July 2016 - Behavioral Health Care Services: Fill & Download for Free

Original question:What is the root cause of mass gun violence in the US, and how should it be solved?What most people think of as mass gun violence involves one or more shooters (usually one, rarely more than that) firing indiscriminately on a crowd. There is actually no accepted definition of the term “mass shooting”. The United States' Congressional Research Service acknowledges that there is not a broadly accepted definition, and defines a "public mass shooting" as one in which four or more people selected indiscriminately, not including the perpetrator, are killed, echoing the FBI definition of the term "mass murder". [Wikipedia] The Gun Violence archive uses what they term an “FBI derived definition” of “FOUR or more shot and/or killed in a single event [incident], at the same general time and location, not including the shooter”, which can broaden the range of incidents to include things that most people would term “gang violence” rather than a “mass shooting. There is a range of definitions in between.In the majority of mass shootings, the perpetrator, acting alone, targets a venue full of people unknown to him and fires indiscriminately until he encounters resistance or responding police. In most cases, hostages are not the point; it’s as if the perpetrator is attempting the new “high score.” But even the body count is secondary to the shooting or the weapon of choice would be something other than firearms. In most cases, the perpetrator has a history of odd behavior and/or mental heath issues. MAJ Nidal Hasan, the Fort Hood shooter, while apparently radicalized over the internet, had a history of making statements that made other people uncomfortable. The recent Orlando shooter, while probably self-radicalized (but very confused about the groups he thought he was supporting), had a history of odd behavior dating back to the third grade and had been removed from his security guard post at a courthouse because of his habit of making comments that disturbed people.It seems clear to me, at least, that the common denominator among these incidents is mental health issues. I can attest, over a thirty-three year law enforcement career, that it’s virtually impossible to involuntarily commit a person for mental health treatment. Ever since O'Connor v. Donaldson, 422 U.S. 563 (1975), involuntary committal has been difficult, at best, and impossible, at worst, even for short-term observation. Even worse, access to mental health care is poor and getting poorer. What community-based programs exist are underfunded and understaffed. All this means that people who need treatment can’t get it and are left to stew in their own juices or self-medicate.Now, people who have been judicially committed to a mental health institution are prohibited from purchasing firearms, as are convicted felons, those convicted of crimes of domestic violence, among other prohibited classes [see 18 USC 922 (o)]. But, the chances of someone being judicially committed approach zero under current case law and the states are not inclined to report what committals there are to NICS.So, what’s to be done? First, don’t panic. Your chances of being the victim of a mass shooting are vanishingly small. For all the hysteria on television and the internet when a mass shooting occurs, these types of incidents are rare. The Gun Violence Archive (which includes incidents of gang violence and shootings resulting only in injuries) reports 173 shootings fitting their definition as of 05 July 2016. Using the Congressional Research Service definition there have been three. The important thing to remember is that, if you don’t frequent areas where gangs are prevalent, you have little chance of being the (inadvertent) victim of gang violence.As always seems to happen, the first response of the chattering classes is that we have to ban those evil assault rifles. (I suspect they’d call for that if the incident were a mass stabbing.) Leaving aside the fact that assault rifles are already heavily regulated, what they’re really calling for is a ban on cosmetically similar, semi-automatic rifles. How effective would that be?Firearms murders peaked in 1993 when 16,136 people were killed using a firearm. (There were 23,180 total murders in the US in 1993.) Of those, 757 were committed with any type of rifle. In 2014, the last year the FBI has published complete figures for, there were 11,961 murders, 8,124 of which were committed using