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March 2022 (Volume 100)
Quarterly Article
Alan B. Cohen
Oct 23, 2024
Oct 4, 2024
September 2024
Back to The Milbank Quarterly
In this issue of the Quarterly, readers will find an eclectic mix of articles that cut across all four principal areas of the Journal’s editorial interest, covering such diverse topics as Louisiana’s experience with Medicaid program expansion, Washington State’s experience with its “public option” Cascade Care Program, compulsory licensing of pharmaceuticals in high-income countries, the development of a United States Aging Society Index, state-level policies affecting perinatal and infant outcomes, and population health capabilities for strengthening the public health infrastructure.
Twelve states have yet to expand their Medicaid programs under the Affordable Care Act (ACA). In a Perspective titled “A Playbook for Implementing Medicaid Expansion: Louisiana’s Experience,” Will Boles and colleagues discuss how Louisiana offers a model that other states and counties could use to enroll eligible persons while balancing eligibility integrity and limited administrative resources. The authors contend that, in the current COVID-19 health care environment, Medicaid expansion can improve and protect population health and boost state economies, even in the face of budget shortfalls. They believe that Louisiana’s experience with Medicaid expansion compares favorably with other states in terms of eligibility and enrollment efforts, but that future expansions may need to include other social support programs as part of states’ implementation strategies.
Rates of low birth weight (LBW) and infant mortality vary considerably among counties and racial groups in the United States, with economic resources being a likely contributor to observed disparities. In “Does a Rising Median Income Lift All Birth Weights? County Median Income Changes and Low Birth Weight Rates Among Births to Black and White Mothers,” David S. Curtis and colleagues analyzed county median income as a predictor of LBW rates and Black-White LBW disparities. Using national birth records for 1992-2014 from the National Center for Health Statistics, they found that a $10,000 increase in county median income was associated with 0.34 fewer LBW cases per 100 live births and smaller Black-White LBW disparities of 0.58 per 100 births. County rates of maternal sociodemographic and health risks mediated the association between median income and LBW, but racial disparities in risk factors did not mediate the income association with Black-White LBW disparities. They argue that efforts to increase income levels, such as through investing in human capital, enacting labor union protections, and attracting well-paying employment, may have potential to reduce LBW rates and to achieve more equitable outcomes between Black and White mothers.
Read the complete Letter From the Editor
Alan B. Cohen became editor of The Milbank Quarterly in August 2018. He currently is a research professor in the Markets, Public Policy, and Law Department at the Boston University Questrom School of Business, and professor of health law, policy and management at the Boston University School of Public Health. He previously directed the Scholars in Health Policy Research Program and the Investigator Awards in Health Policy Research for the Robert Wood Johnson Foundation. Earlier in his career, he held faculty positions at Johns Hopkins University and Brandeis University, and spent 8 years at the Robert Wood Johnson Foundation. He is a member of the National Academy of Social Insurance. He received his BA in psychology from the University of Rochester, and his MS and ScD in health policy and management from the Harvard School of Public Health.
