Big picture:
Strong performance on prevention *within* the health care system isn’t enough to protect us if prevention *outside* it remains weak.
Work in collaboration w/ Irene Papanicolas @brownpublichealth.bsky.social, Tania Sawaya, & Sara Bleich @harvardhpm.bsky.social @hsph.harvard.edu
3. Public health policies lag far behind — the US has much weaker regulation of food, tobacco, alcohol, and firearms.
At the same time, we eat more calories, have higher obesity prevalence, and more illicit drug/opioid use. This is why Americans are more likely to die prematurely.
3 key takeaways:
1. When it comes to performance *within* primary healthcare system, the US actually *performs better* than most countries (e.g., higher screening, vaccinations, and chronic disease management rates).
2. But millions still lack coverage & reliable access to affordable primary care
We often hear that the U.S. underinvests in primary care and prevention—and that this explains why Americans live shorter, less healthy lives.
In our new @thelancetph.bsky.social, we take a closer look at this issue.
#IrenePapanicolas @Brown
www.sciencedirect.com/science/arti...
It’s hard to put into words how inspiring Dr. Sue Goldie is.
An extraordinary teacher, researcher, leader, and mentor to so many of us @hsph.harvard.edu who now shares her deeply personal story fighting against Parkinson’s disease.
Her story in @nytimes.com www.nytimes.com/interactive/...
Three key findings:
1. In just 1yr, we saw a ~55% enrollment growth among full-benefit duals and >68% among partial duals into C-SNPs.
2. About 1 in 4 duals in 2025 C-SNPs came from plans w/ some form of integration.
3. About 15% of C-SNPs could be terminated if CMS applied “look-alike” rule
In new #HealthAffairs Forefront piece, we show a troubling trend:
Rapid growth of “Chronic Condition Special Needs Plans (C-SNPs)” enrolling dual-eligibles.
We argue their growth is threatening national integrated care efforts for duals.
www.healthaffairs.org/do/10.1377/f...
Federal funding reportedly sent to Harvard for about 200 grants totaling $46 million.
Some welcome relief hopefully to so many.
Story below:
www.thecrimson.com/article/2025...
JAMA Health Forum viewpoint: "Mitigating the Dangers of Medicaid Churn Among Dual-Eligible Beneficiaries" by Eric T. Roberts and José F. Figueroa, published online September 12, 2025.
Viewpoint: #Medicaid is vital for low-income, dual-eligible adults and people with disabilities, but coverage disruptions due to administrative barriers increase health risks. ja.ma/4pBxGUO
Sign of a broken health care system when patients with cancer feel like this:
“I always told myself the stress of dealing with insurance was worse than the cancer.”
Insights from patients w/ cancer dealing with prior authorizations in @jamanetworkopen.com study
jamanetwork.com/journals/jam...
The true cost of the reconciliation bill will be measured in lives—over 50,000 per year.
It’s a predictable result when you cut off insurance to people who are old, poor and sick.
Eric Roberts @pennldi.bsky.social and I discuss @msnbc.com @harvardhpm.bsky.social
www.msnbc.com/opinion/msnb...
Promising development in Congress:
A bipartisan group of House and Senate lawmakers considering finally fixing the MA to VA cost-shifting loophole that currently leads to billions in MA profits to provide zero care while VA foots the bill.
Story by @wsj.com
www.wsj.com/politics/pol...
Our new @JAMAHealthForum study adds more evidence on how Medicare Advantage plans enrolling veterans are maximizing profits by not paying for care.
Veterans in high-veteran MA plans are much more likely to have surgical care paid by VA than plan itself—even when surgery occurs in non-VA hospitals…
I’m honored and excited to have been selected as one of the 2025 Aspen Ideas Health Fellows this year!
Forum brings together a diverse set of people working on issues related to improving health.
Full list of @aspenideas.bsky.social Health Fellows:
www.aspenideas.org/articles/202...
