Expanding dependent coverage for young adults: lessons from state initiatives

The Patient Protection and Affordable Care Act (ACA) requires that adults up to age twenty-six be permitted to enroll as dependents on their parents' health plans. This article examines the experiences of states that enacted dependent expansion laws. Drawing on public information from thirty-one enacting states and case studies of four diverse reform states, it derives lessons that are pertinent to the implementation of this ACA provision. Dependent coverage laws vary across the states, but most impose residency, marital status, and other restrictions. The federal Employee Retirement Income Security Act further limits the reach of state laws. Eligibility for expanded coverage under the ACA is much broader. Rules in some states requiring or allowing separate premiums for adult dependents may also discourage enrollment compared with rules in other states (and the ACA), where these costs must be factored into family premiums. Business opposition in some states led to more restrictive regulations, especially for how premiums are charged, which in turn raised greater implementation challenges. Case study states did not report substantial young adult dependent coverage take-up, but early enrollment experience under ACA appears to be more positive. Long-term questions remain about the implications of this policy for risk pooling and the distribution of premium costs.     

Socioeconomic status,unemployment experience,and political participation: A disentangling of main and interaction effects

A clarification of the effects of unemployment on political participation attitudes and behaviors is developed by contrasting the effect of unemployment experience across categories of socioeconomic status. Data on employed and unemployed heads of household are drawn from the 1976 University of Michigan national presidential election survey. The results indicate both main and interaction effects. Regardless of employment status, lower socioeconomic status respondents are less committed to voting, feel less efficacious, are less interested in politics, and are less politically active than persons of higher status. However, participation attitudes and behaviors are more adversely affected by unemployment experience among those of lower than higher status. Among higher status respondents, attitudes toward self (i.e., feelings of efficacy) and political interest—but not political activity or attitude toward the importance of participation—are altered by unemployment.An earlier version of this paper was presented at the Southwestern Sociological meetings in Ft. Worth, Texas, March 1979.     

Sudden and suspicious deaths outside the deceased's own country — Time for an international protocol

Increased leisure time, international business commitments, and ease of travel have led to an increased incidence of sudden deaths outside the deceased's own country.Methods of investigation of sudden death, and the extent of such enquiries, vary greatly from country to country. The relatives of the deceased frequently make serious allegations relating to the circumstances of the death when they return to their homeland, and when the body is repatriated, a local pathologist may be directed to make an examination. This is frequently limited by inadequate police information, inadequate preservation of the organs and the absence of any autopsy report.Examples of these difficulties are presented, and suggestions offered for a basic protocol for the examination and report upon the death of a foreign national.Following the presentation of this paper at the International Association of Forensic Sciences Meeting in Bergen, considerable discussion took place and there have been further developments in the United Kingdom. These are briefly reported.