Publications by authors named "Steven C Hill"

49 Publications

Shielding of viruses such as SARS-Cov-2 from ultraviolet radiation in particles generated by sneezing or coughing: Numerical simulations of survival fractions.

J Occup Environ Hyg 2021 Jul 21:1-15. Epub 2021 Jul 21.

DEVCOM Army Research Laboratory, Adelphi, Maryland.

SARS-CoV-2 and other microbes within aerosol particles can be partially shielded from UV radiation. The particles refract and absorb light, and thereby reduce the UV intensity at various locations within the particle. Previously, we demonstrated shielding in calculations of UV intensities within spherical approximations of SARS-CoV-2 virions within spherical particles approximating dried-to-equilibrium respiratory fluids. The purpose of this paper is to extend that work to survival fractions of virions (i.e., fractions of virions that can infect cells) within spherical particles approximating dried respiratory fluids, and to investigate the implications of these calculations for using UV light for disinfection. The particles may be on a surface or in air. Here, the survival fraction () of a set of individual virions illuminated with a UV fluence (, in J/m) is assumed described by () = exp(), where is the UV inactivation rate constant (m/J). The average survival fraction () of the simulated virions in a group of particles is calculated using the energy absorbed by each virion in the particles. The results show that virions within particles of dried respiratory fluids can have larger than do individual virions. For individual virions, and virions within 1-, 5-, and 9-µm particles illuminated (normal incidence) on a surface with 260-nm UV light, the = 0.00005, 0.0155, 0.22, and 0.28, respectively, when  10. The decrease to <10, <10, 0.077, and 0.15, respectively, for  = 100. Results also show that illuminating particles with UV beams from widely separated directions can strongly reduce the . These results suggest that the size distributions and optical properties of the dried particles of virion-containing respiratory fluids are likely important to effectively designing and using UV germicidal irradiation systems for microbes in particles. The results suggest the use of reflective surfaces to increase the angles of illumination and decrease the . The results suggest the need for measurements of the of SARS-CoV-2 in particles having compositions and sizes relevant to the modes of disease transmission.
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http://dx.doi.org/10.1080/15459624.2021.1939877DOI Listing
July 2021

The effects of Medicaid on access to care and adherence to recommended preventive services.

Health Serv Res 2021 02 8;56(1):84-94. Epub 2020 Dec 8.

Division of Research & Modeling, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research & Quality, Department of Health and Human Services, Rockville, Maryland, USA.

Objective: To quantify the impact of Medicaid enrollment on access to care and adherence to recommended preventive services.

Data Source: 2005-2015 Medical Expenditure Panel Survey Household Component.

Study Design: We examined several access measures and utilization of several preventive services within the past year and within the time frame recommended by the United States Preventive Services Task Force, if more than a year. We estimated local average treatment effects of Medicaid enrollment using a new, two-stage regression model developed by Nguimkeu, Denteh, and Tchernis. This model accounts for both endogenous and underreported Medicaid enrollment by using a partial observability bivariate probit regression as the first stage. We identify the model with an exogenous measure of Medicaid eligibility, the simulated Medicaid eligibility rate by state, year, and parents vs childless adults. A wide range of changes in Medicaid eligibility occurred during the time period studied.

Data Collection/extraction Methods: Sample of low-income, nonelderly adults not receiving disability benefits.

Principal Findings: Medicaid enrollment decreased the probability of having unmet needs for medical care by 7.5 percentage points and the probability of experiencing delays getting prescription drugs by 7.7 percentage points. Medicaid enrollment increased the probability of having a usual source of care by 16.5 percentage points, the probability of having a routine checkup by 17.1 percentage points, and the probability of having a flu shot in past year by 12.6 percentage points.

Conclusion: Medicaid enrollment increased access to care and use of some preventive services. Additional research is needed on impacts for subgroups, such as parents, childless adults, and the smaller and generally older populations for whom screening tests are recommended.
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http://dx.doi.org/10.1111/1475-6773.13603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7839643PMC
February 2021

Viruses such as SARS-CoV-2 can be partially shielded from UV radiation when in particles generated by sneezing or coughing: Numerical simulations.

J Quant Spectrosc Radiat Transf 2021 Mar 24;262:107489. Epub 2020 Dec 24.

Auburn University, Auburn, AL, USA.

UV radiation can inactivate viruses such as SARS-CoV-2. However, designing effective UV germicidal irradiation (UVGI) systems can be difficult because the effects of dried respiratory droplets and other fomites on UV light intensities are poorly understood. Numerical modeling of UV intensities inside virus-containing particles on surfaces can increase understanding of these possible reductions in UV intensity. We model UV intensities within spherical approximations of virions randomly positioned within spherical particles. The model virions and dried particles have sizes and optical properties to approximate SARS-CoV-2 and dried particles formed from respiratory droplets, respectively. In 1-, 5- and 9-µm diameter particles on a surface, illuminated by 260-nm UV light from a direction perpendicular to the surface, 0%, 10% and 18% (respectively) of simulated virions are exposed to intensities less than 1/100 of intensities in individually exposed virions (i.e., they are partially shielded). Even for 302-nm light (simulating sunlight), where absorption is small, 0% and 11% of virions in 1- and 9-µm particles have exposures 1/100 those of individually exposed virions. Shielding is small to negligible in sub-micron particles. Results show that shielding of virions in a particle can be reduced by illuminating a particle either from multiple widely separated incident directions, or by illuminating a particle rotating in air for a time sufficient to rotate through enough orientations. Because highly UV-reflective paints and surfaces can increase the angular ranges of illumination and the intensities within particles, they appear likely to be useful for reducing shielding of virions embedded within particles.
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http://dx.doi.org/10.1016/j.jqsrt.2020.107489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7836904PMC
March 2021

