Category Archives: Public policy
Sheryl Magzamen, PhD, MPH, is an assistant professor in the College of Veterinary Medicine and Biomedical Sciences at Colorado State University and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2007-2009). She recently published two studies exploring the link between early childhood lead exposure and behavioral and academic outcomes in Environmental Research and the Annals of Epidemiology. She discusses both below.
Human Capital Blog: What are the main findings of your study on childhood lead exposure and discipline?
Sheryl Magzamen: We found that children who had moderate but elevated exposure lead in early childhood were more than two times as likely as unexposed children to be suspended from school, and that’s controlling for race, socioeconomic status, and other covariates. We’re particularly concerned about this because of what it means for barriers to school success and achievement due to behavioral issues.
We are also concerned about the fact that there‘s a strong possibility, based on animal models, that neurological effects of lead exposure predispose children to an array of disruptive or anti-social behavior in schools. The environmental exposures that children have prior to going to school have been largely ignored in debates about quality public education.
This is part of a series introducing programs in the Robert Wood Johnson Foundation (RWJF) Human Capital Portfolio.
The RWJF Health Policy Fellows program will celebrate its 40th anniversary this year. The program supports exceptional midcareer health professionals and behavioral and social scientists to actively participate in health policy processes at the federal level and gain exclusive, hands-on policy experience. Heralded as the “nation’s most prestigious fellowship at the nexus of health science, policy, and politics,” the Health Policy Fellows program provides health professionals the opportunity to work on Capitol Hill and in the Executive Branch, gaining front-line experience in federal health policy-making and an insider’s perspective on our country’s political process.
Founded in 1973, the program is supported by the Robert Wood Johnson Foundation (RWJF) and sponsored by the Institute of Medicine within the National Academies of Science.
Health Policy Fellows have become some of the nation’s most influential leaders in the health care field. As professors, deans, and presidents at major academic institutions, directors of voluntary health organizations and health professional societies, leaders in state and federal government, and experts at think tank and advocacy organizations, the Fellows are transforming the nation’s health care policy and practice.
Margaret Wainwright Henbest, RN, MSN, CPNP, is executive director of the Idaho Alliance of Leaders in Nursing and co-lead of the Idaho Nursing Action Coalition. She served in the Idaho state Legislature from 1996-2008.
I stumbled into politics in the midst of my nursing career. After serving as a nurse practitioner (NP) for two years in California and Oregon, I moved to Idaho in 1986. But it wasn’t until after the move that I discovered that I could not practice in my new home state unless a physician recommended me to the Idaho Board of Medicine (IBM) for licensure. That was not the only barrier to practice: To get my license, I had to interview with the IBM and win its approval.
I took a faculty position instead. But I soon met NPs all across the state who were seeking a change to this restrictive licensing requirement. I somehow wound up as the spokesperson for our eventual legislative effort, which was defeated after its first Senate hearing in the early 1990s.
That experience taught me that if something needs to be done, if a law needs to be changed, no one is going to do it for you; you have to do it yourself. Since I had a part-time job, I had the time to get active in local nursing organizations, and one thing led to another. I was approached to run for office and, after deliberating with family and friends, decided to make the leap. I won by seven votes in 1996. Every vote counts!
When I arrived at the state Capitol, I found that my perspective as a nurse was extremely valuable, especially during health care debates. I recognized prior to running that nurses were educationally and intellectually prepared for public office, and that we had little if any self-serving agenda in health care reform debates. We had a legitimate altruistic interest in patient and community health. This was readily apparent to policy-makers and the public.
Facing What May Be the Affordable Care Act’s Ultimate Challenge: The Gap Separating Evidence from the Policy-Makers Who Need It
David Grande, MD, MPA, is an assistant professor of medicine at the University of Pennsylvania's Perelman School of Medicine, a senior fellow at the Leonard Davis Institute of Health Economics, associate director of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program and an alumnus of the RWJF Health & Society Scholars program. This is part of a series of essays, reprinted from the Leonard Davis Institute of Health Economics’ eMagazine, in which scholars who attended the recent AcademyHealth National Health Policy Conference reflect on the experience.
It’s a time of unprecedented upheaval in U.S. health care. Big changes are bursting through on virtually every front. Legislators and administrators in Washington and 50 state capitals struggle daily to reinvent their health care systems even as they lack an exact blueprint for the new things they’re supposed to be building.
This was nowhere more evident than at the recent AcademyHealth National Health Policy Conference, where state and federal officials and interest groups lined up to present long lists of policy questions that confront them as they grapple with implementation of the Affordable Care Act and mounting public budgetary pressures.
For instance, in the “Opportunities & Challenges for State Officials” session, New Mexico’s Medicaid Director Julie Weinberg described the unknowns surrounding how “churn” between private and public coverage will change and how new Medicaid eligibility standards will impact enrollment processes.
Voters across the country were presented Tuesday with more than 170 ballot initiatives, many on health-related issues. Among them, according to the Initiative & Referendum Institute at the University of Southern California:
- Assisted Suicide: Voters in Massachusetts narrowly defeated a “Death with Dignity” bill.
