The Affordable Care Act,the Medicaid Coverage Gap,and Hispanic Consumers: A Phenomenology of Obamacare

The historic health care reform of the Patient Protection and Affordable Care Act, commonly referred to as Obamacare, enabled more than 20 million Americans to gain health insurance and access to health care. However, the original mandate requiring states to expand Medicaid was ruled as optional in 2012 by the Supreme Court. Focusing on Hispanic consumers residing in a state that opted out of the Medicaid expansion, this study reports on the consumer experience of Obamacare. Findings show that study participants are in an unfavorable situational context, better understood when the cultural context is considered, and cultural resistance recognized. The findings also show that participants are confused, discouraged, and fearful of the continued unaffordability of health insurance and the lawful need to enroll or be penalized. For these participants, affordable health insurance has not been realized and this research gives an insight on those individuals falling through the cracks.     

Empirical evidence of the effect of colorism on customer evaluations

Skin tone is a known influencer of earnings and social status. Its role in marketing has been primarily studied within the context of advertising while focusing on differences between Whites and Blacks. Three experiments were conducted to determine the effect of skin tone on customer evaluations of Black, Hispanic, and White males and females across two industries. In Studies 1 and 2, the Hispanic male was deemed less competent, professional, and worthy of repatronage compared to other service providers. In Study 3, the Hispanic male received higher evaluations when portrayed with a darker skin tone than lighter skin tone. Skin tone identity, ethnic identity, and colorism are found to influence the observed relationship. The research demonstrates that ethnicity matters, gender matters, and skin tone matters when evaluating service providers.     

How Does Race and Ethnicity Affect Persistence in Immature Ventures?

Does race/ethnicity affect persistence in an immature venture? Using data from the Panel Study of Entrepreneurial Dynamics II, we examine how race/ethnicity, access to supplier credit, and personal financial investment affect three entrepreneurial outcomes: continued engagement, new firm creation, and disengagement. We find that compared with whites, blacks were less likely to receive supplier credit and invest more of their own capital, whereas Hispanics did not significantly differ from whites. Blacks were more likely to persist and remain engaged in an immature venture if they did not achieve success after two years in operation, whereas Hispanics were more likely to disengage.     

Age and gender differences in risk-taking behaviour as an explanation for high incidence of motor vehicle crashes as a driver in young males

Risk-taking behaviour has been identified as a possible explanation for the high incidence of motor vehicle crashes involving young male drivers. This study examines the extent to which differences in risk-taking behaviour explain the differential crash rates by age and gender. A random sample of 689 adults aged 17-88 were selected from motor vehicle license holders within randomly selected geographical areas across Queensland. Participants completed a questionnaire covering their attitudes towards driving behaviour and general risk-taking behaviour, selected demographic characteristics and self-reported history of road crashes as a driver. Univariate analysis showed that males scored higher means than females in driver aggression and thrill seeking and in their general risk acceptance. Multivariate logistic regression analysis indicated that males were twice as likely (OR 2.46, CI 1.59-3.83) to have reported at least one crash as a driver compared to females and nearly three times as likely (OR 2.88, CI 1.84-4.49) to have reported two or more crashes. Drivers aged 17-29 were also twice as likely (OR 2.31, CI 1.10-4.19) to have reported at least one crash when compared to those aged over 50 years. When risk-taking behaviours were introduced into the logistic model the odds of males (OR 1.70, CI 1.29-3.30) or 17-29 year olds (OR 1.30, CI 0.93-3.91) being involved in at least one crash substantially reduced. An increased risk of a crash as a driver can, in part, be explained by the age and gender differential in risk-taking behaviour. The challenge for public health professionals is to determine suitable strategies to modify risk-taking behaviour in young or male drivers.     

Latino families report lower child injury rates than white families

Latino children have lower visit rates to emergency departments and primary care physicians than white children in the USA. Using a nationally representative household survey, this study asked whether parental report of injury was also lower for Latino children, after adjusting for demographic, socioeconomic, health status and health care access factors. Data were obtained on injuries for which medical advice or treatment was received from the National Health Interview Survey (NHIS) from 1997 to 2003. Using the multistage probability design of NHIS, annual rates and adjusted odds of childhood injury report by race and ethnicity were calculated. Respondents reported lower rates of injury for Latino children (6.0 (95% CI 5.3-6.8)/100 person-years) than white children (13.4 (12.7-14.2)/100 person-years). Lower injury rates were mainly due to lower rates of sports injuries and accidental falls. Latino children had lower odds of reported injury than white children, even after adjusting for multiple factors (odds ratio 0.7; 95% CI 0.6-0.8). Lower odds of injury report among Latino children are independent of direct measures of demographic, socioeconomic, health status and health care access factors and indirect measures of acculturation including respondent language and country of origin. Potential explanations include lower exposure to risk, greater child supervision, reporting bias, differences in cultural attitudes toward seeking of health care and reduced health care access that cannot be explored in NHIS due to the form of the current questions. Further research is needed to investigate cultural differences in risk exposure, child supervision and seeking of injury care.     