Net Spending On Retail Specialty Drugs Grew Rapidly, Especially For Private Insurance And Medicare Part D.

Health Aff (Millwood) 2020 11;39(11):1970-1976

Yao Ding is a senior economist in the Center for Financing, Access, and Cost Trends, AHRQ.

Specialty drugs are expensive, but spending on specialty drugs is difficult to measure because of proprietary rebate payments by manufacturers to insurers, pharmacy benefit managers, and state Medicaid agencies. Our study extends recent research that documented growing use of and spending on specialty drugs by incorporating manufacturer rebates for both public and private payers. Although specialty drugs make up a small portion of retail prescriptions filled, we found that they accounted for 37.7 percent of retail and mail-order prescription spending net of rebates in 2016-17. From 2010-11 to 2016-17, spending net of rebates tripled for Medicare Part D beneficiaries and more than doubled for people with private insurance. Medicaid spending net of rebates rose more slowly. These results can help inform decision makers as they strive to balance the costs and benefits of innovative drugs.
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http://dx.doi.org/10.1377/hlthaff.2019.01830DOI Listing
November 2020

Patient-Centered Medical Homes and Pediatric Preventive Counseling.

Acad Pediatr 2021 04 7;21(3):488-496. Epub 2020 Jul 7.

Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, Md.

Objective: To measure pediatric preventive counseling at patient-centered medical homes (PCMHs) compared with practices that reported undertaking some or no quality-related activities.

Methods: We analyzed 4814 children and adolescents ages 0 to 17 who visited their usual sources of care in the nationally representative Medical Expenditure Panel Survey Medical Organizations Survey (MEPS-MOS), a household survey combined with a survey of household members' usual sources of care. We identified PCMHs using lists from certifying or accrediting organizations. For other practices in the MEPS-MOS, 2 quality-related activities were 1) reports to physicians about their clinical quality of care, and 2) electronic health record system reminders to physicians. Regressions controlled for practice, child, and family characteristics.

Results: Compared with other practices, PCMHs were generally associated with greater likelihood of receiving preventive counseling. Estimates varied with the quality-related activities of the comparison practices. Counseling against smoking in the home was 10.4 to 18.7 percentage points (both P < .01) more likely for PCMHs. More associations were statistically significant for PCMHs compared with practices that undertook 1 of 2 quality-related activities examined. Among children ages 2 to 5, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on 3 of 5 topics. Among adolescents, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on smoking, exercise, and eating healthy.

Conclusions: PCMHs were associated with substantially greater receipt of pediatric preventive counseling. Evaluations of PCMHs need to account for the quality-related activities of comparison practices.
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http://dx.doi.org/10.1016/j.acap.2020.07.001DOI Listing
April 2021

The effect of Medicaid expansion on prescriptions for breast cancer hormonal therapy medications.

Health Serv Res 2020 06 17;55(3):399-410. Epub 2020 Apr 17.

Department of Economics, Georgia State University, Atlanta, Georgia.

Objective: To quantify the effects of the Affordable Care Act Medicaid expansion on prescriptions for effective breast cancer hormonal therapies (tamoxifen and aromatase inhibitors) among Medicaid enrollees.

Data Source/study Setting: Medicaid State Drug Utilization Database (SDUD) 2011-2018, comprising the universe of outpatient prescription medications covered under the Medicaid program.

Study Design: Differences-in-differences and event-study linear models compare population rates of tamoxifen and aromatase inhibitor (anastrozole, exemestane, and letrozole) use in expansion and nonexpansion states, controlling for population characteristics, state, and time.

Principal Findings: Relative to nonexpansion states, Medicaid-financed hormonal therapy prescriptions increased by 27.2 per 100 000 nonelderly women in a state. This implies a 28.8 percent increase from the pre-expansion mean of 94.2 per 100 000 nonelderly women in expansion states. The event-study model reveals no evidence of differential pretrends in expansion and nonexpansion states and suggests use grew to 40 or more prescriptions per 100 000 nonelderly women 3-5 years postexpansion.

Conclusions: Medicaid expansion may have had a meaningful impact on the ability of lower-income women to access effective hormonal therapies used to treat breast cancer.
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http://dx.doi.org/10.1111/1475-6773.13289DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240774PMC
June 2020

The Dynamics Of Medicaid Enrollment, Employment, And Beneficiary Health Status.

