House Hearing: More Research Needed on Health Effects of Cannabis

House Hearing: More Research Needed on Health Effects of Cannabis

WASHINGTON — Healthcare providers don’t know enough about cannabis to talk with patients about the potential risks and benefits, witnesses said at a mid-January House Energy and Commerce Health Subcommittee hearing.

“We need to have much more education with respect to how the use of marijuana products can negatively impact or help someone,” said Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA). “The problem is we do not have sufficient evidence that could help us mount those programs in a way that’s actually required. At this point, I don’t feel the evidence is sufficient to say, ‘We’re going to recommend that this product should be used by this patient.'” For example, elderly patients who take marijuana-containing products may be on a lot of other medications, and little is known about potential interactions between marijuana and prescription drugs. “So I do believe in the importance of expanding our knowledge so we can develop educational training programs that are based on knowledge, not on anecdote.”

Making it Easier to Research Cannabis

Rep. John Sarbanes (D-Md.) noted that a 2015 survey of healthcare providers concluded that the providers “perceive a knowledge gap related to cannabis dosing, treatment plans, and different areas related to cannabis products, so providers themselves realize the need for research and expertise to be developed in this area.”

The hearing was held to discuss six bills on cannabis, several of which were aimed at making it easier for researchers to obtain cannabis for research purposes. Currently, the only cannabis legally available for research comes from a single farm housed at the University of Mississippi, and researchers who want to use it must get permission from three agencies: the FDA, the Drug Enforcement Administration (DEA), and the NIH. “We need to figure out a way to take advantage of different producers of cannabis plants to evaluate the diversity of products out there, as opposed to limiting us to the Mississippi farm,” said Volkow.

Rep. Kurt Schrader (D-Ore.) agreed. “The sad part is we’re not testing the right stuff,” he said. “I fail to understand why we have one bloody facility that is the sole nexus for research and analysis of CBD [cannabidiol] products. It seems to me we ought to be testing products on the marketplace.” Subcommittee chairman Anna Eshoo (D-Calif.) agreed. “I don’t understand why the three agencies before us can’t get this done,” she said, referring to NIDA, the FDA, and the DEA, which all had officials testifying at the hearing.

The Cannabis Research “Catch-22”

Several subcommittee members expressed frustration over what they called the “Catch 22” problem that cannabis researchers face. “They can’t conduct cannabis research until they can show cannabis has a medical use, but they can’t demonstrate cannabis has a medical use until they conduct research. It doesn’t make sense,” said Eshoo.

“You’ve got to help us figure out how we’re going to get out of this Catch 22,” Rep. Debbie Dingell (D-Mich.) said to the witnesses at the hearing. “This lack of knowledge poses a public health risk.”

One issue with conducting research on marijuana is its classification as a Schedule 1 drug; these are substances deemed to have no medical value and have a high potential for abuse, and their availability is highly restricted. Several bills the subcommittee is considering, including the Legitimate Use of Medicinal Marijuana Act, the Marijuana Freedom and Opportunity Act, and the Marijuana Opportunity Reinvestment and Expungement (MORE) Act, would either downgrade marijuana from a Schedule 1 drug to a Schedule 2 drug, which has fewer restrictions, or remove it from the drug schedule altogether.

Rep. Michael Burgess, MD (R-Texas), the subcommittee’s ranking member, said the latter “is going too far,” adding that “using our congressional authority to override this may be a dangerous move, especially given the lack of research.”

So far, only one marijuana-related drug has been approved by the FDA: Epidiolex, which contains cannabidiol, was approved in June 2018 for treating a rare seizure disorder in patients ages 2 and over.

Diverse Testimony from Both Sides of the Aisle

Both the witnesses and the subcommittee members seemed divided on marijuana’s potential harms and benefits for patients. Volkow mentioned research showing that cannabis exposure during pregnancy was associated with low birthweight and preterm delivery, and added that it was also linked with episodes of psychosis. She also said that there was some evidence that cannabis may be useful in treating spasticity, multiple sclerosis, and pain, “but otherwise there is little benefit for other indications for which patients are using it.”

