State-level Changes Research Articles

Increasing expenditures on home- and community-based services: Do home care workers benefit?

To examine the association of Medicaid home- and community-based services (HCBS) expenditures on the home care workforce. We use two national, secondary data sources from 2008 to 2019: state-level Medicaid HCBS expenditures and the American Community Survey, in which we identify direct care workers in the home (i.e., home care workers), defined as nursing, psychiatric, and home health aides or personal care aides working in home health care services, individual and family services, and private households. Our key explanatory variable is HCBS expenditures per state per year. To estimate the association between changes in Medicaid HCBS expenditures and the workforce size, hourly wages and hours worked, we use negative binomial, linear, and generalized ordered logit regression, respectively. All models include demographic and socioeconomic characteristics, the number of potential HCBS beneficiaries (individuals with a disability and income under the federal maximum income eligibility limits), indicators for minimum wage and/or overtime protections for direct care workers, wage pass-through policies, and state and year fixed effects. We exclude states with incomplete reporting of expenditures. States' HCBS expenditures increased between 2008 and 2019 after adjusting for inflation and the number of potential HCBS beneficiaries. Yet, home care workers' wages remained stagnant at $11-12/h. We find no association between changes in Medicaid HCBS expenditures and wages. For every additional $1 million in Medicaid HCBS expenditures, the expected number of workers increases by 1.2 and the probability of working overtime increased (0.0015% points; p < 0.05). Results are largely robust under multiple sensitivity analyses. We find no evidence of a statistically significant relationship between changes in state-level changes in Medicaid HCBS expenditures and worker wages but do find a significant, but small, association with hours worked and workforce size.

Numerical Study of the Ultra-High-Speed Aerodynamically Alleviated Marine Vehicle Motion Stability in Winds and Waves

The ultra-high-speed aerodynamically alleviated marine vehicle (AAMV) is a high-performance vessel that combines a hydrodynamic configuration and an aerodynamic wing to reduce wave-making resistance during the high-speed planing phase. The forces of the AAMV exhibit strong nonlinear and water–air coupling characteristics, resulting in particularly complex motion characteristics. This paper presents a longitudinal and lateral stability model of the AAMV, which considers the effects of aerodynamic alleviation. Additionally, a numerical model of wind and wave turbulence forces is established, which considers viscous correction based on the potential theory. Finally, the effect of wind and wave turbulence forces on the motion stability of the AAMV under regular and irregular waves is analyzed by numerical solution. The simulation results demonstrate the influence of these disturbance forces on the stability of the AAMV under different sea states. The motion parameters of the AAMV exhibit a pronounced response to changes in sea state level. The aerodynamically alleviated effect is enhanced as speed increases, and the influence of winds and waves on the AAMV is greatly weakened, reducing the possibility of instability. During the cruising phase under class V sea state, the pitch, roll, and heave response are 0.210°, 0.0229°, and 0.0734 m, respectively. This effect can effectively improve the motion stability of the AAMV in winds and waves.

Continuous Medicaid Eligibility During the COVID-19 Pandemic and Postpartum Coverage, Health Care, and Outcomes

Pursuant to the Families First Coronavirus Response Act (FFCRA), continuous Medicaid eligibility during the COVID-19 public health emergency (PHE) created a de facto national extension of pregnancy Medicaid eligibility beyond 60 days postpartum. To evaluate the association of continuous Medicaid eligibility with postpartum health insurance, health care use, breastfeeding, and depressive symptoms. This cohort study using a generalized difference-in-differences design included 21 states with continuous prepolicy (2017-2019) and postpolicy (2020-2021) participation in the Pregnancy Risk Assessment Monitoring System (PRAMS). State-level change in Medicaid income eligibility after 60 days postpartum associated with the FFCRA measured as a percent of the federal poverty level (FPL; ie, the difference in 2020 income eligibility thresholds for pregnant people and low-income adults/parents). Health insurance, postpartum visit attendance, contraceptive use (any effective method; long-acting reversible contraceptives), any breastfeeding and depressive symptoms at the time of the PRAMS survey (mean [SD], 4 [1.3] months postpartum). The sample included 47 716 PRAMS respondents (64.4% aged <30 years; 18.9% Hispanic, 26.2% non-Hispanic Black, 36.3% non-Hispanic White, and 18.6% other race or ethnicity) with a Medicaid-paid birth. Based on adjusted estimates, a 100% FPL increase in postpartum Medicaid eligibility was associated with a 5.1 percentage point (pp) increase in reported postpartum Medicaid enrollment, no change in commercial coverage, and a 6.6 pp decline in uninsurance. This represents a 40% reduction in postpartum uninsurance after a Medicaid-paid birth compared with the prepolicy baseline of 16.7%. In subgroup analyses by race and ethnicity, uninsurance reductions were observed only among White and Black non-Hispanic individuals; Hispanic individuals had no change. No policy-associated changes were observed in other outcomes. In this cohort study, continuous Medicaid eligibility during the COVID-19 PHE was associated with significantly reduced postpartum uninsurance for people with Medicaid-paid births, but was not associated with postpartum visit attendance, contraception use, breastfeeding, or depressive symptoms at approximately 4 months postpartum. These findings, though limited to the context of the COVID-19 PHE, may offer preliminary insight regarding the potential impact of post-pandemic postpartum Medicaid eligibility extensions. Collection of longer-term and more comprehensive follow-up data on postpartum health care and health will be critical to evaluating the effect of ongoing postpartum policy interventions.

