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Recent Trends in Mental Health and Substance Use Concerns Among Adolescents

June 28, 2022

Concerns about adolescent mental health and substance use have increased recently, particularly in light of gun violence and the COVID-19 pandemic. In recent years, many adolescents have experienced worsened emotional health, increased stress, and a lack of peer connection. Other mental health and substance use concerns are on the rise – including drug overdose deaths, self-harm, and eating disorders. Simultaneously, adolescents are spending more time on screens and many report adverse experiences such as parental abuse, hunger, and job loss – all of which can be linked to poor mental health outcomes.This brief explores the state of adolescent mental health and substance use in recent years, highlighting differences observed by sex, racial and ethnic groups, and sexual orientation. Throughout this analysis, we define adolescents as individuals ages 12 to 17. Although data on adolescent mental health is limited, where possible, we draw upon data from the 2020 National Survey of Children's Health (NSCH), which asks parents or guardians questions on behalf of their children and adolescents. We also include data from the Centers for Disease Control and Prevention (CDC) and other surveys conducted during the pandemic.

KFF Health Tracking Poll: Views on and Knowledge about Abortion in Wake of Leaked Supreme Court Opinion

June 9, 2022

For decades, KFF polling has provided insights into national and state-level reproductive health care policy including multiple public opinion polls examining the experiences and attitudes of the general public as well as the group most impacted by such policies – women between the ages of 18 and 49. This latest KFF poll was fielded the week following the leak of a draft of the U.S. Supreme Court opinion on Dobbs v. Jackson Women's Health Center. If the final ruling in the case resembles the leaked draft, the Court would overturn Roe v. Wade and end the constitutional right to abortion. This analysis examines the public's attitudes and understanding of the future of reproductive health and abortion access in the U.S. and looks at the role abortion and a decision on Dobbs may play in the upcoming midterm elections this November.

Abortion at SCOTUS: Dobbs v. Jackson Women’s Health

May 4, 2022

Abortion is among the most contentious issues in the country today. On December 1st, the Supreme Court will hear the first abortion case since Justice Amy Coney Barrett was seated and cemented a solid 6-3 conservative majority on the bench. The case under consideration, Thomas E. Dobbs, State Health Officer of the Mississippi Department of Health v. Jackson Women's Health Organization, involves a Mississippi law banning all abortions over 15 weeks gestational age except in medical emergencies and in the case of severe fetal abnormality. In this case, Mississippi is asking the Court to overturn the long-standing precedent of Roe v. Wade. While the Supreme Court has considered other abortion cases involving state regulations, this is the first case that the high court has taken in which a state is directly asking the Court to overturn the constitutional right to abortion. This issue brief provides background on the legal challenges to the Mississippi law in the context of the Supreme Court abortion precedents, addresses the intersections with the litigation that has arisen from S.B. 8, the Texas 6-week abortion ban, and explains the potential outcomes and how they could impact access to abortion around the country.

The Intersection of State and Federal Policies on Access to Medication Abortion Via Telehealth

February 7, 2022

The Supreme Court's impending ruling on Dobbs v. Jackson Women's Health Organization has renewed attention to medication abortion as a way to expand access to abortion in states protective of abortion access and to preserve access to abortion in states that seek to enact restrictive laws. In recent years, telehealth has been explored and tested as a way to expand access to medication abortion, with growing importance for communities with few abortion providers. This approach has gained additional attention given the need to limit in-person contact during the COVID-19 pandemic.However, expanding access to medication abortion via telehealth has been limited by a Food and Drug Administration (FDA) restriction that had permitted only certified clinicians to dispense mifepristone at a health care setting.This brief outlines the intersection of federal policy regarding dispensing medication abortion with state laws regulating the provision of abortion services and mifepristone dispensing via telehealth and considers the implications of the recent FDA change in different states.

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.

Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare's Solvency and Affordability Challenges

August 17, 2021

The number of people enrolled in Medicare has increased steadily in recent years, and along with it, Medicare spending. In particular, enrollment in Medicare Advantage, the private plan alternative to traditional Medicare, has more than doubled over the last decade. Notably, Medicare spending is higher and growing faster per person for beneficiaries in Medicare Advantage than in traditional Medicare. As enrollment in Medicare Advantage continues to grow, these trends have important implications for total Medicare spending, and costs incurred by beneficiaries. In its 2022 budget, the Biden Administration expressed support for reforming payments to private plans as part of efforts to extend the solvency of the Medicare Hospital Insurance (HI) Trust Fund and improve affordability for beneficiaries.This analysis examines Medicare spending per person for beneficiaries in Medicare Advantage, relative to traditional Medicare. We build on prior work published by the Medicare Payment Advisory Commission (MedPAC) and the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary (OACT) to provide estimates of the amount Medicare would have spent for Medicare Advantage enrollees had they been covered under traditional Medicare in 2019 (the most recent year for which data are available). We use publicly available data from CMS that includes spending for people who were enrolled in both Part A and Part B of traditional Medicare, by category of service, as well as information on average risk scores and enrollment by county. This allows us to calculate per-person spending for beneficiaries in traditional Medicare on a basis comparable to federal payments per enrollee in Medicare Advantage. We also examine the extent to which the projected growth in Medicare Advantage spending is attributable to the growth in enrollment and the increase in spending per person. We then illustrate potential savings to the Medicare program between 2021 and 2029 under two alternative scenarios where Medicare Advantage spending per person is lower or grows slower than under current projections.