Rep. Morgan Griffith (R-Va.) said that his support of medical marijuana began some years ago when he learned that people were smuggling marijuana into a Virginia hospital to help a terminally ill father who wanted to be feeling well enough to spend time with his 2-year-old son. Years later, when he told that story at a high school town hall, one student raised his hand and said, “They did that for my daddy too.”

“These communities were 20 years apart, 30 years apart, yet doctors were turning a blind eye to allow marijuana to be brought into the hospital because they recognized that for those patients who are dying, that was the only way they would get relief and get the nutrients they needed to spend a little more time with their children,” Griffith said.

Rep. Greg Gianforte (R-Mont.) said he was opposed to efforts to “make any Schedule 1 drug legal without adequate research.” Instead, “we should focus on combating addiction,” he said.

by Joyce Frieden, News Editor, MedPage Today

Originally published in MedPage Today

In the Midst of an OUD Crisis, Are Health Practitioners Biased Against Addicted Patients?

In the Midst of an OUD Crisis, Are Health Practitioners Biased Against Addicted Patients?

It is well-known that people with Substance Use Disorder (SUD) and Opioid Use Disorder (OUD) face a heavy stigma in society at large. For instance, in Victoria, BC, while exceptional caregivers such as Corey Ranger, the roving Narcan-toting nurse are saving addicts’ lives, hostile bystanders often offer disdainful suggestions such as “Oh, why bother? Just let them die!”

Indeed, it is not uncommon for the general public to regard SUD and OUD as examples of societal weakness and personal failure, rather than viewing the condition as a medical condition that is frequently combined with other chronic disorders. In many cases, those suffering from addiction are also subjected to negative attitudes from nurses, doctors, and other healthcare practitioners. As a nurse in one study says of SUD patients, “[they create] a cycle of problems,” where “the staff perceives them to be annoying or obnoxious…” Another nurse in the same study notes, “staff attitudes are obvious, you can’t really hide them that well.” It is acknowledged that “Stigmatizing attitudes among health professionals have been shown to be widespread, which has detrimental consequences for connecting persons with OUD to treatment.”

Nurses, Doctors and SUD; Nurses and Doctors with SUD

There is an irony when healthcare practitioners display this attitude toward patients with SUD and OUD. According to the American Journal of Psychiatry and the National Council of State Boards of Nursing [NCSBN] publication “Substance Use Disorder in Nursing,” the prevalence of substance use disorders among doctors and nurses is similar to that of the general population—and is higher than the general public in the case of prescription drugs.

However, doctors’ tendency to protect colleagues with SUD, and the policy of the NCSBN that promotes a nonjudgmental, stigma-free approach to treatment of nurses with SUD (approximately 70% of nurses who seek treatment successfully return to practice) coexists with strong evidence that a substantial number of doctors and nurses have a negative attitude toward addicted patients. The consequences are as grave as they are incongruous; as a study in Canadian Nurse.com remarked, “perceived discrimination on the part of health-care staff was a major barrier to [patients’] seeking medical help, both for their substance abuse and for treatment of general and chronic conditions.”

Doctors and OUD: A Static System

“Fresh out of medical school, you can prescribe for pain relief any of the opioid medications that can lead to addiction, but you have to get a special waiver to treat addiction, a disease process. That just doesn’t make sense…”

–Dr. Sandeep Kapoor, director of the Screening, Brief Intervention and Referral to Treatment (SBIRT) program at Northwell Health

The situation of doctors is particularly unfortunate with regard to patients with OUD. The reaction of one doctor, when asked about the sparse availability of buprenorphine treatment, was a flat comment that “Most doctors don’t want to treat OUD or SUD patients.” A Statnews editorial on this topic concludes that a pervasive problem is that a) many doctors do not see addiction “as a brain disorder requiring treatment, but as a personal failing,” and b) “some physicians believe that medication-assisted therapy is little more than switching one addiction for another.”+

Even among those doctors who are willing to treat OUD patients, the problem is compounded by the fact that even now—in the midst of an opiate crisis—treating addicted patients with medications such as buprenorphine is highly regulated, requiring strict state and federal registration. To be permitted to prescribe, regulations require that doctors take eight hours of training (for NPs and PAs the requirement is 24 hours of training), after which they are required to register for a DEA waiver.

