Heinz College News http://www.heinz.cmu.edu News Stories from H. John Heinz III College Competition and Choice Improve Care and Save Lives, Study Sayshttp://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3897Image associated with news releaseProfessor Martin Gaynor co-authors a study on hospital competition and patient choice and the effects on health care outcomes. "This research shows that once restrictions on patients’ choice in England’s National Health Service were lifted, those requiring heart bypass surgery became more responsive to the quality of care available at different hospitals. This gave hospitals a greater incentive to improve quality and resulted in lower mortality rates. In short–the introduction of choice and competition saved lives."

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http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3897Mon, 11 Nov 2016 16:00:00 GMThttp://www.heinz.cmu.edu/news/news-detail/image.aspx?width=250&mar=1&id=10450Competition and Choice Improve Care and Save Lives, Study Says

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Are Fitness Trackers Effective? A Heinz Expert Gives His Opinionhttp://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3896Image associated with news releaseProfessor Vibhanshu Abhishek discusses consumer adoption of fitness trackers in a column for The Hill. "As improvements in measurements have led to scientific breakthroughs across fields, fitness trackers have the potential to create a significant impact on understanding and affecting people’s health related behavior. However, the scientific research on the effectiveness of fitness trackers remains divided."

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http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3896Mon, 11 Nov 2016 16:00:00 GMThttp://www.heinz.cmu.edu/news/news-detail/image.aspx?width=250&mar=1&id=10445Are Fitness Trackers Effective? A Heinz Expert Gives His Opinion

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It’s Kind of a Big Deal!http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3901Image associated with news releaseDavid Ruppersberger is President of the Pittsburgh Regional Alliance http://www.alleghenyconference.org/PittsburghRegionalAlliance/), an affiliate of the Allegheny Conference for Community Development, and a long time Executive Fellow of the Center for Economic Development at Carnegie Mellon. David came out to talk to Heinz students about the PRA's mission to market our region and the challenge of attracting significant employers to it.  He will also talk about the mega-deal that brought the Royal Dutch Shell Plant to Butler County and its potential.

]]><p> David Ruppersberger is President of the Pittsburgh Regional Alliance <a href="http://www.alleghenyconference.org/PittsburghRegionalAlliance/">http://www.alleghenyconference.org/PittsburghRegionalAlliance/</a>), an affiliate of the Allegheny Conference for Community Development, and a long time Executive Fellow of the Center for Economic Development at Carnegie Mellon.&nbsp; David came out to talk to Heinz students about the PRA&#39;s mission to market our region and the challenge of attracting significant employers to it.&nbsp; He will also talk about the mega-deal that brought the Royal Dutch Shell Plant to Butler County and its potential.</p>
http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3901Mon, 11 Nov 2016 09:56:00 GMThttp://www.heinz.cmu.edu/news/news-detail/image.aspx?width=250&mar=1&id=0It’s Kind of a Big Deal!

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Doctors, Decisions, and Data: Analytics for Better Health Carehttp://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3894Image associated with news releaseA Heinz faculty member and alumna recently teamed up to improve decision-making and care delivery for patients with chronic conditions. Rema Padman and Yiye Zhang’s published their study in the American Journal of Managed Care. Their collaboration—which began while Zhang was a Ph.D. student of Padman’s—sought to utilize statistics and machine learning algorithms to better predict future clinical pathways and best practice treatments, as well as embed cost information in clinical pathways.

]]><p> <em>A <a href="http://www.heinz.cmu.edu/index.aspx" target="_blank">Heinz College</a> faculty member and alumna recently teamed up to improve decision-making and care delivery for patients with chronic conditions. Dr. Rema Padman is a Professor of Management Science and Healthcare Informatics at Carnegie Mellon University&rsquo;s Heinz College. Dr. Yiye Zhang (Ph.D. &rsquo;16) is an Assistant Professor of Healthcare Policy and Research at Cornell University&rsquo;s Weill Cornell Medical College.</em></p> <p> The power of data analytics already guides your purchasing behavior on Amazon and helps you find the next show you&rsquo;ll binge-watch on Netflix. But what if those same algorithms could help you and your doctor choose the best strategy for treating your health problems?</p> <p> Such is the motivation for Rema Padman and Yiye Zhang&rsquo;s new study published in the <em><a href="http://www.ajmc.com/" target="_blank">American Journal of Managed Care</a></em>. Their collaboration&mdash;which began while Zhang was a Ph.D. student of Padman&rsquo;s&mdash;sought to utilize statistics and machine learning algorithms to better predict future clinical pathways and best practice treatments.</p> <p> Padman explains that&mdash;in addition to their own knowledge and experience&mdash;physicians rely on the results of clinical trials to guide their choices about how to treat a particular patient. These large-scale randomized studies have provided information on the treatments for many major diseases, and are the gold standard for guiding health care decision-making.</p> <p> But according to Padman and Zhang, these trials cost a lot of time and money, and they simply can&rsquo;t be used to study every single condition or complication a physician might encounter. Meanwhile, the results of the studies that have been conducted can only tell us about the population in which that experiment was performed, and won&rsquo;t apply to every patient in every setting.</p> <p> Yet, even without good information to guide clinicians in every setting, people are still being treated for a variety of complex chronic conditions on a day-to-day basis. And as those patients receive care, health care facilities are collecting incredible amounts of data about the standard treatments doctors are providing.</p> <p> &ldquo;Every visit, every prescription, every lab result&mdash;it&rsquo;s all being recorded,&rdquo; said Padman. &ldquo;We have data on thousands of patients being treated in multiple settings. Why can&rsquo;t we learn current practices from this vast repository of data, associate them with outcomes to learn what works and what doesn&rsquo;t, and make recommendations on best pathways for individual patients?&rdquo;</p> <p> An advantage of this data-driven approach is that it may help physicians assess better routes of care for individuals suffering from multiple chronic conditions&mdash;something even the best clinical trials aren&rsquo;t able to do.</p> <p> Padman and Zhang&rsquo;s research was able to expose variations in costs among patients who are clinically similar, as well as variations in clinical complexity among patient with similar costs. They were able to group patients based on how their condition was progressing and identify trends in order to predict how a group of patients&rsquo; conditions will evolve and what their next clinical visit might entail, including treatment options.</p> <p> &ldquo;The reality is that few people have just one chronic condition; it&rsquo;s typically a multiplicity of these,&rdquo; said Padman. &ldquo;Understanding the evolution of their condition, their compliance with medication and treatment regimens, and how physicians might best treat them requires a combination of analytical approaches&mdash;not just machine learning, but operations research, statistics, and behavioral economics as well.&rdquo;</p> <p> <img alt="Kidney cross section" src="image.aspx?id=10471&amp;width=600&amp;height=400" style="float: left; width: 30%; height: 30%; margin: 10px;" />Padman and Zhang examined decision-making challenges that arise in managing Chronic Kidney Disease, a condition that currently affects more than 26 million Americans and carries a cost in excess of $23,000 per patient per year.</p> <p> Partnering with <a href="http://tmakidneydoctors.com/" target="_blank">Teredesai, McCann &amp; Associates (TMA)</a>, a local nephrology practice, Padman and Zhang were able to examine the care different patients received over the past two decades, grouping them into different populations based on paths of treatment. (TMA has been recording its patients&rsquo; information in an electronic database since 1994.)</p> <p> &ldquo;Using data analytics to help manage patients with multiple chronic conditions&mdash;like ours&mdash;empowers doctors to spot trends, both good and bad, in a patient&rsquo;s plan of care,&rdquo; said TMA Chief Information Officer Linda Smith. &ldquo;It enables the delivery of a quantitative form of medicine that can detail an exact measurement of the health risks of a condition and the benefits of compliance to the plan of treatment.&rdquo;</p> <p> Padman says that this line of research would be impossible without the cooperation of health care organizations that are willing to share their specialized knowledge, time, data, and human resources to help improve the quality of health care delivery.</p> <p> Zhang praised the TMA team, remarking that they were extremely responsive to queries in addition to giving access to data.</p> <p> &ldquo;The staff and physicians have spent many hours to help us,&rdquo; said Zhang. &ldquo;Without that kind of supportive collaboration, it&rsquo;s very difficult to understand the complex nuances of the health care delivery context well enough to achieve any progress.&rdquo;</p> <p> Padman also credits the collaborative environment at Heinz College for making this kind of research possible. The school&rsquo;s Center for Health Analytics and the Health IT thrust of <a href="http://ilab.heinz.cmu.edu/" target="_blank">iLab</a> represent some of the many ways that Heinz College researchers, students, and faculty members innovate and drive improvement in the health care sector.</p> <p> &ldquo;This type of research and analysis will have a tremendous impact on improving the care process while managing and reducing the costs and improving the quality of care,&rdquo; said Smith.</p> <p> But Padman is quick to point out that this work is just the beginning. The problem-modeling and solution techniques that she and Zhang have proposed will require significant evaluation in the actual decision-making setting before they can be translated into practice. The ultimate goal is to use this information to create computer-based visualizations and automated tools that will help doctors and patients quickly and effectively decide on appropriate treatments in a shared decision-making, patient-centered, care delivery environment.</p> <p> Not only that, but by embedding cost information into clinical pathways and exposing inconsistencies in chronic care delivery, Padman is optimistic that this research can pave the way for improved treatment options that will combine with innovative payment models.</p> <p> &ldquo;You want to be able to manage the patient holistically,&rdquo; said Padman. She gives the example that if a patient has kidney disease and in managing that disease their corresponding diabetes, high blood pressure, and other co-morbidities are also managed together, there is a potential upside for both costs and health outcomes.</p> <p> Zhang, who was recently given the prestigious title of Walsh McDermott Scholar in Public Health by Weill Cornell Medicine, added, &ldquo;I am excited that this work has received considerable attention from both academic and industry collaborators, indicating its potential value. I look forward to implementing and evaluating this research in real patient care settings.&rdquo;</p> <p> Clinicians are already interacting via electronic health records, whether it is entering data for a current visit or to look at a patient&rsquo;s history. Because of this, Padman suggests this innovative analytics approach would fit easily into current practice.</p> <p> &ldquo;If pathway recommendations or associated risk assessments are automatically displayed as a result of the data that&rsquo;s being collected and entered into the electronic health records, that would be the seamless way to enable the delivery of this complex information for timely consumption,&rdquo; said Padman. &ldquo;The possibilities for application are endless.&rdquo;</p> <p> &nbsp;</p> <p> Read Padman and Zhang&rsquo;s publications on this topic &gt;&gt;</p> <p> Y. Zhang, R. Padman, &ldquo;Data-Driven Clinical and Cost Pathways for Chronic Care Delivery&rdquo;, forthcoming in <em>American Journal of Managed Care</em>, special issue on Health Information Technology, 2016.</p> <p> Y. Zhang, R. Padman,<strong> </strong><a href="http://www.ajmc.com/journals/issue/2015/2015-vol21-n12/innovations-in-chronic-care-delivery-using-data-driven-clinical-pathways" target="_blank">Innovations in Chronic Care Delivery Using Data-Driven Clinical Pathways</a>, <em>American Journal of Managed Care</em>, special issue on Health Information Technology, 2015;21(12):e661-e668.</p> <p> Y. Zhang, R. Padman, N. Patel, <a href="http://www.sciencedirect.com/science/article/pii/S1532046415002026" target="_blank">Paving the COWPath: Learning and Visualizing Clinical Pathways from Electronic Health Record Data</a>, <em>Journal of Biomedical Informatics, </em>58 (2015) 186&ndash;197.</p> <p> &nbsp;</p>
http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3894Mon, 11 Nov 2016 16:00:00 GMThttp://www.heinz.cmu.edu/news/news-detail/image.aspx?width=250&mar=1&id=10447Doctors, Decisions, and Data: Analytics for Better Health Care

