Policy Briefs

Policy briefs offer analysis of health-related issues framed for a policy-focused audience.

Lack of Issuer Participation Associated with Higher Marketplace Premiums in Rural Areas in Missouri
by Abigail R. Barker PhD, Kristine Huang BA, and Leah Kemper MPH | March 2020

This brief describes the changes in the 2020 Health Insurance Marketplace pre- and post-subsidy premiums in Missouri compared to national trends as well as changes in issuer participation.  The findings suggest that policies that would increase insurer participation, especially in rural areas, would likely lower premium costs and lower the financial burden of subsidies for the federal government.

Disparities in Access to Specialists Explain Higher Preventable Hospitalization and Mortality Rates for Rural Medicare Patients: Implications for Missouri
by Kenton J. Johnston, Hefei Wen, Timothy L. Wiemken, Kristine Huang, and Karen E. Joynt Maddox | February 2020
Affiliations: Saint Louis University, Harvard Medical School,  Washington University in St. Louis

Rural Medicare beneficiaries age 65 and older with complex chronic conditions had higher preventable hospitalization and mortality rates than their urban peers.  These research findings show that access to care, and particularly a lack of access to specialists, explained a substantial portion of the difference in clinical outcomes between rural and urban beneficiaries. Overall, these results have implications for Missouri health policy and suggest that interventions to increase access to specialty care may be particularly high-impact among Medicare beneficiaries age 65 and older.

Read additional briefs published by the Center for Health Economics and Policy
Impact of State Laws Governing Physical Education on Attendance among U.S. High School Students, 2003-2017
by Ruopeng An, PhD; Mengmeng Ji, MS; Caitlin Clarke, PhD; Chenghua Guan, PhD | January 2020

Schools play a critical role in promoting physical activity among children through physical education (PE), which helps students gain necessary knowledge, skills, and confidence to practice sports and adopt an active lifestyle. Government policies and regulations profoundly influence local schools’ decisions and practices in delivering PE and promoting physical activity among students. This policy brief assessed the influence of state laws governing PE on weekly PE class attendance among U.S. high school students.

Addressing Local Mental Health Needs via County-level Property Tax
by Lindsey Nienstedt, BA, Abigail Barker, PhD, Leah Kemper, MPH, and Timothy McBride, PhD | November 2019

The county-level property-based mill tax is used in some Missouri counties to strengthen mental health programs, services and supports.  This brief examines how this tax works and serves as an informational resource for local governments and organizations looking at a mill tax as a way to address the unmet mental health needs of their communities.

Maternal Mortality in Missouri: A Review of Challenges and State Policy Options
by Jessica Engel, BA; Lindsey Nienstedt, BA; and Leah Kemper, MPH | October 2019 

Missouri ranks 44th in the nation in maternal mortality with 40.7 maternal deaths estimated per 100,000 live births in 2019. This brief examines the risk factors, causes and barriers to access that contribute to this alarming trend, as well as some of the policy options available to the State of Missouri to address this critical public health issue.

Financial Impact of Accounting for Social Risk in the Hospital Readmissions Reduction Program
by Karen E. Joynt Maddox, MD MPH; Mat Reidhead, BS MA; Andrew C. Qi, BS; Kristine Huang, BA; and David R. Nerenz, PhD | October 2019

This research investigates the impact of stratification on hospital penalties under the HRRP.

Effects of Medicaid Expansion on Coverage, Access, Outcomes, and Costs: Implications for Missouri
by Kristine Huang, BA; Leah Kemper, MPH; Timothy D. McBride, PhD, MS; and Karen E. Joynt Maddox, MD. MPH | September 2019

Multiple studies have explored the effects of state Medicaid expansion on coverage, access, outcomes, and costs. This review provides an overview of the findings about Medicaid expansion and its possible implications for Missouri.

Social Risk and Dialysis Facility Penalties Under the End-Stage Renal Disease Quality Incentive Program
by Andrew C. Qi BS, Anne M. Butler PhD, Kristine Huang BA, and Karen E. Joynt Maddox MD, MPH | September 2019

Introduced in 2012, Medicare’s End-Stage Renal Disease Quality Incentive Program (ESRD QIP) is a mandatory pay-for-performance program for U.S. dialysis facilities that penalizes facilities up to 2% of their Medicare payments based on their performance on a set of quality measures. This program has had an impact on dialysis facilities in low-income areas and those with high proportions of Black or dually Medicare and Medicaid enrolled patients. The analysis showed that facilities serving these vulnerable populations have lower quality scores and higher financial penalties. Consequently, the ESRD QIP could cause facilities to avoid caring for high-risk patients, or could worsen facility quality by taking away valuable resources. However, the penalties could also spur facilities to improve quality, which could reduce disparities. The impact of the program needs to continue to be monitored to ensure the program is as equitable as possible.

Medicaid Work Requirements: The Relationship between Work and Health
by Linda Li, MPH, Abigail Barker, PhD, Leah Kemper, MPH, Timothy McBride, PhD | February 2019

Whether work requirements in Medicaid promote health and align with the aims of the program has become a central question in the current policy debate. In this third of three briefs, we assess the relationship between work and health by using longitudinal data to analyze the effects of employment and health status over time. We evaluate the effect of health on work and then examine whether work improves health. Policy implications of current Medicaid work requirements and recommendations follow based on our findings.