A further deterrent to the propagation of buprenorphine treatment is the inspection of office records by DEA agents (see within link, “What to Expect When the DEA Comes to Your Office”). An independent-minded physician—who may already be unenthusiastic about treating “addicts”—is unlikely to readily tolerate this sort of heavy-handed government interference in his or her practice. As it is, at present, despite the generally acknowledged opiate crisis, fewer than 7% of US physicians currently have DEA waivers for the prescription of one of the safest and most effective methods of treatment for opiate addiction.

Ties that Bind

This means that while the opiate crisis is raging, the hands of the practitioners who ought to be on the front lines of the fight are bound—both self-bound and bound by regulations. Doctors Kevin Fiscella and Sarah Wakeman ask in another StatNews editorial, “Would deregulation work?” They go on to note that “after France instituted this approach in 1995, deaths from opioid overdoses dropped nearly 80 percent.” Until attitudes among caregivers become more advanced, and until a proper deregulation movement for the prescription of buprenorphine gains national attention, attempts to stem the crisis are little more than a grand display of running in place.

Bipartisan House Cannabis Decriminalization Bill Passes Initial Committee Vote

Bipartisan House Cannabis Decriminalization Bill Passes Initial Committee Vote

Cannabis and politics are at an intriguing crossroads as we creep ever closer to the next election year. Politicians must decide how to position themselves on the hot-button issue of cannabis legalization. Many potential legalization bills have been proposed in the House of Representatives but very few have ever made it out of committee. National legalization bills have a history of facing intense scrutiny in the houses of Congress. There are a number of reasons for this but the vast differences in political opinions of members of Congress makes compromise on any bill, let alone one about a hot button issue like cannabis legalization, very difficult.

However, on Wednesday, November 20th, a new bill that would decriminalize cannabis nationally, allow states to make their own laws on full-scale legalization, and create the potential for expunging criminal records related to cannabis arrests passed in the House Judiciary Committee.

Chances of the Bill Passing

Though it is tough to envision a cannabis bill actually seeing the light of day, there is hope for this most recent iteration. The bill already has 50 co-sponsors, bipartisan support from notable pro-cannabis legalization Republicans like Matt Gaetz of Florida, and passed the House Judiciary Committee with a vote of 24-10. It is always encouraging when Republicans and Democrats can agree on legislation, especially when it comes to a potential cannabis legalization bill. Recently, the House of Representatives passed the SAFE Banking Act with bipartisan support. The bill allows for cannabis businesses to bank safely and discreetly. Its passage shows the willingness of Congressional Republicans and Democrats to work together to pass a cannabis bill.

The House cannabis bill is undoubtedly an exciting moment for those in the legalization movement. As promising as the bill seems, it is unlikely that it will be passed without major changes. It may pass the Democrat-controlled House of Representatives, but will face an intense battle in the Republican-controlled Senate. As unlikely as the bill’s passage is, those investing in the cannabis industry seem to believe the bill has a chance to become a part of American law soon.

Impact On The Cannabis Industry

As news of the forwarding of the house cannabis bill was announced, cannabis company stocks soared. The three biggest cannabis stocks, Canopy Growth, Tilray Inc., and Aurora Cannabis all saw prices rise between 8% and 15% on Wednesday, according to Reuters. Investor excitement is palpable, but some experts warn about the long term future for the House cannabis bill. Alan Brochstein, managing partner at New Cannabis Ventures, cautioned that the bill is, “such an early step in a long process that there are no near-term implications for cannabis stocks.”