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The Not-So-Affordable Care Act: Heinz Professor Explains Rising Premiumshttp://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3895Image associated with news releaseProfessor Martin Gaynor discusses the possible factors contributing this year's increases in premiums on the ACA exchanges, as well as the future of President Obama's signature legislation following the election victory of Republican Donald Trump.

]]><p> Prior to this year&rsquo;s open enrollment season, analysts predicted that Affordable Care Act insurance premiums were likely to increase, in some states sharply. That prediction proved valid in October when it was revealed that across the country, premiums for health insurance policies offered on federal and state exchanges were set to rise an average of 22 percent.</p> <p> Heinz College professor Martin Gaynor said that the reasons for the increases are complex.</p> <p> In talking with Professor Gaynor, he lays out several contributing factors:</p> <h2> <em><strong>Citing losses, some large insurance firms left the ACA Marketplace</strong></em></h2> <p> &ldquo;This is a new market, and in any market there&rsquo;s always some churn,&rdquo; said Gaynor. Among the firms that exited are prominent names like Aetna. &nbsp;&ldquo;One thing to bear in mind is that just because some firms are exiting doesn&rsquo;t mean they won&rsquo;t come back.&rdquo;</p> <p> Gaynor points to a marketwide phenomenon that many insurance companies underestimated what their expenses would be and weren&rsquo;t covering costs, at least not to the extent desired. In some cases companies intentionally underpriced plans to attract enrollees, and that strategy didn&rsquo;t work out as well as they wanted.</p> <p> Such actuarial errors put some companies in the position where they needed to either leave the market, or raise premiums.</p> <p> &quot;They made a mistake,&rdquo; said Gaynor.</p> <div class="customSidebar" style="float: left;width: 300px;"> <p> <strong>Rise in Premiums for ACA Silver Plans</strong></p> <img align="" alt="ACA premium increases" src="image.aspx?id=10455&amp;width=340&amp;height=798" /> <p> <em>Source: <a href="http://healthcare.mckinsey.com/2017-exchange-market-emerging-pricing-trends" target="_blank">McKinsey Center for U.S. Health System Reform</a></em></p> </div> <h2> <em><strong>Not enough young, healthy people in the risk pool</strong></em></h2> <p> &ldquo;Customers who signed up [for ACA health care] were, in the aggregate, older and sicker patients who require more costly care,&rdquo; said Gaynor. &ldquo;Younger, healthier people who were less likely to need health care services were less likely to sign up.&rdquo;</p> <p> A feature of the ACA that has been very popular&mdash;and pre-dates the exchanges&mdash;is that people under the age of 26 can remain on their parents&rsquo; plan. Many young people have been either exercising that option, or choosing to not buy health insurance and instead incur a tax penalty. (Not inconsequential is the fact that the penalty is less expensive than most health insurance policies.)</p> <h2> <em><strong>Medicaid expansion was thwarted in many states</strong></em></h2> <p> Under the ACA, it was intended that states would expand their Medicaid programs, which would have the effect of providing a greater number of low-income families with state-administered health insurance. That didn&rsquo;t happen.</p> <p> While the law originally required the expansion, the Supreme Court ruled that the requirement was unconstitutional, and as a result many states chose not to expand Medicaid.</p> <p> Gaynor said there are some people who would have been covered by a Medicaid expansion, but who instead entered the ACA exchanges. That had an unforeseen impact on the ACA risk pool as well.</p> <h2> <em><strong>Medical costs drive premiums</strong></em></h2> <p> Something that is important to note in all of this, Gaynor says, is that insurance premiums are almost entirely driven by medical expenses, which have also been increasing since the ACA passed. (He remarks that it is unclear whether or not those increases have anything to do with the ACA.)</p> <p> The rising price of drugs and hospital services can cause insurers to get hit hard, but that this is a part of the equation that Gaynor suggests is largely being ignored.</p> <p> Patented medications&mdash;especially those with highly positive or even curative outcomes&mdash;can be extremely expensive; meanwhile some &ldquo;legacy&rdquo; drugs that are not under patent and yet face little to no competition in the market have been priced more aggressively in recent years.</p> <p> &ldquo;On the hospital side, we&rsquo;ve had a tremendous amount of consolidation in hospitals,&rdquo; said Gaynor. &ldquo;That&rsquo;s nothing new&hellip;but there was a tick up with 457 additional hospital mergers from 2010-2014.&rdquo;</p> <p> He adds that many cities are dominated by a single large health system, and so it&rsquo;s not surprising to see prices rise in the wake of those mergers.</p> <p> &ldquo;If you dominate a market, you can raise your prices and you will. That happens in hospital markets just like it does with gas stations or milk or anything else,&rdquo; said Gaynor.</p> <p> He adds that these activities and their impact are not specific to the ACA, but that they nonetheless have an impact on costs, and therefore affect pricing and premiums.</p> <p> &nbsp;</p> <p> <strong>Policy fixes can help both consumers and insurers</strong></p> <p> Subsidies have increased along with premiums, which will offset some of the direct cost borne by the consumer buying insurance with those subsidies.</p> <p> &ldquo;But that doesn&rsquo;t make the cost go away,&rdquo; said Gaynor. &ldquo;The money has to come from somewhere, and that&rsquo;s being borne by taxpayers.&rdquo;</p> <p> Gaynor also remarks that the ACA originally featured &ldquo;risk corridors&rdquo; that would insulate companies against heavy losses, which especially possible early in the market. Those were phased out, but he says they could be re-implemented.</p> <p> &ldquo;The risk corridors served a beneficial purpose in helping out companies that got an unexpectedly expensive draw from the risk pool,&rdquo; said Gaynor. He adds that risk corridors could help to keep new companies entering the market from getting under water right away, but that they are not long-term solutions because they can be expensive to the system. Also, if not used appropriately they can cause companies to take more risk than they otherwise would when setting prices.</p> <p> Another possibility for improvement, Gaynor says, is to put more work into the ACA&rsquo;s risk adjustment. &ldquo;[The risk adjustment could be] more developed, more granular, and also timely, so if an insurer gets a more expensive risk pool than average, then the exchange is on top of that and they compensate [the insurer] so they aren&rsquo;t carrying those losses,&rdquo; he said.</p> <p> &nbsp;</p> <p> <strong>The future of the ACA in a Trump presidency</strong></p> <div class="customSidebar" style="float: right;width: 250px;"> <h2 style="text-align: center;"> ACA Marketplace Signups during Open Enrollment</h2> <ul style="text-align: left;"> <li> 2014: <a href="http://www.hhs.gov/about/news/2014/05/01/enrollment-health-insurance-marketplace-totals-over-8-million-people.html" target="_blank">8 million</a></li> <li> 2015: <a href="http://www.hhs.gov/about/news/2015/03/10/nationwide-nearly-11-point-7-million-consumers-are-enrolled-in-2015-health-insurance-marketplace-coverage.html" target="_blank">11.7 million</a></li> <li> 2016: <a href="https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-04.html?DLPage=1&amp;DLEntries=10&amp;DLFilter=snap&amp;DLSort=0&amp;DLSortDir=descending" target="_blank">12.7 million</a></li> </ul> </div> <p> Gaynor notes that the troubles with the ACA are not shocking, that with any new program there are imperfections at the outset that get smoothed out over time.</p> <p> Analysts and politicians point to different root causes and solutions, but being that the ACA is the signature legislative accomplishment of the Obama administration, it is a highly politicized topic in which the discussion is usually distorted by ideology.</p> <p> The recent election of Republican Donald J. Trump&mdash;who campaigned in part on a promise to repeal &ldquo;Obamacare&rdquo;&mdash;casts even greater uncertainty, up to and including the possibility that he and the Republican-controlled Congress will seek to rapidly dismantle or defund the ACA, thus rendering all of these financial stresses moot, at least for the time being.</p> <p> Gaynor said the next administration will ultimately have to deal with the ACA. What remains to be seen is whether a Trump administration will make changes that address flaws in the current statute and improve upon it, or whether they will follow through on the promise to repeal and replace the ACA entirely.</p> <p> &ldquo;The latter is far more disruptive than the former.&rdquo;</p> <p> &nbsp;</p> <p> <em>If you wish to be connected with an expert on this topic, please email <a href="mailto:shryansh@andrew.cmu.edu">shryansh@cmu.edu</a>.</em></p>
http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3895Mon, 11 Nov 2016 16:00:00 GMThttp://www.heinz.cmu.edu/news/news-detail/image.aspx?width=250&mar=1&id=10446The Not-So-Affordable Care Act: Heinz Professor Explains Rising Premiums

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Heinz Alumnus at the Center of the Global Fight to End Poliohttp://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3888Image associated with news releaseDr. E. G. P. Haran (Ph.D. '77) is a health consultant with over 35 years of experience in public health. He has worked for such organizations as Rotary International, USAID, and the World Health Organization (WHO), supporting efforts concerning reproductive and child health, family planning, nutrition, and capacity building of NGOs. But nowhere has Haran had a greater impact than in his work toward polio eradication, particularly in India, Bangladesh, China, Indonesia, Thailand, and the Philippines, where he has designed, led, and participated in polio eradication programs. From strategic planning, data analytics, and project design to mobilization, training, and evaluation, you might call Dr. Haran the consummate Heinz College graduate.

