The Milbank Quarterly | A Multidisciplinary Journal of Population Health and Health Policy

June 2026  (Volume 104)

From the Editor

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    In the June 2026 Issue of the Quarterly

    Alan B. Cohen, 

    In this issue of the Quarterly, readers will find four Perspectives on varied topics, such as spending on primary care, coverage contractions under the “One Big Beautiful Bill Act,” the political economy of wellness, and problems associated with the commodification of health care.   More

Perspective

  • Sufficient and Efficient Spending on Primary Care Benefits National Health and Health Systems

    Robert L. Phillips,  Rebecca Fisher,  Claire Jackson,  Danielle Martin,  Tim Olde Hartman,  Felicity Goodyear-Smith, 

    Primary care is the foundation of most health systems; yet across diverse countries, structures, policies, and payment models, it is under threat.  More

  • What Happens When Coverage Is Cut? Looking Backward and Forward From the One Big Beautiful Bill

    Adam Gaffney,  Danny McCormick,  David U. Himmelstein,  Steffie Woolhandler, 

    The so-called One Big Beautiful Bill Act signed into law by President Trump on July 4, 2025 will cut $1 trillion from federal health care programs over the coming decade and cause 10 million individuals to become uninsured according to the Congressional Budget Office. Most analyses of the bill’s impacts have assumed they would be the inverse of those documented from previous coverage expansions. An examination of past coverage cuts might yield additional insights into the probable impacts of this legislation on the medical care and health of the needy.  More

  • The Political Economy of Wellness: Commercial Determinants of a Burgeoning Industry

    Nancy Karreman,  Marco Zenone,  Nason Maani,  Benjamin Hawkins, 

    The global wellness industry has multifaceted impacts on health and well-being, including through the sale and consumption of wellness products, the provision of health information to consumers, and the promotion of specific norms and values. Despite its growing prominence, the wellness industry and its impacts on health and policymaking remain understudied. This article examines how the wellness industry operates as a commercial, social, and political determinant of health.  More

  • Decommodifying and Humanizing Health Care: Revisiting Pellegrino’s Ethical Imperative

    Kevin Fiscella,  Alejandro J. Vera,  Ashley M. Jenkins, 

    Edmund Pellegrino warned about the growing commodification of health and health care in the United States. After twenty-five years, it is worth revisiting Pellegrino’s critique and examining this critique in the current era.  More

Original Scholarship

  • US State Policy Index for Population Health Analyses

    Jennifer Karas Montez,  Iliya Gutin,  Shannon M. Monnat, 

    Recent studies have linked the rising rates and growing disparities in working-age mortality partly to changes in US states’ policy contexts since the 1980s. Yet, such studies largely rely on measures of states’ policy contexts, or “policy indices,” that were created for other purposes, are not regularly updated, and use complex methods that can be difficult to interpret and replicate. Further elucidating the mortality trends and disparities would benefit from a policy index that is designed for population health analyses and a clearer understanding of the utility of such indices.  More

  • US State Policy Contexts and Mental Health Among Working-Age Adults

    Iliya Gutin,  Jennifer Karas Montez,  Emily Wiemers,  Shannon M. Monnat,  Douglas A. Wolf, 

    Mental health among US working-age adults notably worsened during the COVID-19 pandemic, following a steady decades-long decline. The impact of states’ COVID-19 policies on mental health has received much attention; however, less is known about the impact of a broader set of long-standing and overarching state policy contexts.   More

  • Extended Pregnancy Medicaid During COVID-19 and Enrollment and Health Care Use in the Postpartum Year

    Erica L. Eliason,  Maria W. Steenland,  Rebecca A. Gourevitch, 

    Context: Before the COVID-19 pandemic, persons with pregnancy Medicaid coverage were typically disenrolled after 60 days postpartum, at which point they could retain Medicaid only if they qualified through another eligibility category (most commonly as a parent). The March 2020 Families First Coronavirus Response Act (FFCRA) extended postpartum Medicaid coverage by requiring states to pause disenrollment in exchange for enhanced federal funding.  More

  • Medicaid Managed Care Plan Alignment With State Substance Use Disorder Treatment Coverage Requirements

    Sage R. Feltus,  Christina M. Andrews,  Lauren Peterson,  Colleen Grogan,  Amanda J. Abraham,  Olivia M. Hinds,  Maureen T. Stewart, 

    Medicaid is the largest payer of substance use disorder (SUD) treatment in the United States. Managed care plays an important role, administering benefits for more than 80% of Medicaid enrollees. While state governments have enacted coverage requirements for SUD treatment medications that managed care plans must follow, the extent to which managed care coverage policies align with these rules remains largely unknown.  More

  • Long-Term Changes in Health Care Use and Outcomes Among Groups Maintaining Versus Losing Medicaid Upon Medicare Enrollment

    Maryssa Pallis,  Jane L. Tavares,  Reena Sethi,  Kerry Glova,  Marc A. Cohen, 

    About 280,000 older adults experience the “Medicare Cliff” each year, becoming eligible for Medicare and losing Medicaid coverage when they turn age 65 years due to discontinuities in financial eligibility criteria.   More

  • Preemption and Generational Health Equity: The Role of Forced Inaction in Shaping Outcomes

    Margaret H. Swenson,  Lauren D. Boczkowski,  Brad Riley,  K. Noelle Broughton,  Christopher J. Koliba, 

    Racial disparities—unequal outcomes between racial groups—persist in the United States, particularly with respect to health and economic outcomes. There has been increased focus on the ways in which upstream determinants of health contribute to these disparities; however, little is known about how forced inaction on these upstream determinants affects health and economic outcomes.   More