Milbank Memorial Fund

Fear was the tectonic force in the election cycle we just completed, says Milbank Memorial Fund President Christopher Koller in his latest View from Here. Koller observes that the election results suggest that the most popular solution is increased authority, with the hope that projected personal strength will bring security and order. He argues that lessening fear starts, instead, with rebuilding personal and collective trust. To establish any trust, each of us must acknowledge our own fears — and then acknowledge as legitimate the fears of those who disagree with us. “With trust comes durable hope, and with hope, comes the chance for real change,” Koller writes. “We at Milbank are indeed fearful about the possibility of a more authoritarian and politically polarized country,” he says. “But we will work hard to earn the trust of the health leaders with whom we collaborate to improve population health and health equity.”

The cost of childbirth and postpartum health care results in significant, ongoing financial hardship, particularly for lower-income families with commercial insurance, according to a new Milbank Quarterly study. Researchers Heidi L. Allen, PhD, of the Columbia University School of Social Work, Jamie Daw, PhD, of the Columbia University Mailman School of Public Health, and colleagues surveyed people with Medicaid or commercial insurance about a year after they gave birth and found: Over half of respondents with commercially insured births spent more than $1,000 out of pocket on childbirth and nearly 40% reported being somewhat or very worried about paying health care bills Lower income people (with annual incomes of less than about $60,000) with commercially insured births reported particularly high financial strain: nearly half still owed money for childbirth costs, 16% had not made any payments yet, and 1 in 5 had medical debt in collections. Overall, Medicaid was financially protective for birthing families relative to private insurance because only 20% had any out-of-pocket spending on childbirth or health care in the postpartum year. However, any cost-sharing was associated with outstanding medical debt. The authors propose several policy solutions, including eliminating all cost-sharing for pregnant and postpartum people in Medicaid and allowing lower-income birthing people with private insurance to apply for supplemental Medicaid coverage.

A trip home to help with Appalachian mountain relief work in the wake of Hurricane Helene brought lessons on trust and community for @Morgan McDonald, Milbank’s National Director of Population Health and Health Equity Leadership. In a new View from Here, Dr. McDonald reflects on what she witnessed through the lens of her years in public health — and what it means for people in government. Preparing for emergency scenarios takes dedicated and ongoing federal, state, and local funding, as well as attention to building relationships that are put to the test during a pandemic or in a flood recovery, McDonald says.

The Supreme Court’s decision to ban race-conscious admissions has already begun to show troubling impacts on diversity in higher education, including among medical students. How will our healthcare be impacted if medical schools become less diverse? A diverse healthcare workforce benefits everyone. Not only does research continue to show that a health care workforce representative of the patients it serves improves outcomes for marginalized communities, but efforts to improve racial inequities help improve health care for people of all races and ethnicities. Plus, a diversity of thought and perspective helps propel the medical field forward, making health care better for us all. If there are fewer medical students of color coming down the pipeline, our health care workforce will lose some of that valuable diversity. There are programmatic and policy actions that can be taken despite bans on considering race in college admissions. Read more in this article from Milbank Memorial Fund: https://lnkd.in/ebXAWXwq

ICYMI, watch the recording of the October 30 Milbank Quarterly webinar on new research on policy opportunities to improve prevention and access to obesity treatment in the United States. William Dietz of George Washington University moderated a discussion with Liz Ruth of the National Association of Chronic Disease Directors, Neil Mehta of the School of Public and Population Health, The University of Texas Medical Branch, and Fatima Cody Stanford of Harvard Medical School. https://buff.ly/3YKVKJs

Social isolation, a culture of self-reliance, a lack of access to mental health care, and ready access to firearms are factors that contribute to high suicide rates in Mountain West states like Utah. Steve Eliason, a 2023-24 Milbank Fellow serving his 14th year in the Utah House of Representatives, has sought to bring down those rates, particularly among youth, over the last decade. In a new article, Marjorie Cortez describes how Eliason has become Utah’s leading legislator on suicide prevention and related issues. By skillfully navigating Utah’s political landscape and working with gun owners, he has sponsored nearly 60 successful pieces of legislation addressing gun safety, education, and behavioral health care expansion. The vast majority of his legislation has passed unanimously— and data shows improvement in Utah’s youth suicide rates.