firearms. Rifles were used in 248 murders. So, banning the “evil, black rifle” would affect the murder rate little, if at all, given that at least some of those would be carried out by alternate means.Before someone else brings it up, I’m familiar with the Australian semiauto/pump rifle/shotgun ban/buyback. Here’s a link to the figures as supplied by the Australian Institute of Criminology http://www.aic.gov.au/statistics/homicide.html. This chart plots the yearly figures and notes the gun buyback in 1997.As you can see, their numbers have hovered, for the most part, around 300 per year, lower than the US number, but basically flat. The figures for England and Wales are similar.Given that there are some ~310,000,000 firearms in civilian hands in the US and that some of them have been in circulation for 100 or so years without being registered with any law enforcement agency, anywhere, ever (registration is not the norm) trying to remove them would be futile, at best.So if banning the tool is not the answer (and for numerous practical as well as Constitutional reasons it’s not), what can be done? Well, one option is to do nothing new.Murders are at levels comparable to the early 1960s:In fact,While I wouldn’t presume to say that concealed carry is responsible for the fall in violent crime, I think it’s safe to say that it hasn’t caused an increase. So, it’s reasonable to presume that doing nothing will allow the trends in violent crime to continue their downward trend.But, if we must do something, then we should ensure that everyone has access to mental health services and that those in need, but unwilling, can be placed in a facility where they can be helped. This might have to be accomplished as part of a tort reform initiative so that mental health professionals can exercise their best judgment without fear of reprisal.

I do not think that conservatives are convinced that affordable health care for all is not feasible. I think they want to maintain a big business for profit at the expense of the American people’s health . There is a vast network of very rich corporations , pharmaceuticals , hospitals and doctors who profit enormously from the present system of healthcare in the US. I will use a summary of the study done at Yale University and Published in the Lancet medical journal to emphasize my point.SummaryAlthough health care expenditure per capita is higher in the USA than in any other country, more than 37 million Americans do not have health insurance, and 41 million more have inadequate access to care. Efforts are ongoing to repeal the Affordable Care Act which would exacerbate health-care inequities. By contrast, a universal system, such as that proposed in the Medicare for All Act, has the potential to transform the availability and efficiency of American health-care services. Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act, we calculate that a single-payer, universal health-care system is likely to lead to a 13% savings in national health-care expenditure, equivalent to more than US$450 billion annually (based on the value of the US$ in 2017). The entire system could be funded with less financial outlay than is incurred by employers and households paying for health-care premiums combined with existing government allocations. This shift to single-payer health care would provide the greatest relief to lower-income households. Furthermore, we estimate that ensuring health-care access for all Americans would save more than 68 000 lives and 1·73 million life-years every year compared with the status quo.• View related content for this articleThis article is available free of charge.Simply log in to access the full article, or register for free if you do not yet have a username and password.1.Collins SR Gunja MZ Doty MMHow well does health coverage protect consumers from costs? Findings from the Commonwealth Fund Biennial Health Insurance Survey, 2016.http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2017/oct/collins_underinsured_biennial_ib.pdfDate: Oct 11, 2017Date accessed: March 27, 2019View in ArticleGoogle Scholar2.United States Census BureauAnnual estimates of the resident population for selected age groups by sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2017 2017 population estimates.https://factfinder.census.gov/bkmk/table/1.0/en/PEP/2017/PEPAGESEXWe're sorry but this website doesn't work properly without JavaScript enabled. Please enable it to continue.https://factfinder.census.gov/bkmk/table/1.0/en/PEP/2017/PEPAGESEXDate: