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Background: Whether variation in Medicaid reimbursement fees influenced the impacts of the Medicaid expansions is not well understood. Objective: We examine whether changes in health care access associated with Medicaid expansion are different in states with comparatively high Medicaid reimbursement rates compared against expanding in states with lower Medicaid reimbursement rates. Design: Using a difference-in-difference-in-difference (DDD or triple-difference) regression approach, we compare relative differences in Medicaid expansion effects between lower and higher reimbursement states. Participants: 512,744 low-income adults aged 20–64 in the 2011–2019 Behavioral Risk Factor Surveillance System. Main Measures: Health insurance coverage status, unmet medical needs due to cost, regular source for health care, and a regular/scheduled checkup within the past year. Key Results: Medicaid expansion has significant and positive impacts on health coverage and access in both high- and low-fee states. In states with fee levels above the median Medicare-to-Medicaid ratios, expanding Medicaid eligibility reduced uninsurance rate by 15.2 percentage point (ppt, p < 0.01), shrank the cost-associated unmet medical need by 10.3 ppt (p < 0.01), improved access to usual source of care by 1.9 ppt (p < 0.1), and increased regular checkup by 14.4 ppt (p < 0.01), while such effects in low-fee states were 11.7 ppt (p < 0.01), 8.3 ppt (p < 0.01), 3.1 ppt (p < 0.1), and 12.3 ppt (p < 0.01), respectively. Our results suggest that Medicaid expansion effect on unmet medical need due to cost in higher-reimbursing states was 2.98 ppt (p < 0.05) larger than in lower-reimbursing states. Evidence suggests modest increases in health care access were more strongly associated with expansions in higher-fee states. Conclusions: Medicaid's fee structure should be considered as a factor influencing large-scale coverage expansions. [ABSTRACT FROM AUTHOR]

Background: Food insecurity (FI) often co-exists with other social risk factors, which makes addressing it particularly challenging. The degree of association between FI and other social risk factors across different levels of income and before and during the COVID-19 pandemic is currently unknown, impeding the ability to design effective interventions for addressing these co-existing social risk factors. Objective: To determine the association between FI and other social risk factors overall and across different levels of income-poverty ratios and before (2019) and during (2020–2021) the pandemic. Design: We used nationally representative data from the 2019–2021 National Health Interview Survey for our cross-sectional analysis. Social risk factors available in NHIS included difficulties paying for medical bills, difficulties paying for medications, receiving income assistance, receiving rental assistance, and "not working last week". Subjects: 93,047 adults (≥18 years old). Key Results: Individuals with other social risk factors (except receiving income assistance) were more likely to report FI, even after adjusting for income and education inequalities. While poverty leads to a higher prevalence of FI, associations between FI and other social risk factors were stronger among people with higher incomes, which may be related to their ineligibility for social safety net programs. Associations were similar before and during the pandemic, perhaps due to the extensive provision of social safety net programs during the pandemic. Conclusions: Future research should explore how access to a variety of social safety net programs may impact the association between social risk factors. With the expiration of most pandemic-related social supports, further research and monitoring are also needed to examine FI in the context of increasing food and housing costs. Our findings may also have implications for the expansion of income-based program eligibility criteria and screening for social risk factors across all patients and not only low-income people. [ABSTRACT FROM AUTHOR]

This article examines the relationship between food insecurity and binge eating and weight loss behaviors in low-income adults. The study found that food insecurity was associated with a higher prevalence of binge eating behavior, with one in six participants reporting concurrent binge eating and weight loss behaviors. The feast-or-famine hypothesis suggests that those experiencing food insecurity may eat more during periods of food availability, contributing to the cycle of binging and dieting. These findings highlight the need for clinicians to address potential disordered eating behaviors among low-income patients at risk of food insecurity. [Extracted from the article]

The article discusses the Editors in Chief's commitment to promoting diversity, equity, and inclusion (DEI) in the Journal of General Internal Medicine (JGIM). They emphasize the need to address inequities in healthcare access and outcomes and make structural changes to ensure long-term equity. The editors outline a three-level approach to promoting DEI, including developing diverse leadership within JGIM, diversifying the ranks of the journal, and partnering with existing equity leaders and initiatives. They also plan to collect demographic data of reviewers and editors to track diversity and publish a yearly "Equity Report." Additionally, they highlight the importance of including perspectives from the Global South and announce the establishment of the position of Advocate for DEI within JGIM. The article concludes by emphasizing the importance of advocating for equity and change in healthcare. [Extracted from the article]