]]><p> Some people enter the professional world with ambitions of making a global impact. But as a key player in the fight to eradicate polio, Heinz College alumnus E. G. P. Haran (Ph.D. &rsquo;77) was lifted to the world stage without ever planning to end up there.</p> <p> &ldquo;I didn&rsquo;t think big in the beginning,&rdquo; said Haran. &ldquo;Slowly, I got so deeply involved [in polio eradication] that then it became my commitment.&rdquo;</p> <p> Haran is a health consultant with over 35 years of experience in public health. He has worked for such organizations as <a href="https://www.rotary.org/en" target="_blank">Rotary International</a>, <a href="https://www.usaid.gov/" target="_blank">USAID</a>, and the <a href="http://www.who.int/en/" target="_blank">World Health Organization (WHO)</a>, supporting efforts concerning reproductive and child health, family planning, nutrition, and capacity building of NGOs.</p> <p> But nowhere has Haran had a greater impact than in his work toward polio eradication, particularly in India, Bangladesh, Indonesia, China, Sri Lanka, Nepal, and the Philippines.</p> <p> <a href="http://www.cdc.gov/features/poliofacts/" target="_blank">The United States has been polio-free since 1979</a>, but in 1988 (when global eradication efforts began in earnest) there were estimated to be roughly 350,000 cases in 125 countries. By 2002, that came down to less than 2000 cases of the virus in seven countries. Haran attributes that success to a combination of sustained routine immunization, effective mass vaccination campaigns, and high quality disease surveillance. These ingredients, paired with the joint commitment of governments, NGOs, religious leaders, and volunteers, reduced wild poliovirus cases worldwide by over 98 percent in 14 years, a breathtaking public health victory.</p> <h2 style="text-align: right;"> <em><strong>&ldquo;Any bright master&#39;s student with a good analytics systems synthesis approach could have done [the work I did].&rdquo; </strong></em></h2> <h2 style="text-align: right;"> <em><strong>~ Dr. E. G. P. Haran</strong></em></h2> <p> Mass vaccination campaigns using the easy-to-administer oral polio vaccine (OPV, informally &ldquo;polio drops&rdquo;) were integral to that success. These campaigns could be tailored by country, region, and community to have the broadest reach, and would often involve spiritual leaders and celebrities to raise awareness.</p> <p> Even then, there would be resistance.</p> <p> &quot;For hardcore resistors you need to have peers, village leaders&hellip;literally field workers from their own community who will go house to house, talk to them,&rdquo; said Haran.</p> <p> During campaign days, booths would be set up where people could bring children to receive polio drops, and teams would go house to house looking for children to vaccinate, equipped with a list of addresses and mapped routes (these maps were created using a combination of satellite imagery and &ldquo;common sense,&rdquo; according to Haran).</p> <p> The numbers are staggering, and one can easily recognize these campaigns as the triumphs of operations research that they were. For example, <a href="http://www.who.int/features/factfiles/polio/en/" target="_blank">in just one round of national immunization days in India</a>, there were 640,000 vaccination booths, 2.3 million vaccinators, 200 million doses of OPV, 191 million homes visited, and 172 million children immunized.</p> <p> &nbsp;</p> <div class="customSidebar" style="float: left;width: 300px;"> <img align="" alt="Dr E G P Haran" height="400" src="image.aspx?id=10404&amp;width=600&amp;height=400" width="600" /> <p> Dr. E.G.P.Haran speaking at Heinz College</p> </div> <p> <strong>Reaching the unreached</strong></p> <p> At one time, India was a primary exporter of the virus&mdash;especially the northern central states of Uttar Pradesh and Bihar, where a combination of population density, environmental conditions, poor health infrastructure, and opposition from religious fundamentalists stymied the campaign&rsquo;s ability to deliver the vaccine.</p> <p> &ldquo;There were many unreached populations there, so that&rsquo;s where the virus continued for a long time,&rdquo; said Haran.</p> <p> That word&mdash;<em>unreached</em>&mdash;is a vital one. Haran said that perhaps the highest priority for any mass vaccination campaign is &ldquo;reaching the unreached,&rdquo; an evocative phrase that calls to mind images of remoteness and poverty. Indeed, these unreached populations were largely children of seasonal construction workers, farm workers, or homeless migrants who may slip through the cracks of a national vaccination campaign.</p> <p> How were these children located? Haran remarks that data analytics played an enormous role.</p> <p> &ldquo;When we do polio surveillance, we can&rsquo;t look for polio, that would require lab confirmation. We look for reports of any sudden paralysis in any children. Every case of suspected paralysis is immediately investigated to collect information about the profile of the child to learn how many doses of polio drops they&rsquo;d received,&rdquo; said Haran. Once these children were found, researchers could gather information to create a characterization of who the children were, and these surveys found that many of these children had not been vaccinated.</p> <p> &ldquo;Typically, during a campaign you go house to house, but these children don&rsquo;t have a house, so they aren&rsquo;t reached by the health system,&rdquo; said Haran. &ldquo;We also learned where the migrant children would sleep at night, so we could find them in the evenings and give them the vaccine.&rdquo;</p> <p> <img alt="Polio change in India" src="image.aspx?id=10414&amp;width=250&amp;height=500" style="float: right; width: 227.094px; height: 454.188px; margin: 10px;" /></p> <p> India went from having 1600 polio cases reported across 159 districts in 2002, to being removed from the list of polio endemic countries in 2012. In 2014, the entire WHO South-East Asia region <a href="http://www.who.int/mediacentre/factsheets/fs114/en/" target="_blank">was certified polio-free</a>.</p> <p> Today, reported polio cases for 2016 number fewer than 30, confined to only three endemic countries: Afghanistan, Pakistan, and Nigeria. Conflict situations and extremist groups in those countries have complicated attempts to deliver polio drops to pockets of children who are most vulnerable to the disease. Those complications range from disruption (intercepting supplies), to manipulation (spreading misinformation), to tragedy (killing health workers). At this point, Haran said that there is little more the outside community can do, that those countries must solve the issue from within.</p> <p> &ldquo;Nobody like me going there can solve it. We have to wait to see what will happen,&rdquo; said Haran.</p> <p> In the meantime, the spread of the virus is still very much possible, so the world must stay vigilant. Two years ago, <a href="https://www.unicef.org/media/media_78947.html" target="_blank">Iraq and Syria had an outbreak of the disease</a>. That outbreak was quickly contained, but Iraqi leaders wanted to get their medical officers trained in polio eradication methods. Haran was chosen to conduct the training for over thirty officers (a group he described as uniquely enthusiastic and knowledgeable) at a site outside of the conflict zone in Amman, Jordan. He was given just one month to prepare the module.</p> <p> &ldquo;It was not enough time. I felt like I was choking,&rdquo; said Haran, laughing. He needed to spend much of that time reading up on the current Iraqi program and having conferences with Iraqi leadership via Skype. &ldquo;I couldn&rsquo;t imagine talking to Iraqis about what&rsquo;s valid for India or Pakistan, I needed to make it relevant for Iraqis.&rdquo;</p> <p> From strategic planning, capacity building, and project design to mobilization, training, and evaluation, you might call Dr. Haran the consummate Heinz College graduate. He fondly recalls interactions with founding dean Bill Cooper, who Haran credits with expanding his interests and making him more flexible and adaptable in his thinking.</p> <p> Haran humbly suggests that while his Ph.D. gave him credentials and credibility to deal with senior officials, that a path like his would be open to any Heinz College grad with an interest in public health.</p> <p> &ldquo;Any bright master&#39;s student with a good analytics systems synthesis approach could have done [the work I did],&rdquo; said Haran.</p> <p> &nbsp;</p> <p> <strong>Eradication endgame</strong></p> <div class="customSidebar" style="float: right;width: 250px;"> <h2 style="text-align: center;"> Polio Eradication Resources</h2> <ul style="text-align: left;"> <li> <a href="http://www.who.int/topics/poliomyelitis/en/" target="_blank">Polio Facts (WHO)</a></li> <li> <a href="http://www.cdc.gov/polio/" target="_blank">Polio Eradication (CDC)</a></li> <li> <a href="http://www.unicef.org/immunization/polio/" target="_blank">Eradicating Polio (UNICEF)</a></li> <li> <a href="http://www.rotary.org/en/end-polio" target="_blank">End Polio Now</a></li> <li> <a href="http://polioeradication.org/" target="_blank">Global Polio Eradication Initiative</a></li> </ul> </div> <p> The polio virus only exists in humans, not animals, and cannot live outside the human body for long, which makes it truly eradicable. So what does it mean to completely eradicate a disease?</p> <p> To put it simply, eradication will be achieved when the vast majority of the world&rsquo;s children receive routine immunization on schedule (think 80-90 percent), and that level is sustained for a three-year period during which time disease surveillance validates no new virus anywhere on the globe. Routine immunization will start to feature doses of inactivated polio vaccine (IPV, or the &ldquo;Salk&rdquo; vaccine), rather than the live, attenuated OPV.</p> <p> Haran says it will happen in one day&mdash;the whole world will collectively stop giving polio drops. Then, all remaining polio viruses can be contained in a laboratory and destroyed, and a horrible disease will be gone from the planet.</p> <p> Haran holds his thumb and forefinger an inch apart, smiling. &ldquo;We are <em>this</em> close.&rdquo;</p> <p> &nbsp;</p> <p> <em>For more information about how you can support efforts to eradicate polio, Dr. Haran encourages you to visit </em><a href="http://www.endpolio.org"><em>www.endpolio.org</em></a><em>.</em></p>
http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3888Mon, 11 Nov 2016 16:00:00 GMThttp://www.heinz.cmu.edu/news/news-detail/image.aspx?width=250&mar=1&id=10448Heinz Alumnus at the Center of the Global Fight to End Polio

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Heinz Students Voice Opinions on Election Issueshttp://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3882Image associated with news releaseThree current Heinz College students share their views on contentious election themes including gerrymandering, deportation, and GMOs.