Feb 18, 2018Date accessed: July 3, 2018View in ArticleGoogle Scholar3.Auter ZU.S. uninsured rate steady at 12·2% in fourth quarter of 2017.U.S. Uninsured Rate Steady at 12.2% in Fourth Quarter of 2017The uninsured rate among U.S. adults held steady at 12.2% in the fourth quarter of 2017, but is up 1.3 points since the end of 2016.https://news.gallup.com/poll/225383/uninsured-rate-steady-fourth-quarter-2017.aspxDate: Jan 16, 2018Date accessed: July 3, 2018View in ArticleGoogle Scholar4.Fiedler M Adler LHow will the Graham-Cassidy proposal affect the number of people with health insurance coverage?.How will the Graham-Cassidy proposal affect the number of people with health insurance coverage?Matthew Fiedler and Loren Adler estimate that the Graham-Cassidy legislation would reduce the number of people with insurance coverage by around 22 million each year during the 2020 through 2026 period.https://www.brookings.edu/research/how-will-the-graham-cassidy-proposal-affect-the-number-of-people-with-health-insurance-coverage/Date: Sept 22, 2017Date accessed: March 27, 2019View in ArticleGoogle Scholar5.Organisation for Economic Co-operation DevelopmentOECD Health Statistics 2015.OECD Health StatisticsThis dataset includes comparative tables analysing various health care resources such as total health and social employment, physicians by age, gender, categories, midwives, nurses, caring personnel, personal care workers, dentists, pharmacists, physiotherapists, hospital employment, graduates, remuneration of health professionals, hospitals, health equipment, hospital beds, medical technology with their respective subsets. The statistics are expressed in different units of measure such as number of persons, salaried, self-employed, per population.https://www.oecd-ilibrary.org/social-issues-migration-health/data/oecd-health-statistics_health-data-enDate: 2015Date accessed: March 27, 2019View in ArticleGoogle Scholar6.Centers for Medicare and Medicaid ServicesNHE Fact Sheet.NHE Fact Sheet | CMSHistorical NHE, 2019: NHE grew 4.6% to $3.8 trillion in 2019, or $11,582 per person, and accounted for 17.7% of Gross Domestic Product (GDP). Medicare spending grew 6.7% to $799.4 billion in 2019, or 21 percent of total NHE. Medicaid spending grew 2.9% to $613.5 billion in 2019, or 16 percent of total NHE. Private health insurance spending grew 3.7% to $1,195.1 billion in 2019, or 31 percent of total NHE. Out of pocket spending grew 4.6% to $406.5 billion in 2019, or 11 percent of total NHE. Hospital expenditures grew 6.2% to $1,192.0 billion in 2019, faster than the 4.2% growth in 2018. Physician and clinical services expenditures grew 4.6% to $772.1 billion in 2019, a faster growth than the 4.0% in 2018. Prescription drug spending increased 5.7% to $369.7 billion in 2019, faster than the 3.8% growth in 2018. The largest shares of total health spending were sponsored by the federal government (29.0 percent) and the households (28.4 percent).   The private business share of health spending accounted for 19.1 percent of total health care spending, state and local governments accounted for 16.1 percent, and other private revenues accounted for 7.5 percent. For further detail see NHE Tables in downloads below. Projected NHE, 2019-2028: National health spending is projected to grow at an average annual rate of 5.4 percent for 2019-28 and to reach $6.2 trillion by 2028. Because national health expenditures are projected to grow 1.1 percentage points faster than gross domestic product per year on average over 2019–28, the health share of the economy is projected to rise from 17.7 percent in 2018 to 19.7 percent in 2028. Price growth for medical goods and services (as measured by the personal health care deflator) is projected to accelerate, averaging 2.4 percent per year for 2019–28, partly reflecting faster expected growth in health sector wages. Among major payers, Medicare is expected to experience the fastest spending growth (7.6 percent per year over 2019-28), largely as a result of having the highest projected enrollment growth. The insured share of the population is expected to fall from 90.6 percent in 2018 to 89.4 percent by 2028. For further detail see NHE projections 2019-2028 in downloads below. NHE by Age Group and Gender, Selected Years 2002, 2004, 2006, 2008, 2010, 2012, and 2014: Per person personal health care spending for the 65 and older population was $19,098 in 2014, over 5 times higher than spending per child ($3,749) and almost 3 times the spending per working-age person ($7,153). In 2014, children accounted for approximately 24 percent of the population and about 11 percent of all PHC spending. The working-age group comprised the majority of spending and population in 2014, almost 54 percent and over 61 percent respectively. The elderly were the smallest population group, nearly 15 percent of the population, and accounted for approximately 34 percent of all spending in 2014. 