Health Aff (Millwood) 2019 09;38(9):1491-1495

Steven C. Hill ( ) is a senior economist in the Division of Research and Modeling, Center for Financing, Access, and Cost Trends, AHRQ.

Some policy makers are proposing Medicaid work or community engagement requirements. Using national data, we found that 13.9 percent of new, nonelderly adult Medicaid beneficiaries in 2015-16 had experienced a decline in health before enrollment, and a similar percentage had had jobs that ended before they enrolled. These findings highlight the need for careful design of work requirement policies.
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http://dx.doi.org/10.1377/hlthaff.2019.00066DOI Listing
September 2019

Public insurance expansions and smoking cessation medications.

Econ Inq 2019 Oct 7;57(4):1798-1820. Epub 2019 May 7.

Senior Economist, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, 5600 Fishers Lane, Mail Stop 07W41A, Rockville MD 20857.

We study the effect of public insurance on smoking cessation medication prescriptions and financing. We leverage variation in insurance coverage generated by recent Affordable Care Act expansions to Medicaid. We estimate differences-in-differences models using administrative data on the universe of Medicaid-financed prescriptions sold in retail and online pharmacies 2011-2017. Our findings suggest that these expansions increased Medicaid-financed smoking cessation prescriptions by 34%. This increase reflects new medication use and a shift in payment from private insurers and self-paying patients to Medicaid. Adjusting our estimate for changes in financing implies that Medicaid expansion lead to a 24% increase in new medication use.
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http://dx.doi.org/10.1111/ecin.12794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699517PMC
October 2019

Effects of improvements in the CPS on the estimated prevalence of medical financial burdens.

Health Serv Res 2019 08 29;54(4):920-929. Epub 2019 Apr 29.

Department of Economics Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia.

Objective: To measure the effects of questionnaire and imputation improvements in the Current Population Survey (CPS) on the estimated prevalence of high medical financial burden, that is, families spending more than 10 percent of income on medical care.

Data Source: Matched longitudinal sample of CPS data for 2013 and 2014 calendar years.

Study Design: The CPS used a split-sample design to field traditional and redesigned questions about 2013 income, and old and new out-of-pocket premium imputation procedures, respectively. For both samples, CPS data for 2014 were from the redesigned income questions and the new imputation procedures. We quantify the effects of the combined survey improvements using differences-in-differences methods.

Principal Findings: The improvements were not associated with changes in the estimate of burden in the full sample. Estimated prevalence increased by 2.6 percentage points among nonelderly adults with private insurance, decreased by 6.6 percentage points among nonelderly adults with public coverage, and decreased by 5.8 percentage points among elderly adults with Medicare and no private coverage.

Conclusions: Improvements in the CPS changed the estimated prevalence of high medical financial burden among key subgroups. Researchers should use caution when tracking burden across the time-period in which these improvements were implemented.
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http://dx.doi.org/10.1111/1475-6773.13158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6606553PMC
August 2019

Impact of Recent Medicaid Expansions on Office-Based Primary Care and Specialty Care among the Newly Eligible.

Health Serv Res 2018 08 20;53(4):2426-2445. Epub 2017 Oct 20.

Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD.

Objective: To quantify the effect of Medicaid expansions on office-based care among the newly eligible.

Data Source: 2008-2014 Medical Expenditure Panel Survey.

Study Design: The main sample is adults age 26-64 with incomes ≤138% of poverty who were not eligible for Medicaid prior to the Affordable Care Act. For this population, difference-in-differences linear probability models compare utilization between expansion and nonexpansion states and between 2008-2013 and 2014.

Extraction Methods: Medicaid eligibility is simulated using data on family relationships, state of residence, and income.

Principal Findings: Relative to comparable adults in nonexpansion states, newly eligible adults in expansion states were 9.1 percentage points more likely to have any office-based primary care physician visit in 2014, a 21.4% increase from 2013 (p-value = .004); 6.9 percentage points more likely to have a specialist visit, a 25.2% increase from 2013 (p-value = .036); and 5.1 percentage points more likely to have a visit with a nurse practitioner, nurse, or physician assistant, a 34.5% increase from 2013 (p-value = .016).

Conclusions: State Medicaid expansions in 2014 were associated with greater likelihoods of visits with a variety of office-based providers. The estimated effects are larger among newly eligible compared with previous estimates on broader populations of low-income adults.
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http://dx.doi.org/10.1111/1475-6773.12793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051968PMC
August 2018

Trends over time in enrollment in non-group health insurance plans by tobacco use in the United States.

Prev Med Rep 2017 Sep 17;7:46-49. Epub 2017 May 17.

Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Rockville, MD, United States.

