Relocating health behaviors within a political-economic framework, this article utilizes health behavior and health insurance governance perspectives to showcase the complexities of cultural and economic factors (e.g., job lock, wage differentials, social location, and health insurance status) that influence choices in efforts to mitigate the financial burden of health risk. By exploring the financial links to health behaviors that emerged through ethnographic participant observation and semistructured interviews with community and union members of the United Steelworkers and Retail, Wholesale, and Department Store Union in a metropolitan Central Appalachian community in 2007–8, this article argues for expanding the health behaviors concept to include a broader array of actions individuals and families take to better their health and well-being in the context of neoliberal shifting of risk management to individuals through increased consumer market-based cost-sharing health insurance disincentives. In so doing, this article argues for the importance of social and political-economic context in health behaviors and in evaluating health policy, including the Affordable Care Act.

What is the importance of political speechmaking? Do state governors discuss presidential priorities? This study addresses these questions by analyzing the contents of annual State of the State addresses given by governors from 2012 to 2014 during the presidency of Barack Obama. A descriptive paper provides evidence that governors primarily discuss employment and economic issues in their addresses, are discussing greater number of policy issues than in previous decades, and are delivering their address before the presidential State of the Union message. Examining health care and immigration policy in separate empirical papers, I theorize that contextual factors, including legislative partisanship, public approval, and presidential influence may affect the extent to which policies supported by the Obama administration are rhetorically referenced by governors. Empirical analyses found limited support for the influence of divided government, but demonstrated significant evidence for the importance of including state-centric factors, including annual employment rate and proximity to Mexico, as well as temporal effects, into future analyses of gubernatorial rhetoric.

The human papilloma virus (HPV) is the most frequent cause of sexually transmitted diseases (STDs) and cancers for U.S. adults. The Affordable Care Act (ACA), enacted in 2010, eliminated copay expenses for childhood immunizations and expanded access to health care. The purpose of this secondary data analysis study was to determine if there was an association between ACA and the usage of HPV vaccine among adolescent females in Georgia. Data concerning HPV vaccinations from 2011 to 2015 were obtained from the National Immunization Survey-Teen dataset. Andersen's BM of health care use was applied to ascertain the factors that enhanced the usage of HPV vaccine. Multiple logistic regression analysis was used to determine if there was any association between ACA and HPV vaccination. The study results showed a significant association between ACA and provider visit (p<.05). Also, provider visit was significantly associated with HPV vaccination rate (p<.05). Adolescent females with health insurance had a higher rate of provider visit after the passage of ACA. From 2011 to 2015, 87.2% of insured adolescent females visited their provider. The rate of HPV vaccination increased among the insured adolescent females who visited the provider from 35.3% in 2011 to 53.9% in 2015. Provider visit was identified as the most influencing factor that enhanced usage of HPV vaccine. The knowledge gained from the results contributed to social change by providing insight on how, through increased provider visits, ACA has improved the HPV vaccination rate among teenage females in Georgia. The conclusion will assist in developing effective strategies and policies that will achieve the Healthy People 2020 goal of 80% of herd immunity against HPV.

Health care costs for small businesses have been rising annually for the past few decades. Congress voted to pass the Affordable Care Act (ACA) to lower the cost of health care in 2010. The purpose of this phenomenological study was to explore small business owners' experiences in implementing ACA requirements and how the ACA affects small businesses as their owners work to make these organizations profitable. Complex adaptive systems theory formed the conceptual framework for this study Data were gathered during face-to-face and telephone interviews with a sample of 20 small business owners in the Philadelphia region. The research questions focused on participants' experiences with the ACA and changes made to their business model to maintain profits throughout the implementation process. A modified version of the Van Kamm data process assisted in finding themes within the data collected and analyzed using descriptive coding. Following data analysis, member checking was used to establish the trustworthiness of the outcomes. The themes that emerged indicated that small business owners adjusted their strategies because of ACA implementation but were concerned about the healthcare needs of their employees. This study may promote positive social change by informing small business leaders about ways to create efficient and inventive prototypical solutions specific to the needs of the business community, as well as ways to improve profitability. Both employees and employers may benefit.

The Patient Protection and Affordability Act of 2010 (PPACA) addressed the access to healthcare in the United States. One of the problems of this healthcare access was rooted in disproportionally lower access among minority populations. The purpose of this quantitative study, guided by the consumer behavior theory, was to examine the association between race/ethnicity and enrollment within the Covered California-?¢ (CoveredCA) Insurance Exchange. A cross-sectional study design was used to investigate the association between race/ethnicity and the use of Covered CA health benefit exchange. Logistic regression analysis was used to examine the relationship between enrollment and race/ethnicity, having adjusted for covariates of age, gender, and literacy. The results revealed that, while all other race/ethnicity groups were less likely to purchase Bronze level versus Silver and above coverage compared to the Hispanic race/ethnicity, Asians (OR =1.16, 95% CI: 1.11, 1.20) and Whites (OR = 1.12, 95% CI: 1.02, 1.14) were more likely to purchase Bronze level versus Silver and above coverage compared to the Hispanic group. Chi-square test results indicated a statistically significant difference in the proportion of individuals selecting the Bronze level coverage compared to the Silver and above among the various race/ethnicity groups ï?£2 (13, N= 763,531), 1922.083, p < 0.0001. The Hispanic race/ethnicity was more likely to enroll in the Bronze versus Silver and above compared to other race/ethnicities. The results of this study may contribute to positive social change by informing policy that besides income and age, race/ethnicity is an important determinant of the likelihood of enrollment in the Covered CA health exchange.