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Between 2016 and 2017, the number of people with health insurance coverage increased by 2.3 million, up to 294.6 million. • In 2017, private health insurance coverage continued to be more prevalent than government coverage, at 67.2 percent and 37.7 percent, respectively. Of the subtypes of health insurance coverage, employer-based insurance was the most common, covering 56.0 percent of the population for some or all of the calendar year, followed by Medicaid (19.3 percent), Medicare (17.2 percent), direct-purchase coverage (16.0 percent), and military coverage (4.8 percent). • Between 2016 and 2017, the rate of Medicare coverage increased by 0.6 percentage points to cover 17.2 percent of people for part or all of 2017 (up from 16.7 percent in 2016). • The military coverage rate increased by 0.2 percentage points to 4.8 percent during this time. 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Hispanics had the highest uninsured rate (16.1 percent). • Between 2016 and 2017, the percentage of people without health insurance coverage at the time of interview decreased in three states and increased in 14 states.https://www.census.gov/library/publications/2018/demo/p60-264.htmlDate: Sept 12, 2018Date accessed: January 14, 2020View in ArticleGoogle Scholar56.Duron VP Monaghan SF Connolly MD et al.Undiagnosed medical comorbidities in the uninsured: a significant predictor of mortality following trauma.J Trauma Acute Care Surg. 2012; 73: 1093-1098View in ArticleScopus (31)PubMedCrossrefGoogle Scholar57.Lopez-Gonzalez L Pickens GT Washington R Weiss AJCharacteristics of medicaid and uninsured hospitalizations, 2012.Characteristics of Medicaid and Uninsured Hospitalizations, 2012 #182Location of patients' residence Place of residence is based on the urban-rural classification scheme for U.S. counties developed by the National Center for Health Statistics (NCHS). For this Statistical Brief, we collapsed the NCHS categories into either urban or rural according to the following: Urban: Large Central Metropolitan: includes metropolitan areas with 1 million or more residents Large Fringe Metropolitan: includes counties of metropolitan areas with 1 million or more residents Medium and Small Metropolitan: includes areas with 50,000 to 999,999 residents. Rural: Micropolitan and Noncore: includes nonmetropolitan counties (i.e., counties with no town greater than 50,000 residents). Median community-level income Median community-level income is the median household income of the patient's ZIP Code of residence. The cut-offs for the quartile designation are determined using ZIP Code demographic data obtained from the Nielsen Company. The income quartile is missing for patients who are homeless or foreign. Payer Payer is the expected primary payer for the hospital stay. To make coding uniform across all HCUP data sources, payer combines detailed categories into general groups: Medicare: includes patients covered by fee-for-service and managed care Medicare Medicaid: includes patients covered by fee-for-service and managed care Medicaid Private Insurance: includes Blue Cross, commercial carriers, and private health maintenance organizations (HMOs) and preferred provider organizations (PPOs) Uninsured: includes an insurance status of self-pay and no charge Other: includes Worker's Compensation, TRICARE/CHAMPUS, CHAMPVA, Title V, and other government programs Hospital stays billed to the State Children's Health Insurance Program (SCHIP) may be classified as Medicaid, Private Insurance, or Other, depending on the structure of the State program. Because most State data do not identify patients in SCHIP specifically, it is not possible to present this information separately. When more than one payer is listed for a hospital discharge, the first-listed payer is used. Patients covered by both Medicare and Medicaid with Medicare listed as the primary payer were excluded from this analysis. About HCUP The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ). HCUP databases bring together the data collection