The merits of the House cannabis bill will likely debated for the next few months. Changes will be made and votes will be cast before anything is set in stone. Whether or not this iteration of a legalization bill becomes law is unknown, but the fact that some politicians continue to fight for cannabis legalization is tremendously promising.

Border Flu Shot Protest: 4 Docs arrested

Border Flu Shot Protest: 4 Docs arrested

Four physicians and two others protesting their inability to vaccinate migrant detainees at the U.S. Customs and Border Protection (CBP) headquarters here were arrested last Tuesday for failing to comply with federal orders to disperse.

They were held for about an hour, according to some of those who were arrested.

The two groups of protesters — about 60 people in total — had gathered in two driveways leading to CBP headquarters for about an hour when one of the groups received a warning from federal officials that if they stayed in the driveway, they would be arrested, said Marie DeLuca, MD, an emergency room physician from New York who was one of those arrested. Some of the members had blocked the driveway by laying down across the road while others chanted, “No more death.”

“We stayed peacefully in the driveway entrances of their building and said that if they weren’t going to let us in to vaccinate against the flu, we were going to remain. They didn’t let us. Instead they chose to arrest members in one of the two groups,” DeLuca said.

She said her hands were secured behind her back with zip ties by officials from the Department of Homeland Security (DHS) as she and the other protesters were led into a conference room and told to wait. After about an hour following the protest, they were issued tickets with a court date for “failure to comply with the lawful direction of federal police officers or other authorized individuals,” and then released, she said.

A San Diego Union-Tribune reporter posted a video of some of those doctors being arrested.

At about 2 p.m. Tuesday, DHS’s press secretary tweeted a picture of the protesters and said, “Of course Border Patrol isn’t going to let a random group of radical political activists show up and start injecting people with drugs.”

Sen. Elizabeth Warren (D-Mass.) also tweeted a link to a video of the protesters, saying that “Children are dying in CBP custody due to the flu. Refusing to administer flu vaccines is neglectful and cruel.”

Other doctors arrested, who were part of the group Doctors For Camp Closure, included Mario Mendoza, MD, a former anesthesiologist who now lives in New York City and runs the organization Lifeundocumented.org; Hannah Janeway, MD, an emergency room physician in Los Angeles who helps run the Refugee Health Alliance; and Mathieu De Schutter, a pediatric hospitalist from San Luis Obispo, California. The non-physicians arrested were Rebecca Wollner of Jewish Action San Diego and Matthew Hom, a graduate student from Cerritos, California, who works with the group Never Again Action.

On Monday, the physicians began their three-day vigil and protest of federal immunization policies at the gate of the detention center in San Ysidro at about 11:30 a.m. They stayed until about 4:30 p.m. with no response despite repeated requests. Tuesday’s action took place nearby at the Chula Vista CBP headquarters.

DeLuca said the doctors and their supporters planned to return Wednesday to try one more time to administer the 120 influenza vaccines they brought with them for the detainees. They say it’s important for public health, not just to protect these detainees, but also everyone else they come in contact with.

Members of the groups chanted slogans and carried banners and signs calling on federal officials to let them administer the vaccinations to those inside. The vaccines were purchased with financial donations.

Originally published in MedPage Today.

Climate Change Awareness: The Role of Health Providers

Climate Change Awareness: The Role of Health Providers

As trusted professionals in the eyes of the public, health providers are considered stewards of public health and safety.

A view of Hong Kong smog from Victoria Peak.
A polluted morning in Hong Kong.

Health providers are ethically bound to advance health holistically, and with climate change, this means translating information into advocacy. The effects of climate change call for the many roles that medical providers take on: first responder to disaster, risk educator of patients and public, and — in an almost exact reenactment of Florence Nightingale’s work — defender of clean water, nutritious food, and sanitation.