- Health Exchanges: Missouri voters passed a measure that prohibits the state from establishing a health care exchange without legislative or voter approval.
- Home Health Care: Michigan voters struck down a proposal that would have required additional training for home health care workers and created a registry of those providers.
- Individual Mandate: Floridians defeated a measure to reject the health reform law’s requirement that individuals obtain health insurance. Voters in Alabama, Montana and Wyoming passed similar measures, which are symbolic because states cannot override federal law.
- Medical Marijuana: Measures to allow for medical use of marijuana were passed in Massachusetts and upheld in Montana, which will make them the 18th and 19th states to adopt such laws. A similar measure was rejected by voters in Arkansas.
- Medicaid Trust Fund: Voters in Louisiana approved an initiative that ensures the state Medicaid trust fund will not be used to make up for budget shortfalls.
- Reproductive Health: Florida voters defeated two ballot measures on abortion and contraceptive services: one that would have restricted the use of public funds for abortions; and one that could have been interpreted to deny women contraceptive care paid for or provided by religious individuals and organizations. Montanans approved an initiative that requires abortion providers to notify parents if a minor under age 16 seeks an abortion, with notification to take place 48 hours before the procedure.
- Tobacco: North Dakota voters approved a smoking ban in public and work places. Missouri voters rejected a tobacco tax increase that would have directed some of the revenue to health education.
Samir Soneji, PhD, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program, and an assistant professor at the Dartmouth College Institute for Health Policy and Clinical Practice and the Norris Cotton Cancer Center. His study on the statistical security for Social Security was published in the August 2012 issue of Demography. Read the study.
Human Capital Blog: This study is a follow-up to your previous research. Can you briefly describe what you’ve studied up to this point?
Samir Soneji: Previously we studied the impact of historical smoking and obesity patterns on future mortality and life expectancy trends. For men there’s been a steady decline in cigarette smoking, and so also a gain in life expectancy. Women have also experienced a decline in cigarette smoking, but not as quickly. The rise in obesity has been much more recent than the historic decline in smoking, and we don’t know yet the impact of that rise. There’s a lag—the effect of today’s obesity may affect the population in 15-20 years, or later. One possibility may be that the rise in obesity may partially offset what’s been achieved by the historic reductions in smoking. Taking these factors into account, we found that both men and women will have an increase in life expectancy in the next 25 to 30 years.
HCB: Your new study looks at the solvency of Social Security. Tell us more about what you were analyzing.
Soneji: The Social Security Administration and Medicare use the same mortality and demographic forecasts to determine the number of beneficiaries, and the number of working age adults who are contributing payroll taxes to support those retirees.
This post is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Hahrie Han, PhD, is an associate professor of political science at Wellesley College. She was an RWJF Scholar in Health Policy Research from 2009-2011.
The Supreme Court’s decision to uphold the Affordable Care Act is unlikely to change anyone’s mind, but its political legacy may lie in its ability to energize the base of each party.
From a policy standpoint, there is no doubt that the Supreme Court’s decision to uphold the health reform law has vast implications for millions of Americans. The political impact of the decision, however, remains unclear. Will it help Obama in 2012 by affirming the centerpiece of his legislative record? Will it hurt him by firing up the Tea Partiers in opposition? Or, will it have little to no impact on the 2012 election?
Initial polling results from the Kaiser Family Foundation show that people’s views on the law have not changed as a result of the Supreme Court’s decision. People who opposed the law in the past are still opposed to it and people who supported it still support it.
What has changed, according to Kaiser, is the intensity of partisan support for the law. In May, only 31 percent of Democrats reported having “very favorable” views of the ACA. In the days after the Supreme Court’s ruling, that number had jumped 16 percentage points to 47 percent. (Republicans remained consistent in their dislike for the law, with 64 percent reporting “very unfavorable” views.)
This surge in Democratic enthusiasm could make an electoral difference in our polarized political climate. Elections in polarized times are often about turnout more than persuasion. An election that is about persuasion is won or lost on a candidate’s ability to persuade the undecided voter to support his or her side. An election that is about turnout hinges not on the undecided voter but instead on the candidate’s ability to turn out the partisan base. When elections are very polarized, as this year’s presidential election is, the undecided voter is an ever-narrowing slice of the population. Turning out the partisan base thus becomes that much more important.
The question is how stable rising Democratic enthusiasm for the law is. Republican opposition to the law has been very stable and research shows that people are more likely to take political action to fight against laws they do not like (threats) as opposed to supporting laws they do (opportunities). The Supreme Court’s decision seems only to have reinforced Republican opposition to Obama. Will it also solidify Democratic support for Obama?
The Obama campaign’s ability to capitalize on this surge in enthusiasm may depend on its ability to organize its supporters using the venerated organizing machine it built in 2008. As I have argued in my work, people are motivated to take political action when they are personally invested. To connect people’s personal lives to the Supreme Court decision, the Obama campaign would need to rebuild the personal relationships and neighborhood teams that were the secret to its success in 2008.