How ballot access laws increase primary competition and decrease party unity

How do electoral institutions affect primary competition and legislative behavior? This paper examines the understudied electoral rule known as ballot access laws, advancing the novel theory that denying ballot access to minor candidates forces these outsiders into major parties. I find that in American states that adopt high ballot access thresholds experience higher rates of ideological heterogeneity and primary competition, and those that reduce their thresholds experience a reduction in heterogeneity and competition. Using an original dataset on state-level changes to ballot access thresholds from 1990 to 2018, I find that an increase in the number and type of primary competition leads to an increase in heterogeneity within both party caucuses. This paper adds to the literature on legislative behavior and electoral institutions, demonstrating institutions role in shaping electoral competition and the ideology of those represented in office.

State-to-State Variation in Opioid Dispensing Changes Following the Release of the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain

Evidence suggests that opioid prescribing was reduced nationally following the 2016 release of the Guideline for Prescribing Opioids for Chronic Pain by the US Centers for Diseases Control and Prevention (CDC). State-to-state variability in postguideline changes has not been quantified and could point to further avenues for reducing opioid-related harms. To estimate state-level changes in opioid dispensing following the 2016 CDC Guideline release and explore state-to-state heterogeneity in those changes. This cross-sectional study included information on opioid prescriptions for US individuals between 2012 and 2018 from an administrative database. Serial cross-sections of monthly opioid dispensing trajectories in each US state and the District of Columbia were analyzed using segmented regression to characterize preguideline dispensing trajectories and to estimate how those trajectories changed following the 2016 guideline release. Data were analyzed January to March 2023. The March 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. Four measures of opioid dispensing: opioid dispensing rate per 100 000 persons, long-acting opioid dispensing rate per 100 000 persons, high-dose (90 or more morphine milligram equivalents [MME] per day) dispensing rate per 100 000 persons, and average per capita MME. All measures were calculated monthly, from January 2012 through December 2018. Data from approximately 58 900 retail pharmacies were included in analysis, representing approximately 92% of US retail prescriptions. The overall monthly dispensing rate in the US in early 2012 was approximately 7000 per 100 000 population. Following the 2016 guideline release, the already-decreasing slope accelerated nationally for the overall dispensing rate (preguideline slope, -23.19; postguideline slope, -48.97; change in slope, 25.97 [95% CI, 18.67-32.95]), long-acting dispensing rate (preguideline slope, -1.03; postguideline slope, -5.94; change in slope, 4.90 [95% CI, 4.26-5.55]), high-dose dispensing (preguideline slope, -3.52; postguideline slope, -7.63; change in slope, 4.11 [95% CI, 3.49-4.73]), and per-capita MME (preguideline slope, -0.22; postguideline slope, -0.58; change in slope, 0.36 [95% CI, 0.30-0.42]). For all outcomes, nearly all states showed analogous acceleration of an already-decreasing slope, but there was substantial state-to-state heterogeneity. Slope changes (preguideline - postguideline slope) ranged from 9.15 (Massachusetts) to 74.75 (Mississippi) for overall dispensing, 1.88 (Rhode Island) to 13.41 (Maine) for long-acting dispensing, 0.71 (District of Columbia) to 13.68 (Maine) for high-dose dispensing, and 0.06 (Hawaii) to 0.91 (Arkansas) for per capita MME. The 2016 CDC Guideline release was associated with broad reductions in prescription opioid dispensing, and those changes showed substantial geographic variability. Determining the factors associated with these state-level differences may inform further improvements to ensure safe prescribing practices.

