Early Views

Access to sexual and reproductive health care varies widely by geography, and state-level policies play a major role in establishing the contours that govern the coverage, provision, availability, and costs of services.  More

Rural and urban areas have diverged significantly in health care access and health outcomes over the last four decades.  More

The US public health system is facing an inflection point characterized by chronic underinvestment, workforce and service delivery challenges, outdated data infrastructure, growing health inequities, and increasing instability within the broader health care safety net including projected Medicaid coverage changes and continued rural hospital closures.  More

Building narrative power, a foundational strategy used in community organizing, involves dismantling dominant narratives that uphold inequity and constructing counternarratives that advance health equity and racial justice by reshaping how people make sense of the world.  More

Housing is a fundamental social determinant of health and is particularly amenable to policy intervention.   More

Medicaid Section 1115 demonstration projects are widely used to test innovative policies but are subject to “budget neutrality” limits so that federal expenditures do not exceed what the federal government would have spent if the project was not adopted.  More

Racial equity impact assessments (REIAs) are used by local governments to integrate equity considerations into policymaking and decision-making processes by evaluating potential impacts of proposed legislation before enactment.  More

From 2021 to 2025, federal nutrition assistance policy in the United States shifted rapidly from expansion to contraction, with major implications for food insecurity, diet quality, and chronic disease risk.  More

The United States incarcerates more people per capita than any peer nation, and its criminal justice system disproportionately impacts Black, Indigenous, and other communities of color.  More

Trust in the US health care system has declined substantially in recent years, threatening patient engagement, care outcomes, and health policy effectiveness.  More

The 1992 340B Drug Pricing Program (“340B”) started as a narrowly focused program aimed at Public Health Service Act–funded clinics and public hospitals. Today 340B includes two-thirds of all nonprofit hospitals in the United States and accounts for more than $80 billion in discounted drug purchases.   More

In April 2018, a naked man with an AR-15 burst into a Waffle House restaurant in Nashville, Tennessee. Firing at random, he murdered four people and gravely injured five more before escaping into the night.  More

Context: Politics is increasingly important to many Americans. Yet little is known about how the increasing centrality of politics affects…  More

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

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

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

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

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

In response to the high cost of state-run Medicaid programs, the 1993 Medicaid estate recovery policy was established to enable states to recover assets from the estates of beneficiaries after death. Estate recovery may trigger behavioral responses from older adults who may no longer view real estate as an attractive asset, may borrow money from home equity to cover the cost of increasing care needs, or may avoid enrolling in Medicaid altogether.  More

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

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

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

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

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