I want to emphasize that this is 18,000 avoidable deaths per year *of Medicare enrollees.*
They aren't in CBO's "uninsured" count — they're older people and folks with disabilities on Medicare who won't get extra financial help because of a proposed moratorium on a regulation.
Estimates are based on our recent @nejm.org study showing that loss of subsidized coverage (the Part D Low-Income Subsidy) led to significant increases in mortality among low-income Medicare beneficiaries.
@pennldi.bsky.social @harvardhpm.bsky.social
Link to study: www.nejm.org/doi/full/10....
CBO projects that House reconciliation bill will cause 1.38 million low-income Medicare beneficiaries to lose Medicaid coverage
We estimate that this will lead to over 18,000 avoidable deaths per year stemming from loss of drug subsidies
Link to our memo led by @pennldi.bsky.social:
bit.ly/4mwfcDA
Last week was hard for us @hsph.harvard.edu after losing all NIH grants.
This week, we are forced to reckon with what’s next, including shutting down research portfolios, considering staffing cuts, and scrambling to cover salaries.
HSPH: “ground zero” of NIH cuts
www.nytimes.com/2025/05/21/u...
Link to study 1: www.nber.org/papers/w33719
Link to study 2, which is our @nejm.org study led by Eric Roberts: www.nejm.org/doi/full/10....
Great summary of 2 recent studies in @npr.org by @lesliemwalker.bsky.social that show:
1) Value of having Medicaid (Wyse & Meyer, NBER)
2) Human costs of losing Medicaid & linked subsidized drug coverage in @nejm.org
Lives saved in study 1 and lives lost in study 2
www.npr.org/sections/sho...
Table 1. Characteristics of Veterans With Medicare Advantage vs Traditional Medicare, 2018-2021
Veterans in Medicare Advantage and Traditional Medicare used dental and vision services at similar rates, with no significant difference in total spending. #SGIM25
https://ja.ma/3ZficKj
Taken together, the comprehensive CMS payments MA plans get to care for vets (especially those who get little to no medical care paid by MA) are simply not justified by the “extra” MA supplemental benefits.
Urgent need for VA and CMS to fix this inefficiency to tune of $BILLIONS per year.
Using national survey data, we find:
1. No significant differences in total utilization or spending of dental & vision services between vets in MA vs TM.
2. MA plans only spend ~$82 per veteran enrollee on dental care and ~$6 more on vision aids than what TM vets get.
Many veterans enrolling in Medicare Advantage get zero care paid by plans.
MA insurers argue that vets get extra benefits (vision + dental).
But in new @jama.com study, we find that this claim is NOT actually the truth.
@adambeckman.bsky.social @hsph.harvard.edu
jamanetwork.com/journals/jam...
Loss of Subsidized Drug Coverage and Mortality among Medicare Beneficiaries | New England Journal of Medicine www.nejm.org/doi/full/10....
How important is help with drug costs? For dual Medicare-Medicaid beneficiaries, it saves lives.
As @lesliemwalker.bsky.social writes for Tradeoffs today, discussing the paper’s findings, that regulation “was poised to help nearly 1 million more duals gain this extra medication assistance, but the latest Republican proposal delays that rule until 2035.”
Talk about some timely research.
Here's the punchline: "Loss of drug subsidies after Medicaid disenrollment was associated with higher mortality among low-income Medicare beneficiaries."
www.nejm.org/doi/full/10....
Eric Roberts and @joefigs.bsky.social led a groundbreaking new study on Medicaid and Medicare, out today in NEJM. I’m lucky to have been a part of it.
Medicare saves lives. But is it enough to save lives of the most vulnerable Americans? The study suggests no; Medicaid still matters. (1/11)
The White House's "skinny budget" clarifies that they are, indeed, proposing to end all new extramural AHRQ funding while folding it into ASPE. www.whitehouse.gov/wp-content/u...
(Standard disclaimer that AHRQ is an agency created and funded by Congress, not at the whims of the executive branch)