Supplemental Nutrition Assistance Program Emergency Allotments and Food Security, Hospitalizations, and Hospital Capacity

Understanding how social policies shape health is a national priority, especially in the context of the COVID-19 pandemic. To understand the association between politically motivated changes to Nebraska's Supplemental Nutrition Assistance Program (SNAP) policy and public health measures during the COVID-19 pandemic. This cross-sectional study used synthetic control methods to estimate the association of Nebraska's decision to reject emergency allotments for the SNAP with food security and hospital capacity indicators. A counterfactual for Nebraska was created by weighting data from the rest of the US. State-level changes in Nebraska between March 2020 and March 2021 were included. Data were acquired from the Census Bureau's Household Pulse Survey on individual food security and mental health indicators and from the US Centers for Disease Control and Prevention on hospital-level capacity indicators. Data analysis occurred between October 2022 and June 2023. The rejection of additional SNAP funds for low-income households in Nebraska from August to November 2020. Food insecurity and inpatient bed use indicators (ie, inpatient beds filled, inpatient beds filled by patients with COVID-19, and inpatients with COVID-19). The survey data of 1 591 006 respondents from May 2020 to November 2020 was analyzed, and 24 869 (1.56%) lived in Nebraska. Nebraska's population was composed of proportionally more White individuals (mean [SD], 88.70% [0.29%] vs 78.28% [0.26%]; P < .001), fewer individuals who made more than $200 000 in 2019 (4.20% [0.45%] vs 5.22% [0.12%]; P < .001), and more households sized 1 to 3 (63.41% [2.29%] vs 61.13% [1.10%); P = .03) compared with other states. Nebraska's rejection of additional funding for SNAP recipients was associated with increases in food insecurity (raw mean [SD] difference 1.61% [1.30%]; relative difference, 19.63%; P = .02), percentage of inpatient beds filled by patients with COVID-19 (raw mean [SD] difference, 0.19% [1.55%]; relative difference, 3.90%; P = .02), and percentage of inpatient beds filled (raw mean [SD] difference, 2.35% [1.82%]; relative difference, 4.10%; P = .02). In this cross-sectional study, the association between social policy, food security, health, and public health resources was examined, and the rejection of emergency allotments in Nebraska was associated with increased food insecurity. Additionally, this intervention was associated with an increased rate of hospitalizations for COVID-19 and non-COVID-19 causes.

Power surge: How a multistakeholder coalition promotes equity in computer science education policy

The Computer Science (CS) for All national movement is increasingly relying on state-level change to broaden participation in computing. To foster an environment in which all students have opportunities to thrive in CS education, policy action is necessary to help create the learning conditions for success. CS education in California has grown substantially in the last decade, yet opportunity gaps remain for young women and Black, Latinx, and Native American students. Early grassroots efforts to advance equity in computing evolved into the Computer Science for California coalition of K–16 educators, industry leaders, and other equity advocates to promote the growth of equity-minded teaching and learning opportunities in K–12 CS education. New policies at the state level reflect an increasing commitment among Sacramento policymakers to expand CS education. Yet troubling disparities in CS access and success continue to exist between traditionally advantaged students and their historically underserved peers. By drawing on interviews with 20 individuals involved in CS education policy, this study illuminates the contributing factors to recent policy successes and considerations for achieving further progress. Interviewees described the importance of tapping into the values of influential decision makers, educating policymakers about the benefits of CS education, and identifying the problems and solutions that require policy attention. To build the capacity of key policy actors in making informed decisions, this research demonstrates the continued value of providing useful information, developing relationships with policymakers, and creating resources that are easy to consume and understand. The interviews also suggest that attention to funding, disruptions from the COVID-19 pandemic, equity, and ongoing stakeholder support will shape prospects for CS education policy success moving forward.

