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

September 2025 

From the Editor

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    The Ongoing Assault on Science and Truth

    Alan B. Cohen, 

    The Trump administration’s efforts to eliminate all manner of diversity, equity, and inclusion (DEI) practices from government agencies, universities, and private sector workplaces has been coupled with steep funding cuts to key health agencies and the cancellation or freezing of medical research grants and contracts. It’s not just the careers of promising scientists and medical researchers that are at stake, but also the nation’s preeminent standing in the scientific community. Science unfortunately has become the latest victim in the culture wars taking place in the United States.  More

Perspective

  • From Disappointment to Predominance: Medicare Advantage’s Ascendancy and Transformation of Medicare

    Rick Mayes,  Micah Johnson, 

    From 2004 to 2024, Medicare Advantage (MA) went from being a “policy disappointment,” covering 12% of all Medicare beneficiaries, to predominance, covering more than one-half (52%), with more growth predicted in the future. Drawing on an extensive review and synthesis of the literature, Medicare Payment Advisory Commission (MedPAC) reports, congressional committee hearings, and Centers for Medicare and Medicaid Services (CMS) data, this paper analyzes the evolution of Medicare and managed care in three parts  More

  • National Analysis of the Requirements and Implementation of State Prescription Drug Price Transparency Laws

    Hannah Rahim,  Aaron S. Kesselheim, 

    Prescription drug prices in the United States are substantially higher than in other high-income countries, with US prices reported to be an average of 2.78 times those of other countries in the Organisation for Economic Co-operation and Development.1 In response to these high prices, along with an opaque supply chain that can lead to substantial discrepancies in prices across different payors, states have passed drug price transparency laws that require manufacturers to disclose information on drug prices.  More

  • No Data, No Problem: Quantifying Latine Individuals Eligible for but Not Enrolled in Medicaid or Affordable Care Act Marketplace-Based Insurance in North Carolina

    Gabriela Plasencia,  Kamaria Kaalund,  Olurotimi Kukoyi,  Viviana Martinez-Bianchi,  Andrea Thoumi, 

    Populations that identify as Latino/a/e/x or Hispanic (herein referred to as Latine) in the United States continue to face disproportion-ate health and socioeconomic challenges that were exacerbated during the COVID-19 pandemic and persist in the current political climate.  More

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

    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.   More

  • A Framework for Assessing the Permissibility of Academic Leaders’ Outside Activities

    MATTHEW S. McCOY,  MARTHA E. GAINES,  STEVEN JOFFE,  Genevieve Pham-Kanter,  EMILY A. LARGENT,  Bernard Lo,  HOLLY FERNANDEZ LYNCH,  ALLISON M. WHELAN,  Michelle M. Mello, 

    Leaders at many of the country’s top academic medical centers earned—in addition to their institutional salaries—hundreds of thousands of dollars a year as directors of pharmaceutical and device companies. Critics have urged academic institutions to rethink conflict of interest policies governing leaders’ outside activities, which are understood to pose not only individual conflicts for leaders themselves but also institutional conflicts for their academic employers.  More

Original Scholarship

  • Turf Wars: How Growth and Competitive Shocks Have Affected the Performance and Stability of Community Health Centers

    Justin Markowski, 

    Community health centers (CHCs) are a critical and growing part of the health care safety net, doubling over the past 15 years to expand access to essential health care services to over 31 million patients in traditionally underserved communities.   More

  • The Significance of Definitions in Determining the Level of Community Benefits for Nonprofit Hospitals

    Hossein Zare,  Gerard Anderson, 

    The American Hospital Association determined that in 2022 nonprofit hospitals spent $129 billion on community benefits. This is more than the entire budget for the US public health service. Different organizations estimate different amounts of community benefit spending depending on their definition of community benefit.  More

  • State Public Coverage of Pregnant Undocumented Immigrants and Prenatal Insurance Uptake

    Meghan Bellerose,  Linqing Zheng,  Arielle Desir,  Rachel E. Fabi,  Laura R. Wherry,  Maria W. Steenland, 

    Health insurance coverage increases access to recommended pregnancy care, but undocumented immigrants are not eligible for pregnancy Medicaid coverage without state uptake of alternative policy options. Twenty-four states and the District of Columbia (DC) offer public insurance to undocumented immigrants who are income eligible for pregnancy Medicaid through the Children’s Health Insurance Program From-Conception-to-End-of-Pregnancy option or state funds.  More

  • Lobbying in the Shadows: A Comparative Analysis of Government Lobbyist Registers

    Jennifer Lacy-Nichols,  Hedeeyeh Baradar,  Eric Crosbie,  Katherine Cullerton, 

    Information about lobbying is crucial to alert the public about undue influence in government decision making. Yet, government disclosures of lobbying activities are rare internationally and vary considerably in their completeness and accessibility. Building on a framework to measure lobbying transparency, this study benchmarked national government disclosures to understand what information was shared and to develop recommendations to strengthen political transparency.  More

  • Incarceration and Psychiatric Emergency Department Visits Among Black Americans

    Abhery Das,  Michael Esposito,  Tim A. Bruckner,  Hedwig Lee, 

    The justice system incarcerates nearly 2.3 million individuals in the United States. Black Americans comprise 40% of those incarcerated despite representing less than 15% of the population. Theoretical work posits that mass incarceration can erode social capital by straining social and family networks as well as inducing carceral churn and coercive mobility within Black communities. Scholars report that greater incarceration may influence population-level health, specifically in communities of color. However, previous work does not address whether incarceration, as well as the racial disparity in incarceration, corresponds with psychiatric help seeking in the Black community.  More

  • Advancing Equity: Lean Leader Practices and a Path Forward

    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