]]><table> <tbody> <tr> <td style="border: none;"> <p> <img align="" alt="gerrymander crop" src="image.aspx?id=10368" style="width: 25%; margin: 10px; float: left;" /></p> <h2> A Call to Curb Gerrymandering by 2020</h2> <p> 2020 will be a census year election, after which new congressional district lines will be drawn nationwide. Heinz College student Ben Simmons argues that now is the time for all states to create independent re-districting commissions to ensure fair competition and reflective representation.</p> <p> <a href="http://heinz.cmu.edu/news/news-detail/index.aspx?nid=3877" target="_blank">Read the full article</a></p> </td> </tr> <tr> <td style="border: none;"> <p> <img align="" alt="deportation" src="image.aspx?id=10373" style="width: 25%; margin: 10px; float: left;" /></p> <h2> Deportation and Decency</h2> <p> Rational debate over the humanity (or lack thereof) of deportation often falls apart before it can begin. Those who favor the deportation of unauthorized immigrants and those who oppose the practice tend to frame the issue in dramatically different ways that the other side finds impertinent, uncivil, even distasteful. Have we reached a point in our political discourse where we cannot assume the decency of those who disagree with us? Heinz College student Andrew Lewis discusses this troubling phenomenon.</p> <p> <a href="http://heinz.cmu.edu/news/news-detail/index.aspx?nid=3876" target="_blank">Read the full article</a></p> </td> </tr> <tr> <td style="border: none;"> <p> <img align="" alt="gmo labels" src="image.aspx?id=10374" style="width: 25%; margin: 10px; float: left;" /></p> <h2> GMO-Labeling: Positive or Pernicious?</h2> <p> Anti-GMO activists have been successful in shaping the conversation about genetically modified foods among the American public as well as legislators. Federal regulation is likely to compel manufacturers to label foods that contain GMOs. While this will improve transparency, it may reinforce negative stigmas associated with GMOs and have unintended consequences. Heinz College student Ada Tso discusses this issue further.</p> <p> <a href="http://heinz.cmu.edu/news/news-detail/index.aspx?nid=3878" target="_blank">Read the full article</a></p> </td> </tr> <tr> <td style="border: none;"> <p> <img align="" alt="Immigration-phobia" src="image.aspx?id=10423" style="width: 25%; margin: 10px; float: left;" /></p> <h2> Immigration-phobia: Negative Narratives Thrive, Despite Research</h2> <p> In the 2016 campaign, Republican candidates across the country&mdash;and most notably, at the top of the ballot&mdash;sought to paint illegal immigration as an urgent economic and national security issue with damning anecdotes regarding sanctuary cities and migrants stealing American jobs. Such assertions are at odds with a host of recent academic studies pertaining to undocumented immigrants and their impact on economic growth, employment, and crime.</p> <p> <a href="http://heinz.cmu.edu/news/news-detail/index.aspx?nid=3891" target="_blank">Read the full article</a></p> </td> </tr> <tr> <td style="border: none;"> <p> <img align="" alt="Third Party Viability" src="image.aspx?id=10422" style="width: 25%; margin: 10px; float: left;" /></p> <h2> Third Party Viability Still Elusive in U.S. Politics</h2> <p> Theodore Roosevelt, George Wallace, and Ross Perot each ascended as third party candidates during times of great upheaval. Each allied themselves closely with a singular cause and each attracted masses of voters through forceful rhetoric. In time, history may well identify 2016 as a year of equal turmoil, but the highest-polling duo in this year&rsquo;s campaign&mdash;Libertarian candidates Gary Johnson and Bill Weld&mdash;do not fit this model. Add to that the enduring impression of Ralph Nader as a spoiler of the 2000 election, and third party candidates continue to struggle in a largely disaffected nation.</p> <p> <a href="http://heinz.cmu.edu/news/news-detail/index.aspx?nid=3892" target="_blank">Read the full article</a></p> </td> </tr> <tr> <td style="border: none;"> <p> <img align="" alt="The Divisiveness of “Religious Freedom”" src="image.aspx?id=10424" style="width: 25%; margin: 10px; float: left;" /></p> <h2> The Divisiveness of &quot;Religious Freedom&quot;</h2> <p> Though religious freedom is not the singular political topic of this election, it is clear that that &ldquo;religious freedom&rdquo; has become a uniquely polarizing political phrase, conveying very different ideas to different audiences. What makes &quot;religious freedom&quot; such a loaded concept?</p> <p> <a href="http://heinz.cmu.edu/news/news-detail/index.aspx?nid=3893" target="_blank">Read the full article</a></p> </td> </tr> <tr> <td style="border: none;"> <p> <img align="" alt="In Appalachia, Fierce TPP Debate Mirrors Political Realignment" src="image.aspx?id=10425" style="width: 25%; margin: 10px; float: left;" /></p> <h2> In Appalachia, Fierce TPP Debate Mirrors Political Realignment</h2> <p> Analyzing changing demographics in West Virginia and Pennsylvania, we can note a marked rightward political shift and exodus from the Democratic Party in these regions as wages have stayed stagnant and manufacturing job losses have continued.</p> <p> <a href="http://heinz.cmu.edu/news/news-detail/index.aspx?nid=3885" target="_blank">Read the full article</a></p> </td> </tr> <tr> <td style="border: none;"> <p> <img align="" alt="On Trade, Economists Get Shouted Down" src="image.aspx?id=10426" style="width: 25%; margin: 10px; float: left;" /></p> <h2> On Trade, Economists Get Shouted Down</h2> <p> Populism and expediency, empowered by social media, often lift opinion over analysis. While that can be said of many issues in American politics today, it is particularly hard-felt in the conversation surrounding the Trans-Pacific Partnership (TPP). Despite broad endorsement of the deal by those who can be objectively deemed experts on the topic, the conversation surrounding TPP is devoid of measured analysis, intellectual curiosity, or academic inquiry.</p> <p> <a href="http://heinz.cmu.edu/news/news-detail/index.aspx?nid=3890" target="_blank">Read the full article</a></p> </td> </tr> <tr> <td style="border: none;"> <p> <img align="" alt="TPP and the Deepening Politicization of Trade" src="image.aspx?id=10436" style="width: 25%; margin: 10px; float: left;" /></p> <h2> TPP and the Deepening Politicization of Trade</h2> <p> Anti-trade sentiment featured prominently in the 2016 presidential election. During the primaries, Donald Trump and Bernie Sanders established a base of support around their opposition to the Trans-Pacific Partnership. By Election Day, Hillary Clinton also opposed TPP. In looking at competitive Senate races, it is clear that the tide against TPP reached down-ballot elections as well and resulted in a shift in stance on TPP by many candidates. How did trade become so politicized?</p> <p> <a href="http://heinz.cmu.edu/news/news-detail/index.aspx?nid=3886" target="_blank">Read the full article</a></p> </td> </tr> </tbody> </table>
http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3882Mon, 17 Oct 2016 22:06:00 GMThttp://www.heinz.cmu.edu/news/news-detail/image.aspx?width=250&mar=1&id=10382Heinz Students Voice Opinions on Election Issues

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Police, Violence, and Data: The BlackLivesMatter Movementhttp://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3860Image associated with news releaseIn the wake of recent incidences of lethal violence involving law enforcement officials in Baton Rouge, Falcon Heights, and Dallas, we sat down with Dan Nagin to talk to him about what factors led to these events, why there is apparent mistrust between citizens and law enforcement officials, and what policy, research, and training measures can be taken to help prevent these situations in the future.

