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  • Issue Brief Health Care Affordability

    How States Strengthened Their Health Care Markets in the 2025 Legislative Session

    August 2025 Nathan Hostert

    In the first half of 2025, states enacted numerous laws to strengthen their health care markets. These new laws address several recurring policy issues affecting states across the country, including skyrocketing health care costs, increased consolidation in the healthcare sector, and the heightened penetration of private equity in health care systems. This brief highlights trends in state health policy across four major themes and identifies states that have made significant reforms in each of these areas this year. More

  • Health Care Practice / Quality Health Equity

    Advancing Equity: Lean Leader Practices and a Path Forward

    August 2025 Dorothy Y. Hung LILLIAN C. LEVY Thomas G. Rundall ELINA REPONEN WILLIAM HUEN Stephen M. Shortell

    Lean management is a sociotechnical approach to quality improvement that aims for consistency in work processes and outcomes. This can be leveraged to reduce inequities by ensuring delivery of high-quality care to meet the needs of patients with diverse backgrounds. Despite recent efforts in the field, there is limited study on how managers implement health equity and workforce diversity goals as strategies to improve patient care. Given the important role of leadership in fostering workplace culture, we examined leader activities and specifically their use of lean management practices to support equity initiatives in health care. More

  • Health Care Practice / Quality Primary Care

    Measuring Primary Care Productivity in the Era of Interprofessional Team Care: Stakeholder, Scoping Review, and Implementation Perspectives

    August 2025 LISA V. RUBENSTEIN SYDNE J. NEWBERRY ISHITA GHAI ANEESA MOTALA IDAMAY CURTIS PAUL G. SHEKELLE TODD H. WAGNER L. DIEM TRAN STEPHEN D. FIHN KARIN M. NELSON

    Current primary care productivity measures do not account for investment in interprofessional primary care teams in relation to primary care goals and thus are insufficient for assessing and improving primary care efficiency and productivity. We explored alternative productivity measurement methods. More

  • Health Equity Public Health Racism

    Changing the Story on Health and Racial Equity: Why Public Health Needs an Infrastructure for Building Narrative Power

    August 2025 LORI DORFMAN Sarah E. Gollust MAKANI THEMBA PRITPAL S. TAMBER Anthony Iton

    A growing body of scholarship and practice in public health attests to the importance of addressing differences in power as a fundamental determinant of health inequities. To pursue health equity, public health practitioners must move beyond identifying differences in health outcomes among populations (disparities) to articulating why those differences are unfair or unjust (inequities) and then identifying structures, such as laws, policies, practices, and norms, that advantage some and disadvantage others. The act of doing so forces public health practitioners to consider the allocation of public resources, a process that is ultimately political. Fundamentally, going this far “upstream” to the root causes of inequity means confronting, understanding, and then addressing differences in power among and across populations. More

  • Health Care Practice / Quality Integrated Care Mental Health

    Determinants of When Community Behavioral Health Clinics Partner With Emergency Response Systems: The Role of Capacity in 911 Referral and Co-response Models

    August 2025 Amanda I. Mauri Zoe Lindenfeld Charley Willison THERESE L. TODD Jonathan Purtle DIANA SILVER

    Individuals with behavioral health disorders are more likely to experience substantial harm from a police encounter, prompting reforms to minimize encounters between police and people experiencing a behavioral health crisis. One strategy involves expanding partnerships between certified community behavioral health clinic (CCBHC) mobile crisis teams and emergency response systems, often through two models: 911 referral, wherein a CCBHC’s behavioral health practitioner–only team responds to 911 calls, and co-response, wherein a CCBHC clinician joins a police or emergency medical services (EMS) team. We examine whether the internal capacity of the CCBHC and external police capacity influence when CCBHCs engage in these partnerships. More

  • Health Equity Health Insurance Immigration Policy

    County-Level Immigration Policy and Health Insurance Among Latino Adults and Youth

    August 2025 Maria-Elena De Trinidad Young Danielle M. Crookes Sarina Rodriguez Fabiola Perez-Lua Ninez A. Ponce Alexander N. Ortega

    Federal and state immigration policies influence access to health insurance for Latino populations. Local jurisdictions also have immigration-related policymaking power, but there has been limited study of their influence on health care access. We examined the relationship between county-level immigration policy contexts and health insurance coverage of Latino adults and youth in California using two measures that capture local-level policy decisions and immigration policy–related social inequity. More

  • The Largest Program for Opioid Use Disorder in a Statewide Carceral System: A Collaborative Multi-Agency Initiative

    Integrated Care Opioid Use Disorder

    The Largest Program for Opioid Use Disorder in a Statewide Carceral System: A Collaborative Multi-Agency Initiative

    August 2025 ASHLY E. JORDAN RABIAH GAYNOR CAROL MOORES YOLANDA CANTY CHINAZO O. CUNNINGHAM

    In the United States, substance use disorder (SUD) is a significant public health and public safety challenge. Up to two-thirds of individuals who are incarcerated meet SUD criteria, compared with 16.7% of the general population. Individuals who have opioid use disorder (OUD) are also overrepresented in criminal legal settings: approximately 15.0% to 30.0% of individuals who are incarcerated have OUD, compared with 3.7% of the general population. Furthermore, individuals who are incarcerated are at high risk for fatal overdose both inside carceral facilities and upon reentry to the community. Overdose is the third leading cause of death in jails, and overdose deaths have increased more than six times over the past two decades in prisons. Among those reentering the community, fatal overdose is the leading cause of death. The risk of fatal overdose within the first two weeks following reentry is more than 100 times higher than in the general US population. More

  • Health Insurance

    Chief Justice Roberts’ 2012 Ruling Should Undermine Work Requirements

    August 2025 John E. McDonough

    No discernible difference exists between the ACA mandate penalty that was overturned by the US Supreme Court and the mandate penalty in the 2025 OBBBA. More

  • Health Insurance

    Nullifying the Affordable Care Act: What the Medicaid Work Requirement Really Is All About

    August 2025 Sara Rosenbaum

    Despite a mountain of evidence showing its deleterious effects, a Medicaid work requirement is now law. The mandate, considered by its supporters to be a centerpiece of the One Big Beautiful Bill Act (OBBBA), is the product of a desperate search to find ways to help offset over $3 trillion in tax losses, coupled with the enduring desire among Affordable Care Act (ACA) opponents to repeal the Medicaid expansion for working-age adults. To accomplish their goal, Medicaid advocates coupled a claim that removing millions of people from Medicaid somehow makes the program more efficient with grossly misleading “research” characterizing Medicaid beneficiaries as healthy adults living off their benefits, with free time on their hands. More

  • Fact Sheet Milbank State Leadership Network Health Care Affordability

    State Strategies to Address Rising Prescription Drug Costs: Virtual Convening of Milbank State Leadership Network

    August 2025 Mary Louise Gilburg Morgan McDonald

    Event Date: July 22, 2025 The Milbank State Leadership Network hosted a virtual session for state legislators and legislative staff to discuss… More