Healthcare.gov was created to facilitate the market for non-group insurance in states that did not establish their own marketplaces. In Healthcare.gov, families are asked to report their tobacco use status, and tobacco use surcharges of up to 50% may result. We tabulate enrollment information for 35 states offering insurance plans through Healthcare.gov in both 2014 and 2016. The Centers for Medicare and Medicaid Services provided counts of enrollees indicating tobacco use, by state, year, and risk level. The number of enrollees increased from 5.0 million in 2014 to 9.4 million in 2016. From 2014 to 2016, the number of enrollees rose 39% for tobacco users and 90% for non-tobacco users. Reported non-tobacco user enrollment rose faster than reported tobacco user enrollment in 30 out of 35 states. Reported tobacco users are enrolling in marketplace plans at a lower rate and are more likely to enroll in less generous plans. The decline in smoking as reported when purchasing insurance on Healthcare.gov surpasses declines in smoking observed in other data sources, which suggests that tobacco users may be decreasingly likely to report their tobacco use status accurately to avoid surcharges. Finally, we find no evidence of the surcharges being associated with lower enrollment among self-reported tobacco users, or in rates of smoking.
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http://dx.doi.org/10.1016/j.pmedr.2017.05.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5447394PMC
September 2017

Growing Insurance Coverage Did Not Reduce Access To Care For The Continuously Insured.

Health Aff (Millwood) 2017 05;36(5):791-798

Steven C. Hill is a senior economist at the Agency for Healthcare Research and Quality.

Recent expansions in health insurance coverage have raised concerns about health care providers' capacity to supply additional services and how that may have affected access to care for people who were already insured. When we examined data for the period 2008-14 from the Medical Expenditure Panel Survey, we found no consistent evidence that increases in the proportions of adults with insurance at the local-area level affected access to care for adults residing in the same areas who already had, and continued to have, insurance. This lack of an apparent relationship held true across eight measures of access, which included receipt of preventive care. It also held true among two adult subpopulations that may have been at greater risk for compromised access: people residing in health care professional shortage areas and Medicaid beneficiaries.
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http://dx.doi.org/10.1377/hlthaff.2016.1671DOI Listing
May 2017

Adults Are More Likely To Become Eligible For Medicaid During Future Recessions If Their State Expanded Medicaid.

Health Aff (Millwood) 2017 01;36(1):32-39

Salam Abdus is a senior economist at AHRQ.

Eligibility for and enrollment in Medicaid can vary with economic recessions, recoveries, and changes in personal income. Understanding how Medicaid responds to such forces is important to budget analysts and policy makers tasked with forecasting Medicaid enrollment. We simulated eligibility for Medicaid for the period 2005-14 in two scenarios: assuming that each state's eligibility rules in 2009, the year before passage of the Affordable Care Act (ACA), were in place during the entire study period; and assuming that the ACA's expanded eligibility rules were in place during the entire period for all states. Then we correlated the results with unemployment rates as a measure of the economy. Each percentage-point increase in the unemployment rate was associated with an increase in the share of people eligible for Medicaid of 0.32 percentage point under the 2009 eligibility rules and 0.77 percentage point under the ACA rules. Our simulations showed that the ACA expansion increased Medicaid's responsiveness to changes in unemployment. For states that have not expanded Medicaid eligibility, our analysis demonstrates that increased responsiveness to periods of high unemployment is one benefit of expansion.
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http://dx.doi.org/10.1377/hlthaff.2016.1076DOI Listing
January 2017

Psychological Distress and Enrollment in Medicaid.

J Behav Health Serv Res 2017 Oct;44(4):523-535

Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Mail Stop #07W41A, 5600 Fishers Lane, Rockville, MD, 20857, USA.

Adults with poor mental health may want and need insurance to obtain care, but symptoms may impede enrollment into public health insurance. This study compares Medicaid enrollment responses to eligibility expansions by mental health status using a sample of non-elderly adults in both the 2000-2011 Medical Expenditure Panel Survey and the National Health Interview Survey (N = 27,494). The impact of Medicaid income eligibility thresholds (defined as the maximum family income level allowed in each state to be considered eligible for Medicaid) on Medicaid enrollment was estimated from linear regression models allowing for differential enrollment responses by mental and physical health status. Increasing income eligibility thresholds by 100% of the federal poverty level (FPL) was associated with a five-percentage-point increase in the probability of Medicaid enrollment in the non-disabled population under 300% FPL. The enrollment response to Medicaid expansions prior to the Affordable Care Act was stronger for adults symptomatic of psychological distress compared with adults without distress and compared to adults with chronic physical health problems.
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http://dx.doi.org/10.1007/s11414-016-9532-9DOI Listing
October 2017

Raman scattering and red fluorescence in the photochemical transformation of dry tryptophan particles.

Opt Express 2016 May;24(11):11654-67

Tryptophan is a fluorescent amino acid common in proteins. Its absorption is largest for wavelengths λ ≲ 290 nm and its fluorescence emissions peak around 300-350 nm, depending upon the local environment. Here we report the observation of red fluorescence near 600 nm emerging from 488-nm continuous-wave (CW) laser photoexcitation of dry tryptophan (Trp) particles. With an excitation intensity below 0.5 kW/cm2, dry Trp particles yield distinctive Raman scattering peaks in the presence of relatively weak and spectrally broad emissions with λ ∼500-700 nm, allowing estimation of particle temperature at low excitation intensities. When the photoexcitation intensity is increased to 1 kW/cm2 or more for a few minutes, fluorescence intensity dramatically increases by more than two orders of magnitude. The fluorescence continues to increase in intensity and gradually shift to the red when photoexcitation intensity and the duration of exposure are increased. The resulting products absorb at visible wavelengths and generate red fluorescence with λ ∼ 650-800 nm with 633-nm CW laser excitation. We attribute the emergence of orange and red fluorescence in the Trp products to a photochemical transformation that is instigated by weak optical transitions to triplet states in Trp with 488-nm excitation and which may be expedited by a photothermal effect.
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http://dx.doi.org/10.1364/OE.24.011654DOI Listing
May 2016

The Affordable Care Act and Expanded Insurance Eligibility Among Nonelderly Adult Cancer Survivors.