The scope of climate-related effects on human health is simultaneously as broad as global drought and as specific as increased incidence of skin cancers. Health providers are uniquely positioned to address the health implications of climate change, providing education within the context of direct patient care and speaking with authority on policy decisions that affect public health.

Climate Change and Human Harm

Health providers warn that climate change can cause or increase the severity of a range of dangerous respiratory ailments.

Scientists are still working to understand the full impact of climate change on human health; however, there are existing studies that show severe effects on human health as a result of environmental hazards. According to the National Institutes of Health, there are several key areas of concern regarding climate and health, and many opportunities for health providers to offer prevention and education.

THREATS TO RESPIRATORY HEALTH

Implications: Lung disease, allergies, and asthma will be worsened by longer allergy seasons and deteriorating air quality.

Health Provider Recommendations: Support staying inside on poor air quality days and remind vulnerable populations to adhere to medical treatment plans and medication.

VECTOR-BORNE DISEASES

Implications: Ticks and mosquitoes will be more active for longer and range farther.

Health Provider Recommendations: Encourage people to use bug repellent when outdoors or in any areas with insects. Monitor and record reports of disease outbreaks. Inform others about signs and symptoms of diseases and when to call a health care provider.

WEATHER-RELATED ILLNESS AND INJURY

Implications: Extreme temperature fluctuations affect outdoor laborers, children, pregnant women, and older adults and can cause pulmonary and cardiovascular problems and dehydration. In addition, increased particulate matter, ozone concentrations, and extreme weather events may trigger stress and respiratory issues that lead to heart disease.

Health Provider Recommendations: Educate about the risks of heat exposure. Ensure access to air conditioning for vulnerable or older adults and homeless populations. Also, encourage people to drink enough water throughout the day and not just when they feel thirsty.

MENTAL HEALTH AND STRESS DISORDERS

Implications: Extreme weather can be destructive to property and quality of life, often resulting in the loss of homes, belongings, and loved ones. Prolonged exposure to these stressful experiences can manifest psychologically as people try to navigate grief and loss with interrupted access to care.

Health Provider Recommendations: Encourage others to speak openly about their grief to reduce stigma. Identify gaps in mental health literacy and teach patients about signs and symptoms of mental health risks. In addition to educating, refer at-risk patients to a mental health provider as soon as possible.

Spreading the Word About Disaster Preparedness and Dangers

One result of climate change is more frequent and more powerful natural disasters, like hurricanes. Pictured are specialists testing the flooded river during Hurricane Harvey
Flooding after hurricane Harvey

In a 2018 World Health Organization report on climate change and health,  experts state that “globally, the number of reported weather-related natural disasters has more than tripled since the 1960s.” For this reason, it’s essential that health providers inform their communities about disaster preparedness and dangers. The best time to get involved is before a disaster; therefore, it’s critical for providers to leverage any one-on-one time with patients to address holistic health and emergency concerns. Special attention should be paid to those who may be vulnerable in the wake of disasters. For example, this could include people with chronic conditions, physical disabilities, or respiratory diseases; infants and children; pregnant women; and older adults.

Thin Ice: The Life-Threatening Effects of Climate Change

Air Temperature Change

  • Increase in heat exhaustion
  • Spread of disease vectors among animals, insects, and people

Air Pollution

  • Increased movement of airborne allergens and diseases
  • Higher risk of respiratory illness  
Climate change affects pets, too. Rescued dogs from Hurricane Harvey are being treated by volunteer health providers.
Volunteer care providers treat pets rescued after hurricane Harvey.

Extreme Weather

  • Chronic stress
  • Geographic displacement
  • Loss of loved ones and pets

Water Temperature Change

  • Changes to coastal ecosystem health that will affect food supply and erosion
  • Increased likelihood of extreme precipitation, drought, or flooding
  • Water contamination due to harmful chemicals and pathogens

Food Security

  • Malnutrition, especially for prenatal or early childhood development
  • Exposure to pesticides and toxic contaminants
  • Increase in harmful algal blooms

Source: Health Effects of Climate Change.  U.S. Department of Health and Human Services, 2018. Accessed April 23, 2019.