Political scientist Gerald Rosenberg has argued that the major legacy of the Supreme Court’s decision in Roe v. Wade was not to make legal abortions more widely available to women, but instead to spur a political backlash that polarized the debate over reproductive rights and is still felt today.
Time will tell if the legacy of this decision by the high Court lies in its impact on improving the health of millions of Americans, spurring political backlash, or both.
This post is part of a series in which Robert Wood Johnson Foundation (RWJF) leaders, scholars, grantees and alumni offer perspectives on the U.S. Supreme Court rulings on the Affordable Care Act. Hans Noel, PhD, is an assistant professor of government at Georgetown University and an alumnus of the RWJF Scholars in Health Policy Research program.
In the last few weeks, I've been asked by a variety of audiences some version of the question, how will the Supreme Court's ruling on the Affordable Care Act affect the 2012 presidential election?
You might think this would be a hard question to answer, since at the time I couldn't have guessed that the Court would uphold the act in a 5 to 4 decision, written by Justice Roberts. But my answer has not changed. How will the ruling affect the presidential election?
But that's not stopping anyone from speculating. Even before the ruling, soothsayers were prognosticating. I think I've heard every variation on following Mad Lib: if the Supreme Court rules up/down/a mix, then liberals/conservatives will be emboldened/demoralized/satiated, and so will be a larger/smaller force in the 2012 election.
While I am sure there are some activists for whom the Affordable Care Act is the most important thing, and there may even be some whose passion changes, the effects will be trivial. Most partisans will vote, as partisans tend to do. And they will vote for the party they are loyal to, as partisans tend to do. What will swing the election will be bigger things than this, notably the state of the economy.
It is also probably true that the ruling—however it had come out—will shape the details of the debate between Romney and Obama. But only the details. The fight over health care is far from over, and the ruling does not take the issue off the agenda. Nor does it elevate it. So what they could say did not change last week.
But the fact that I was asked this question so much is interesting, especially in light of the claim that political scientists are so lousy at forecasting, which lit up the blogosphere a while back. The takeaway from that discussion was (1) political science is not about prediction and (2) political scientists are at worst no better but also no worse than other supposed experts. And yet we still get asked. Even when the answer is often, no, that thing you are so interested in probably does not matter.
Hans Noel is an assistant professor of Government at Georgetown University. He blogs regularly at http://mischiefsoffaction.blogspot.com.
By Mark L. Hatzenbuehler, PhD, Robert Wood Johnson Foundation (RWJF) Health & Society Scholar at Columbia University. This post is part of a series on the RWJF Health & Society Scholars program, running in conjunction with the program’s tenth anniversary. The RWJF Health & Society Scholars program is designed to build the nation’s capacity for research, leadership and policy change to address the multiple determinants of population health. Hatzenbuehler is a member of the program’s 8th cohort.
The topic of same-sex marriage in the United States was once again front and center in the public discourse several weeks ago when North Carolina joined 30 other states in banning same-sex marriage. The debates surrounding same-sex marriage policies have been waged on many grounds—moral, legal, religious, and economic. Conspicuously absent from this debate has been a discussion of whether same-sex marriage bans harm the health of lesbian, gay, bisexual, and transgender (LGBT) individuals.
In a New York Times article from May 11, Gary Pearce, a former advisor to Jim Hunt, a Democratic governor in North Carolina, explained that those who voted against same-sex marriage “genuinely and honestly believe it violates their fundamental religious beliefs.” He added, “They don’t really want to hurt people.”
Wizdom Powell, PhD, a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar (2005-2007) has been chosen for the prestigious White House Fellows program. The nonpartisan program is designed to offer hands-on, up-close experience in government, with participants working at senior levels of the Executive Branch of the federal government. According to the White House, “Selected individuals typically spend a year working as a full-time, paid Fellow to senior White House Staff, Cabinet Secretaries and other top-ranking government officials. Fellows also participate in an education program consisting of roundtable discussions with renowned leaders from the private and public sectors, and trips to study U.S. policy in action both domestically and internationally.”
Powell is currently on leave from her post as an assistant professor of health behavior and health education at the University of North Carolina (UNC) at Chapel Hill Gillings School of Global Public Health, and from her position as a UNC Lineberger Comprehensive Cancer Center faculty member. Her research focuses on the impact of neighborhood, health care and socioeconomic resources on racial health disparities, and she has focused particularly on health disparities among African American men. Earlier this year, she presented findings from her recent work at a gathering of current and alumni Health & Society Scholars at the National Institutes of Health.
Powell will spend her fellowship at the U.S. Department of Defense.
She is the second Health & Society Scholar to be named to the program, following in the footsteps of Mehret Mandefro, MD, MSc, from the 2007-2009 cohort, who served in the Department of Veterans Affairs as part of the 2009-2010 class of White House Fellows. In addition, four RWJF Clinical Scholars have served as White House Fellows.