]]><p> <em>Professor Daniel Nagin is the 2014 recipient of the prestigious Stockholm Prize on Criminology, an elected fellow of the American Society of Criminology, and the Teresa and H. John Heinz III University Professor of Public Policy and Statistics. His research focuses on the evolution of criminal and antisocial behaviors over the life course the deterrent effect of criminal and non-criminal penalties on illegal behaviors, and the development of statistical methods for analyzing longitudinal data.</em></p> <p> <em>In the wake of recent incidences of lethal violence involving law enforcement officials in Baton Rouge, Falcon Heights, and Dallas, we sat down with Nagin to talk to him about what factors led to these events, why there is apparent mistrust between citizens and law enforcement officials, and what policy, research, and training measures can be taken to help prevent these situations in the future.&nbsp;</em></p> <p> <strong style="font-size:1.05em;color:#616161;">Q. <em style="font-size:1.05em;color:#616161;">Based on your research, are the events in recent years and weeks that have led to the growth of the Black Lives Matter movement reflective a small number of outlying incidents, or is it symptomatic of a systemic problem?</em></strong></p> <p> The Black Lives Matter Movement has to be understood in the context of the historical legacy of the ill treatment of blacks by the police and the criminal justice system and American political and social institutions more generally. That legacy is a fact. The Movement, I think, is a reflection of and reaction to that legacy. I don&rsquo;t think people should be surprised by it, and it&rsquo;s part of why people should listen to the Black Lives Matter position. At the same time getting people to listen has been greatly complicated by the lethal ambushes of police officers in Dallas and Baton Rouge.</p> <p> &nbsp;</p> <p> <strong style="font-size:1.05em;color:#616161;"><em style="font-size:1.05em;color:#616161;">Q. Live telecasting or near-real time videos of events as they are happening makes them so much more apparent and visceral, as opposed to reading a news article about it.</em></strong></p> <p> When you see video, for example, of the incident in North Charleston, where a police officer gunned down a man who was running away from him &ndash; you can&rsquo;t deny those facts. I don&rsquo;t know what motivated this cop to do it, but I&rsquo;m not surprised that black people interpreted it as still another instance of their mistreatment by the police.</p> <p> &nbsp;</p> <p> <strong style="font-size:1.05em;color:#616161;"><em style="font-size:1.05em;color:#616161;">Q. You mentioned recent studies about lethal force. In terms of research, what do we know about the disproportionate targeting of minorities, particularly African-Americans, by law enforcement agencies?</em></strong></p> <p> Studies on this question come to conflicting conclusions. Some studies have concluded that minorities are disproportionately targeted, and others reach the opposite conclusion. In fact, in a recent study on this issue, Roland Fryer from Harvard reached the conclusion that it depends on what kind of tactic you&rsquo;re talking about. He concluded that for non-lethal uses of force, involving things like handcuffing the person, shoving them, or having some physical contact with them, those events were in the order of 10 to 25 percent more likely for blacks than for whites. On the other hand, he reached the conclusion that, if anything, lethal use of force is more common among whites than blacks. So it&rsquo;s hard to draw really strong conclusions one way or the other on this issue.</p> <p> &nbsp;</p> <p> <strong style="font-size:1.05em;color:#616161;"><em style="font-size:1.05em;color:#616161;">Q. Why don&rsquo;t researchers currently have a better answer to this question?</em></strong></p> <p> I think there are a couple of reasons for that. One is that we simply don&rsquo;t have very good data about these incidences. As surprising as this is, there is not a national database where you can confidently get a count of the number of people against which police used lethal violence, let alone on instances when they discharge firearms. So the studies that have been done are based on data from specific localities that are often of uneven quality. For this reason alone, findings may differ across studies.</p> <p> Another issue is that, conceptually, this is a really hard problem. And it&rsquo;s a hard problem because there are differences across racial and ethnic groups in the frequency that they commit crime, which puts some groups in contact with the police at a rate that disproportionate to their presence in the population. Taking account of those differences in involvement in crime is not easy to do from a statistical perspective.</p> <p> The problem is made even further difficult because we also live in a racially segregated society. So if you are going to send the police where there is the most crime, you&rsquo;re also going to wind up sending the police to what are typically racially segregated communities. For example, there was a study done of the locations of &ldquo;stop, question, and frisk&rdquo; in New York City. SQFs tended to be heavily concentrated in so-called crime &ldquo;hot spots,&rdquo; which themselves tend to be disproportionately located in minority communities.</p> <p> So it&rsquo;s conceptually a hard problem to grapple with because it is so complex. But the fact that we don&rsquo;t have good data on these kinds of incidences is unforgivable. These are the two main reasons why we don&rsquo;t currently have a better answer to the question of whether black and other minorities are disproportionately targeted on account of their race or ethnicity.</p> <p> &nbsp;</p> <p> <strong style="font-size:1.05em;color:#616161;"><em style="font-size:1.05em;color:#616161;">Q. In addition to collecting better data, what are some other factors that will help to solve this issue?</em></strong></p> <p> The problem of data can be solved, and it should be solved. But even if it is solved, the data can only help us understand and explain the problem. It can&rsquo;t fix the problem. Once you use data to identify what the problem is, then you&rsquo;re going to have to change what the police do, and how they interact with the public. And in that regard, there is wide agreement among policing scholars that the research on the effectiveness of police training is woefully inadequate. There are very few careful studies on what&rsquo;s effective and what&rsquo;s not effective in changing the behavior of police in the field.</p> <p> &nbsp;</p> <p> <strong style="font-size:1.05em;color:#616161;"><em style="font-size:1.05em;color:#616161;">Q. Can you provide an example of that, or a hypothetical question that you would like to answer through this type of research?</em></strong></p> <p> For example: when police do use force, how well considered is it? Would a trained observer conclude that the use of force was necessary and appropriate? Was there a conceivable way that the use of force could have been avoided by some kind of de-escalation tactic?</p> <p> The comparison I would give is that police, in general, do not receive anywhere near the level of training that we give to the members of our military on how to control their emotions and respond in a way that is going to be effective and constructive in conflict situations. People in our military, and in the best militaries in the world, get intensive training in those kinds of things, and by and large police don&rsquo;t get anywhere near that level of training.</p> <p> <img align="" alt="Black Lives Matter Movement 2" src="image.aspx?id=10230" style="width: 50%; margin: 10px; float: left;" /></p> <p> &nbsp;</p> <p> <strong style="font-size:1.05em;color:#616161;"><em style="font-size:1.05em;color:#616161;">Q. As a point of comparison, where do police stand compared to the military in terms of conflict training?</em></strong></p> <p> Again, there is not really good data on training, but I think that it&rsquo;s well understood that, in general, it&rsquo;s nowhere near as complete and thorough as in the military. Part of the issue with training is that, in the United States, there are over 18,000 police departments, and most of them are very small. And when you have these little police departments, the capacity to properly train the police officers and establish a culture of accountability is really limited. So I think there&rsquo;s an important need to consolidate the number of police departments that exist nationwide, for a variety of reasons.</p> <p> &nbsp;</p> <p> <strong style="font-size:1.05em;color:#616161;"><em style="font-size:1.05em;color:#616161;">Q. From a policy standpoint, what effect do you think the recent events will have on policy procedures and oversight in law enforcement on different levels?</em></strong></p> <p> I think that we already see it happening. Police executives are talking about the importance of training police to better interact with people in the community, and about using other methods to try to diffuse tense situations. There&rsquo;s also this idea of implicit bias. All of these notions are laudable, but getting back to my prior point: if you were to candidly ask a police chief, &ldquo;tell me the proven methods to do &lsquo;X,&rsquo; &lsquo;Y,&rsquo; and &lsquo;Z,&rsquo; the chief wouldn&rsquo;t be able to honestly respond to that question, &ldquo;here are the proven methods,&rdquo; because hardly any of them have been properly evaluated. So everybody is kind of flying by the seat of their pants, or making decisions based on overblown claims about the effectiveness of these various training programs. Therefore, whether they are reacting in an effective way to these events is hard to know.</p> <p> Right now, for obvious reasons, the pendulum is focused very much on what the police can do to improve their credibility in the community. Well, 20 years ago, when crime rates were high, the focus was on doing anything they could to reduce the crime rate. What police departments ultimately have to do is to recognize that both of these values are important. It&rsquo;s important that they do things to help make the community safe. But it is also important that they do things in a way that leaves the community with confidence and trust in them, and to keep in mind that sometimes these two different objectives can wind up being in conflict. They&rsquo;ve got to balance these two objectives, and know that one shouldn&rsquo;t have the status to trump the other. The idea is not to have a safe police state. The idea is to have a safe democratic society.</p> <p> &nbsp;</p> <p> <strong style="font-size:1.05em;color:#616161;"><em style="font-size:1.05em;color:#616161;">Q. In your research and experience in this area, are there certain strategies that law enforcement officials can use to prevent these situations from occurring?</em></strong></p> <p> It is clear that police presence at places where there is a lot of crime &ndash; I call this the &ldquo;sentinel&rdquo; role in policing &ndash; can be very effective in preventing crime. A simple analogy is that nobody is going to rob a liquor store if a cop is standing right outside. The key for police officers is using that presence to interact with citizens in a way that doesn&rsquo;t create conflict.</p> <p> &nbsp;</p> <p> <strong style="font-size:1.05em;color:#616161;"><em style="font-size:1.05em;color:#616161;">Q. Do you think there is any hope in solving this challenge?</em></strong></p> <p> I am optimistic and hopeful that the current tensions will recede. But it is important to keep in mind that, over the long haul, these things are not going to be resolved unless resources are committed to having good measurement systems to collect quality data on what the police are doing in regard to the use of force. The necessary resources also have to be committed to generally having better data systems for monitoring how communities feel about the police, and to developing training systems where police are trained to use to what are known to be effective methods both for improving community trust, and also for preventing crime. Good intentions alone are not going to make our communities safe and solve the problem of citizen distrust of the police in some communities.</p> <p> &nbsp;</p> <p> <strong style="font-size:1.05em;color:#616161;"><em style="font-size:1.05em;color:#616161;"><a href="http://www.heinz.cmu.edu/faculty-and-research/faculty-profiles/faculty-details/index.aspx?faculty_id=69" target="_blank">Read more about Daniel Nagin &gt;&gt;</a></em></strong></p>
http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3860Mon, 16 Oct 2016 10:51:00 GMThttp://www.heinz.cmu.edu/news/news-detail/image.aspx?width=250&mar=1&id=10370Police, Violence, and Data: The BlackLivesMatter Movement

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She is The Night!http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3900Image associated with news releaseYes! Bwah-hah-hah-hah!  Well actually, no she’s not a vampire, but to celebrate Halloween we had a visit from the Nighttime Economy Coordinator of the City of Pittsburgh.  Wait what - that’s a thing?  Yes, it is.  The mission of the NTC is to retain and grow the economic value of the social and nighttime economy while effectively preventing and addressing nuisance activities, managing public safety risks, and alleviating quality of life impacts. Some of the NTC’s goals and responsibilities include helping neighborhoods with both residential and commercial activity to achieve peaceful and mutually beneficial co-existence; helping hospitality business operators to achieve consistent compliance through increased education, increasing the efficiency of city government processes related to business development, regulation and enforcement; advising the Mayor and City Council on social and nighttime economy, and reviewing and proposing relevant policy and legislation. Presented in conjunction with the student chapter of the International City/County Management Association and the Heinz Career Center.