Low-income affordable housing remains an issue for the town on Martha's Vineyard where this study was conducted, in which an estimated 54% of low-/moderate-income households spend more than 50% of monthly income on housing. Using Schneider and Ingram's work regarding the social construction of target populations as the foundation, the purpose of this qualitative research was to assess how the perceived social standing and political power contributed to determining the benefits and burdens allocated to the town's low-income households. Data for this study consisted of 14 individual semistructured interviews with members of low-income households who were seeking or in affordable housing. The research concentrated on the obstacles and reactions the low-income households experienced in the quest for affordable housing. Data were coded and analyzed using a value coding procedure followed by thematic analysis. Three themes emerged from the research: a perception by the participants of not being valued in the community and a lack of attention by town leadership to their affordable housing struggles; a self-reliance to find affordable housing; and coping strategies by renting bedrooms with shared kitchen and living areas or resorting to a 9-month lease and being displaced during the summer tourist season. The research illuminated the low-income community's housing experiences and perceptions, thereby helping town leaders to form housing policy and make fiscal decisions. The implications for positive social change include recommendations to town leadership to examine incentivizing homeowners to offer affordable rentals, investigating congregate housing solutions, and developing multifamily affordable housing for the town's low-income households.

The Patient-Centered Medical Home (PCMH) is an innovative, team-based health care model that was applied during the implementation of the Affordable Care Act (ACA). However, the competencies for PCMH health care social worker team members are not identified within this model. Thus, the purpose of this phenomenological study focused on identifying the core competencies that will enable social workers to perform competently in PCMHs. This study also explored the roles and training needs as related to improving the competence of social workers. Sandberg's and Parry's conceptualization of the competency model was used as the theoretical framework. Data were acquired through interviews with 10 PCMH social workers. These data were then inductively coded and analyzed using a modified Moustakas method. Key findings indicated that these social workers believed that improvements in competencies may include training and knowledge with mental health and physical health knowledge which consist of diagnoses, interventions, medications, symptoms, and terminology. It was also noted that knowledge of evidence-based practices for mental health interventions and patient-centered, team-based principles were essential to ACA policy implementation. The positive social change implications of this study include recommendations to health care leadership, educational institutions, and other PCMH providers to develop competency-based training for social workers. Recommendations are also put forth to adapt social work curriculum to ensure the effective implementation of the principles of the ACA policy and to improve social work practice in PCMH health care settings.

The Indian urban rental market is complex and yet ever-changing, with the ups and downs of housing demand playing a fundamental role in the affordability and stability of the market. This paper determines the income and price elasticities of demand using the demand function and Slutsky equation, respectively, for the urban rental market in order to help craft suitable national housing policy. Through this analysis, it is determined that the urban rental price elasticity of demand is -0.93 and the income elasticity is 0.81, suggesting that rental price subsidies and private income taxes are the most effective policy measures to ensure affordability in urban India.

An analysis of the evolution of the Commerce Clause, the Justices on the Supreme Court, and the arguments presented in this case indicate that the minimum coverage provision of the Patient Protection and Affordable Care Act will be struck down. Although the Court will likely be split 5 to 4 along ideological lines, each of the justices will have a unique rationale behind their decision. Chief Justice Roberts, Justice Scalia, and Justice Kennedy were heavily targeted by both parties’ oral and written arguments because there was speculation that any one of these traditionally conservative justices could be the fifth vote to uphold the individual mandate. However, it does not appear likely that the federal government supported their claims well enough to yield such a result. Instead, the Court will respond in the negative to the issue of "Whether Congress had the power under Article I of the Constitution to enact the minimum coverage provision." The Court’s interpretation of the Congress' commerce power has undergone two major expansions since the Constitution was ratified, and both of these expansions were met with a contractionary response to prevent the commerce clause’s growth into an unchecked power. This Court will not open a new frontier of power for the Congress, but rather it will respect the limits on Congressional power established by the Rehnquist Court.

Sheltering has been one of the basic rights of human beings during the history of civilization. As it is stated in the Article 25 of Universal Declaration of Human Rights, dated 1948, housing right is one of the basic human rights. Therefore, housing is always taken as one of the core issues for the life of individuals and states undertake this matter on behalf of its citizens. However, a full supply of proper housing to meet the housing need of particularly low income groups is still an unresolved issue in many countries. Therefore, states take different actions for the solution of the issue. In Turkey, TOKI has become the single authority in meeting the housing need of lower income households. Within this context, this thesis focuses on the adequate supply of housing in meeting housing need in provinces and searched for the housing provision of TOKI as a governmental agency and a significant housing provider. In order to show this, a case study was conducted on provinces in Turkey by comparing the total number of dwelling units and dwelling units provided by TOKI with newly formed households / in addition by calculating the number of dwelling units per 1000 households per year. The case study covered the populations and annual housing starts in the municipalities of 81 provinces. The hypothesis of the thesis that expects to find mismatch between housebuilding by TOKI, which produces housing on publicly owned land, and housing need is not fully confirmed in this study. It appears that TOKI has intensified producing housing in many eastern and south-eastern provinces where the number of authorized housing built has been less than the need.