Milbank Quarterly最新文献

{"title":"Longitudinal Associations From US State/Local Police and Social Service Expenditures to Suicides and Police-Perpetrated Killings Between Black and White Residents.","authors":"Devin English, Ty A Robinson, Lori S Hoggard, Felix M Muchomba, Sharifa Z Williams, Joel C Cantor, Paul R Duberstein, Brett M Millar","doi":"10.1111/1468-0009.70018","DOIUrl":"https://doi.org/10.1111/1468-0009.70018","url":null,"abstract":"<p><p>Policy Points Despite documented inequities in suicide trends and police-perpetrated killing for Black compared with White Americans, government expenditures have not been examined as upstream drivers of these inequities. This longitudinal study found police expenditures predicted increases in suicide and police-perpetrated killings for Black, but not White, residents. Housing and community development expenditures were associated with decreases in suicide for Black residents only, and kindergarten through 12th grade (K-12) education expenditures were associated with decreases in suicide for White residents only. Findings suggest reducing police, and increasing housing, expenditures may reduce Black-White inequities in suicide and police-perpetrated killing.</p><p><strong>Context: </strong>Despite documented inequities in suicide trends and police-perpetrated killing for Black US Americans, there is little research investigating how structural factors like government expenditures may drive these outcomes. This study examined associations from police and social services expenditures to later suicides and police-perpetrated killings for Black and White residents.</p><p><strong>Methods: </strong>This longitudinal study analyzed 2010-2020 US Census of Governments-tracked state and local government expenditures and Centers for Disease Control and Prevention (CDC)-tracked years of potential life lost (YPLL) to suicide and police-perpetrated killing. Dynamic structural equation models estimated 1- and 5-year lagged associations. Models adjusted for reverse associations (i.e., violent death to later expenditures) and state-level variables including Medicaid expansion, Black-White population, racial residential segregation, political representation, overall expenditures, state firearm policies, and firearm violence rates.</p><p><strong>Findings: </strong>For suicide, every $100 increase in per capita police expenditures was associated with 35 more YPLL 1 year later (γ = 0.35, 95% credible interval [CI] 0.02-0.90) and 28 more YPLL 5 years later (γ = 0.28, 95% CI 0.001-0.55) per 100,000 Black residents. For police-perpetrated killings, every $100 increase in per capita police expenditures was associated with 7 more YPLL 1 year later (γ = 0.07, 95% CI 0.02-0.12) per 100,000 Black residents. As such, a $100 per capita increase in annual police expendiutres translated to 14,385 more YPLL to suicide, and 2,877 more YPLL to police-pepetrated killing, 1 year later for the United States' 41.1 million Black residents. There were no associations between police expenditures and outcomes for White residents. Conversely, every $100 increase in per capita housing and community development expenditures was associated with 29 fewer YPLL to suicide 5 years later per 100,000 Black residents (γ = -0.29, 95% CI -0.53 to -0.05). Every $100 increase in per capita kindergarten through 12th grade (K-12) education expenditures was associated with 4 fewer YPLL to suicide 1 ye","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"State Health Care Cost Commissions: Their Priorities and How States' Political Leanings, Commercial Hospital Prices, and Medicaid Spending Predict Their Establishment.","authors":"Brent D Fulton, Daniel R Arnold, Jordan M Wolf, Richard M Scheffler","doi":"10.1111/1468-0009.70019","DOIUrl":"https://doi.org/10.1111/1468-0009.70019","url":null,"abstract":"<p><p>Policy Points States are concerned about rising health care spending, and this study identifies states that have established health care cost commissions and describes the political and economic factors associated with their establishment. As of August 2024, 17 states had established commissions to reduce the growth of health care spending using various methods, including setting spending growth targets. Politically Democratic states and those with higher commercial hospital prices and higher Medicaid spending were more likely to establish such commissions. Because federal health care reform is difficult to enact, states are enacting their own reforms, tailored to their needs and political feasibility.</p><p><strong>Context: </strong>States are becoming increasingly concerned about rising health care spending because it crowds out budgets for education and other obligations and it burdens consumers, exposing them to medical debt and bankruptcies. This study identifies states that have established health care cost commissions (HCCCs), examines state-level political and economic factors associated with their establishment, and reports which of these states have also enacted health care competition-related laws that further equip these commissions.