All health providers are important voices in preemptively educating patients about disaster preparedness, but nurses specifically make up a crucial part of disaster response.

More than 20,000 licensed and student nurses serve the Red Cross in a variety of roles — some as first responders and CPR educators and others as supervisors and organizational managers.

While the effect of climate-related health issues increases alongside the shortage of nurses and other medical providers, there’s great reason for all providers to advocate for change.

A Rising Tide Lifts All Boats: Advocacy for Climate-Related Health Policy

Nurses and other health providers are advocating for climate action.
Alliance of Nurses for Healthy Environments at September 2019 rally in D.C.

Climate change may be politically polarizing, but illness and injuries seen by first responders and health providers are concrete outcomes and can translate into loss of life on a global scale.

In a 2018 report on climate change and health that accounted for continued economic growth and medical progress, the World Health Organization stated that “climate change is expected to cause approximately 250,000 additional deaths per year between 2030 and 2050.” These fatalities are projected to come from the following climate-related health complications:

— 38,000 due to heat exposure in older adults

— 48,000 due to diarrhea

— 60,000 due to malaria

— 95,000 due to childhood undernutrition

Health providers can draw awareness to this dire need for attention at the policy and community levels. They can also share firsthand experience and research. This is an ethical duty that can result in widespread support of strong public health programs and climate justice.

How to Get Involved in Climate and Health Policy

In addition to in-person education with patients, health providers can do a variety of things to spread awareness about climate and health policy in their communities:

Leverage social media. Share articles with verified, evidence-based information on social channels. Use hashtags related to climate and health that make your posts easier to find. For example, #ActOnClimate, #Go100Percent, #Renewables, #SaveThePlanet, and #ClimateChange.

Continue your education. Request or attend an educational presentation from a trained professional, then collaborate with community organizations to educate people in your area. Volunteer with climate- or policy-focused organizations to gain perspective.

Participate in civic engagement. Call your representatives to let them know whether you support specific legislation. And always, vote in local and national elections.

Organizations for Further Reading or Involvement

If you are a health care provider looking to learn more about climate and health policy, you may wish to visit the websites of these organizations.

Citation for this content: [email protected], the online DNP program from the Simmons School of Nursing

Stanford Study Finds no Link Between Immigrant Health Coverage and In-Migration Rates

Stanford Study Finds no Link Between Immigrant Health Coverage and In-Migration Rates

Extending insurance coverage to immigrant children and pregnant women did not appear to influence whether they crossed state borders (known as in-migration) to acquire care, according to survey data.

Among 36,438 lawful permanent residents with children, the average in-migration rate 1 year before public health insurance was expanded to cover immigrants was 3.9% and 1 year after the implementation, the rate remained essentially unchanged at 3.7%, reported Vasil Yasenov, PhD, MA, of the Immigration Policy Lab at Stanford University in California, and colleagues.

Similarly, among 87,418 women of reproductive age, the in-migration rate 1 year before expansion was 2.7% and 1 year after it was 4.6%, the team wrote in JAMA Pediatrics.

“No Discernable Association” Between In-Migration and Insurance Expansion

“If an expansion of health insurance coverage was associated with in-migration to another state, the probability of in-migration would have increased in the treatment group compared with the control group,” the researchers wrote. “There was no discernable association between the in-migration from any state among the treatment group relative to the control group and public health insurance expansion.”

The authors compared the group of immigrants with children with a control group of lawful permanent residents without children. The proportion that migrated among immigrants without children was slightly higher before and after expansion (4.0% and 5.9%, respectively), but not significantly different from immigrants with children, Yasenov and his team reported.