J Natl Cancer Inst 2015 Sep 1;107(9). Epub 2015 Jul 1.

Yale School of Public Health, New Haven, CT (AJD); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD (SCH); Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD (DB); Health Services and Economics Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD (KRY).

Background: Cancer survivors may face barriers to accessing health insurance and experience financial hardship because of medical expenditures. We examined potential improvements in access to insurance for cancer survivors through adult Medicaid expansions and premium tax credits in the new insurance marketplaces under the Affordable Care Act (ACA).

Methods: Eligibility for Medicaid and premium tax credits was simulated for cancer survivors age 18 to 64 years in the 2008 to 2010 Medical Expenditure Panel Survey using a detailed deterministic model. Financial hardship was determined as: 1) delays or unmet need for medical, prescription, or dental care because of cost or insurance issues and/or 2) family out-of-pocket medical spending that was 20% or more of gross income. Descriptive analyses were stratified by whether the state of residence chose to expand Medicaid by January 2015. All statistical tests were two-sided.

Results: Overall, 14.7% of 9.44 million cancer survivors were uninsured, with 18% reporting financial hardship. Under the ACA, 19% overall, 30% of the uninsured, and 39% of those reporting financial hardship would be Medicaid eligible. An additional 10% would be eligible for premium tax credits, with the remainder able to participate in the Marketplace without tax credits. However, 21% of uninsured cancer survivors in states not expanding Medicaid would be ineligible for assistance with coverage.

Conclusions: Under the ACA, many of the uninsured and a larger proportion of survivors facing financial hardship will be eligible for Medicaid or premium tax credits in the Marketplaces. ACA implementation will dramatically enhance insurance availability and is likely to reduce financial hardship for vulnerable cancer survivors.
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http://dx.doi.org/10.1093/jnci/djv181DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4651107PMC
September 2015

If rollbacks go forward, up to 14 million children could become ineligible for public or subsidized coverage by 2019.

Health Aff (Millwood) 2015 May;34(5):864-70

Thomas M. Selden is the director of the Division of Modeling and Simulation, Center for Financing, Access, and Cost Trends, AHRQ.

In spring 2015 Congress passed legislation to extend funding for the Children's Health Insurance Program (CHIP) through the end of fiscal year 2017. This two-year extension pushes to 2017 the question of whether CHIP funding will end, allowing states to end their separate state CHIP programs. Also, when the Affordable Care Act's maintenance-of-effort requirements expire after 2019, states will be allowed to roll back Medicaid- and CHIP-eligibility thresholds to minimum levels allowed by federal law. This study investigated the potential health insurance options available to low-income children if these events happen. If all states roll back coverage to federal statutory minimums, then, among children in families with incomes up to 400 percent of the federal poverty guidelines, the share ineligible for public coverage or subsidized Marketplace coverage would increase from 22 percent in 2014 (12.5 million children) to 46 percent after 2019 (26.5 million children). While not all states are likely to reduce eligibility to federal statutory minimums, these estimates highlight the fact that many children who do lose public eligibility will not become eligible for subsidized Marketplace coverage.
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http://dx.doi.org/10.1377/hlthaff.2015.0004DOI Listing
May 2015

Photophoretic trapping of airborne particles using ultraviolet illumination.

Opt Express 2015 Feb;23(3):3630-9

We demonstrate photophoretic trapping of micron-sized absorbing particles in air using pulsed and continuous-wave (CW) ultraviolet laser illumination at wavelengths of 351 nm and 244 nm. We compared the particle trapping dynamics in two trapping geometries consisting of a hollow optical cone formed by light propagating either with or against gravity. This comparison allowed us to isolate the influence of the photophoretic force from the radiative pressure and the convective forces. We found that the absorbing spherical particles tested experienced a positive photophoretic force, whereas the spatially irregular, non-spherical particles tested experienced a negative photophoretic force. By using two trapping geometries, both spherical and non-spherical absorbing particles could be trapped and held securely in place. The position of the trapped particles exhibited a standard deviation of less than 1 µm over 20 seconds. Moreover, by operating in the UV and deep-UV where the majority of airborne materials are absorptive, the system was able to trap a wide range of particle types. Such a general purpose optical trap could enable on-line characterization of airborne particles when coupled with interrogation techniques such as Raman spectroscopy.
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http://dx.doi.org/10.1364/OE.23.003630DOI Listing
February 2015

Does increased adherence to medications change health care financial burdens for adults with diabetes?

