the problem of deep and persistent poverty in the United States. This paper summarizes the history of US antipoverty policies, synthesizes existing knowledge about poverty and deep poverty, and presents a framework for understanding the complex and multi-faceted landscape of antipoverty efforts today. It also draws on interviews with over 30 experts, philanthropists, and thought leaders in the field to review and distill the most current thinking about promising strategies for tackling deep and persistent poverty. Drawing on these facts and insights, we present a series of questions and choices that any foundation wishing to invest in this area would be well-advised to consider.”

More via Addressing Deep and Persistent Poverty: A Framework for Philanthropic Planning and Investment.

Filed under: ACA and Medicaid, access to education, Blogosphere, Children and Poverty, Data Trends - American Demographics and Public Opinion, Demographic Change, Feminization of Poverty, Medicaid Expansion, News, Public Policy