Fashion leadership,shopping enjoyment,and gender: Hispanic versus,Caucasian consumers׳ shopping preferences

The purpose of this study was to examine the role of gender and ethnicity of Hispanic and Caucasian Gen Y consumers as they impact fashion leadership and shopping enjoyment. Previous research comparing these groups on fashion leadership is limited. Results indicated that differences exist between ethnic groups, between genders, and between genders within the Hispanic group and among Hispanic fashion leaders. In general, Hispanics indicated higher levels of fashion leadership and shopping enjoyment. In addition, the research has implications regarding shopping channels and clothing idea sources among levels of Hispanic fashion leadership.     

How do racial minority consumers process a model race cue in CSR advertising? A comparison of Asian and White Americans

This study proposes that model race and race of consumers play an important role in processing corporate social responsibility (CSR) advertising. The aim of the study is to examine why a racial mismatch between target consumers and featured model race might work better among Asian Americans in the context of CSR ads, guided by motivated reasoning and self-referencing information processing mechanisms. Through an experiment, the study finds that people who perceive that money means social status tend to have more positive responses to CSR ads regardless of their race or ethnicity. In addition, Asian Americans who highly equate money with status are likely to evaluate CSR ads featuring a white model more positively than the ad with an Asian model. The study also reveals that Asian Americans with higher money as status perception tend to self-reference only when they view the CSR ad featuring a white model, but not an Asian model. However, White Americans do not vary in self-referencing based on model’s race when viewing the CSR ads.     

Behaviors of Pre-Venture Entrepreneurs and Perceptions of Their Financial Needs

Some studies have examined different barriers faced by entrepreneurs in starting their firms. For example, lack of business education, training, or managerial experience may have an impact on the firm's success. This study sought to determine whether there were any differences in the assistance and training needs between male and female pre-venture entrepreneurs as well as between Hispanic and Anglo pre-venture entrepreneurs. The training needs focused on the areas of finance and accounting. A sample of 133 clients of a regional Small Business Development Center (SBDC) was used to make this comparison. The results indicated differences between males and females in most cases and especially between Hispanic females and Hispanic males. The Hispanic males felt they needed less assistance in the areas of finance and accounting than the Hispanic females did. However, the SBDC consultants felt that both the Anglo and Hispanic females needed less assistance in those areas than the Anglo and Hispanic males needed.     

Quality choice in Medicaid markets. The case of nursing homes.

This article examines whether private patients, who typically pay a price higher than the Medicaid reimbursement rate, receive the same or higher quality services than Medicaid patients in the same health care facility. Because the mix of patients will affect the firm's cost only when Medicaid and private patients receive different levels of quality, the cost function can be used to test for the presence of quality differences. Estimates of a cost function for Texas nursing home in 1983 indicate that the mix of patients does not affect the firm's cost. Thus, private and Medicaid patients in the same nursing home receive the same level of quality.     

Understanding the Impact of Health Reform on the States: Expansion of Coverage through Medicaid and Exchanges

The Affordable Care Act (ACA) expands Medicaid coverage and creates subsidized state health insurance exchanges. The implementation of the ACA will impact the states and consequently the state residents differently. We discuss the factors contributing to the variation in uninsured rates and the Medicaid population, and we predict that these underlying economic, demographic factors and state policies will continue to affect health insurance coverage. Using data from the March 2010 Current Population Survey (CPS), we examine health care coverage at the state level prior to the ACA and forecast the percentage of state residents eligible for expanded Medicaid and the exchanges. Our results suggest the percentage of state population eligible for expanded Medicaid and subsidized exchanges will vary considerably, especially for adults. Further, we show that current state Medicaid eligibility rules, the percentage of employers offering health insurance and poverty rates will continue to shape the variation in projected health insurance coverage across the states. Finally, we discuss the potential impact of the Supreme Court decision that allowed states to opt‐out of Medicaid expansion.     