Assessing Theories of State and Trait Change in Neuroticism and Symptom Improvement in the Unified Protocol

Researchers have shown neuroticism decreases with treatment (Roberts et al., 2017), although it is unclear if this reflects fleeting state-level changes (state-artifact position) or trait-level change (cause-correction hypothesis). These theories further propose that changes in neuroticism predict symptom change (cause-correction hypothesis) or are predicted by symptom change (state-artifact position). We compared these theories in a clinical trial of the Unified Protocol (UP). Participants (N = 38; Mage = 34.55, 71.1% female, 78.9% Caucasian) meeting DSM-5 criteria for a primary emotional disorder completed up to 12 weekly sessions of the UP. Neuroticism exhibited state-level changes by Session 6 but trait-level changes by Session 12. Within-person reductions in neuroticism exhibited bidirectional relations with anxiety symptom change but predicted unidirectional session-to-session reductions in depression. These findings provide relatively more nuanced support for the cause-correction hypothesis that the UP leads to trait changes in neuroticism that tend to precede symptom change.

State Medicaid and private telemedicine coverage requirements and telemedicine use, 2013-2019.

To examine the association between state Medicaid and private telemedicine coverage requirements and telemedicine use. A secondary objective was to examine whether these policies were associated with health care access. We used nationally representative survey data from the 2013-2019 Association of American Medical Colleges Consumer Survey of Health Care Access. The sample included Medicaid-enrolled (4492) and privately insured (15,581) adults under age 65. The study design was a quasi-experimental two-way-fixed-effects difference-in-differences analysis that took advantage of state-level changes in telemedicine coverage requirements during the study period. Separate analyses were conducted for the Medicaid and private requirements. The primary outcome was the past-year use of live video communication. Secondary outcomes included same-day appointment, always able to get needed care, and having enough options for where to go to receive care. N/A. Medicaid telemedicine coverage requirements were associated with a 6.01 percentage-point increase in the use of live video communication (95% CI, 1.62 to 10.41) and an 11.12 percentage-point increase in always being able to access needed care (95% CI, 3.34 to 18.90). While generally robust to various sensitivity analyses, these findings were somewhat sensitive to included study years. Private coverage requirements were not significantly associated with any of the outcomes considered. Medicaid telemedicine coverage during 2013-2019 was associated with significant and meaningful increases in telemedicine use and health care access. We did not detect any significant associations for private telemedicine coverage policies. Many states added or expanded telemedicine coverage policies during the COVID-19 pandemic, but states will face decisions about whether to maintain these enhanced policies now that the public health emergency is ending. Understanding the role of state policies in promoting telemedicine use may help inform policymaking efforts going forward.

MP19-16 LARGE STATE-LEVEL VARIATION IN INTRAVESICAL TREATMENT FOR NON-MUSCLE INVASIVE BLADDER CANCER DURING THE BCG DRUG SHORTAGE

You have accessJournal of UrologyCME1 Apr 2023MP19-16 LARGE STATE-LEVEL VARIATION IN INTRAVESICAL TREATMENT FOR NON-MUSCLE INVASIVE BLADDER CANCER DURING THE BCG DRUG SHORTAGE Brian Chun, Meiqi He, Cameron Jones, Robin Vasan, Bruce Jacobs, Inmaculada Hernandez, and Benjamin Davies Brian ChunBrian Chun More articles by this author , Meiqi HeMeiqi He More articles by this author , Cameron JonesCameron Jones More articles by this author , Robin VasanRobin Vasan More articles by this author , Bruce JacobsBruce Jacobs More articles by this author , Inmaculada HernandezInmaculada Hernandez More articles by this author , and Benjamin DaviesBenjamin Davies More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003244.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bacillus Calmette-Guerin (BCG) is the gold standard for treatment of non-muscle invasive bladder cancer. In the last two decades, the two major manufacturers of BCG have suffered production failures or have left the market due to economic infeasibility. This has resulted in a worldwide shortage of this important biologic drug. We used a national representative dataset to describe the effect of this shortage on intravesical treatment patterns for non-muscle invasive bladder cancer. METHODS: Using claims data from a 5% random sample of Medicare beneficiaries, we identified patients ≥66 years of age who received intravesical therapy within 1 year of bladder cancer diagnosis from 2010-2017. The BCG shortage period was defined from July 2012, when the FDA ordered Sanofi to immediately cease drug production due to a facility contamination. We estimated changes in the proportion of patients treated with BCG, mitomycin C, gemcitabine, or other intravesical agents before and during the shortage. We evaluated state-level changes in BCG induction rates before and during the shortage period. RESULTS: 7971 patients were included in our study. The proportion of eligible patients receiving BCG induction therapy decreased 5.9%, from 38.9% (1030 of 2648 patients) in the pre-shortage period, to 33.0% (1756 of 5323 patients) in the shortage period (p<0.001). Mitomycin C use increased from 24.6% in 2010 to a peak in 30.9% in 2014 and 2015 (p=0.001). The use of gemcitabine remained stable (p=0.55). Among 19 states reporting data on ≥50 patients, 16 (84%) had a decrease in BCG initiation rate during the shortage period, ranging from 5.1% (New Jersey) to 35.5% (Washington). CONCLUSIONS: During the BCG drug shortage, BCG use for non-muscle invasive bladder cancer decreased with a compensatory rise in mitomycin C. A large variation in state-level BCG utilization may reflect differences in regional practice patterns or BCG availability. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e271 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian Chun More articles by this author Meiqi He More articles by this author Cameron Jones More articles by this author Robin Vasan More articles by this author Bruce Jacobs More articles by this author Inmaculada Hernandez More articles by this author Benjamin Davies More articles by this author Expand All Advertisement PDF downloadLoading ...