efforts of State data organizations, hospital associations, private data organizations, and the Federal government to create a national information resource of encounter-level data (HCUP Partners). HCUP includes the largest collection of longitudinal hospital care data in the United States, with all-payer, encounter-level information beginning in 1988. These databases enable research on a broad range of health policy issues, includinghttps://www.hcup-us.ahrq.gov/reports/statbriefs/sb182-Medicaid-Uninsured-Hospitalizations-2012.jspDate: Oct 1, 2014Date accessed: March 27, 2019View in ArticleGoogle Scholar58.The Kaiser Family Foundation and Health Research & Educational TrustEmployer health benefits 2017 summary of findings.http://files.kff.org/attachment/Summary-of-Findings-Employer-Health-Benefits-2017Date: Jun 15, 2017Date accessed: March 27, 2019View in ArticleGoogle Scholarhttp://59.US Census BureauAmerica's families and living arrangements: 2017, Average number of people (AVG table series). United States Census Bureau.America’s Families and Living Arrangements: 2017Table FG3. 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It considers how countries have used available health care resources to reduce the overall burden of CVD and diabetes, and it focuses on the variation in OECD health systems’ ability to convert health care inputs (such as expenditure) into health gains.https://read.oecd-ilibrary.org/social-issues-migration-health/cardiovascular-disease-and-diabetes-policies-for-better-health-and-quality-of-care_9789264233010-enDate: June 17, 2015Date accessed: July 2, 2019View in ArticleGoogle Scholar75.Thomas K Ornstein CAmid opioid crisis, insurers restrict pricey, less addictive painkillers.Amid Opioid Crisis, Insurers Restrict Pricey, Less Addictive Painkillers (Published 2017)Drug companies and doctors have been accused of fueling the opioid crisis, but some question whether insurers have played a role, too.https://www.nytimes.com/2017/09/17/health/opioid-painkillers-insurance-companies.htmlDate: Sept 17, 2017Date accessed: December 1, 2019View in ArticleGoogle Scholar76.Amos OWhy opioids are such an American problem.BBC, Oct 25, 2017Why opioids are such an American problemPeople in America take more opioids - such as morphine and codeine - than in any other country. 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Most of the original guidance remains the same, but limited changes have been made as a result of: (1) the Supreme Court's decision in US Airways, Inc. v. Barnett, 535 U.S., 122 S. Ct. 1516 (2002), and (2) the Commission's issuance of new regulations under section 501 of the Rehabilitation Act. The major changes in response to the Barnett decision are found on pages 4-5, 44-45, and 61-62. In addition, minor changes were made to certain footnotes and the Instructions for Investigators as a result of the Barnett decision and the new section 501 regulations. EFFECTIVE DATE: Upon receipt. EXPIRATION DATE: As an exception to EEOC Order 205.001, Appendix B, Attachment 4, . a(5), this Notice will remain in effect until rescinded or superseded. ORIGINATOR: ADA Division, Office of Legal Counsel. INSTRUCTIONS: File after Section 902 of Volume II of the Compliance Manual. Enforcement Guidance: Reasonable Accommodation and Undue Hardship Under the Americans with Disabilities Act Table of Contents INTRODUCTION GENERAL PRINCIPLES REQUESTING REASONABLE ACCOMMODATION REASONABLE ACCOMMODATION AND JOB APPLICANTS REASONABLE ACCOMMODATION RELATED TO THE BENEFITS AND PRIVILEGES OF EMPLOYMENT TYPES OF REASONABLE ACCOMMODATIONS RELATED TO JOB PERFORMANCE JOB RESTRUCTURING LEAVE MODIFIED OR PART-TIME SCHEDULE MODIFIED WORKPLACE POLICIES REASSIGNMENT OTHER REASONABLE ACCOMMODATION ISSUES UNDUE HARDSHIP ISSUES BURDENS OF PROOF INSTRUCTIONS FOR INVESTIGATORS APPENDIX: RESOURCES FOR LOCATING REASONABLE ACCOMMODATIONS INDEX This Enforcement Guidance clarifies the rights and responsibilities of employers and individuals with disabilities regarding reasonable accommodation and undue hardship. Title I of the ADA requires an employer to provide reasonable accommodation to qualified individuals with disabilities who are employees or applicants for employment, except when such accommodation would cause an undue hardship. This Guidance sets forth an employer's legal obligations regarding reasonable accommodation; however, employers may provide more than the law requires. This Guidance examines what "reasonable accommodation" means and who is entitled to