JAMA Health Forum Conversations

Through the Patient Protection and Affordable Care Act, Medicaid expansion has yielded clear improvements in insurance coverage and access to care for low-income adults younger than 65, but has Medicaid expansion also had spillover benefits for adults 65 and older? In this interview with JAMA Health Forum Editor John Ayanian, MD, MPP, and Deputy Editor Melinda Buntin, PhD, Melissa McInerney, PhD, describes how older adults with low incomes and limitations related to chronic conditions were more likely to have Medicaid coverage and recent visits with physicians in states that have expanded Medicaid for younger adults than those in nonexpansion states. Related Content: Spillover Benefits of Medicaid Expansion for Older Adults With Low Incomes Medicaid Expansion and Health Care in Older Adults With Low Income and Chronic Condition Limitations

The COVID-19 pandemic has created an unprecedented need for accelerated collaborative research in health care systems. In a conversation with JAMA Health Forum Editor John Ayanian, MD, MPP, and Deputy Editor Melinda Buntin, PhD, Jonathan Perlin, MD, PhD, of the Joint Commission (and formerly of HCA Healthcare) discusses lessons learned from a novel COVID-19 research consortium developed through a collaboration of HCA Healthcare, the federal Agency for Healthcare Research and Quality, and numerous academic partners. Related Content: Harnessing COVID-19 Data Through Collaboration—The Consortium of HCA Healthcare and Academia for Research Generation

The health care workforce has yet to recover from the COVID-19 pandemic, and there is a concerning trend of increasing numbers of physicians leaving the workforce. JAMA Health Forum Editor John Ayanian, MD, MPP, and Deputy Editor Melinda Buntin, PhD, discuss with Bianca Frogner, PhD, of the University of Washington new findings that show how all segments of the health care workforce have struggled, with more pronounced effects among long-term care workers, aides, assistants, workers with young children, and workers of color. Related Content: Tracking Turnover Among Health Care Workers During the COVID-19 Pandemic US Health Care Workforce Changes During the COVID-19 Pandemic Changes in Material Hardship During the First Year of the COVID-19 Pandemic

Prison staff and residents have faced increased risks of COVID-19 infections. JAMA Health Forum Editor John Ayanian, MD, MPP, and Deputy Editor Melinda Buntin, PhD, speak with Jeremy Goldhaber-Fiebert, PhD of Stanford University about patterns of COVID-19 vaccinations among staff in California state prisons. They also speak with Jaimie Meyer, MD, MS of Yale University about efforts to promote COVID-19 vaccinations among prison staff and residents in California and other states. Related Content: Uptake of COVID-19 Vaccination Among Frontline Workers in California State Prisons

For the duration of the COVID-19 pandemic public health emergency, state Medicaid programs elected to maintain eligibility for Medicaid recipients in exchange for increased federal funding. In this podcast, Dr Laura Dague of the Bush School of Government & Public Service at Texas A&M University discusses her JAMA Health Forum article finding that this policy was associated with the higher Medicaid enrollment seen during the pandemic. JAMA Health Forum Editor John Ayanian and Deputy Editor Melinda Buntin discuss the policy implications of this work with Dr Dague and other recent articles touching on Medicaid enrollment. Related Content: Trends in Medicaid Enrollment and Disenrollment Early in the COVID-19 Pandemic in Wisconsin Medicaid Disenrollment After the COVID-19 Pandemic Medicaid Coverage Disruptions Among Children Enrolled in North Carolina Medicaid, 2016-2018 Association of Medicaid Expansion in Arkansas With Postpartum Coverage, Outpatient Care, and Racial Disparities

Overuse of health care, or providing services of low value or no value, is wasteful, potentially harmful to patients, and a contributor to high US health care costs. Jodi Segal, MD, of the Johns Hopkins University School of Medicine joins JAMA Health Forum Editor John Ayanian and Deputy Editor Melinda Buntin to discuss characteristics of health systems associated with overuse of health care services for Medicare beneficiaries and the implications for health systems, hospitals, and clinicians seeking to reduce such overuse. Related Content: Factors Associated With Overuse of Health Care Within US Health Systems

Cost sharing is particularly burdensome for some Medicare beneficiaries, particularly those with incomes just above the poverty level, those with disabilities, or those who have multiple chronic health conditions. Jeanne Madden, PhD, of the Northeastern University School of Pharmacy, and Eric Roberts, PhD, of the University of Pittsburgh Graduate School of Public Health, speak with JAMA Health Forum Editor John Ayanian and Deputy Editor Melinda Buntin about the implications of high cost-sharing burdens in Medicare and options for policy makers to limit these burdens for Medicare beneficiaries who are at greatest risk. Related Content: Affordability of Medical Care Among Medicare Enrollees Unequal Burdens of Cost Sharing for Medicare Beneficiaries

There are many actors in the drug supply and distribution system, and little is known about the share of drug expenditures going to each, making it more difficult to rein in costs. JAMA Health Forum Associate Editor, Julie Donohue, PhD, and Deputy Editor, Melinda Buntin, PhD, speak with Neeraj Sood, PhD, lead author in a JAMA Health Forum study that unpacks the distribution of insulin expenditures, revealing that a surprising share goes to intermediaries. They also spoke with Bernie Good, MD, who wrote an invited commentary about this study. Related Content: Share of Net Insulin Expenditures Captured in the US Pharmaceutical Distribution System Decomposition of Expenditures for Insulins Across the Distribution Chain—Insights Into Rising Prices?

State Medicaid programs are required to cover all drugs approved by the US Food & Drug Administration (FDA), including those that have received accelerated approval from the FDA to treat serious or life-threatening illnesses such as HIV or cancer. These drugs with accelerated approval may be beneficial based on surrogate end points such as changes in imaging or blood test results, but they have not yet been shown to improve health outcomes or survival. Rachel Sachs, JD, MPH, of the Washington University in St. Louis School of Law speaks with JAMA Health Forum Editor, John Ayanian, and Deputy Editor, Melinda Buntin, about how utilization and spending for costly drugs with accelerated approval have grown in the Medicaid program nationally since 1992, representing 9% of all Medicaid drug spending for just 0.2% of all prescriptions in 2018. Related Content: Medicaid Use and Spending for Drugs With FDA Accelerated Approval

We know that the pandemic caused millions of people to lose their jobs, and potentially their job-based insurance, and yet new survey data showed surprisingly small changes in uninsurance rates at the end of 2020. Kate Bundorf, PhD, from the Sanford School of Public Policy at Duke University and Jessica Banthin, PhD, of the Urban Institute talk to JAMA Health Forum Deputy Editor Melinda Buntin about these trends and the role played by Medicaid and exchange coverage. JAMA Health Forum Editor John Ayanian and Melinda Buntin also discuss other recent work about health insurance coverage and the ACA that has appeared in JAMA Health Forum. Related Content: Trends in US Health Insurance Coverage During the COVID-19 Pandemic Fewer People May Have Become Uninsured in 2020 Than Feared Outcomes After Changes to US Health Insurance Marketplace Automatic Renewal Rules Income Eligibility for Medicaid vs Marketplace Coverage for Insurance Enrollment Among Low-Income Adults Making the Affordable Care Act Marketplace More Affordable