Watters 1

Katelyn Watters

Professor Jennifer Santiago

UWRT 1102-027

14 February 2017

Annotated Bibliography

Azvolinsky, Anna. Academic Medical Centers Fear Squeeze from Affordable Care Act.

Nature Medicine, vol. 20, no. 2, 2014, pp. 106106. Academic Search Complete,

doi:10.1038/nm0214-106.

In Azvolinskys article, she discusses how the ACA has created a decrease in academic

medical centers profit margins from patient care, which has notably reduced the funding

available for research. These AMCs heavily rely on profit margins, as the contributions made

from the NIH are generally subsidized and grants usually fall short by approximately 25-30%.

The impact differs by state. Tennessee has yet to expand Medicaid coverage, taking the largest

hit, as they are unable to receive the additional funding the ACA offers for providing health

coverage for low-income families. Azvolinsky also argues that it is not all due to the ACA, as the

influx of Medicare patients also contributes to lower margins as well. She concludes by stating

that pressure on the government for more funding and increased philanthropic support will likely

have the most positive impact on the future of AMCs research departments.

This article will be especially important in my inquiry paper, the author introduces an

uncommon perspective. While many peer-reviewed articles that I have discovered have been in

favor of the ACA and/or arguing against a repeal, this author focuses on the negative impact that

the ACA has had on AMC hospitals research departments. The mention of how academic

medical centers are affected by Medicare patients is important, as I want to explore all sides of
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an issue and my focus had become a bit narrowed on the impact of Medicaid, while not thinking

much about how Medicare plays a role as well. While this article mainly discusses a downfall

of the ACA, the article remains effectively unbiased, as it relays the facts in an accurate

manner without the interjection of the authors opinions which is incredibly important in my

research.

Cramer, Geri Rosen, et al. The Progress of US Hospitals in Addressing Community Health

Needs. American Journal of Public Health, vol. 107, no. 2, 2017, pp. 255261.

Academic Search Complete, doi:10.2105/AJPH.2016.303570.

Cramer focuses on how the tax-exempt hospitals are progressing in light of the

community health needs assessment (CHNA) implementation as a result of the ACA. He begins

by introducing how the ACA expanded the requirements tax-exempt hospitals face to continue to

be recognized as nonprofit, such as the application of the CHNA mandate. The CHNA is done

every three years to ensure that the hospital is doing everything that it can to meet the

communitys needs, such as promoting preventative care. The author details the controversy,

discussing that certain policy makers that believe the federal government does not have enough

regulations on the provision of the money spent on community benefits. The article then

references specific studies regarding the relationship between local health departments and

hospitals, and how these relationships affect the CHNA results. The article concludes by

discussing the CHNAs future and its optimistic outlook to improve population health.

This article is rather technical, and while it briefly introduces topics, it is written

with the assumption that the reader is relatively familiar with the terminology used and the

issues being discussed. While this alone might rule out its purpose in my paper, its complexity
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and thoroughness offers a lot of useful information and statistics that offer an alternate

perspective. While I may not use this information directly, it can be useful to further other

related claims that I may wish to make in my paper. I wish to offer many perspectives in my

paper to make it as informational as I can, and the information provided about how the ACA

affects nonprofit hospitals will be incredibly helpful, and may possibly lead me to more

information regarding this topic.

Dalen, James E., et al. Why Do So Many Americans Oppose the Affordable Care Act? The

American Journal of Medicine, vol. 128, no. 8, 2015, pp. 807810. PubMed.gov, doi :

0.1016/j.amjmed.2015.01.032.

In Dalens article Why Do So Many Americans Oppose the Affordable Care Act, he

attempts to inform the public of the primary goals of ACA, the overall positive impact that it has

had on the general American, and where the seemingly wide opposition likely stems from. He

begins by introducing the ACA and detailing the number of Americans that have acquired health

coverage since its implementation, all while referencing of statistical data that is provided

graphically in the margins. He then mentions the opposition that Americans have, referencing

studies that have been done to conclude that general Republican distrust in the government plays

a role, as well as the conservative idea that the government should not play a dominant role in

healthcare. He then thoroughly discusses the heavy impact that media has had on the public,

while referencing a study showing that 60% of Americans get their information solely from

television.

This article will be incredibly applicable to my research because the author approaches

the issue with little biases and provides a multitude of credible statistics as evidentiary

support for his claims. Dalen quotes, More than 60% of Americans have stated that most of
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what they know about the ACA came from watching TV. From this, I can draw the conclusion

that part of the problem is not only just the media, but the unquestionable trust that certain

groups of individuals have for the media. People frequently take what they hear on the news for

fact, even though most media outlets often have their own private agendas, in this case, often

disparaging the ACA and glossing over its benefits to many.