J Diabetes 2015 Nov 6;7(6):872-80. Epub 2015 May 6.

Division of Modeling and Simulation, Center for Financing, Access and Cost Trends Agency for Healthcare Research and Quality, Rockville, Maryland, USA.

Background: The aim of the present study was to investigate increased out-of-pocket drug costs and financial burdens of achieving adherence to oral antidiabetic medications and medications for prevalent comorbidities.

Methods: Concurrent adherence to medications, out-of-pocket drug costs, and financial burdens were measured among non-elderly adults with diabetes in the Medical Expenditure Panel Survey. "Financial burden" was defined as spending on health care exceeding 10% of family income. This study simulated the increased out-of-pocket drug costs and financial burdens that would result if non-adherent adults in our sample had obtained sufficient medications to be adherent. For each adult, for all therapeutic classes in which they were non-adherent, we calculated the additional days supplied required to become adherent, as well as out-of-pocket spending on these additional days supplied.

Results: Approximately one-quarter adhered to all required medications. Among non-adherent adults with employer-sponsored insurance and public insurance, the mean annual out-of-pocket drug costs of achieving adherence were US$171 and US$68, respectively, which was generally affordable. However, 35.6% of the uninsured lived in families that spent 10% or more of their income on health care. Mean simulated additional out-of-pocket drug costs of achieving adherence were US$310 for the uninsured. These additional drug costs would increase those spending 10% or more of income to 39.6% of the uninsured.

Conclusions: Efforts to reduce the costs faced by the uninsured and insured will make adherence more affordable and, therefore, more attainable for some adults with diabetes.
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http://dx.doi.org/10.1111/1753-0407.12292DOI Listing
November 2015

Medicaid expansion in opt-out states would produce consumer savings and less financial burden than exchange coverage.

Authors:
Steven C Hill

Health Aff (Millwood) 2015 Feb;34(2):340-9

Steven C. Hill is a senior economist in the Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, in Rockville, Maryland.

In the twenty-three states that have decided against expanding Medicaid under the Affordable Care Act, uninsured adults who would have been eligible for Medicaid and have incomes at or above the federal poverty guidelines are generally eligible for Marketplace (insurance exchange) premium tax credits and plans with generous benefits. This study compared estimated out-of-pocket spending for care and premiums, as well as the financial burdens they impose, for the families of these adults under two simulation scenarios: obtaining coverage through a silver plan with subsidized cost sharing and enrolling in expanded Medicaid. Compared with Marketplace coverage, Medicaid would more than halve average annual out-of-pocket spending ($938 versus $1,948), while dramatically reducing the percentage of adults in families with out-of-pocket expenses exceeding 10 percent or 20 percent of income (6.0 percent versus 17.1 percent and 0.9 percent versus 3.7 percent, respectively). Larger reductions would be seen for families with smokers, who under Medicaid would no longer be subject to Marketplace tobacco user surcharges. Medicaid expansion may offer a greater opportunity than access to Marketplace insurance to promote the financial well-being of previously uninsured low-income adults.
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http://dx.doi.org/10.1377/hlthaff.2014.1058DOI Listing
February 2015

Children's health insurance program premiums adversely affect enrollment, especially among lower-income children.

Health Aff (Millwood) 2014 Aug;33(8):1353-60

Thomas M. Selden is director of the Division of Modeling and Simulation, Center for Financing, Access, and Cost Trends, AHRQ.

Both Medicaid and the Children's Health Insurance Program (CHIP), which are run by the states and funded by federal and state dollars, offer health insurance coverage for low-income children. Thirty-three states charged premiums for children at some income ranges in CHIP or Medicaid in 2013. Using data from the 1999-2010 Medical Expenditure Panel Surveys, we show that the relationship between premiums and coverage varies considerably by income level and by parental access to employer-sponsored insurance. Among children with family incomes above 150 percent of the federal poverty level, a $10 increase in monthly premiums is associated with a 1.6-percentage-point reduction in Medicaid or CHIP coverage. In this income range, the increase in uninsurance may be higher among those children whose parents lack an offer of employer-sponsored insurance than among those whose parents have such an offer. Among children with family incomes of 101-150 percent of poverty, a $10 increase in monthly premiums is associated with a 6.7-percentage-point reduction in Medicaid or CHIP coverage and a 3.3-percentage-point increase in uninsurance. In this income range, the increase in uninsurance is even larger among children whose parents lack offers of employer coverage.
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http://dx.doi.org/10.1377/hlthaff.2014.0182DOI Listing
August 2014

Spectrally-resolved fluorescence cross sections of aerosolized biological live agents and simulants using five excitation wavelengths in a BSL-3 laboratory.

