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
Professor of Management, Vanderbilt University Owen Graduate School of Management
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...
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
November 9, 2025 at 4:45 PM
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...
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...
Reposted by John Graves
@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)
(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
October 28, 2025 at 3:01 PM
@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)
(h/t to coauthor @johngraves.bsky.social)
Reposted by John 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.
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.
October 20, 2025 at 5:33 PM
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.
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.
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.
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.
October 20, 2025 at 2:33 PM
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.
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.
Reposted by John Graves
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...
jamanetwork.com/journals/jam...
September 24, 2025 at 3:43 PM
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...
jamanetwork.com/journals/jam...
Reposted by John Graves
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...
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
September 23, 2025 at 3:15 PM
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...
Co-As: @ankurfactorial.bsky.social, @leah-rand.bsky.social, @akesselheim.bsky.social, & George Goshua.
🔗: link.springer.com/article/10.1...
Reposted by John 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?
Why is this happening?
September 8, 2025 at 8:58 PM
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?
Why is this happening?
Reposted by John 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-...
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
July 30, 2025 at 10:50 PM
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-...
Here's my overview of how it all works, including examples: www.healthinsurance.org/faqs/is-the-...
Until this year, consumers were largely shielded from rising premiums in exchange plans because enhanced premium tax credits capped premiums at no more than ~9% income for everyone.
But not next year: premium tax credits will be lower & consumers will additionally shoulder the premium increases.
But not next year: premium tax credits will be lower & consumers will additionally shoulder the premium increases.
Cost trends in general for patients on ACA exchange and Medicaid plans. Basically the premiums they set aren't high enough to cover the actual health care utilization of those to groups. Policy changes in Medicaid payouts are also playing a role.
Any idea why payouts are suddenly skyrocketing?
July 29, 2025 at 12:46 PM
Until this year, consumers were largely shielded from rising premiums in exchange plans because enhanced premium tax credits capped premiums at no more than ~9% income for everyone.
But not next year: premium tax credits will be lower & consumers will additionally shoulder the premium increases.
But not next year: premium tax credits will be lower & consumers will additionally shoulder the premium increases.
New teaching hook for covering "job lock" in health economics courses just dropped.
Venus Williams after becoming the oldest WTA match winner since 2004:
“I had to come back for the insurance, because they informed me this year that I’m on cobra. So it’s like, I got to get my benefits on” 😭😭😭😭
“I had to come back for the insurance, because they informed me this year that I’m on cobra. So it’s like, I got to get my benefits on” 😭😭😭😭
July 23, 2025 at 4:15 PM
New teaching hook for covering "job lock" in health economics courses just dropped.
Nearly everything I do today is empirics and coding. But my English degree is unquestionably the most important thing I took from (liberal arts) undergrad.
Decades of mechanistic talk about university degrees as if they were bundles of 'skills' and 'prep' are about to be proved completely wrong (obviously). Want to get a real boost? Do History or English.
July 13, 2025 at 11:46 AM
Nearly everything I do today is empirics and coding. But my English degree is unquestionably the most important thing I took from (liberal arts) undergrad.
Reposted by John Graves
Decades of mechanistic talk about university degrees as if they were bundles of 'skills' and 'prep' are about to be proved completely wrong (obviously). Want to get a real boost? Do History or English.
July 13, 2025 at 10:19 AM
Decades of mechanistic talk about university degrees as if they were bundles of 'skills' and 'prep' are about to be proved completely wrong (obviously). Want to get a real boost? Do History or English.
Reposted by John Graves
Trump's bill could strip Medicaid from 12 million Americans. Repeal isn't enough. Democrats must use this opportunity to propose bold reforms that truly fix Medicaid’s core problems.
In @thebulwark.com, I share how to build a system that actually works: www.thebulwark.com/p/democrats-...
In @thebulwark.com, I share how to build a system that actually works: www.thebulwark.com/p/democrats-...
Dems Must Really Fix Medicaid, Not Just Undo Trump’s Damage to It
The party should use this as an opportunity to build toward universal coverage—working from these seven principles for reforming health care.
www.thebulwark.com
July 9, 2025 at 3:40 PM
Trump's bill could strip Medicaid from 12 million Americans. Repeal isn't enough. Democrats must use this opportunity to propose bold reforms that truly fix Medicaid’s core problems.
In @thebulwark.com, I share how to build a system that actually works: www.thebulwark.com/p/democrats-...
In @thebulwark.com, I share how to build a system that actually works: www.thebulwark.com/p/democrats-...