Alcohol as a risk factor for unintentional rail injury fatalities during daylight hours

Railway fatalities account for approximately 10% of transport fatalities in Cape Town. The objective of this study was to examine alcohol intoxication as a risk factor during daylight hours by conducting a case - control study to compare rail passenger and pedestrian fatalities (cases) with motor vehicle passenger and pedestrian fatalities (controls). Rail passenger and rail pedestrian fatalities were defined as cases with motor vehicle passenger and pedestrian fatalities as the respective controls. Data were collected from post-mortem reports at two mortuaries from 1994 to 1996. Blood alcohol concentration was the dependent variable. The independent variables were age, gender, date of death, day of week, time of injury and external cause of death. The late afternoon and early evening period from 1600 hours to 1900 hours had the highest frequency of fatalities for all case and control groups. Of the 56 predominately male (89%) railway passenger cases with an average age of 34.5 (SD 12.5) years, Friday (27%) was the most frequent day of death. Railway pedestrian cases (89% male, average age 36.8 years (SD 13.3)) were more likely to be killed on a Monday (11% of cases). Among the controls, motor vehicle passengers (63% male, average age 39.9 (SD 15.5)) were more likely to die on a Sunday (25%) and pedestrians (82% male, average age 41 (SD 14.7)) on a Saturday (21%). The study showed that alcohol consumption is an important risk factor for rail fatalities during daylight hours, with rail passenger fatalities being 4.71 (1.72 - 12.88) and rail pedestrian fatalities 1.62 (0.98 - 2.69) times more likely to be intoxicated than the respective controls. The results provide more evidence for public health campaigners to tackle endemic alcohol abuse and to develop diverse interventions that do not exclusively target motor vehicle drivers.     

Peer Group Influence on Urban Preadolescents' Attitudes Toward Material Possessions: Social Status Benefits of Material Possessions

This study explores peer influence on urban preadolescents' perceptions of social status benefits of material possessions. A longitudinal design is used. Natural, interaction‐based peer groups are identified through the Social Cognitive Map procedure. Findings indicate that high‐status rather than low‐status peers in a group are influential on individuals. Strong influence of high‐status peers is observed in both boys' and girls' groups. High‐status peers are particularly influential on low‐status individuals in girls' groups and on high‐status individuals in boys' groups. Additionally, high‐status peers' influence is stronger on African Americans than on Hispanic Americans and tends to be stronger on Hispanic Americans than on White Americans. These findings imply that special attention should be given to high‐status youth in groups who highly endorse social benefits of material possessions. Characteristics of the target youth (e.g., gender, ethnicity and individual status) should be considered in future efforts for reducing the pervasiveness of materialism .     

Characteristics of Consumers of Unpasteurized Milk in the United States

Despite considerable scientific evidence about the health risks of drinking unpasteurized (raw) milk, advocates continue to lobby for the reduction of state regulatory restrictions on the sale of unpasteurized milk. Multivariate analyses were performed on 1998–1999, 2002–2003 and 2006–2007 FoodNet Population Survey data to determine characteristics of unpasteurized milk consumers. Across all years of the survey, 3.4% of respondents reported consuming unpasteurized milk at some point in the previous seven days. Our findings indicate that unpasteurized milk drinkers in the states covered by the analysis are more likely to be Hispanic, less educated and of lower income than non‐drinkers and they are more likely to report drinking unpasteurized juice .     

Child–mother nutrition and health status in rural Kenya: the role of intra‐household resource allocation and education

There exists gender bias in resource ownership in many parts of Kenya with women being more disadvantaged. Resource ownership and control within the household has differential impacts on the health and overall well‐being of male and female members. This paper examines intra‐household resource ownership and how it affects nutrition and health status of household members. Data from a household survey containing detailed gender‐disaggregated information on resource ownership as well as food and anthropometry were collected from a rural Kenyan district and used in the analysis. Results showed that male members of the household had more access to education, income and land than the females. Mothers’ education, household income, frequency of illness and nutrient intake were the most important factors that contributed to the nutritional status of children. The education and household’s economic status were important determinants of child morbidity. Malnutrition and poor health of children and women is linked to the existing poverty in the study region, therefore emphasis needs to be put on eradication of discrimination against women in accessing education and accessing land, which will contribute to an increase in household incomes. Government policies need to focus on promotion of nutrition education through adult education programmes and incorporating it in the school curricula. Improvement of health‐care facilities in rural areas is also paramount to improving health and nutrition in these areas.     

Information search in health care decision-making: a study of word-of-mouth and internet information users

This paper investigates how individual consumers may differ in their information search behavior in health care decision-making. Results indicate that most consumers still use word-of-mouth as a primary information source for health care decisions. However, usage of the Internet is increasing. The results of this study indicate that consumers who are most likely to use the Internet for health care information are single, younger, and less educated, whereas consumers who are most likely to use word-of-mouth are middle-aged, married, with higher income and higher education. Surprisingly, no significant gender difference was found in information search behavior for health care decision-making. The results also suggest that consumers with the highest tendency to use word-of-mouth are also the lowest users of the Internet in health care decision-making. Implications of these findings are discussed.     