Medicare and Dental Coverage: A Closer Look

July 28, 2021

Dental benefits are not generally covered by Medicare, except under limited circumstances, and many people on Medicare do not have any dental coverage at all. Some Medicare beneficiaries have access to dental coverage through other sources, such as Medicare Advantage plans, but the scope of dental benefits, when covered, varies widely and is often quite limited, which can result in high out-of-pocket costs among those with serious dental needs or unmet need.Policymakers are now discussing options to make dental care more affordable by broadening dental coverage for people on Medicare. President Biden's FY 2022 budget request includes as part of the President's healthcare agenda "improving access to dental, hearing, and vision coverage in Medicare." Senate Democrats recently announced an agreement to include Medicare expansions, including dental, vision, and hearing, as part of the budget reconciliation package, though details of the agreement have not yet been released. In 2019, the House of Representatives passed the Elijah E. Cummings Lower Drug Costs Now Act (H.R.3) that would add a dental benefit to Medicare Part B, along with a vision and hearing benefit, in addition to provisions to reduce prescription drug costs. Earlier this year, Representative Doggett, joined by 76 members of the House of Representatives, introduced the Medicare Dental, Vision, and Hearing Benefit Act (H.R. 4311) which would cover these benefits under Medicare Part B.In light of these ongoing policy discussions, this brief provides new data on the share of Medicare beneficiaries with dental coverage, the share with a dental visit in the past 12 months, and out-of-pocket spending on dental care. It also takes a closer look at the scope of dental benefits offered to Medicare Advantage enrollees in individual plans in 2021. We focus on Medicare Advantage plans because they have become the leading source of dental coverage among Medicare beneficiaries. Our analysis draws from multiple datasets, including the Medicare Current Beneficiary Survey for information on dental visits and out-of-pocket dental costs and the Medicare Advantage Enrollment and Benefit files for data on individual Medicare Advantage plans. To present a more detailed picture of dental benefits beyond what's available in these data sets, we examine dental coverage offered by 10 geographically dispersed Medicare Advantage plans offered by different insurers with relatively high enrollment that offer dental benefits.

Donor Government Funding for HIV in Low- and Middle-Income Countries in 2020

July 15, 2021

This report, Donor Government Funding for HIV in Low- and Middle-Income Countries in 2020, tracks funding levels of the donor governments that collectively provide the bulk of international assistance for AIDS through bilateral programs and contributions to multilateral organizations. The new report, produced as a partnership between KFF and UNAIDS, provides the latest data available on donor funding disbursements based on data provided by governments. It includes their bilateral assistance to low- and middle-income countries and contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria as well as UNITAID.

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. 

Women's Sexual and Reproductive Health Services: Key Findings from the 2020 KFF Women's Health Survey

April 21, 2021

Sexual and reproductive health is an integral part of women's overall health. Access to these services is shaped by a broad range of factors including coverage and affordability, national and state policies, availability of care, health provider characteristics, as well as individual preferences and experiences. For many women, the Affordable Care Act (ACA) improved access to sexual and reproductive health care by expanding pathways to Medicaid eligibility and making private insurance more affordable. The ACA also required private health insurance plans to cover many recommended preventive services without any patient cost-sharing, such as sexually transmitted infection counseling and screening and all 18 FDA-approved contraceptive methods. While the ACA has expanded sexual and reproductive health care, state and federal policy actions in recent years have resulted in more limited access to comprehensive sexual and reproductive health care, including abortion referrals and services, particularly for women who depend on publicly supported health care providers and clinics.Access in the past year has also been undoubtedly affected by the COVID-19 pandemic, which has forced providers to find ways to make contraceptive and STI services available via telehealth or through minimal contact, like no-test medication abortions. There is increasing interest in expanding efforts to allow pharmacists to prescribe birth control, gain FDA approval for over-the-counter oral contraception without a prescription, and expanding access to contraception through smartphone apps or online platforms that no longer require a visit to a brick-and-mortar clinic or doctor's office.While the system is undergoing constant change, the perspectives and experiences of women in obtaining sexual and reproductive health care can help to shape the next generation of policies and programs. This brief provides a window into some of those voices and perspectives by presenting selected findings from the 2020 KFF Women's Health Survey, a nationally representative survey of women conducted in November/December of 2020. The survey covered a wide range of topics related to women's coverage, use, access, and experiences with the health care system. This brief presents survey findings on coverage and use of reproductive and sexual health services among different subgroups of 2,695 women ages 18 to 49.

Employer Health Benefits 2016 Annual Survey

September 14, 2016

This annual survey of employers provides a detailed look at trends in employer-sponsored health coverage including premiums, employee contributions, cost-sharing provisions, and employer opinions. The 2016 survey included almost 1,900 interviews with non-federal public and private firms.Annual premiums for employer-sponsored family health coverage reached $18,142 this year, up 3 percent from last year, with workers on average paying $5,277 towards the cost of their coverage, according to the Kaiser Family Foundation/Health Research & Education Trust 2016 Employer Health Benefits Survey. The 2016 survey includes information on the use of incentives for employer wellness programs, plan cost-sharing as well as firm offer rate. Survey results are released here in a variety of ways, including a full report with downloadable tables on a variety of topics, summary of findings, and an article published in the journal Health Affairs.