]]><p> Yes! Bwah-hah-hah-hah!&nbsp; Well actually, no she&rsquo;s not a vampire, but to celebrate Halloween we had a visit from the <strong>Nighttime Economy Coordinator </strong>of the City of Pittsburgh.&nbsp; Wait what - that&rsquo;s a thing?&nbsp; Yes, it is.&nbsp; The mission of the NTC is to retain and grow the economic value of the social and nighttime economy while effectively preventing and addressing nuisance activities, managing public safety risks, and alleviating quality of life impacts.&nbsp; Some of the NTC&rsquo;s goals and responsibilities include helping neighborhoods with both residential and commercial activity to achieve peaceful and mutually</p> <p> beneficial co-existence; helping hospitality business operators to achieve consistent compliance through increased education, increasing the efficiency of city government processes related to business development, regulation and enforcement; advising the Mayor and City Council on social and nighttime economy, and reviewing and proposing relevant policy and legislation.&nbsp; Presented in conjunction with the student chapter of the International City/County Management Association and the Heinz Career Center.</p>
http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3900Mon, 16 Oct 2016 09:55:00 GMThttp://www.heinz.cmu.edu/news/news-detail/image.aspx?width=250&mar=1&id=0She is The Night!

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Prof. Gaynor Elected to National Academy of Medicinehttp://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3881Image associated with news releaseMartin Gaynor, E.J. Barone Professor of Economics and Public Policy at Heinz College, has been elected to the National Academy of Medicine. National Academy membership is among the highest professional distinctions awarded to scientists, social scientists, engineers, and medical and health professionals, and honors those who have made outstanding contributions to their fields.

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http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3881Mon, 15 Oct 2016 21:56:00 GMThttp://www.heinz.cmu.edu/news/news-detail/image.aspx?width=250&mar=1&id=10376Prof. Gaynor Elected to National Academy of Medicine

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President Obama Visits Campushttp://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3880Image associated with news release"Pittsburgh has been revitalizing itself through technology for a very long time." President Barack Obama made his fifth visit to Carnegie Mellon University today, this time for The White House Frontiers Conference, a large gathering of national thought-leaders co-hosted by CMU and the University of Pittsburgh, to discuss building America's capacity in science, technology and innovation.

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http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3880Mon, 15 Oct 2016 21:41:00 GMThttp://www.heinz.cmu.edu/news/news-detail/image.aspx?width=250&mar=1&id=10375President Obama Visits Campus

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Prof. Brian Kovak on Trade, Immigration, and the 2016 Electionhttp://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3874Image associated with news releaseBrian Kovak is an assistant professor of economics and public policy at Heinz College. He is a research fellow at the National Bureau of Economic Research as well as the Institute for the Study of Labor (IZA). Kovak was the 2014 winner of the IZA Young Labor Economist Award, and is an expert in immigration policy, international trade, and labor markets.

]]><p> <em>Brian Kovak is an assistant professor of economics and public policy at Heinz College. He is a research fellow at the National Bureau of Economic Research as well as the Institute for the Study of Labor (IZA). Kovak was the 2014 winner of the IZA Young Labor Economist Award, and is an expert in immigration policy, international trade, and labor markets.</em></p> <p> Recent populist rhetoric suggests that immigration and international trade hurt local economies. But does data support that argument?</p> <p> &ldquo;Some of what drives a particular election cycle is idiosyncratic,&rdquo; said Kovak. &ldquo;But historically, immigration tends to become contentious during periods of economic stagnation.&rdquo;</p> <p> That may explain why, despite the fact that the number of unauthorized immigrants in the U.S. <a href="http://www.pewresearch.org/fact-tank/2016/09/21/unauthorized-immigrant-population-stable-for-half-a-decade/" target="_blank">has been roughly constant since 2009</a>, the perception persists that the U.S. has experienced massive increases in unauthorized migration.</p> <p> &ldquo;You can find examples of [anti-immigration sentiment] in essentially every recession or depression that the United States has experienced. The Great Recession is no exception,&rdquo; said Kovak.</p> <div class="customSidebar" style="float: left;width: 300px;"> <img align="" alt="Brian_Kovak1" src="image.aspx?id=10349&amp;width=355&amp;height=237" /> <p> Brian Kovak, economist and Heinz College faculty member</p> </div> <p> Though the recession hit in 2008 and recovery began in 2009, gains have been uneven across the United States. In areas that have been heavily invested in manufacturing&mdash;Kovak gives Pittsburgh&rsquo;s Monongahela Valley as an example&mdash;employment has often flattened or declined.</p> <p> He suggests that technological change contributes more to those losses than immigration, but that local constituents need relief nonetheless, and that creates pressure on lawmakers.</p> <p> &ldquo;It&rsquo;s hard to imagine the government trying to slow down technological change, but something that one can imagine the government doing is to try to decrease immigration,&rdquo; said Kovak.</p> <p> Political candidates have hotly debated the topics of immigration and trade this election season, specifically their effects on local economies and on the well-being of the American public.</p> <p> Eschewing snappy sound bites in favor of data and research, Kovak has some remarkable findings on how immigrants, specifically migrant workers from Mexico, impact the U.S. economy.</p> <p> &nbsp;</p> <p> <strong>Immigrants integrate U.S. job markets</strong></p> <p> <img align="" alt="PewGraph Unauthorized-02" src="image.aspx?id=10353&amp;width=415&amp;height=506" style="width: 30%; margin: 10px; float: right;" /></p> <p> Recently, Kovak published a study in the <u>American Economic Journal</u> titled &ldquo;<a href="https://www.andrew.cmu.edu/user/bkovak/cadenakovak_greatrecession.pdf" target="_blank">Immigrants Equilibrate Lo</a><a href="https://www.andrew.cmu.edu/user/bkovak/cadenakovak_greatrecession.pdf">cal Labor Markets: Evidence from the Great Recession</a>,&rdquo; a collaboration with Brian Cadena, associate professor of economics at University of Colorado-Boulder. Kovak and Cadena analyzed employment data and the behaviors of Mexican-born, low-skilled workers to understand how their physical movement affects local labor markets. They chose to study Mexican-born workers because they are the largest group of immigrants in the U.S.</p> <p> Through their research, Kovak and Cadena discovered that immigrant workers stabilize local economies by moving between them. When employment falls substantially in a local labor market with a high number of Mexican-born workers, the Mexican low-skilled workers are subsequently much more likely to move away from that place than are native-born low-skilled workers.</p> <p> &ldquo;They essentially decrease competition for the native-born workers who remain in that place,&rdquo; said Kovak.</p> <p> On the other hand, Kovak is quick to note that growing labor markets tend to attract immigrant workers, which increases competition in those stronger markets, but also &ldquo;improves conditions in the most depressed markets, where it counts the most.&rdquo;</p> <p> &ldquo;Essentially, the native workers bear the full brunt of the local economic conditions when there are no Mexican-born workers to equalize those conditions by moving across space,&rdquo; he explained.</p> <p> Kovak says that, in the interest of mitigating the negative impact to native-born workers and maintaining the mobility of immigrant workers, he supports a comprehensive approach to immigration reform. He cites the Border Security, Economic Opportunity, and Immigration Modernization Act of 2013 as a good example of this type of approach.</p> <p> The comprehensive reform bill addresses a variety of issues related to immigration reform, including increased border controls, guest worker programs, incentives to hire authorized workers, and a legal channel for current unauthorized immigrants to regularize their status. The bill was passed by the Senate in June of 2013, but has not yet been addressed by the House of Representatives.</p> <p> Based on his research findings, Kovak suggests that a guest worker system should be structured to allow workers to easily switch from one employer to another, avoiding situations in which employers might try to exploit migrant workers whose work authorization is tied to their business. This has the added benefit of providing a &ldquo;release valve&rdquo; in locations experiencing economic decline.</p> <p> &ldquo;It would maintain this feature of the labor market that we&rsquo;ve documented, in which migrant workers are able to move across space and hopefully equalize outcomes throughout the country and integrate the U.S. labor market,&rdquo; he said.</p> <p> &nbsp;</p> <p> <strong>International trade: Keeping gains and cushioning losses</strong></p> <p> Kovak suggests that when discussing immigration alongside international trade, it&rsquo;s not entirely unreasonable to conflate the two, explaining that the theoretically predicted effects of trade and immigration are very similar.</p> <p> Along with Rafael Dix-Carneiro, assistant professor of economics at Duke University, Kovak <a href="https://www.andrew.cmu.edu/user/bkovak/DCK_PnP.pdf" target="_blank">researched the effects of trade liberalization in Brazil</a>, and found large and lasting disparities in labor market outcomes for workers in different local labor markets. Following trade liberalization, workers in regions producing products that began competing with international suppliers experienced wage and employment declines compared to workers in more favorably affected regions.</p> <p> It is entirely possible that the effects in Brazil are similar to those in the U.S. from increased trade with China or the off-shoring of U.S. jobs.</p> <p> <img alt="trade displacement_hard hat" src="image.aspx?id=10355&amp;width=4288&amp;height=2848" style="float: left; width: 225.594px; margin: 10px;" /></p> <p> However, Kovak points out that it&rsquo;s relatively easy to predict what areas and industries might be negatively impacted by a trade deal, and shares some ideas on how policymakers can improve outcomes, including greater resources for training, moving assistance, and a stronger social safety net to put a floor on how much a person&rsquo;s prospects can fall. He supports testing an idea called &ldquo;wage insurance,&rdquo; in which the government would make up some of the loss in earnings if a displaced worker changes locations or industries.</p> <p> &ldquo;The idea is to incentivize people to take a job in a growing industry or stronger market, as well as effectively subsidize on-the-job training for a person who may be very competent but has skills that are not well-rewarded by the current labor market,&rdquo; said Kovak.</p> <p> &nbsp;</p> <p> <strong>Shaping November</strong></p> <p> The two major party presidential candidates have starkly different ideas where it comes to immigration, trade, and the social safety net. Those issues are likely to weigh heavily on the minds of voters leading up to Election Day.</p> <p> A recent report published by the <a href="http://www.nationalacademies.org/" target="_blank">National Academies of Sciences, Engineering and Medicine</a> stated that immigration had little to no negative effects on overall wages and employment of native-born workers in the longer term, and that high-skilled immigrants, in areas like science and technology, make a significant positive imprint on the U.S. economy.</p> <p> Academic studies won&rsquo;t necessarily quell public emotion, however, and overall national growth is cold comfort for individuals in an economically depressed area. Ultimately, these day-to-day experiences are often big factors in how people vote when they head to their polling places. &nbsp;</p> <p> &ldquo;For the workers in these markets, they frankly don&rsquo;t care whether [diminished prospects] are the result of technological change, trade, or immigration,&rdquo; said Kovak, &ldquo;and we don&rsquo;t have many policies that try to soften the blow for individuals who face these phenomena.&rdquo;&nbsp;</p> <p> &nbsp;</p> <p> <style type="text/css"> p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 11.0px Calibri} span.s1 {font-kerning: none} </style> </p> <p class="p1"> <em><span class="s1">As a 501&copy;3 nonprofit corporation Carnegie Mellon University does not support or oppose any particular candidate.</span></em></p>
http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3874Mon, 14 Oct 2016 10:45:00 GMThttp://www.heinz.cmu.edu/news/news-detail/image.aspx?width=250&mar=1&id=10354Prof. Brian Kovak on Trade, Immigration, and the 2016 Election