</p><p><strong>Methods: </strong>To identify states with HCCCs and competition-related laws, we reviewed prior reports, supplemented by our own research on state websites and from organizations that track state-level legislative and executive activity in health care. We estimated a regression model to understand how political and economic factors are related to these commissions being established.</p><p><strong>Findings: </strong>As of August 2024, 17 states had established HCCCs that aim to reduce the growth of health care costs using a variety of methods, such as collecting health care use and spending data and setting spending growth targets. States that lean politically Democratic were more likely to establish these commissions, particularly those states with higher commercial hospital prices or higher Medicaid spending as a share of the state budget, or both. States with HCCCs have also enacted competition-related laws but to varying degrees.</p><p><strong>Conclusions: </strong>Because health care reform is difficult to enact at the federal level, many states are enacting their own reforms, tailored to their needs and political feasibility with many establishing HCCCs to limit health care spending increases. Future research should study the impact of these commissions on health care spending that increases short-term spending yet moderates long-term spending, including the feasibility and impact of increased spending on primary care services as well as the impact of spending on new health care technologies.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for and Barriers to Communicating About Health Equity in Challenging Times: Qualitative Interviews With Public Health Communicators.","authors":"Sarah E Gollust, Kristina Medero, Quin Mudry Nelson, Ceron Ford, Erika Franklin Fowler, Jeff Niederdeppe, Rebekah H Nagler","doi":"10.1111/1468-0009.70022","DOIUrl":"https://doi.org/10.1111/1468-0009.70022","url":null,"abstract":"<p><p>Policy Points Public health communicators in practice discuss health equity issues in a competitive information environment. Through interviews with 36 communicators from diverse professional perspectives (i.e., journalists, advocates, public health leaders) in 2022-2023, we illuminated key challenges they face and strategies and resources that might mitigate these challenges. Findings can inform communication research priorities and investment in resources to help practitioners communicate about health equity amid a challenging political landscape.</p><p><strong>Context: </strong>Communicating about health equity is increasingly challenging in light of a changing information environment and the emergence of opposition to equity and equity-related concepts since 2020. Public health communicators often discuss health equity-related concepts, but it is not clear what strategies they use or what resources can support them to overcome challenges they face.</p><p><strong>Methods: </strong>We conducted qualitative interviews (N = 36) with communicators across four professional categories (public health leaders, journalists, thought leaders, and health advocates/organizers) from late 2022 to mid-2023 to discuss the strategies they employ; the challenges or barriers they face related to audiences, their institutions, or the broader communication landscape; and the resources they rely on, including their social networks, toolkits or guides, trainings, and research.</p><p><strong>Findings: </strong>Communicators use a range of strategies to explain health equity, the causes of disparities, and the imperative of solutions; data and stories were common approaches used, although these strategies were not considered a panacea. They also face consistent challenges, such as concerns about audience resistance, lack of public understanding of terminology, and a fragmented communication landscape-and for journalists in particular, institutional barriers and the challenge of identifying diverse sources. Communicators rely on a range of resources, though mainly colleagues and interpersonal support, with the use of research-based resources being relatively uncommon. Although there were commonalities among public health leaders' and advocates' approaches, journalists' concerns and resources were often different.</p><p><strong>Conclusions: </strong>Communicators could benefit from more research to confirm or offset some of their concerns (such as the potential for resistance from the use of key phrases, like \"systemic racism,\" or unintended consequences of using disparities data); researchers must also disseminate this work to these practitioners, including journalists. Academic researchers, foundations, and nonprofit organizations all can play roles in building infrastructure for resource sharing, research dissemination, and convening communicators to build stronger connections and support.