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Climate-Related Health Risks Among Workers: Who is at Increased Risk?

June 26, 2023

Over the past few years, a plethora of research has linked climate change to adverse health outcomes around the world. People may be exposed to climate-related health risks through a variety of pathways, including through their work. The Centers for Disease Control and Prevention (CDC) and Environmental Protection Agency (EPA) note that disproportionate exposure to adverse climate change-related conditions can exacerbate existing health and safety issues among certain workers and could potentially cause new and unanticipated harms. Risk of climate-related health impacts varies across occupations, with many of the same underlying drivers of disparities in climate vulnerability overall reflected in the occupational sector.This analysis identifies occupations that are at increased risk of climate-related health impacts, examines the characteristics of workers in these jobs, and discusses the implications of these findings.

Employment Among Immigrants and Implications for Health and Health Care

June 12, 2023

Immigrants are an integral part of our nation, including our nation's workforce. Immigrants support the U.S. economy and its workforce by filling unmet labor market needs, especially in industries such as construction and agriculture that are at increased risk of adverse health outcomes and injuries, including climate-related health hazards. Through entrepreneurship and establishment of businesses, immigrants also create jobs that generate employment for other U.S. residents, including U.S.-born citizens. However, their employment patterns contribute to them having higher uninsured rates and facing increased health risks relative to their U.S.-born peers. While their employment patterns, in part, reflect lower educational attainment levels and skills among immigrant workers versus U.S.-born workers, research and data suggest that some immigrant workers may be overqualified for their jobs—that is having education or skills beyond what is necessary for their job. Addressing this occupational mismatch could help reduce disparities in health and health care faced by immigrant families and positively benefit the U.S. economy.This brief examines socioeconomic characteristics and employment patterns among immigrant workers and examines how they compare to U.S.-born workers, including differences among college-educated workers. It discusses the implications of these patterns for their health and well-being as well as the nation's economy.

How Recognizing Health Disparities for Black People is Important for Change

February 13, 2023

February 1st marked the beginning of Black History Month. The 2023 theme for Black History Month is Black Resistance, an exploration of how African Americans have nurtured and protected Black lives, and fought against historic and current racial inequality. In fact, while Black people have made great contributions and achievements in the United States, they continue to face many health and health care disparities that adversely impact their overall health and well-being. These disparities have been exacerbated by the uneven impacts of the COVID-pandemic, ongoing racism and discrimination, and police violence against and killings of Black people. Moreover, the long history of inequitable health outcomes among Black people reflects the abuses faced during slavery, segregation, mass incarceration and their persistent legacies.

Racial Disparities in COVID-19 Impacts and Vaccinations for Children

September 16, 2021

Although children have not borne the most severe brunt of COVID-19 relative to adults, some do become hospitalized, suffer long-term consequences, and even death from the disease. There is growing attention to how children are being affected by the pandemic, particularly as in-person school returns, and those younger than age 12 are not yet eligible for vaccination. While data remain limited, available research and data to date suggest that children of color have been disproportionately affected by COVID-19 and may be less likely to have been vaccinated, mirroring racial disparities observed among the broader population. These disparities may leave children of color at increased risk, particularly as they return to in-person school. Together the findings point to the importance of increasing data available to understand racial disparities in COVID-19 impacts and vaccinations among children and efforts to mitigate disproportionate impacts of COVID-19 for children of color going forward.

Asian Immigrant Experiences with Racism, Immigration-Related Fears, and the COVID-19 Pandemic

June 18, 2021

Asian immigrants have faced multiple challenges in the past year. There has been a rise in anti-Asian hate crimes, driven, in part, by inflammatory rhetoric related to the coronavirus pandemic, which has spurred the federal government to make a recent statement condemning and denouncing acts of racism, xenophobia, and intolerance against Asian American communities and to enact the COVID-19 Hate Crimes Act. At the same time, immigrants living in the U.S. have experienced a range of increased health and financial risks associated with COVID-19. These risks and barriers may have been compounded by immigration policy changes made by the Trump administration that increased fears among immigrant families and made some more reluctant to access programs and services, including health coverage and health care. Although the Biden administration has since reversed many of these policies, they may continue to have lingering effects among families.Limited data are available to understand how immigrants have been affected by the pandemic, and there are particularly little data available to understand the experiences of Asian immigrants even though they are one of the fastest growing immigrant groups in the U.S. and are projected to become the nation's largest immigrant group over the next 35 years. To help fill these gaps in information, this analysis provides insight into recent experiences with racism and discrimination, immigration-related fears, and impacts of the COVID-19 pandemic among Asian immigrant patients at four community health centers.The findings are based on a KFF survey with a convenience sample of 1,086 Asian American patients at four community health centers. Respondents were largely low-income and 80% were born outside the United States. The survey was conducted between February 15 and April 12, 2021. 

Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost Sharing Policies as of January 2018: Findings from a 50-State Survey

March 20, 2018

This 16th annual 50-state survey provides data on Medicaid and the Children's Health Insurance Program (CHIP) eligibility, enrollment, renewal and cost sharing policies as of January 2018. It takes stock of how the programs have evolved as the fifth year of implementation of the Affordable Care Act (ACA) begins, discusses policy changes made during 2017, and looks ahead to issues that may affect state policies moving forward. It is based on a survey of state Medicaid and CHIP officials conducted by the Kaiser Family Foundation and the Georgetown University Center for Children and Families.Key FindingsMedicaid and CHIP provide a robust base of coverage for low-income children. All but two states cover children with incomes up to at least 200% of the federal poverty level (FPL, $41,560 per year for a family of three in 2018), including 19 states that cover children with incomes at or above 300% FPL. The ten-year extension of federal funding for CHIP approved by Congress provides states stable funding to maintain children's coverage and continues protections for children's coverage moving forward.There have been major gains in Medicaid eligibility for parents and other adults under the Affordable Care Act (ACA) Medicaid expansion, but eligibility remains limited in the 19 states that have not implemented the expansion. Among non-expansion states, the median eligibility level for parents is 43% FPL ($8,935 for a family of three in 2018) and other adults generally are ineligible. Alabama and Texas have the lowest parent eligibility limits at 18% FPL or $3,740 per year for a family of three. Additional states may expand Medicaid for adults in the coming year, which would reduce the number of poor uninsured adults who fall into the coverage gap. States moving forward with expansion may seek waivers to add requirements or restrictions for adults as a condition of expanding.Through significant investments of time and resources, most states have transformed their Medicaid and CHIP enrollment and renewal processes to provide a modernized, streamlined experience as outlined in the ACA. With these processes, a growing number of states are processing real-time eligibility determinations and automated renewals through electronic data matches with trusted data sources. Looking ahead, waivers and other proposed changes for adults, including premiums and cost sharing, work requirements, and lockout periods, require complex documentation and costly administrative processes that run counter to the simplified enrollment and renewal processes states have implemented under the ACA.

Living in an Immigrant Family in America: How Fear and Toxic Stress are Affecting Daily Life, Well-Being, & Health

December 13, 2017

Immigration policy has been and continues to be a controversial topic in the U.S. Over the course of the election and since taking office, President Trump has intensified national debate about immigration as he has implemented policies to enhance immigration enforcement and restrict the entry of immigrants from selected countries the Administration believes may pose a threat to the country. The climate surrounding these policies and this debate potentially affect 23 million noncitizens in the U.S., including both lawfully present and undocumented immigrants, many of whom came to the U.S. seeking safety and improved opportunities for their families.They also have implications for the over 12 million children who live with a noncitizen parent who are predominantly U.S-born citizen children. We conducted focus groups with 100 parents from 15 countries and 13 interviews with pediatricians to gain insight into how the current environment is affecting the daily lives, well-being, and health of immigrant families, including their children.