receive it. The Guidance addresses what constitutes a request for reasonable accommodation, the form and substance of the request, and an employer's ability to ask questions and seek documentation after a request has been made. The Guidance discusses reasonable accommodations applicable to the hiring process and to the benefits and privileges of employment. The Guidance also covers different types of reasonable accommodations related to job performance, including job restructuring, leave, modified or part-time schedules, modified workplace policies, and reassighttps://www.eeoc.gov/policy/docs/accommodation.html#leaveDate: 2002Date accessed: January 6, 2020View in ArticleGoogle Scholar82.Blinder V Eberle C Patil S Gany FM Bradley CJWomen with breast cancer who work for accommodating employers more likely to retain jobs after treatment.Health Aff. 2017; 36: 274-281View in ArticleScopus (41)CrossrefGoogle Scholar83.Aizer AA Falit B Mendu ML et al.Cancer-specific outcomes among young adults without health insurance.J Clin Oncol. 2014; 32: 2025-2030View in ArticleScopus (83)PubMedCrossrefGoogle Scholar84.Substance Abuse and Mental Health Services AdministrationBehavioral health trends in the United States: results from the 2014 national survey on drug use and health.https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdfDate: Sept 10, 2015Date accessed: March 27, 2019View in ArticleGoogle Scholar85.National Institute of Mental HealthMental Illness.NIMH " Mental IllnessMental Illness Mental illnesses are common in the United States. Nearly one in five U.S. adults live with a mental illness (51.5 million in 2019). Mental illnesses include many different conditions that vary in degree of severity, ranging from mild to moderate to severe. Two broad categories can be used to describe these conditions: Any Mental Illness (AMI) and Serious Mental Illness (SMI). AMI encompasses all recognized mental illnesses. SMI is a smaller and more severe subset of AMI. Additional information on mental illnesses can be found on the NIMH Health Topics Pages . Definitions The data presented here are from the 2019 National Survey on Drug Use and Health (NSDUH) by the Substance Abuse and Mental Health Services Administration (SAMHSA). For inclusion in NSDUH prevalence estimates, mental illnesses include those that are diagnosable currently or within the past year; of sufficient duration to meet diagnostic criteria specified within the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV); and, exclude developmental and substance use disorders. Any Mental Illness Any mental illness (AMI) is defined as a mental, behavioral, or emotional disorder. AMI can vary in impact, ranging from no impairment to mild, moderate, and even severe impairment (e.g., individuals with serious mental illness as defined below). Serious Mental Illness Serious mental illness (SMI) is defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. The burden of mental illnesses is particularly concentrated among those who experience disability due to SMI. Prevalence of Any Mental Illness (AMI) Figure 1 shows the past year prevalence of AMI among U.S. adults. In 2019, there were an estimated 51.5 million adults aged 18 or older in the United States with AMI. This number represented 20.6% of all U.S. adults. The prevalence of AMI was higher among females (24.5%) than males (16.3%). Young adults aged 18-25 years had the highest prevalence of AMI (29.4%) compared to adults aged 26-49 years (25.0%) and aged 50 and older (14.1%). The prevalence of AMI was highest among the adults reporting two or more races (31.7%), followed by White adults (22.2%). The prevalence of AMI was lowest among Asian adults (14.4%). Figure 1 Past Year Prevalence of Any Mental Illness Among U.S. Adults (2019) Demographic Percent Overall 20.6 Sex Female 24.5 Male 16.3 Age 18-25 29.4 26-49 25.0 50+ 14.0 Race/Ethnicity Hispanic or Latino* 18.0 White 22.2 Black or African American 17.3 Asian 14.4 NH/OPI 16.6 AI/AN 18.7 2 or More 31.7 *Persons of Hispanic origin may be of any race; all other racial/ethnic groups are non-Hispanic. NH/OPI = Native Hawaiian / Other Pacific Islander | AI/AN = American Indian / Alaskan Native Mental Health Services — AMI Figure 2 presents data on mental health services received within the past year by U.S. adults aged 18 or olhttps://www.nimh.nih.gov/health/statistics/mental-illness.shtmlDate: Nov, 2017Date accessed: June 8, 2018View in ArticleGoogle Scholar86.Firth J Kirzinger A Brodie MKaiser Health Tracking Poll: