Turf Wars: How Growth and Competitive Shocks Have Affected the Performance and Stability of Community Health Centers
Context: 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. However, increasingly, CHCs have opened care delivery locations in communities already served by another CHC, potentially creating competitive markets with unknown implications for how this safety net operates. More
Legal Barriers to Safer Smoking Supplies Cause Harm and Should Be Removed
The United States continues to experience a nearly unprecedented level of drug-related health harms, with over 105,000 Americans dying of overdose in 2023 alone. Although overall overdose deaths declined slightly from 2022 to 2023, rates for Black people continued to rise. Stimulants such as cocaine and methamphetamine are increasingly involved in overdose deaths, and xylazine and other contaminants continue to be prevalent in the illicit drug supply. More
Lobbying in the Shadows: A Comparative Analysis of Government Lobbyist Registers
nformation 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
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
Laws Governing Substance Use During Pregnancy: Next Steps for Health Equity Research
See all articles in the special issue, Mental Health and Substance Use Challenges Facing the United States: What Can State Policymakers… 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
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… More
Integrating Mental Health and Substance Use Treatment With Emergency and Primary Care: The Case of Opioid Use Disorder and Suicide
The United States is facing an ongoing mental health and substance use crisis. In 2023, 58.7 million US adults had a past-year mental illness, 46.3 million had a substance use disorder (SUD), and 20.4 million had both. More
National Analysis of the Requirements and Implementation of State Prescription Drug Price Transparency Laws
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
A Framework for Assessing the Permissibility of Academic Leaders’ Outside Activities
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
Stemming the Tide of the US Overdose Crisis: How Can We Leverage the Power of Data Science and Artificial Intelligence?
People in the United States are dying at record numbers from overdose. Overdose deaths increased from fewer than 17,000 deaths in 1999 to an estimated 100,000 deaths approximately 25 years after, with a peak of almost 108,000 deaths in 2022. Racial/ethnic minoritized groups are now particularly affected: in 2023, the highest rates of overdose were among non-Hispanic Black and American Indian/Alaska Native Americans. Although overdoses increasingly involve both opioids and stimulants, opioids contribute to over three-quarters of all overdose deaths, primarily driven by illegally manufactured synthetic opioids like fentanyl. More
US State Policies Regarding Social Media: Do Policies Match the Evidence?
The potential adverse effects of social media use for adolescents have received substantial attention. In response, a growing number of state-level social media regulations are emerging in the United States. These policy interventions are being implemented in the context of mixed scientific evidence, forcing policymakers to weigh the need for proactive regulation against the limitations of extant research. We explore policymakers’ publicly stated rationales for social media regulations and contextualize their claims within extant scientific literature. More
Facilitators of, Barriers to, and Innovations in the Implementation of the Trauma Recovery Center Model for Underserved Victims of Violent Crime in Los Angeles County
The Trauma Recovery Center (TRC) model brings comprehensive care to underserved victims of crime, with improvements in PTSD symptoms and quality of life. Funding concerns were the central limitation in model implementation according to TRC staff. More
Medicaid’s Role in Addressing the Mental Health and Substance Use Disorder Challenges of Its Members
Medicaid has both greatly advanced the scope and integration of mental health and substance use disorder services among payers and remains a work in progress with respect to scaling and funding these services across the country. More
Mapping Mental Health Across US States: The Role of Economic and Social Support Policies
Mental health (e.g., anxiety, depression) continues to be a major public health concern in the United States that impacts millions of individuals, their families, and communities. Approximately 21% of adults 18 years and older, or 55 million adults, reported symptoms of recent depression in 2022, demonstrating the wide reach of mental health challenges. More
Review of Emergent Financing Models for Mental Health Crisis Systems
In this article, we provide an overview of emergent models for funding crisis systems in the United States and the policy and service contexts related to these models. Our review assesses the status of crisis system financing recommendations proposed by Hogan and Goldman proposed in 2020 and complements prior reports about financing crisis services. More
State Policy Strategies to Promote the Recruitment and Retention of the Behavioral Health Workforce
See all articles in the special issue, Mental Health and Substance Use Challenges Facing the United States: What Can State Policymakers Do? Access… More
Reported Strategies by Medicaid Managed Care Organizations to Improve Access to Behavioral Health Services
Behavioral health access gaps are well documented in Medicaid, in which managed care now covers most enrollees, and for which there are typically fewer options for going out-of-network for care. Despite the growing role of managed care organizations (MCOs) in financing and delivering behavioral health services, little is known about MCO levers that can improve access to care. More
The Long Arc of Substance Use Policy Innovation in Medicaid: Looking Back, Looking Forward
This Perspective examines the role of Medicaid in the innovation of substance use disorder (SUD) treatment. In 2023, an estimated 49 million Americans met criteria for an SUD and more than 100,000 people died of a drug overdose. Compared with the general population, people with SUD experience worse self-rated health, a higher burden of other chronic diseases, and more hospital care. More