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Who Enrolls in Coverage and Who Remains Uninsured? Medicaid Take-Up Before and After the Affordable Care Act and During Unwinding.","authors":"Rebecca Brooks Smith, Gabriella Aboulafia, Benjamin D Sommers","doi":"10.1111/1468-0009.70020","DOIUrl":"https://doi.org/10.1111/1468-0009.70020","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Policy Points The Affordable Care Act (ACA) dramatically expanded Medicaid eligibility in participating states. However, many eligible individuals remain uninsured because they do not enroll in (or \"take up\") coverage. The unwinding of the pandemic continuous enrollment provision in 2023-2024 further raised the importance of this issue. After the ACA, we found a significant increase in Medicaid take-up among eligible individuals across all eligibility pathways; these gains persisted into 2023, which coincided with the beginning of the unwinding. However, important vulnerabilities in enrollment are still apparent, including a steep drop-off in take-up when children become young adults and persistent lower take-up among childless adults and residents of nonexpansion states. These findings can guide policies in the postpandemic post-ACA era and suggest that efforts to reduce outreach or scale back the ACA will threaten coverage for many Medicaid beneficiaries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;Many uninsured individuals in the United States are eligible for Medicaid but not enrolled. The Affordable Care Act (ACA) expanded Medicaid eligibility starting in 2014, streamlined enrollment, and boosted outreach. During the 2020 COVID-19 pandemic, states were required to provide continuous coverage to Medicaid enrollees, a policy that ended in April 2023, with resulting coverage losses during the \"unwinding\" of this policy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Using household data from the American Community Survey and state-level eligibility criteria, we assessed Medicaid participation among US citizens younger than 65 years old who either had Medicaid coverage or no insurance. We compared results before the ACA (2008-2010), after the ACA (2017-2019), and during \"unwinding\" (2023). We utilized logistic regression to identify predictors of take-up in each of these time periods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;The national take-up rate among Medicaid-eligible individuals rose from 76.5% before the ACA to 85.0% after the ACA. These gains persisted in 2023 as unwinding began, when take-up was slightly higher (86.5%) than before the pandemic. Post-ACA participation was highest among eligible children; Asian American, Pacific Islander, and Native Hawaiian and Black individuals; and residents of expansion states. Participation was lowest among adults ages 19-21 years old, American Indian and Alaska Native (AI/AN) individuals, employed adults, and those facing premiums for Medicaid coverage. Take-up improved post-ACA in both more and less deprived neighborhoods, whereas urban areas saw greater growth in take-up than rural areas.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;From the pre- to post-ACA period, Medicaid take-up rates among eligible individuals increased, and these gains persisted during the beginning of the unwinding period, potentially reflecting increased outreach efforts under the Biden administration. However, areas of vulnerability remain among young adult","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward Monitoring and Addressing the Commercial Determinants of Health: Where Can We Go From Here?","authors":"Raquel Burgess, Tanja Srebotnjak, Christine Lin, Lawrence Grierson, Daniel C Esty, Yusuf Ransome, Nicholas Freudenberg","doi":"10.1111/1468-0009.70012","DOIUrl":"https://doi.org/10.1111/1468-0009.70012","url":null,"abstract":"<p><p>Policy Points We describe ways to advance two key priorities related to the commercial determinants of health (CDH): the development of systems to monitor commercial practices and the creation of policy recommendations to address the CDH. Specifically, we discuss corporate nonfinancial reporting as a potential mechanism to obtain data on commercial practices that influence population health, describe the potential risks and benefits, and propose opportunities to advance high-quality corporate reporting on health impacts. We also review previous global agenda-setting exercises to suggest five key considerations to inform the World Health Organization's forthcoming policy recommendations for addressing the CDH.