Reposted by John Graves
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)
Medicare saves lives. But is it enough to save lives of the most vulnerable Americans? The study suggests no; Medicaid still matters. (1/11)
Loss of Subsidized Drug Coverage and Mortality among Medicare Beneficiaries | NEJM
A total of 14 million Medicare beneficiaries receive the Low-Income Subsidy (LIS),
which reduces cost sharing in Medicare Part D. Losing the LIS may impede medication
access and affect mortality. U...
www.nejm.org
May 14, 2025 at 9:32 PM
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)
Medicare saves lives. But is it enough to save lives of the most vulnerable Americans? The study suggests no; Medicaid still matters. (1/11)
Reposted by John Graves
ADVISEES: YOUR MENTORS WANT TO KNOW HOW YOU'RE DOING.
(And, yes, I know I could do better with reaching out to you, but leave that aside for the moment.)
Please don't ever think you're bothering your former mentors with requests to catch up. They are not a bother. They want to hear from you.
(And, yes, I know I could do better with reaching out to you, but leave that aside for the moment.)
Please don't ever think you're bothering your former mentors with requests to catch up. They are not a bother. They want to hear from you.
May 12, 2025 at 9:32 PM
ADVISEES: YOUR MENTORS WANT TO KNOW HOW YOU'RE DOING.
(And, yes, I know I could do better with reaching out to you, but leave that aside for the moment.)
Please don't ever think you're bothering your former mentors with requests to catch up. They are not a bother. They want to hear from you.
(And, yes, I know I could do better with reaching out to you, but leave that aside for the moment.)
Please don't ever think you're bothering your former mentors with requests to catch up. They are not a bother. They want to hear from you.
Reposted by John Graves
The Value Zeitgeist — Considering the Slowdown in Health Care Spending Growth | New England Journal of Medicine www.nejm.org/doi/full/10.... @melindabbuntin.bsky.social , Carrie Colla, and I argue it's too soon to give up on value-based care.
The Value Zeitgeist — Considering the Slowdown in Health Care Spending Growth | NEJM
Over the past two decades, the health care spending growth rate in the United States
has declined. But reducing the emphasis on value-based care could lead to a resurgence
in spending growth.
www.nejm.org
April 12, 2025 at 2:27 PM
The Value Zeitgeist — Considering the Slowdown in Health Care Spending Growth | New England Journal of Medicine www.nejm.org/doi/full/10.... @melindabbuntin.bsky.social , Carrie Colla, and I argue it's too soon to give up on value-based care.
Reposted by John Graves
New article out in Health Affairs Scholar with a great group of co-authors led by Jane Zhu providing a novel view on provider networks & adequacy from the carrier perspective
Medicaid managed care organizations' experiences with network adequacy
doi.org/10.1093/hasc...
#HAScholar
Medicaid managed care organizations' experiences with network adequacy
doi.org/10.1093/hasc...
#HAScholar
April 9, 2025 at 6:16 PM
New article out in Health Affairs Scholar with a great group of co-authors led by Jane Zhu providing a novel view on provider networks & adequacy from the carrier perspective
Medicaid managed care organizations' experiences with network adequacy
doi.org/10.1093/hasc...
#HAScholar
Medicaid managed care organizations' experiences with network adequacy
doi.org/10.1093/hasc...
#HAScholar
April 8, 2025 at 3:34 PM
An influential recent finding in health economics is that the welfare benefit of Medicaid to beneficiaries may be less than the cost to the gov't for providing it.
This indicates we need a strong social appetite for redistribution to justify that $ transfers involved. (1/2)
This indicates we need a strong social appetite for redistribution to justify that $ transfers involved. (1/2)
🚨 Rethinking Moral Hazard: Moral hazard in health insurance—the increased spending that comes when you get insured—is usually seen as wasteful due to insurance’s price distortion. This paper challenges that view.
April 7, 2025 at 3:45 PM
An influential recent finding in health economics is that the welfare benefit of Medicaid to beneficiaries may be less than the cost to the gov't for providing it.
This indicates we need a strong social appetite for redistribution to justify that $ transfers involved. (1/2)
This indicates we need a strong social appetite for redistribution to justify that $ transfers involved. (1/2)
Reposted by John Graves
🚨 Rethinking Moral Hazard: Moral hazard in health insurance—the increased spending that comes when you get insured—is usually seen as wasteful due to insurance’s price distortion. This paper challenges that view.
