Carolyn Watts

To compare insured youth (age 15–25 years) with and without disabilities on risk of insurance loss. We conducted a cross-sectional study using data from the Survey of Income and Program Participation 2001. Descriptive statistics characterized insured youth who maintained and lost insurance for at least 3 months over a 3-year time frame. We conducted logistic regression to calculate the association between disability and insurance loss. Adjustment variables were gender, race, ethnicity, age, work or school status, poverty status, type of insurance at study onset, state generosity, and an interaction between disability and insurance type. This study includes 2,123 insured youth without disabilities, 320 insured youth with non-severe disabilities, and 295 insured youth with severe disabilities. Thirty-six percent of insured youth without disabilities lost insurance compared to 43% of insured youth with non-severe disabilities and 41% of insured youth with severe disabilities (P = .07). Youth with non-severe disabilities on public insurance have an estimated 61% lower odds of losing insurance (OR: 0.39; 95% CI: 0.16, 0.93; P = .03) compared to youth without disabilities on public insurance. Further, youth with severe disabilities on public insurance have an estimated 81% lower odds of losing insurance (OR: 0.19; 95% CI: 0.09, 0.40; P < .001) compared to youth without disabilities. When examining youth with private insurance, we find that youth with severe disabilities have 1.63 times higher odds (OR: 1.63; 95% CI: 1.03, 2.57; P = .04) of losing health insurance compared to youth without disabilities. Insurance type interacts with disability severity to affect odds of insurance loss among insured youth.

States include genetics services among their public health programs, but budget shortfalls raise the question, is genetics an essential part of public health? We used the Essential Services of Public Health consensus statement and data from state genetics plans to analyze states’ public health genetics programs. Public health genetics programs fulfill public health obligations: birth defects surveillance and prevention programs protect against environmental hazards, newborn screening programs prevent injuries, and clinical genetics programs ensure the quality and accessibility of health services. These programs fulfill obligations by providing 4 essential public health services, and they could direct future efforts toward privacy policies, research on communications, and rigorous evaluations.

Objectives: Washington was the first state to require insurance companies to cover all categories of licensed providers. The purpose of this paper was to examine the effect of Washington's law on coverage decisions of major health plans. Design: The study uses literature and document review as well as key informant interviews. Settings/location: The study focuses on legislation and other legal activity in the state of Washington. The key informant interviews are focused on the decisions of three major health plans. Results: Although the law had a major effect on complementary and alternative medicine (CAM) coverage in Washington, the impact on the use of CAM services and expenditures has been bounded by changing market forces. Conclusions: CAM providers face scientific tests of measurable efficacy and market tests of consumer value. In this economic environment, CAM stakeholders will have to work hard to maintain their political gains.