Stable Income, Stable Family

Abstract We document the effect of unemployment insurance generosity on divorce and fertility using an identification strategy that leverages state-level changes in maximum benefits over time and comparisons across workers who have been laid off and those that have not been laid off. The results indicate that higher maximum benefit levels mitigate the effects of layoffs. In particular, they mitigate increases in divorce associated with men's layoffs; increases in separations associated with women's layoffs; reductions in fertility associated with men's layoffs; and increases in fertility associated with women's layoffs.

Labor Unemployment Risk and CEO Incentive Compensation

Unemployment risk influences workers’ incentives to invest in firm-specific human capital. This paper investigates the impact of unemployment risk on chief executive officers (CEOs)’ risk-taking incentive compensation. Exploiting state-level changes in unemployment benefits, we find that after unemployment insurance benefits become more generous, boards increase the convex payoff structure of CEO pay to encourage risk taking. The increase in CEOs’ convexity payoff is stronger in firms with more independent and diverse boards, higher ownership of long-term shareholders, and in industries requiring highly skilled labor. Our findings suggest that boards internalize workers’ interests in firms’ risk-taking decisions and executive compensation is one mechanism used. This paper was accepted by David Simchi-Levi, finance. Funding: K. Zhang acknowledges financial support from the National Natural Science Foundation of China [Grants 72272099 and 71902115]. Supplemental Material: Data and the online appendix are available at https://doi.org/10.1287/mnsc.2023.4714 .

Impact of State-Level Changes to School-Based Autism Identification Criteria

School and medical settings often use different identification criteria for autism spectrum disorder (ASD), a neurodevelopmental disability affecting social-communication, behavioral patterns, and sensory experiences. Further, individual states may use varied definitions for special education eligibility. On January 1, 2019, the State of Oregon began implementing overhauled statewide criteria and evaluation requirements for ASD special education eligibility that directly align with current medical system criteria specified in the Diagnostic and Statistical Manual, Fifth Edition (DSM-5). Immediately following these changes, and then again 1 year later in January of 2020 (prior to the COVID-19 pandemic), we surveyed school-based practitioners across the state about their ASD evaluation practices as well as their knowledge, training, and beliefs regarding the newly revised standards. Our results indicated that practitioners felt more familiar with and had received better training on the new standards after a full year of implementation and that 58% of practitioners had changed their evaluation procedures in some way. However, 74% of practitioners reported that despite these changes, there was no difference in the number of students being found eligible for an ASD diagnosis, indicating that the real-world impact of the statewide policy change might be more limited than initially believed. Limitations and future directions are discussed.

Does subsidized public health insurance for parents improve children's human capital and close achievement gaps?

Between 2009 and 2018, many states dramatically changed income eligibility limits for parental Medicaid. We examine whether increasing parental Medicaid eligibility had spillover benefits on children's development. We study the effects of state-level changes in parental income limits for Medicaid on 3rd through 8th grade mathematics and English-language arts (ELA) achievement using county-level administrative test score data. We find that a 50-percentage point increase in parental Medicaid income limits, roughly equal to the average state increase in eligibility over this period, is associated with a 1.5% reduction in the socioeconomic achievement gap for math and a 3% reduction in the white-black math achievement gap. Math test scores improved significantly following parental Medicaid eligibility expansions among black students residing in poorer counties, with little estimated change in test scores for black students in higher income counties. We find no effect in ELA achievement gaps or white-Hispanic test score gaps. Our findings suggest that means-tested policies that improve parental and family wellbeing have important spillover benefits to children's educational achievement and can help reduce inequities in children's human capital development.

