JAMA Health Forum最新文献

{"title":"Medicaid Lesser-of Rules and Disparities in Skilled Nursing Facility Quality.","authors":"Kalli G Koukounas, Fangli Geng, David C Grabowksi, Kali S Thomas, Vince Mor, Momotazur Rahman, Cyrus M Kosar","doi":"10.1001/jamahealthforum.2026.3736","DOIUrl":"10.1001/jamahealthforum.2026.3736","url":null,"abstract":"<p><strong>Importance: </strong>Individuals dually eligible for Medicare and Medicaid have historically faced barriers to accessing high-quality skilled nursing facilities (SNFs) for postacute care. One factor potentially contributing to this disparity is that dually eligible individuals yield lower margins than Medicare-only beneficiaries due to the widespread adoption of lesser-of rules by state Medicaid programs; these rules allow states to provide little to no reimbursement for Medicare coinsurance among these patients.</p><p><strong>Objective: </strong>To examine the association of lesser-of rules with disparities in access to high-quality SNFs between dually eligible and Medicare-only beneficiaries.</p><p><strong>Design, setting, and participants: </strong>This cross-sectional study included discharges from a hospital to an SNF financed by traditional Medicare in the US from January 1, 2018, to December 31, 2022. Discharges of individuals already residing in an SNF before hospitalization were excluded. Data were analyzed between July 1 and December 22, 2025.</p><p><strong>Exposure: </strong>States' lesser-of vs full coinsurance payment policy for dually eligible individuals.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes were admitting SNF dependence level on Medicaid long-term care reimbursement, a proxy for facility resources, and admitting SNF 5-star rating. Adjusted mean differences between dually eligible and non-dually eligible patients were calculated and compared across lesser-of and full-payment states via regressions of each outcome on the interaction between patient dual eligibility and state lesser-of status.</p><p><strong>Results: </strong>The sample included 5 126 814 SNF discharges (mean [SD] patient age, 79.7 [10.6] years; 60% female). In lesser-of states, SNFs that admitted dually eligible individuals demonstrated higher Medicaid dependence compared with facilities admitting Medicare-only beneficiaries (β [SE], 8.51 [0.03] percentage points [pp]; P < .001), a metric that was 43% smaller in full-payment states (β [SE], -3.63 [0.07] pp; P < .001). For dually eligible individuals in lesser-of states, admittance to high-quality SNFs was lower compared with Medicare-only beneficiaries (β [SE], 9.42 [0.07] pp; P < .001), a metric lower by 54% in full-payment states (β [SE], -5.04 [0.16] pp; P < .001).</p><p><strong>Conclusions and relevance: </strong>This cross-sectional study found that disparities in access to higher-quality SNFs between dually eligible and Medicare-only beneficiaries were larger when states used lesser-of rules for determining Medicare coinsurance reimbursements. Our findings underscore the need for policies that address states' Medicare spending without shifting costs to health care organizations serving the vulnerable dually eligible population.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 10","pages":"e263736"},"PeriodicalIF":12.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"JAMA Health Forum.","authors":"","doi":"10.1001/jamahealthforum.2025.6028","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2025.6028","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 10","pages":"e256028"},"PeriodicalIF":12.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Federal Funding Cuts and the Future of Health Care in Schools.","authors":"Angélica Meinhofer, Caroline H Kelly, Sasha Pudelski, Jessie Mandle","doi":"10.1001/jamahealthforum.2026.2852","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.2852","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e262852"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proposing a Grand Bargain for More Affordable Employer-Sponsored Insurance.","authors":"Benjamin D Sommers, Nima Ghasoor","doi":"10.1001/jamahealthforum.2026.4359","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.4359","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e264359"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overseeing Agentic AI in Medicine From First Principles.","authors":"Joshua M Sharfstein","doi":"10.1001/jamahealthforum.2026.4455","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.4455","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e264455"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Policy Research Priorities Toward Improved Rural Population Health.","authors":"Sandro Galea, Timothy D McBride","doi":"10.1001/jamahealthforum.2026.2241","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.2241","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e262241"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Regulatory Restrictions on Physician Dual Fee Schedules and Cash Pricing Make Health Care More Expensive.","authors":"David A Hyman, Sidney Haitoff, Ge Bai","doi":"10.1001/jamahealthforum.2026.2881","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.2881","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e262881"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148946171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Error in Funding/Support.","authors":"","doi":"10.1001/jamahealthforum.2026.3963","DOIUrl":"10.1001/jamahealthforum.2026.3963","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e263963"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149065151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wielding Cost Sharing Wisely.","authors":"Katherine Baicker, Raymond Fisman, Michael Luca","doi":"10.1001/jamahealthforum.2026.4262","DOIUrl":"https://doi.org/10.1001/jamahealthforum.2026.4262","url":null,"abstract":"","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e264262"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health Care Spending and Insurance Premiums Among the Privately Insured.","authors":"Zack Cooper, Stuart V Craig","doi":"10.1001/jamahealthforum.2026.3005","DOIUrl":"10.1001/jamahealthforum.2026.3005","url":null,"abstract":"<p><strong>Importance: </strong>Large shares of the US public are struggling to afford their health insurance. High premiums limit access to coverage. Rising premiums in the market for employer-sponsored health insurance, where the plurality of the privately insured get their coverage, are also causing reductions in wage growth, lowering employment, and fueling income inequality.</p><p><strong>Objective: </strong>To analyze the extent to which rising health insurance premiums reflect growth in health spending vs growth in markups in the large-group market, small-group market, and in the health insurance exchanges.</p><p><strong>Design, setting, and participants: </strong>This cohort study analyzed the 2011 to 2024 Public Use Files from the Medical Loss Ratio Data provided by the Center for Consumer Information and Insurance Oversight at the Centers for Medicare & Medicaid Services. The data include information on insurance premiums, health spending, and insurer markups and are published annually. These data include information on the large-group market, small-group market, and health insurance exchanges.</p><p><strong>Main outcomes and measures: </strong>Insurance premiums, health spending, and insurer markups (profits combined with administrative costs).</p><p><strong>Results: </strong>From 2011 to 2024, across the large-group market, small-group market, and health insurance exchanges, the enrollee-weighted mean of insurance premiums grew by 78.4% ($3143). In percentage terms, insurer markups decreased from 18.6% in 2011 to 14.9% in 2024. Ultimately, 91% of the growth in health insurance premiums was explained by growth in health spending (R2 = 0.91).</p><p><strong>Conclusions and relevance: </strong>This cohort study found that rising health spending explained 91% of the growth in insurance premiums from 2011 to 2024. This finding suggests that efforts to slow the growth in health insurance premiums should focus on slowing growth in health care spending.</p>","PeriodicalId":53180,"journal":{"name":"JAMA Health Forum","volume":"7 9","pages":"e263005"},"PeriodicalIF":12.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13545668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}