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Heinz Students Putting Elections in Your Hands. Literally.http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3875Image associated with news releaseWhen compared to technology advances elsewhere in American society, elections have stayed relatively “old school”—with good reason, according to many experts. Innovations in electronic voting could streamline the process and boost civic engagement, but pose substantial security hurdles. Students at Heinz College have recently worked to understand this important and complex issue.

]]><p> When compared to technology advances elsewhere in American society, elections have stayed relatively &ldquo;old school&rdquo;&mdash;with good reason, according to many experts. Innovations in electronic voting could streamline the process and boost civic engagement, but pose substantial security hurdles. Students at Heinz College have recently worked to understand this important and complex issue.</p> <p> Turnout among eligible voters was estimated to be about <a href="http://bipartisanpolicy.org/library/2012-voter-turnout/" target="_blank">57.5 percent for the 2012 presidential election</a> and only <a href="http://www.pbs.org/newshour/updates/2014-midterm-election-turnout-lowest-in-70-years/" target="_blank">36.4 percent for the 2014 midterm</a>. Voting remotely from a computer or mobile device could make the franchise more accessible to many voters&mdash;citizens with disabilities and overseas voters, for example. But such an option may also improve domestic turnout, particularly among young voters. If secure, such a system could change the political landscape, not only for the U.S., but for other democratic nations and future democracies across the globe.</p> <p> &nbsp;</p> <p> <strong>Addressing major problems in Internet voting security</strong></p> <p> A team of Heinz students in the <a href="http://www.heinz.cmu.edu/school-of-information-systems-and-management/information-security-policy-management-msispm/index.aspx" target="_blank">Master of Science in Information Security Policy and Management (MSISPM)</a> program recently collaborated with Oregon-based R&amp;D firm <a href="https://galois.com/" target="_blank">Galois</a> and the <a href="https://www.usvotefoundation.org/" target="_blank">U.S. Vote Foundation</a> on a report on Internet voting.</p> <p> &ldquo;There have been many [Internet voting] projects in other countries,&rdquo; said Susan Dzieduszycka-Suinat, president and CEO of the U.S. Vote Foundation. &ldquo;We wanted to do a U.S.-based research project which basically answered the question, &lsquo;If we had to develop an Internet voting system for the U.S., how would we do it?&rsquo;&rdquo;</p> <p> Among the team of experts contributing to the project, there was general consensus that the only acceptable system for an American election would be an end-to-end verifiable (E2E-V) voting system.</p> <div class="customSidebar" style="float: left;width: 300px;"> <img align="" alt="Ron Bandes" src="image.aspx?id=10360&amp;width=355&amp;height=237" /> <p> Ron Bandes, cybersecurity expert and Heinz College alumnus</p> </div> <p> &ldquo;The [Heinz] students were asked to do research on existing systems and to put together a competitive analysis,&rdquo; said Dzieduszycka-Suinat, remarking that the students&rsquo; analysis was slotted into the final report on the topic. &ldquo;[Their work] was very helpful and it showed us that the state of play in E2E-V systems is poor. It was extremely useful to have that contribution. It was something that we would never have had enough time for, and it gave great headway.&rdquo;</p> <p> The intent of the project was to research and lay the groundwork for a prototype E2E-V Internet voting system that could be both secure and scalable to national elections. The Heinz students found that current technologies were insufficient in fundamental ways&mdash;usability was a major area of deficiency&mdash;and could not meet the unique privacy and security demands of elections.</p> <p> Heinz alumnus Ron Bandes (MSISPM &rsquo;10), president of <a href="http://www.voteallegheny.org/" target="_blank">VoteAllegheny</a> and a cybersecurity expert for the Pennsylvania Joint State Government Commission Advisory Committee on Election Technology, says that where privacy is concerned, people often conflate e-commerce and voting transactions, though they are structured very differently.</p> <p> &ldquo;In fact, voting is a much more difficult security problem,&rdquo; said Bandes. &ldquo;With e-banking and e-commerce you have receipts, so you can prove the transaction. You can&rsquo;t have a receipt in voting. You can have a receipt that says, &lsquo;I voted.&rsquo; You cannot have a receipt that says, &lsquo;This is <em>how</em> I voted,&rsquo; because of the possibilities of vote buying or coercion.&rdquo;</p> <p> The gold standard in elections for years has been paper ballots for their ability to be both verified and re-counted by hand. But many states have created processes by which voters can return ballots electronically. Only five&mdash;Alabama, Alaska, Arizona, Missouri, and North Dakota&mdash;<a href="http://www.ncsl.org/research/elections-and-campaigns/internet-voting.aspx" target="_blank">allow ballots to be returned via web portal</a>. Alaska is the only state in which web-based voting is available to all eligible voters.</p> <p> Many cybersecurity experts treat Internet voting as not only a technical challenge, but also <a href="https://engineering.stanford.edu/news/david-dill-why-online-voting-danger-democracy" target="_blank">a matter of national security</a>. Recent hacks of the Democratic National Committee and several states&rsquo; voter databases have exacerbated those concerns.</p> <p> <img align="" alt="online voting hacker" src="image.aspx?id=10359&amp;width=5514&amp;height=3676" style="width: 30%; margin: 10px; float: right;" /></p> <p> MSISPM Program Director Randall Trzeciak advised the student team on the Galois project.</p> <p> &ldquo;There are risks associated with [online voting],&rdquo; said Trzeciak. &ldquo;If you ask any bank or financial institution, they write off a certain amount of fraud as a cost of doing business. There is, in my opinion, not an acceptable level of fraud that could occur in a voting process. We should have confidence that every vote would count as was intended.&rdquo;</p> <p> The students&rsquo; recommendations for the security system included robust validation of user credentials, an encrypted exchange of information from server to user and from user to database, and an audit capability that would give the voter confidence that their vote was both recorded as cast and counted in the official tally.</p> <p> &nbsp;</p> <p> <strong>Driving voter engagement at home and abroad</strong></p> <p> <img align="" alt="Pew Research voter turnout 2014" src="image.aspx?id=10357&amp;width=376&amp;height=555" style="margin: 10px; float: right; width: 30%;" /></p> <p> Working with the <a href="https://www.overseasvotefoundation.org/vote/home.htm" target="_blank">Overseas Vote</a> initiative of the U.S. Vote Foundation, another team of Heinz College students created voting information widgets for the client&rsquo;s Voter Account application. The widgets provide the voter with key election information regardless of their current physical location, meaning that an active duty servicewoman stationed in Kuwait could download the app, authenticate her identity and voting privileges, plug in her permanent address in California, and find out exactly what and who is on the ballot back home.</p> <p> In 2014, U.S. voter turnout was at its lowest since World War II, and media outlets devote a lot of attention to the voting habits (or non-habits) of members of the &ldquo;millennial&rdquo; generation.</p> <p> While millennials (roughly defined as people currently ages 18-35) <a href="http://www.pewresearch.org/fact-tank/2016/05/16/millennials-match-baby-boomers-as-largest-generation-in-u-s-electorate-but-will-they-vote/" target="_blank">have the lowest voter turnout of any age group domestically</a>, representation is far worse for overseas voters. The Federal Voting Assistance Program (FVAP) reported that only <a href="https://www.fvap.gov/uploads/FVAP/Reports/FVAP-OCPAsummarybrief.pdf" target="_blank">4 percent of eligible overseas voters cast ballots in 2014</a>, a shockingly low figure.</p> <p> Dzieduszycka-Suinat suggests that many overseas voters don&rsquo;t know their rights, and are not properly informed of their voting rights when they leave the country. Nor are they required to register with an embassy or consulate, making them difficult to track down.</p> <p> Even among the registered overseas voters who requested a ballot in 2014, the FVAP report said less than 60 percent of them confirmed they &ldquo;definitely voted.&rdquo; This is despite the fact that, according to Dzieduszycka-Suinat, absentee voting is a simpler process for an overseas voter than it is for a domestic one.</p> <p> <img align="" alt="OVF interface" src="image.aspx?id=10356&amp;width=1621&amp;height=1490" style="width: 249.297px; margin: 10px; float: left;" /></p> <p> While technology would help overseas voters stay more informed about (and possibly feel more connected to) American elections, this has clear upsides for domestic voters as well. The student deliverables to Overseas Vote included a polling location widget that uses Google Maps to guide the voter to his or her polling place, and the capability to communicate via social media features to maximize voter engagement, particularly among millennials.</p> <p> The students took steps to ensure confidence that the information being transmitted via the widgets were correct for the user, such as multi-factor authentication and other security validations that would mitigate the risk of attacks that could deliberately misinform voters.</p> <p> As an advocate for responsible voting, Bandes applauds the project, stating that it&rsquo;s good for people to be able to obtain information in the modality they&rsquo;re most comfortable with.</p> <p> &ldquo;People want to go to the polls informed about who really stands for what,&rdquo; said Bandes. &ldquo;They don&rsquo;t want buyer&rsquo;s remorse.&rdquo;</p> <p> &nbsp;</p> <p> <strong>The future of voting</strong></p> <p> In American life, there is arguably no asset more valuable than the people&rsquo;s right to vote and make their voices heard. That principle has led some experts to insist that our voting systems should be accorded the <a href="http://www.prnewswire.com/news-releases/members-of-the-aspen-institute-homeland-security-group-issue-statement-on-dnc-hack-300306004.html" target="_blank">same level of security as other critical infrastructure</a>. While Internet voting may not plausible in the immediate future, that&rsquo;s just one small piece of the puzzle. Until the technology catches up, Dzieduszycka-Suinat says that policy can start to close the gaps, such as automatically registering men and women in the armed services.</p> <p> &ldquo;You can see improvement in a lot of ways through reasonable, sensible reforms that don&rsquo;t involve risking the integrity of the ballot.&rdquo;</p>
http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3875Mon, 14 Oct 2016 13:36:00 GMThttp://www.heinz.cmu.edu/news/news-detail/image.aspx?width=250&mar=1&id=10372Heinz Students Putting Elections in Your Hands. Literally.