April 2016.Kaiser Health Tracking Poll: April 2016 - Substance Abuse and Mental HealthThe April Kaiser Health Tracking Poll examines public opinion on the severity of health problems in the U.S. and takes a closer look at attitudes towards current health problems; including access t…https://www.kff.org/report-section/kaiser-health-tracking-poll-april-2016-substance-abuse-and-mental-health/Date: April 28, 2016Date accessed: March 27, 2019View in ArticleGoogle Scholar87.National Alliance on Mental Illness (NAMI)A Long Road Ahead: Achieving True Parity in Mental Health and Substance Use Care.NAMI, 2015https://www.nami.org/about-nami/publications-reports/public-policy-reports/a-long-road-ahead/2015-alongroadahead.pdfDate accessed: January 6, 2020View in ArticleGoogle ScholarUncited References64.Sommers BD Long SK Baicker KChanges in mortality after Massachusetts health care reform: a quasi-experimental study.Ann Intern Med. 2014; 160: 585-593Scopus (128)PubMedCrossrefGoogle Scholar65.Sommers BDState medicaid expansions and mortality, revisited: a cost-benefit analysis.Am J Health Econ. 2017; 3: 392-421Scopus (30)CrossrefGoogle Scholar66.Kronick RHealth insurance coverage and mortality revisited.Health Serv Res. 2009; 44: 1211-1231Scopus (38)PubMedCrossrefGoogle Scholar67.Franks PHealth insurance and mortality. 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There was actually no ‘strong support of trump’! Hillary Clinton at last count had 2.8 million more votes than trump ….. and the count continues! Because of trumps public call on Putin to aid in his nomination, Putin did so and tipped the Electoral balance enough for trump to win the Electoral nomination. Roughly 232 U.S. citizens decided that trump should become the next president of the U.S.A few facts on Obama’s presidency.1. Passed Health Care Reform: After five presidents over a century failed to create universal health insurance, signed the Affordable Care Act (2010). It will cover 32 million uninsured Americans beginning in 2014 and mandates a suite of experimental measures to cut health care cost growth, the number one cause of America’s long-term fiscal problems.2. Passed the Stimulus: Signed $787 billion American Recovery and Reinvestment Act in 2009 to spur economic growth amid greatest recession since the Great Depression. Weeks after stimulus went into effect, unemployment claims began to subside. Twelve months later, the private sector began producing more jobs than it was losing, and it has continued to do so for twenty-three straight months, creating a total of nearly 3.7 million new private-sector jobs.3. Passed Wall Street Reform: Signed the Dodd-Frank Wall Street Reform and Consumer Protection Act (2010) to re-regulate the financial sector after its practices caused the Great Recession. The new law tightens capital requirements on large banks and other financial institutions, requires derivatives to be sold on clearinghouses and exchanges, mandates that large banks provide “living wills” to avoid chaotic bankruptcies, limits their ability to trade with customers’ money for their own profit, and creates the Consumer Financial Protection Bureau (now headed by Richard Cordray) to crack down on abusive lending products and companies.4. Ended the War in Iraq: Ordered all U.S. military forces out of the country. Last troops left on December 18, 2011.5. Began Drawdown of War in Afghanistan: From a peak of 101,000 troops in June 2011, U.S. forces are now down to 91,000, with 23,000 slated to leave by the end of summer 2012. According to Secretary of Defense Leon Panetta, the combat mission there will be over by next year.6. Eliminated Osama bin laden: In 2011, ordered special forces raid of secret compound in Abbottabad, Pakistan, in which the terrorist leader was killed and a trove of al-Qaeda documents was discovered.7. Turned Around U.S. Auto Industry: In 2009, injected $62 billion in federal money (on top of $13.4 billion in loans from the Bush administration) into ailing GM and Chrysler in return for equity stakes and agreements for massive restructuring. Since bottoming out in 2009, the auto industry has added more than 100,000 jobs.8. Recapitalized Banks: In the midst of financial crisis, approved controversial Treasury Department plan to lure private capital into the country’s largest banks via “stress tests” of their balance sheets and a public-private fund to buy their “toxic” assets. Got banks back on their feet at essentially zero cost to the government.9. Repealed “Don’t