Opt Express 2014 Apr;22(7):8165-89

A system for measuring spectrally-resolved fluorescence cross sections of single bioaerosol particles has been developed and employed in a biological safety level 3 (BSL-3) facility at Edgewood Chemical and Biological Center (ECBC). It is used to aerosolize the slurry or solution of live agents and surrogates into dried micron-size particles, and to measure the fluorescence spectra and sizes of the particles one at a time. Spectrally-resolved fluorescence cross sections were measured for (1) bacterial spores: Bacillus anthracis Ames (BaA), B. atrophaeus var. globigii (BG) (formerly known as Bacillus globigii), B. thuringiensis israelensis (Bti), B. thuringiensis kurstaki (Btk), B. anthracis Sterne (BaS); (2) vegetative bacteria: Escherichia coli (E. coli), Pantoea agglomerans (Eh) (formerly known as Erwinia herbicola), Yersinia rohdei (Yr), Yersinia pestis CO92 (Yp); and (3) virus preparations: Venezuelan equine encephalitis TC83 (VEE) and the bacteriophage MS2. The excitation wavelengths were 266 nm, 273 nm, 280 nm, 365 nm and 405 nm.
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http://dx.doi.org/10.1364/OE.22.008165DOI Listing
April 2014

Adults in the income range for the Affordable Care Act's Medicaid expansion are healthier than pre-ACA enrollees.

Health Aff (Millwood) 2014 Apr 26;33(4):691-9. Epub 2014 Mar 26.

The Affordable Care Act (ACA) has dramatically increased the number of low-income nonelderly adults eligible for Medicaid. Starting in 2014, states can elect to cover individuals and families with modified adjusted gross incomes below a threshold of 133 percent of federal poverty guidelines, with a 5 percent income disregard. We used simulation methods and data from the Medical Expenditure Panel Survey to compare nondisabled adults enrolled in Medicaid prior to the ACA with two other groups: adults who were eligible for Medicaid but not enrolled in it, and adults who were in the income range for the ACA's Medicaid expansion and thus newly eligible for coverage. Although differences in health across the groups were not large, both the newly eligible and those eligible before the ACA but not enrolled were healthier on several measures than pre-ACA enrollees. Twenty-five states have opted not to use the ACA to expand Medicaid eligibility. If these states reverse their decisions, their Medicaid programs might not enroll a population that is sicker than their pre-ACA enrollees. By expanding Medicaid eligibility, states could provide coverage to millions of healthier adults as well as to millions who have chronic conditions and who need care.
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http://dx.doi.org/10.1377/hlthaff.2013.0743DOI Listing
April 2014

Fluorescence of bioaerosols: mathematical model including primary fluorescing and absorbing molecules in bacteria.

Opt Express 2013 Sep;21(19):22285-313

This paper describes a mathematical model of fluorescent biological particles composed of bacteria, viruses, or proteins. The fluorescent and/or light absorbing molecules included in the model are amino acids (tryptophan, etc.); nucleic acids (DNA, RNA, etc.); coenzymes (nicotinamide adenine dinucleotides, flavins, and vitamins B₆ and K and variants of these); and dipicolinates. The concentrations, absorptivities, and fluorescence quantum yields are estimated from the literature, often with large uncertainties. The bioparticles in the model are spherical and homogeneous. Calculated fluorescence cross sections for particles excited at 266, 280, and 355 nm are compared with measured values from the literature for several bacteria, bacterial spores and albumins. The calculated 266- and 280-nm excited fluorescence is within a factor of 3.2 of the measurements for the vegetative cells and proteins, but overestimates the fluorescence of spores by a factor of 10 or more. This is the first reported modeling of the fluorescence of bioaerosols in which the primary fluorophores and absorbing molecules are included.
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http://dx.doi.org/10.1364/OE.21.022285DOI Listing
September 2013

Changes in fluorescence spectra of bioaerosols exposed to ozone in a laboratory reaction chamber to simulate atmospheric aging.

Opt Express 2012 Dec;20(28):29867-81

Johns Hopkins University Applied Physics Laboratory, Laurel, Maryland 20723, USA.

A laboratory system for exposing aerosol particles to ozone and rapidly measuring the subsequent changes in their single-particle fluorescence is reported. The system consists of a rotating drum chamber and a single-particle fluorescence spectrometer (SPFS) utilizing excitation at 263 nm. Measurements made with this system show preliminary results on the ultra-violet laser-induced-fluorescence (UV-LIF) spectra of single aerosolized particles of Yersinia rohdei, and of MS2 (bacteriophage) exposed to ozone. When bioparticles are exposed in the chamber the fluorescence emission peak around 330 nm: i) decreases in intensity relative to that of the 400-550 nm band; and ii) shifts slightly toward shorter-wavelengths (consistent with further drying of the particles). In these experiments, changes were observed at exposures below the US Environmental Protection Agency (EPA) limits for ozone.
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http://dx.doi.org/10.1364/OE.20.029867DOI Listing
December 2012

Validity of reported Medicare Part D enrollment in the Medical Expenditure Panel Survey.

Med Care Res Rev 2012 Dec 28;69(6):737-50. Epub 2012 Aug 28.

Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, 540 Gaither Rd, Rockville, MD 20850, USA.

