John Graves
johngraves.bsky.social
John Graves
@johngraves.bsky.social

Professor of Health Policy and Medicine, Vanderbilt University School of Medicine
Professor of Management, Vanderbilt University Owen Graduate School of Management

Economics 47%
Public Health 23%
We would like to recruit a stellar junior faculty member in the Division of Child Health Research and Policy @deptpopmed.bsky.social at Harvard. Please circulate this announcement widely!

www.populationmedicine.org/divisions-ce...

100% -- its the accumulation of micro-tasks and micro-asks.

love this! I've taken a similar approach and a positive for me is the recognition that you often go deeper by going longer. the unconscious processing you allow yourself by not rushing to write really enriches thinking & the end product. the risk, though, is a fine line b/t this and procrastinating
Thanks to claude code, I wrote my first iphone app:
apps.apple.com/us/app/time-...
It's what I have always wanted for a talk timer (as both a speaker and a chair). It's very minimal, designed to be read from across the room, and make it clear when you're running out of time.
Time Will Tell App - App Store
Download Time Will Tell by Hadley Wickham on the App Store. See screenshots, ratings and reviews, user tips, and more games like Time Will Tell.
apps.apple.com

AEA has always been really good on this -- they really economize (no pun intended) on the cost of entry.

That said, it helps for cost minimization that most of the AEA meetings are held in January in places like Philly, Chicago, Boston, etc. :)

Reposted by John A. Graves

Really enjoyed this candid ("Because I’m rich as fuck and I didn’t care about the money") conversation between @citizencohn.bsky.social and @mcuban.bsky.social

www.thebulwark.com/p/mark-cuban...
Mark Cuban Tells Us How He Can Fix America’s Shitty Health Care
The entrepreneur wants to do what many in his position have tried and failed to accomplish.
www.thebulwark.com
🚨 Predoc Opportunity at Yale! 🚨

Care about research that changes policy?

My research team works within state government to advance evidence and learning for a smarter safety net!

And our predocs have excellent PhD placements. Apply here!

#EconSky #EconTwitter #Predoc #ResearchJobs #HealthPolicy
Economics of the Safety Net
tobin.yale.edu

Values are in $1,000s -- so there are some states like West Virginia where folks well over $200k would receive a subsidy because premiums are so high there. But in other areas, the "disattachment point" is $100k or less.

ACA enhanced subsidies cap the maximum percent of income all Americans pay for non-group premiums at 8.5% income.

But that doesn't mean everyone gets a subsidy. What's the maximum income you could have and still get a tax credit?

The attached shows that max income for a single 57 year old in '26

Negotiating it as a straight subsidy would reduce the uncertainty around having to precisely predict your income--or else face potentially significant financial consequences at tax time.

The CBO projected that dynamic could depress enrollment in the marketplaces.

This proposal would directly deposit the subsidy into HSAs -- and it's not clear how they'd be structured. Would it be a tax credit still subject to overpayment clawbacks? or a straight subsidy?

H.R.1. eliminates these safe harbors--meaning that if you receive an advance credit that is $2,000 too high, your tax liability goes up by the full $2,000 overpayment.

The original ACA put in place these safe harbors in case someone's projected income (i.e., what they think their income will be next year) doesn't match their actual income.

For incomes under 200% of FPL, repayment caps were around $325 for an individual or $650 for a family.

This proposal is worth engaging for an under-appreciated reason....

H.R.1., passed this past summer, eliminates tax credit overpayment safe harbors for advance credits that end up too large relative to realized income the individual has during the coverage year

www.wsj.com/politics/pol...
Republicans Pitch Alternative to ACA Extension to End Government Shutdown
GOP senators have proposed sending money directly to consumers’ health accounts rather than to insurance companies.
www.wsj.com

The supplemental materials have a ZIP-to-PESA (Pediatric Emergency Service Area) and ZIP-to-PERR (Pediatric Emergency Referral Region) crosswalk, for those who are interested in using the Atlas!
@allanmjoseph.bsky.social has been telling me there needs to be a "Dartmouth Atlas, but for pediatrics" for maybe a literal decade? And now there is!

(h/t to coauthor @johngraves.bsky.social)
Development of an Atlas for US Pediatric Acute Care
This cross-sectional study offers a national US atlas of pediatric acute care centers in the US.
jamanetwork.com

Reposted by John A. Graves

When is the point of no return for extending ACA tax credits?

They expire 12/31, so that’s a drop dead date.

Open enrollment starts November 1. If they’re not extended by then, enrollees may start dropping out. Even if open enrollment is extended, people could be hard to reach.

ggplot + gganimate FTW.

and similar in 2015 -- but v different than 2010!

yay! congrats stacie!

As one might imagine given these age dynamics and the state's demographics, Florida is the top state where folks are most dependent on this coverage over their lifetimes.

So sharp changes in the affordability of plans due to expiring enhanced tax credits is going to be acutely felt there.

At any given time, less than 10% of the non-Medicare-eligible population is covered with private plans in the marketplaces.

But there is a minor surge in so-called "non-group" coverage in early adulthood.

And then, as folks approach Medicare, non-group coverage really takes off.

What's at stake in the debate over enhanced subsidies?

The "average" American will spend about five years of their pre-Medicare lives in privately-purchased coverage.

But these are often short spells, where marketplace plans provide a critical "bridge" at key transitional moments in life.
A new paper led by Harvard Health Policy PhD student Ye Shen finds that, in the current policy environment, more than six in ten kids will have been enrolled in Medicaid for some period of time by their 18th birthday; the program is absolutley critical for children.

jamanetwork.com/journals/jam...
Excited to share new research led by Jessica Harvey exploring the budget impact of gene therapies for sickle cell disease, with a focus on Medicaid programs.

Co-As: @ankurfactorial.bsky.social, @leah-rand.bsky.social, @akesselheim.bsky.social, & George Goshua.

🔗: link.springer.com/article/10.1...
Modeling the Budgetary Impacts of Sickle Cell Disease Gene Therapies on State Medicaid Programs - Journal of General Internal Medicine
Journal of General Internal Medicine -
link.springer.com

Reposted by John A. Graves

Overall, we estimate that longer hospital stays for Medicare Advantage patients are contributing to close to 2 million extra hospital bed days occupied by people who don't need to be there any more annually. This is a huge waste and bad for patient care.

Why is this happening?

Reposted by John A. Graves

Next year, Marketplace enrollees are going to have a pay a larger percentage of their income in premiums (assuming Congress doesn't extend the current subsidy enhancements).

Here's my overview of how it all works, including examples: www.healthinsurance.org/faqs/is-the-...
Does the IRS change how much I'll have to pay for my health insurance each year?
Unless Congress extends the subsidy enhancements, the percentage of income that you have to pay for self-purchased (individual/family) health coverage is going to increase significantly in 2026. This ...
www.healthinsurance.org

Jan 26

alas it will have to live as “personal correspondence” for now …

When TN had it's "mini unwinding" back in 2016 (due to difficulties implementing the MAGI conversion, resulting in delays implementing eligibility system) the demographic group that saw the most rapid disenrollments were those 19-21.

in a way--the enhanced premiums were scheduled to expire and the OBBB codified a decision not to extend them past 2025