Ask, Don’t Tell”: Ended 1990s-era restriction and formalized new policy allowing gays and lesbians to serve openly in the military for the first time.10. Toppled Moammar Gaddafi: In March 2011, joined a coalition of European and Arab governments in military action, including air power and naval blockade, against Gaddafi regime to defend Libyan civilians and support rebel troops. No American lives were lost.11. Told Mubarak to Go: On February 1, 2011, publicly called on Egyptian President Hosni Mubarak to accept reform or step down, thus weakening the dictator’s position and putting America on the right side of the Arab Spring.12. Reversed Bush Torture Policies: Two days after taking office, nullified Bush-era rulings that had allowed detainees in U.S. custody to undergo certain “enhanced” interrogation techniques considered inhumane under the Geneva Conventions.13. Improved America’s Image Abroad: With new policies, diplomacy, and rhetoric, reversed a sharp decline in world opinion toward the U.S. (and the corresponding loss of “soft power”) during the Bush years. From 2008 to 2011, favorable opinion toward the United States rose in ten of fifteen countries surveyed by the Pew Global Attitudes Project, with an average increase of 26 percent.14. Kicked Banks Out of Federal Student Loan Program, Expanded Pell Grant Spending: As part of the 2010 health care reform bill, signed measure ending the wasteful decades-old practice of subsidizing banks to provide college loans. Starting July 2010 all students began getting their federal student loans directly from the federal government. Treasury will save $67 billion over ten years, $36 billion of which will go to expanding Pell Grants to lower-income students.15. Created Race to the Top: With funds from stimulus, started $4.35 billion program of competitive grants to encourage and reward states for education reform.16. Boosted Fuel Efficiency Standards: Released new fuel efficiency standards in 2011 that will nearly double the fuel economy for cars and trucks by 2025.17. Coordinated International Response to Financial Crisis: To keep world economy out of recession in 2009 and 2010, helped secure from G-20 nations more than $500 billion for the IMF to provide lines of credit and other support to emerging market countries, which kept them liquid and avoided crises with their currencies.18. Passed Mini Stimuli: To help families hurt by the recession and spur the economy as stimulus spending declined, signed series of measures (July 22, 2010; December 17, 2010; December 23, 2011) to extend unemployment insurance and cut payroll taxes.19. Began Asia “Pivot”: In 2011, Executed multipronged strategy of positively engaging China while reasserting U.S. leadership in the region by increasing American military presence and crafting new commercial, diplomatic, and military alliances with neighboring countries made uncomfortable by recent Chinese behavior.20. Increased Support for Veterans: With so many soldiers coming home from Iraq and Iran with serious physical and mental health problems, yet facing long waits for services, increased 2010 Department of Veterans Affairs budget by 16 percent and 2011 budget by 10 percent. Also signed new GI bill offering $78 billion in tuition assistance over a decade, and provided multiple tax credits to encourage businesses to hire veterans.21. Tightened Sanctions on Iran: In effort to deter Iran’s nuclear program, signed Comprehensive Iran Sanctions, Accountability, and Divestment Act (2010) to punish firms and individuals who aid Iran’s petroleum sector.22. Created Conditions to Begin Closing Dirtiest Power Plants: New EPA restrictions on mercury and toxic pollution, issued in December 2011, likely to lead to the closing of between sixty-eight and 231 of the nation’s oldest and dirtiest coal-fired power plants. Estimated cost to utilities: at least $11 billion by 2016. Estimated health benefits: $59 billion to $140 billion.23. Passed Credit Card Reforms: Signed the Credit Card Accountability, Responsibility, and Disclosure Act (2009), which prohibits credit card companies from raising rates without advance notification, mandates a grace period on interest rate increases, and strictly limits overdraft and other fees.24. Eliminated Catch-22 in Pay Equality Laws: Signed Lilly Ledbetter Fair Pay Act in 2009, giving women who are paid less than men for the same work the right to sue their employers after they find out about the discrimination, even if that discrimination happened years ago.