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Will Obamacare Survive? A Heinz Alumna Weighs Inhttp://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3879Image associated with news releaseHeinz College alumna Tara O'Neill, a Health Care Analyst with the American Action Forum, shares her view on the state of the ACA Exchanges ahead of the fourth open enrollment season under the law.

]]><p> <em>Author:&nbsp;Tara O&#39;Neill (MSPPM &#39;14)</em></p> <p> <em>(Editor&#39;s note: This content was written and provided by a guest author. The views and analysis expressed are those of the author and do not necessarily reflect the views of Heinz College, Carnegie Mellon University, their faculty, or staff.)</em></p> <p> One of the key provisions of the Affordable Care Act was the establishment of online &ldquo;Exchanges&rdquo; where consumers could purchase individual or small group health insurance plans. The law included many provisions outlining requirements that any plan sold on the Exchanges must meet, including coverage of certain services, restrictions on variations in premium rates, guaranteed renewability, and a prohibition on medical underwriting. (Some of these requirements apply to all plans, regardless of whether they are offered through the Exchange or not.) Individuals who qualify for a premium tax credit must purchase a plan sold through the Exchange in order to receive the subsidy.</p> <p> Coverage for plans sold through the Exchanges began in January 2014, and the fourth open enrollment season is quickly approaching. While it was to be expected that it would take some time to iron out the wrinkles of this new marketplace&mdash;as is the case with any new government program&mdash;it seems that even after three years, the problems persist and may be worsening. Some fear this may be the start of a &ldquo;death spiral&rdquo;&mdash;where rising premiums lead to only the sickest patients signing up, causing premiums to rise further, and so on until the market collapses.</p> <p> When consumers begin shopping for health insurance coverage for 2017 this November, just a week before the elections, many will find the premiums have increased dramatically. <a href="http://healthcare.mckinsey.com/2017-exchange-market-emerging-pricing-trends" target="_blank">Analysis</a> of currently available data finds that the average premium rate request for the lowest-cost &ldquo;Silver&rdquo; plan among national carriers is an increase of 27 percent; this follows average premium increases of <a href="http://healthcare.mckinsey.com/2016-individual-exchange-rates" target="_blank">10.8 percent</a> last year. Shoppers in <a href="http://www.tennessean.com/story/money/industries/health-care/2016/08/23/insurers-get-approval-for-2017-obamacare-rates/89196762/" target="_blank">Tennessee</a> will find premiums that have increased at least 44 percent and as much as 62 percent. But at least they will have options, right? Wrong. According to preliminary <a href="http://kff.org/health-reform/issue-brief/preliminary-data-on-insurer-exits-and-entrants-in-2017-affordable-care-act-marketplaces/?mc_cid=f7c9689d65&amp;mc_eid=71a4d8f464" target="_blank">analysis</a>, in 2017 consumers in roughly one third of the nation&rsquo;s counties (up from 7 percent in 2016) will have only a single insurer from which to purchase coverage; nearly two-thirds of the counties will be covered by no more than two insurers.</p> <p> This reduction in choice across the country is largely the result of compounding factors. Many insurers have had to exit the market because they have suffered unsustainable financial losses. Nearly all of the 23 consumer operated and oriented plans (CO-OPs)&mdash;created under the ACA as an alternative health insurance option from the well-established insurers and a compromise for the lack of a &ldquo;<a href="https://www.americanactionforum.org/daily-dish/july-11th-edition-2/" target="_blank">public option</a>&rdquo;&mdash;have <a href="https://www.americanactionforum.org/weekly-checkup/17-co-ops-failed-receiving-nearly-2-billion-taxpayer-financing/" target="_blank">collapsed</a>. The CO-OPs have been unable to cover costs&mdash;premium revenues have not been sufficient to cover medical claims&mdash;and, because the businesses were new and funded with loans from the federal government, they did not have capital reserves to weather the storm. For these CO-OPS, the Exchange business is their only business. More well-established insurers that were in the market prior to the ACA, on the other hand, have other lines of business. They can exit these unprofitable markets, absorb the losses, and continue operating elsewhere. And that is exactly what most of them are doing. While some may argue that the &ldquo;Big Five&rdquo; insurers (Aetna, Anthem, Cigna, Humana, and United) should have been able to make a profit in these markets, the fact that they have not underscores the extent of the problems. UnitedHealth Group is on track to lose more than <a href="http://time.com/money/4300900/united-healthcare-obamacare-exit/" target="_blank">$1 billion</a> between 2015 and 2016 on its Exchange plans; <a href="http://www.wsj.com/articles/aetna-tops-views-stops-aca-expansion-plans-1470134736" target="_blank">Aetna</a> is projected to lose $300 million in 2016 on its Exchange plans.</p> <p> People are not just facing higher premiums and fewer choices each year; the continued increase in the number of people enrolled in high-deductible health plans (HDHPs) leaves many people feeling like the health insurance they have is <a href="https://www.americanactionforum.org/weekly-checkup/deductibles-matter-too/" target="_blank">worth less and less</a>. More than 40 percent of individuals are now enrolled in <a href="http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur201609.pdf" target="_blank">high-deductible health plans</a> (HDHPs), up from just 25 percent the year the ACA was signed into law. The average deductible for &ldquo;<a href="https://www.americanactionforum.org/weekly-checkup/most-exchange-enrollees-will-never-reach-deductible/" target="_blank">Silver</a>&rdquo; plans is now <a href="https://www.healthpocket.com/healthcare-research/infostat/2016-obamacare-premiums-deductibles#.V9hBlPorKCg" target="_blank">$3,117</a> and the average out-of-pocket maximum is $6,110. For many people, these up-front costs pose a financial barrier to accessing care. Compounding the problem, 64 percent of <a href="http://www.beckershospitalreview.com/payer-issues/75-of-aca-plans-in-18-states-will-have-narrow-networks-next-year.html" target="_blank">provider networks</a> in 2016 are deemed &ldquo;narrow&rdquo; (having a very limited number of physicians participating in the network), and this is expected to increase to 75 percent next year. Nearly 20 percent of plans offered on the Exchange last year were found to be &ldquo;<a href="https://www.americanactionforum.org/weekly-checkup/exchange-plans-cover-limited-specialists-in-network/" target="_blank">specialist-deficient</a>&rdquo; (covering fewer than six specialists in a particular field within 100 miles). Narrow networks further complicate people&rsquo;s ability to access care, particularly individuals with chronic conditions needing specialized and more regular treatments.</p> <p> Additionally, roughly half of those enrolled in the individual market (or approximately 8 million people), are purchasing plans off the exchange. In setting premiums, insurers must consider people in the individual market, both on and off the exchange, to be in the same risk pool. If a plan is offered both on and off the exchange, it must have the same premium. Thus, when premiums for these plans increase, the individuals purchasing off-exchange bear the full cost of that increase because they are ineligible for the ACA subsidies as a result of not purchasing through the exchange.</p> <p> The bad news for the ACA, the White House, and consumers continues day after day. While the uninsured rate has dropped significantly, those with insurance are facing higher premiums, higher deductibles, reduced choice, and reduced access to care. The next administration will find it still has many of the pre-ACA health insurance problems to solve, along with plenty of new ones.</p> <p> <em>Tara O&#39;Neill is a Health Care Analyst with the <a href="https://www.americanactionforum.org/" target="_blank">American Action Forum</a>, a center-right policy think tank. This article was originally published on the AAF website.</em></p> <p> &nbsp;</p>
http://www.heinz.cmu.edu/news/news-detail/index.aspx?nid=3879Mon, 14 Oct 2016 08:58:00 GMThttp://www.heinz.cmu.edu/news/news-detail/image.aspx?width=250&mar=1&id=10449Will Obamacare Survive? A Heinz Alumna Weighs In

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