Fox, Jared, and Wanda Barfield. Decreasing Unintended Pregnancy Opportunities Created by

the Affordable Care Act. The Journal of the American Medical Association, vol. 316, no.

8, 2016, pp. 12. PubMed.gov, doi : 10.1001/jama.2016.8800.

In Fox and Barfields article Decreasing Unintended Pregnancy Opportunities Created

by the Affordable Care Act, they discuss the effects the ACA has on the decrease in unintended

pregnancies. They detail the impact access to long-acting reversible contraception (LARC) in

decreasing teenage pregnancies, as these are often related to delayed prenatal care, fetal

exposures to alcohol and tobacco, and overall poorer health outcomes for newborns. While the

ACAs coverage of contraception has been a legal battle with the Supreme Court, the ACA

explicitly states that insurers must provide coverage for contraception without cost sharing. They

conclude by stating that even though the financial barrier has been effectively eliminated, access

can still be a struggle for women due to conflicting policies regarding reimbursement for

clinicians, limited availability and unawareness. They stress that it is important that physicians

ensure women are made aware that these methods are available to them at affordable prices.

This article is helpful to my research as it discusses the ACAs coverage of contraception

which has been a controversial topic at the front lines, only being escalated due to the recent

inauguration of Donald Trump and the transition of administration. One can gather by reading

the article that many women depend on their access to contraception, and without this, it is
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highly likely that unintended pregnancy rates would increase, resulting in the need for more

patient care under the ACA. I can draw by reviewing the information provided in the article that

since teenagers are less likely to receive timely prenatal care, it will only result in higher

healthcare costs once the baby is born due to the poorer health outcomes of the newborn.

Jost, Timothy S. A Critical Year For The Affordable Care Act. Health Affairs, vol. 35, no. 1,

2016, pp. 811. Academic Search Complete, doi:10.1377/hlthaff.2015.1458.

Josts article A Critical Year For The Affordable Care Act, discusses how 2016 has

been a turning point, or watershed for the ACA. He begins by discussing the advantages that

the ACA has had for many lower income families and the significant reduction in uninsured

Americans. He discusses the components making up the ACA, such as the lack of coverage

penalties, affordability, Medicare and Medicaid and concludes by discussing the future of the

ACA post-election. Jost broadly introduces current issues affecting the ACA, and also mentions

upcoming Supreme Court rulings, such as the legality of religious organizations denying their

employees contraception coverage. The author provides this information to relay the fact that the

ACA has come a long way since its implementation, with many of the kinks having been

smoothed, while also discussing the reduction in benefits proposed by Republicans.

This article is especially comprehensive, broaching a wide number of topics backed

by credible information that will be useful in my paper. While this article is a bit outdated, as it

was published prior to the transition from the Obama administration to the Trump administration,

it is still relevant for my inquiry paper since it provides factual information about the ACA.

While this article does appear in a medical journal, it is relatively easy to understand,

which leads me to believe this was written not only for healthcare professionals but to
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anyone seeking up to date information about the ACA and its future direction. It is broad,

yet remains detailed enough to provide adequate information for someone who is not

knowledgeable on the subject to be able to comprehend the intended message.

Knopf, Alison. How ACA Repeal Could Hurt Treatment. Brown University Child &

Adolescent Behavior Letter, vol. 33, no. 2, 2017, pp. 77. Academic Search Complete,

doi:10.1002/cbl.30193.

Nowak, Sarah A., et al. Alternatives to the ACA's Affordability Firewall. Rand Health

Quarterly, vol. 5, no. 4, 2016. PubMed.gov, https://www-ncbi-nlm-nih-

gov.librarylink.uncc.edu/pmc/articles/PMC5158218/.

Westmoreland, Timothy M. The Affordable Care Act in the United States and HIV Disease:

Past, Present, and Future. Topics in Antiviral Medicine, vol. 24, no. 2, 2016, pp. 98102.

PubMed.gov, http://www.iasusa.org/sites/default/files/tam/24-2-98.pdf.

Why Do We Need the Affordable Care Act? The American Public Health Association, Aug.

2012, www.apha.org/~/media/files/pdf/topics/aca/why_we_need_the_aca_aug2012.ashx.

Wilensky, Gail R. How Will Public Health Fare in a Trump Administration? American

Journal of Public Health, vol. 107, no. 2, 2017, pp. 235237. Academic Search Complete

[EBSCO], doi:10.2105/AJPH.2016.303594.