Join a Milbank Quarterly webinar, Wednesday, October 30, 1 p.m. to 2 p.m. ET, about new research on policy opportunities to improve prevention and access to obesity treatment in the United States in the context of new anti-obesity medications. William Dietz of George Washington University will moderate a discussion with Liz Ruth, the director of policy at the National Association of Chronic Disease Directors, and the authors of two recent Milbank Quarterly articles to discuss the findings and policy implications. Speakers include: William Dietz, Professor and Director of Research and Policy, Global Food Institute, George Washington University (moderator) Neil Mehta, Professor and Associate Dean for Research, School of Public and Population Health, The University of Texas Medical Branch, author of the recent MQ article obesity as a main threat to population health Fatima Cody Stanford, Associate Professor and Director of Diversity, Nutrition Obesity Research Center at Harvard, Harvard Medical School, author of the recent MQ article on increasing access to effective obesity therapeutics Liz Hurst Ruth, Director of Policy, National Association of Chronic Disease Directors Register here: https://lnkd.in/efmzmSAK

States increasingly are taking advantage of the Medicaid Reentry Section 1115 Demonstration Opportunity that provides prerelease and transition services to incarcerated individuals. In a new Milbank Quarterly article, Elizabeth T. Chin of the Johns Hopkins Bloomberg School of Public Health and coauthors estimated the size of the eligible population in prisons and jails, and the prevalence of disease within this population, to inform state Medicaid plans. The authors found that rates of behavioral health conditions, hepatitis C, and chronic kidney disease were much higher in the incarcerated population than in the existing civilian Medicaid population. Additionally, if the new Medicaid eligibility rules were broadly applied, there would be a sizable increase in enrollments in smaller rural states. These findings suggest that state Medicaid programs, health plans, and providers may benefit from advanced planning to prepare for program implementation, the authors say.

Traditional implementation and enforcement of public health laws, such as those covering tobacco sales to youth or housing safety, is often reactive rather than proactive. These practices often rely on complaints and incident reporting and can exacerbate socioeconomic disparities given underreporting, fear of retaliation, and limited knowledge of laws among people who face discrimination because of their educational attainment or income, for example. In a new blog, Maya Hazarika Watts of ChangeLab Solutions and Elizabeth Tobin-Tyler of Brown University describe these harms and offer several recommendations, including prioritizing enforcement of laws that proactively protect health and supporting community-based programs that empower individuals and communities to exercise their legal rights.

Driven, innovative, compassionate. The highlight of the last few weeks has been getting to know this remarkable group of state legislators and executive branch health policy experts in the launch of this year’s Milbank Memorial Fund Fellows program. The trust and comraderie shown was an immediate reflection of their dedication to personal growth and exceptional public service in extremely difficult roles. I’m thankful they are at the helm in 23 states across the country. Thank you to Ann Gillespie , Senator Laura Fine and Courtney Phillips for giving your talents and wisdom once again. Chris Koller, Sofia Espinosa, Karam Ahmad, MPH Michele Lueck, Lisa Asare, Palav Babaria, Kyle Brown, Becky Buhner, Senator Colleen Burton, Christopher Chen, MD, MBA , Ebony Clarke, LCSW, Kelly Crosbie, Senator Cindy Friedman, Ashley Goss, Scott Holcomb, Kirsten Johnson, Representative Lee Johnson, Joseline Pe?a-Melnyk , Elizabeth Edsall Kromm, PhD , Matthew Lesser , Chimene Liburd , Representative Missy McGee, Assembly Member Amy Paulin, Senator Jennnifer Plumb, Wayne Salter, Patricia Tilley , Puthiery Va