The authors validate reported Part D coverage in the Medical Expenditure Panel Survey (MEPS) and assess the impact of misreporting on descriptive and behavioral analyses. MEPS participants with Medicare coverage during 2006 to 2007 were matched to Medicare administrative data. A summary measure of Part D coverage based on several questions has substantial validity (κ = .70) and an agreement rate of 85.1%. Some beneficiaries confused Part D and private drug coverage, leading to both under- and overreported Part D coverage. Accuracy varies little by sociodemographic group. Standard regression models of the determinants of Part D enrollment were estimated with both MEPS-based and administrative data-based measures of Part D enrollment. In this analysis, the signs of the marginal effects were the same, the magnitudes were similar, and mostly the same variables had statistically significant effects in both regressions. Thus, behavioral analyses are largely unaffected by misreporting.
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http://dx.doi.org/10.1177/1077558712457595DOI Listing
December 2012

Individual insurance benefits to be available under health reform would have cut out-of-pocket spending in 2001-08.

Authors:
Steven C Hill

Health Aff (Millwood) 2012 Jun 16;31(6):1349-56. Epub 2012 May 16.

Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, in Rockville, Maryland, USA.

Under the Affordable Care Act, individual health insurance will probably become more generous and more like employment-related insurance. Currently, individual insurance typically has less generous benefits than employment-related insurance. This study compared out-of-pocket spending on health care between individual and employment-related insurance, controlling for numerous characteristics such as health status. Then it simulated the impact of full implementation of provisions of the Affordable Care Act on adults who currently have individual insurance, including important subgroups-adults with chronic conditions, the near-elderly (ages 55-64), and low-income populations. If adults who had individual insurance during 2001-08 had instead had benefits similar to those under the Affordable Care Act, their average annual out-of-pocket spending on medical care and drugs might have been $280 less. The near-elderly and people with low incomes might have saved $589 and $535, respectively. An important improvement would have been the reduced probability of incurring very high out-of-pocket spending. The likelihood of having out-of-pocket expenditures on care exceeding $6,000 would have been reduced for all adults with individual insurance, and the likelihood of having expenditures exceeding $4,000 would have been reduced for many.
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http://dx.doi.org/10.1377/hlthaff.2011.1206DOI Listing
June 2012

Photophoretic trapping of absorbing particles in air and measurement of their single-particle Raman spectra.

Opt Express 2012 Feb;20(5):5325-34

U.S. Army Research Laboratory, 2800 Powder Mill Road, Adelphi, Maryland 20783, USA.

A new method is demonstrated for optically trapping micron-sized absorbing particles in air and obtaining their single-particle Raman spectra. A 488-nm Gaussian beam from an Argon ion laser is transformed by conical lenses (axicons) and other optics into two counter-propagating hollow beams, which are then focused tightly to form hollow conical beams near the trapping region. The combination of the two coaxial conical beams, with focal points shifted relative to each other along the axis of the beams, generates a low-light-intensity biconical region totally enclosed by the high-intensity light at the surface of the bicone, which is a type of bottle beam. Particles within this region are trapped by the photophoretic forces that push particles toward the low-intensity center of this region. Raman spectra from individual trapped particles made from carbon nanotubes are measured. This trapping technique could lead to the development of an on-line real-time single-particle Raman spectrometer for characterization of absorbing aerosol particles.
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http://dx.doi.org/10.1364/OE.20.005325DOI Listing
February 2012

Implications of the accuracy of MEPS prescription drug data for health services research.

Inquiry 2011 ;48(3):242-59

Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, Rockville, MD 20850, USA.

This paper assesses the quality of the Medical Expenditure Panel Survey (MEPS) drug data and the impact that misreporting prescription drug data has on descriptive and behavioral analyses. It does this by matching MEPS participants with Medicare Part D coverage during the period 2006-2007 to their Part D claims data. In the validation sample, the number of drug fills and total expenditures are reasonably accurate compared with claims. Household respondents tended to underreport the number of different drugs taken, but tended to overreport the number of fills of each drug. Behavioral analyses of the determinants of medication use and expenditures were largely unaffected because underreporting cut across most sociodemographic groups.
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http://dx.doi.org/10.5034/inquiryjrnl_48.03.04DOI Listing
January 2012

Adults with diagnosed and untreated diabetes: who are they? How can we reach them?

J Health Care Poor Underserved 2011 Nov;22(4):1221-38

Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, USA.

Untreated or undertreated diabetes can cause debilitating complications such as blindness and amputations. Information about the factors associated with diagnosed but untreated diabetes may help target efforts to promote appropriate treatment. Using the Medical Expenditure Panel Survey, we examine: (1) use of insulin or oral medications, (2) use of diet only, and (3) no treatment. We analyze covariates of this trichotomous outcome using multinomial logit regression. Among adults diagnosed with diabetes, 87.0% used oral medications or insulin, 10.6% used diet only, and 2.4% were untreated. Lacking a usual source of care, poor mental health, being single, and being an Asian/Pacific Islander are associated with lack of treatment. Better health, lacking a usual source of care, and attitudes against medical care are associated with using diet only. Adults with diagnosed but untreated or undertreated diabetes may be difficult for service providers to reach, and multiple strategies are needed to initiate treatment.
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http://dx.doi.org/10.1353/hpu.2011.0149DOI Listing
November 2011
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