April 7, 2025 at 3:21 PM
🚨 Rethinking Moral Hazard: Moral hazard in health insurance—the increased spending that comes when you get insured—is usually seen as wasteful due to insurance’s price distortion. This paper challenges that view.
Reposted by John Graves
Instead, people are just really bad at estimating percentages
They systematically overestimate smaller %s and underestimate larger %s, including ENTIRELY NON-POLITICAL %s, such as the % of the population that owns an Apple product, has a passport, or has indoor plumbing
They systematically overestimate smaller %s and underestimate larger %s, including ENTIRELY NON-POLITICAL %s, such as the % of the population that owns an Apple product, has a passport, or has indoor plumbing
April 7, 2025 at 12:00 PM
Instead, people are just really bad at estimating percentages
They systematically overestimate smaller %s and underestimate larger %s, including ENTIRELY NON-POLITICAL %s, such as the % of the population that owns an Apple product, has a passport, or has indoor plumbing
They systematically overestimate smaller %s and underestimate larger %s, including ENTIRELY NON-POLITICAL %s, such as the % of the population that owns an Apple product, has a passport, or has indoor plumbing
Reposted by John Graves
Not too much goin' on today, so thought I'd tell you about a new paper out in @nejm.org w/Angrist, Gao, and Yeh
We explain & demonstrate why instrumental variable methods are essential for trials of medical interventions that fail to play out as intended
Check it: www.dropbox.com/scl/fi/lsnmm...
We explain & demonstrate why instrumental variable methods are essential for trials of medical interventions that fail to play out as intended
Check it: www.dropbox.com/scl/fi/lsnmm...
April 3, 2025 at 7:14 PM
Not too much goin' on today, so thought I'd tell you about a new paper out in @nejm.org w/Angrist, Gao, and Yeh
We explain & demonstrate why instrumental variable methods are essential for trials of medical interventions that fail to play out as intended
Check it: www.dropbox.com/scl/fi/lsnmm...
We explain & demonstrate why instrumental variable methods are essential for trials of medical interventions that fail to play out as intended
Check it: www.dropbox.com/scl/fi/lsnmm...
Reposted by John Graves
New: ACA enrollment has more than doubled since 2020, with the greatest growth in states won by President Trump. If enhanced premium aid is allowed to expire at the end of this year, those states will see big out-of-pocket premiums hikes and loss of health coverage.
www.kff.org/policy-watch...
www.kff.org/policy-watch...
April 2, 2025 at 1:33 PM
New: ACA enrollment has more than doubled since 2020, with the greatest growth in states won by President Trump. If enhanced premium aid is allowed to expire at the end of this year, those states will see big out-of-pocket premiums hikes and loss of health coverage.
www.kff.org/policy-watch...
www.kff.org/policy-watch...
Reposted by John Graves
Thread: Obviously I'm very pleased at this recognition, but I'm sharing this for other reasons. 1st, many have the impression that people who have been successful professionally have walked a straight path - got the right degree, right 1st job, succeeded right away.
Congratulations to Martin Gaynor, who has been honored with the Victor R… | Carnegie Mellon University - Heinz College of Information Systems and Public Policy | 43 comments
Congratulations to Martin Gaynor, who has been honored with the Victor R. Fuchs Award for Lifetime Contributions to the Field of Health Economics by the… | 43 comments on LinkedIn
www.linkedin.com
March 31, 2025 at 4:09 PM
Thread: Obviously I'm very pleased at this recognition, but I'm sharing this for other reasons. 1st, many have the impression that people who have been successful professionally have walked a straight path - got the right degree, right 1st job, succeeded right away.
Reposted by John Graves
Using a personal example, AHRQ funded my dissertation research (it was NCHSR then) for $15K in 1981. 44 years later, between policy relevant research, 2 terms of public service (@FTC @DOJ), founding a health care data repository (@HCCI) & teaching health economics, I think the investment paid off.
Some bad AHRQ puns and some good reporting on the details about the potential elimination of AHRQ. Seems almost identical to the USAID playbook, just a month or so further down the timeline.
Exclusive: Get ready for worse health care and more medical errors unless this ongoing illegal impoundment is stopped and quickly reversed. www.offmessage.net/p/the-trump-...
March 19, 2025 at 3:10 PM
Using a personal example, AHRQ funded my dissertation research (it was NCHSR then) for $15K in 1981. 44 years later, between policy relevant research, 2 terms of public service (@FTC @DOJ), founding a health care data repository (@HCCI) & teaching health economics, I think the investment paid off.