Key Issues in Children's Health Coverage

February 15, 2017

This brief reviews children's coverage today and examines what is at stake for children's coverage in upcoming debates around funding for the Children's Health Insurance Program (CHIP), repeal and replacement of the Affordable Care Act (ACA), and restructuring of Medicaid financing to a block grant or per capita cap. Following decades of steady progress, largely driven by expansions in Medicaid and CHIP, the children's uninsured rate has reached an all-time low of 5%. Medicaid and CHIP are key sources of coverage for our nation's children, covering nearly four in ten (39%) children overall and over four in ten (44%) children with special health care needs. Medicaid serves as the base of coverage for the nation's low-income children and covered 36.8 million children in fiscal year 2015. CHIP, which had 8.4 million children enrolled in fiscal year 2015, complements Medicaid by covering uninsured children above Medicaid eligibility limits.There is much at stake for children's coverage in upcoming debates. New legislative authority is needed to continue CHIP funding beyond September 30, 2017. In addition, the Administration and Republican leaders in Congress have called for repeal and replacement of the ACA and restructuring of Medicaid financing to a block grant or per capita cap. Loss of CHIP funding, repeal of the ACA, and capping Medicaid financing all have the potential to reverse the coverage gains achieved to date and increase the number of uninsured children. In addition, rollbacks in coverage for parents could contribute to coverage losses among children and increased financial instability among families.Reductions in children's coverage would lead to reduced access to care and other long-term effects for children and increase financial pressure on states and providers. Reductions in children's coverage would result in fewer children accessing neededcare, including preventive services such as well child visits and immunizations. Research also suggests that reductions in children's coverage could have broader long-term negative effects on their health, education, and financial success as adults. In addition, loss of CHIP funding and reductions in federal Medicaid financing would create funding gaps that would increase financial pressure on states and providers.

Health and Health Coverage in the South: A Data Update

February 1, 2016

With its recent adoption of the Affordable Care Act (ACA) Medicaid expansion to adults, Louisiana became the 32nd state to move forward with the expansion, and the 7th of the 17 states that make up the American South to expand. However, within the South, which has high rates of chronic disease and poor health outcomes, the majority of states still have not adopted the Medicaid expansion. The ACA and its Medicaid expansion offer important opportunities to expand access to health coverage, particularly in the South, where Medicaid and CHIP eligibility levels across groups have lagged behind other regions for many years.1 While many factors contribute to chronic disease and poor health outcomes, expanding health coverage can provide an important step in improving health by supporting individuals' ability to access preventive and primary care and ongoing treatment of health conditions. This brief provides key data on the South and the current status of health and health coverage in the South to provide greater insight into the health needs in the region and the potential coverage gains that may be achieved through the ACA. State specific data for the indicators presented in the brief are available in Tables 1 through 6.

Medicaid and CHIP Eligibility, Enrollment, Renewal, and Cost-Sharing Policies as of January 2016: Findings from a 50-State Survey

January 19, 2016

January 2016 marks the end of the second full year of implementation of the Affordable Care Act's (ACA) key coverage provisions. This 14th annual 50-state survey of Medicaid and CHIP eligibility, enrollment, renewal, and cost-sharing policies provides a point-in-time snapshot of policies as of January 2016 and identifies changes in policies that occurred during 2015. Coverage is driven by two key elements -- eligibility levels determine who may qualify for coverage, and enrollment and renewal processes influence the extent to which eligible individuals are enrolled and remain enrolled over time. This report provides a detailed overview of current state policies in these areas, which have undergone significant change as a result of the ACA.Together, the findings show that, during 2015, states continued to implement the major technological upgrades and streamlined enrollment and renewal processes triggered by the ACA. These changes are helping to connect eligible individuals to Medicaid coverage more quickly and easily and to keep eligible people enrolled as well as contributing to increased administrative efficiencies. However, implementation varies across states, and lingering challenges remain. The findings illustrate that the program continues to be a central source of coverage for low-income children and pregnant women nationwide and show the growth in Medicaid's role for low-income adults through the ACA Medicaid expansion.

Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity

November 5, 2015

This issue brief discusses the effort to improve health in the United States, which has traditionally looked to the health care system as the key driver of health and health outcomes. The Affordable Care Act (ACA) increased opportunities to improve health by expanding access to health coverage and supporting reforms to the health care delivery system. While increasing access to health care and transforming the health care delivery system are important, research demonstrates that improving population health and achieving health equity also will require broader approaches that address social, economic, and environmental factors that influence health.

Performing Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2011-2012

January 18, 2012

Analyzes findings on state trends in maintaining or expanding eligibility for public coverage and improving enrollment and renewal procedures. Highlights some states' expansion of Medicaid eligibility and the use of technology to achieve efficiencies.