South African consumers' opinions and beliefs regarding the health benefits of soy and soy products

Studies linking diet and health and consumers' demand for health information, has led to an increasing awareness of the role of nutrition in health and disease. Interest in soy foods and an awareness of its health benefits has also increased. The objective was to assess South African (SA) consumers' opinions and beliefs regarding the health benefits of soy and soy products using different statements. This cross‐sectional study randomly selected 3001 respondents from metropolitan and rural areas in South Africa. Data of 81% of respondents (n = 2437), who had heard of soy, were used. Trained fieldworkers administered questionnaires as face‐to‐face interviews. Fifteen statements probing consumers' opinions regarding the health benefits of soy were used. The data were weighted to be representative of the total South Africa adult population (n = 18 251 000) based on gender, age, living environment and race distribution in 2000. Effect sizes were used to determine the strength of associations (practical significance), since statistical significance could be attributed to the large study population. No practically significant differences between either gender or age groups, or between rural and metropolitan respondents' opinions were found. Most respondents in the total study population (50–75%), as well as within all race groups agreed that soy has many health benefits; soy is good for you; soy lowers cholesterol; soy is good for people with a milk allergy; soy helps keep your heart healthy; soy is good for diabetes and soy is good for growing children. Medium to large practically significant differences were found between racial groups regarding some of the statements. Practically significantly more adult Black consumers believed that soy is only for people with a low‐income, and fewer that soy milk is good for people with a milk allergy than did White, Indian and Coloured consumers. Whites were relatively more positive towards the use of soy for people with a milk allergy opposed to Blacks, while Blacks were relatively more positive than Whites towards the statement that soy helps keep your bones strong. The results indicate that SA consumers held positive opinions and associate consumption of soy with several health benefits. The role of soy is seen more as being preventative than curative. It may represent a challenge to the food industry to design soy‐containing products that appeal to a broader spectrum of consumers.     

Health insurance coverage during the COVID-19 pandemic: The role of Medicaid expansion

Using data from the US Census Bureau's Household Pulse Survey, we analyzed the likelihood of loss of health insurance and enrollment into new health coverage during the early months of the COVID-19 pandemic. Loss of employment was associated with a significant increase in the likelihood of loss of health insurance and, specifically, an increase in the likelihood of employer-sponsored health insurance. However, individuals in Medicaid expansion states experienced a lower likelihood of loss of health insurance compared with individuals in nonexpansion states. At the same time, there was a statistically significant increase in Medicaid enrollment in expansion states, by 3.2 percentage points. Reemployment or acquiring employment was associated with a gain in health insurance coverage. During an economic downturn, eligibility, and coverage gaps leave many without affordable coverage options, and the pandemic will likely bring renewed attention to gaps in Medicaid coverage in nonexpansion states.     

A comparative study of codes of ethics in health care facilities and energy companies

Though written corporate codes of ethics have been touted as a panacea for the embarrassments and uncertainties of the past two decades, the absence of clear evaluation procedures severely compromises their usefulness. An ethnographic study comparing development processes and compliance outcomes in large health care facilities and energy companies shows that neither of the two industries has encountered much success with a codes of ethics program. Companies that distribute copies of their code of ethics seldom ensure the process is completed or that employees understand the purpose of the document, and staff responsible for the code give it a low priority relative to their overall responsibilities. Contrary to expectations, health care facilities are no more likely to develop or implement codes of ethics effectively than are energy companies. More extensive research is needed in order to generate the data necessary for the development of realistic standards for the evaluation of codes of ethics.Isaac D. Montoya, is President of Affiliated Systems Corporation, a management and research consulting practice specializing in the health care industry. He has worked with numerous hospitals, medical schools, and government entities in developing health care systems around the world. He has developed training programs for health care personnel, administrators, and Boards of Directors as well as taught at the University of Texas Health Science Center at Houston. He serves on a number of Boards of Directors and Federal grant review committees.Alan J. Richard, is a Research Assistant for Affiliated Systems Corporation. Recently, he helped prepare a statistical analysis of Ryan White funding priorities for Harris County HIV Services. He is currently engaged in an evaluation of cocaine abuse treatment modalities at Riverside Hospital in Houston, Texas.     

An investigation of restaurant food safety performance: A comparison between ethnic and nonethnic and chain and independent restaurants in Louisiana

This study examines health inspection data from casual dining restaurants and compares differences of food code violations between ethnic and nonethnic restaurants. A total of 7,415 violations were retrieved from the restaurant inspection reports of 769 restaurants. Ethnic restaurants have more violations than nonethnic restaurant in categories related to food time/temperature violations, cross contamination, and food condition/surface/labels. Nonethnic and chain restaurants had fewer behavioral violations than ethnic and independently operated restaurants. Ethnic restaurants were 1.74 times more likely than nonethnic restaurants to have critical violations. Meanwhile, independent restaurants were 1.64 times more likely than chain restaurants to have critical violations.