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitators of, Barriers to, and Innovations in the Implementation of the Trauma Recovery Center Model for Underserved Victims of Violent Crime in Los Angeles County.","authors":"Annette M Dekker, Adrian Yen, Andrea Larco Canizalez, Yesenia Perez, David Salazar, Bita Ghafoori, Dorit Saberi, Breena R Taira","doi":"10.1111/1468-0009.70017","DOIUrl":"https://doi.org/10.1111/1468-0009.70017","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Policy Points California government codes 13963.1 and 13963.2 guide the funding and implementation of the Trauma Recovery Center model to provide mental health treatment and case management to underserved victims of violent crime. In Los Angeles County, Trauma Recovery Centers successfully engage underserved victims of crime and improve posttraumatic stress disorder (PTSD) symptoms, quality of life, and social needs for those who receive care. The sustainability of the Trauma Recovery Center model is threatened by current funding policies, including a 2-year grant cycle. California legislators should consider greater flexibility in spending and alternatives to the current model of funding, including integrating the model into continuous care systems CONTEXT: Victimization is widespread in the United States. Marginalized communities are at higher risk of violence and are less likely to receive victim services despite dedicated funding through policies such as the Victims of Crime Act. In California, legislation supports the Trauma Recovery Center (TRC) model, which provides comprehensive mental health and case management services to underserved victims of violent crime. The objective of this study is to describe the implementation of the TRC model in Los Angeles (LA) County.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used an explanatory sequential mixed methods approach to assess implementation of five TRCs in LA County between 2021 and 2023. Descriptive analyses included process and outcome metrics. A Wilcoxon signed-rank test was used to assess the difference between pre- and postassessment measures, including change in the Posttraumatic Stress Disorder (PTSD) Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), World Health Organization Quality of Life (WHOQOL), and social needs. Subsequent qualitative interviews of TRC staff were conducted to identify drivers of process and outcome metrics. Interviews were guided and analyzed using the Consolidated Framework for Implementation Research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;There were 1,662 victims who received care at the TRCs; they were predominantly female (78.6%, n = 1,174) and Latinx (68.1%, n = 970) and had less than a high school education (41.7%, n = 561). Mean PTSD Checklist for the DSM-5 scores improved from 42.3 to 27.6 (p &lt; 0.001), and WHOQOL scores improved by at least 0.8 points across each domain (p &lt; 0.001). A total of 36 TRC staff members participated in interviews that revealed four themes: 1) clients have complex mental health needs, 2) social needs are compounded by a limited safety net, 3) implementation varies by existing infrastructure and leadership, and 4) funding restrictions limit care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The TRC model brings comprehensive care to underserved victims of crime, with improvements in PTSD symptoms and quality of life. Funding concerns were the central limitation in model implementation according to TR","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Policy and Regulatory Framework to Promote Care Delivery Redesign and Production Efficiency in Health Care Markets.","authors":"Dennis P Scanlon, Jillian B Harvey, Cheryl L Damberg, Pratiksha Mahendra Bhagat, Yunfeng Shi","doi":"10.1111/1468-0009.70016","DOIUrl":"https://doi.org/10.1111/1468-0009.70016","url":null,"abstract":"<p><p>Policy Points Antitrust enforcement has been too narrowly focused on predicting postmerger market share and not enough on the likely impact of mergers and acquisitions on production efficiency and quality. Care delivery redesign is a term that captures various innovations and changes in the organization and delivery of health care, which may lead to increased production efficiency and improved quality of care. Regulators and policymakers can use the framework to develop empirical measures to assist in understanding changes in production processes as well as in resultant outcomes. Significant opportunities exist to improve data collection and require reporting to better assist regulators with antitrust enforcement and help policymakers create effective legislation. Examples include improving compliance with required hospital and insurer transaction price data reporting, growing the availability of all-payer claims databases, improving existing Medicare cost reporting, and achieving consensus on quality measures that are best used to measure the impact of consolidation. There is a fundamental need to systematically track health care organizations and their affiliations and component parts (e.g., hospitals, physician practices, skilled nursing facilities, etc.) longitudinally, especially as organizations expand across markets and state boundaries and are owned by various entities, including private equity.