Meanwhile, among a control group of post-reproductive women, the rate of in-migration was 3.5% and 3.9% in the years before and after expansion, respectively, which was also not significantly different than the group of women of reproductive age, the researchers added.

“We hope policy makers concerned with spiraling costs and people flooding in from other states will have the evidence they need to make a decision when thinking about extending public healthcare benefits for legal immigrants in the U.S.,” Yasenov told MedPage Today.

Findings Indicate Immigrants are Fleeing Violence and Corruption, Not Chasing Health Coverage

As of 2016, immigrants with children were covered by public insurance in 31 states and pregnant immigrants were covered in 32 states. Many Democratic candidates for the 2020 election support extending healthcare to undocumented immigrants, a policy that has been suggested will increase the flow of immigration within the U.S.

These null findings make sense in the context in which most U.S. immigration takes place, wrote Jonathan Miller, JD, of the Office of the Massachusetts Attorney General in Boston, and Elora Mukherjee, JD, of the Immigrants’ Rights Clinic of Columbia Law School in New York City, in an accompanying editorial.

Namely, many people coming to the U.S. are fleeing from violence or political corruption in their home countries, and “do not seek refuge in the [U.S.] because of potential access to healthcare,” Miller and Mukherjee said.

“Making it easier for immigrant communities to connect to and seek care from physicians will not radically shift migration patterns. Instead, allowing access to the basic human right of health care shows a common commitment to human decency for all who are in the [U.S.],” the editorialists stated.

Immigrants Sampled Were Below 200% of Fed Poverty Thresholds

For this study, data were collected from individuals residing in the U.S. from 1 to 6 years — but who were not born in the U.S. and were not citizens — from the American Community Survey. Notably, the sample was restricted to individuals who were below 200% of the federal poverty thresholds to identify people who would qualify for public insurance if it were extended, the authors noted. Immigrants on student visas, veterans, or those married to U.S.-born citizens were excluded because they qualify for other healthcare benefits, the team added.

The data were controlled for personal characteristics like age, race/ethnicity, and marital status, as well as things that varied by state and time such as cash assistance and economic conditions.

In total, 208,060 immigrants — mean age of 33 years, 47% of whom were female — were included. About two-thirds were Hispanic (63%), and the in-migration rate among the entire sample was 3%.

“Near-Zero” Likelihood

Overall, the likelihood that lawful permanent residents would migrate to a state where public health insurance has been expanded to cover immigrants was practically zero before and after expansion was implemented (percentage change from -1.21 to 1.78), the authors reported.

The likelihood was also close to zero among lawful permanent-resident women of reproductive age when compared with a control group of lawful permanent-resident post-reproductive women (percentage change from -1.20 to 1.38).

In a model specifically looking at whether public health insurance expansion would bring in migrants from a neighboring state, no association was found between policy implementation and the rates of in-migration of immigrants with children (–0.03 percentage points, 95% CI –0.5 to 0.44) or pregnant women (–0.02 percentage points, 95% CI –0.48 to 0.09), the researchers reported.

The primary limitation of the study, they said, was the inability to account for time-varying factors that could undermine the analysis, and it was also not possible to isolate states among the border and determine whether there was an association between in-migration and health policy specifically in these states. Lastly, the investigators said, the association was not analyzed among county-level or city-level programs.

The study was funded by the Stanford Child Health Research Institute.

The authors and editorialists reported having no conflicts of interest.

Primary Source

JAMA Pediatrics

Source Reference: Yasenov V, et al “Public health insurance expansion for immigrant children and interstate migration of low-income immigrants” JAMA Pediatrics 2019; DOI: 10.1001/jamapediatrics.2019.4241.

  • Secondary Source

JAMA Pediatrics

Source Reference: Miller J, Mukherjee E “Health care for all must include everyone” JAMA Pediatrics 2019; DOI: 10.1001/jamapediatrics.2019.4247.

by Elizabeth Hlavinka, Staff Writer, MedPage Today

This story was originally published by MedPage Today.

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