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicaid's Role in Addressing the Mental Health and Substance Use Disorder Challenges of Its Members.","authors":"Kate McEvoy, Hannah Maniates","doi":"10.1111/1468-0009.70010","DOIUrl":"https://doi.org/10.1111/1468-0009.70010","url":null,"abstract":"<p><p>Policy Points Improving care for people with mental health (MH) and substance use disorder (SUD) conditions is a top priority for Medicaid leaders. Medicaid has often led the way for Medicare and other payers in coverage of MH and SUD services and in modeling the applied practice of cross-disciplinary work, but there is more work to be done to develop a comprehensive, community-based system of care for MH and SUD conditions. Medicaid's work in MH and SUD conditions is both standard bearing and an important work in progress.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Shadow Price of Uncertainty: Consequences of Unpredictable Insurance Coverage for Access, Care, and Financial Security.","authors":"Mark Schlesinger, Deepon Bhaumik","doi":"10.1111/1468-0009.70006","DOIUrl":"https://doi.org/10.1111/1468-0009.70006","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Policy Points Health insurance reform in the United States has fostered enrollment to promote access to care and reduce financial insecurity. However, enrollees' inability to reliably predict what insurance will cover (a.k.a. \"coverage uncertainty\") impedes these goals, often as much as being uninsured. The Patient Protection and Affordable Care Act initially expanded enrollment and reduced coverage uncertainty. After the mid-2010s, trends in coverage uncertainty plateaued, and it now impedes access to care for four times as many households as lack of health insurance. A variety of policies can moderate coverage uncertainty, but other popular reform strategies exacerbate it instead. Our findings suggest that structural reforms represent the most promising remedial strategies, particularly those that can enhance support for households negotiating coverage denials with insurers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Context: &lt;/strong&gt;Health insurance reform in the United States has focused on expanding enrollment, a goal inhibited by complex insurance provisions. Research documents this complexity and shows how it increases consumers' challenges in anticipating needs and making informed choices, potentially deterring policy purchases. Little is known about how coverage uncertainty impacts those who have insurance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Drawing on a multiwave survey with nationally representative data, we assessed consumer experiences and expectations in 2009, 2014, and 2021. Respondents identified (a) worries about the reliability of health insurance coverage, and (b) experiences of insurance not covering major medical expenses. Respondents also reported on three health care-related experiences-whether they delayed access to needed care, had been unable to effectively care for chronic health conditions, or felt anxious about future medical expenses. We estimated regressions associating metrics of coverage uncertainty with the three health care-related outcomes, controlling for socioeconomic status and other household characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Of American households, 32% reported intense worry about coverage reliability in 2009. This declined to 27% in 2014, then rebounded to 31% in 2021. Experiences of coverage shortfalls followed a similar pattern, declining from 27% to 17%, then rising back to 21%. Coverage uncertainty has statistically significant associations with all three outcomes, with access being the most sensitive to low-level uncertainty. By 2021, coverage uncertainty deterred timely access in care for one in five American households, five times as many as among the uninsured.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Coverage uncertainty has become the predominant barrier to timely access. It also disrupts care for chronic conditions and exacerbates anxiety over medical expenses. These harms can be reduced. However, several popular health care reform strategies instead exacerbate coverage uncertainty. We explicate these overlo","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping Mental Health Across US States: the Role of Economic and Social Support Policies.","authors":"Rachel Donnelly, Mateo P Farina","doi":"10.1111/1468-0009.70015","DOIUrl":"https://doi.org/10.1111/1468-0009.70015","url":null,"abstract":"<p><p>Policy Points This perspective argues that state economic and social support policies are key determinants of population mental health. Key policy successes of the past decade include state expansion of Medicaid eligibility, increase in minimum wage, and implementation of paid sick leave. Key policy priorities include the prioritization of evidence-based policies that improve economic security and the expansion of social support policies that are not tied to employment.</p>","PeriodicalId":49810,"journal":{"name":"Milbank Quarterly","volume":" ","pages":""},"PeriodicalIF":4.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}