Análise das correlações entre nitrogênio total e clorofila a em reservatórios do Ceará/Brasil

ABSTRACT Chlorophyll a (Chla) concentration is an important indicator to characterize algal biomass, reflecting water quality and the level of eutrophication of aquatic environments. This study analyzed 4315 total nitrogen (TN) and Chla samples in 155 reservoirs in Ceará, Brazil. Relationships were obtained between TN and Chla through simple linear regression and classified according to the statistical performance of the coefficient of determination (R²). The dynamics of these correlations were examined by analyzing the variance between classification groups concerning watershed, reservoir size, coefficient of variability, and trophic state. The concentration of pollutants was influenced by seasonality, which increased significantly from the wet to the dry period in most basins. The coefficients of determination between Chla and TN for the watersheds followed the trends of classic curves in the literature, with satisfactory models (R² &gt; 0.3) in most reservoirs (53.3%). The variance analysis attested that the models’ performance was affected by the basins, the volumetric variation, and the change in the trophic state levels. There was no significant variance of R² between reservoirs of different sizes.

Changes in State-Level Cigarette Sales During the COVID-19 Pandemic

This cohort study estimates state-level changes in cigarette sales in the US during the COVID-19 pandemic.

Change in US state-level public opinion about climate change: 2008–2020

Public attitudes toward climate change influence climate and energy policies and guide individual mitigation and adaptation behaviors. Over the last decade, as scientific certainty about the causes and impacts of, and solutions to the climate crisis has increased, cities, states, and regions in the United States have pursued diverse policy strategies. Yet, our understanding of how Americans’ climate views are changing remains largely limited to national trends. Here we use a large US survey dataset () to estimate dynamic, state-level changes in 16 climate change beliefs, risk perceptions, and policy preferences over 13 years (2008–2020). We find increases in global warming issue importance and perceived harm in every state. Policy support, however, increased in more liberal states like California and New York, but remained stable elsewhere. Year-by-year estimates of state-level climate opinions can be used to support sub-national mitigation and adaptation efforts that depend on public support and engagement.

Associations Between State-Level Changes in Reproductive Health Services and Indicators of Severe Maternal Morbidity

This cross-sectional study examines the legislative, state, economic, and racial factors in increased severe maternal morbidity risk in pregnant individuals.

European Antitrust Enforcement in the Digital Era: How It Started, How It’s Going, and the Risks Lying Ahead

The digitalization of economy, the proliferation of data collection, and the increased dependency of consumers on online services has brought about new ecosystems, new business models, and new, complex antitrust issues. Delineating the new remits of antitrust enforcement to tackle those issues is not an easy task. The present contribution discusses significant legislative and enforcement changes in Europe, both at Union and Member State level and identifies risks for the future of antitrust enforcement.

Geographic Variations in Growth of Radiologists and Medicare Enrollees From 2012 to 2019

ObjectiveAnalyze changes in the number of Medicare-serving radiologists and Medicare enrollees nationwide and by geographic region and state from 2012 to 2019 to understand variations in allocation of imaging health care services over the past decade. MethodsThe number of radiologists submitting claims to Medicare was extracted from the CMS Physician and Other Supplier Public Use File Database. The number of Medicare enrollees by state was obtained from the Kaiser Family Foundation. National-, regional-, and state-level changes in rates of growth of radiologists, Medicare enrollees, and radiologists per 100,000 Medicare enrollees from 2012 to 2019 were tabulated. ResultsThe overall number of radiologists per 100,000 Medicare enrollees was 79.7 in 2012, increasing to 79.9 in 2019. In 2012, the number of radiologists per 100,000 enrollees was lower than the national average in the South (66.9; 16% lower) and Midwest (79.1; 0.7% lower) and higher in the Northeast (98.3; 23% higher) and West (88.8; 11% higher). In 2019, the number of radiologists per 100,000 enrollees was lower than the national average in the South (69.8; 12% lower) only and was higher in the Midwest (81.4; 1.9% higher), Northeast (99.3; 24% higher), and West (80.2; 0.4% higher). By state, there was a 4.2-fold variation in the number of radiologists per 100,000 Medicare enrollees, ranging from 38.8 in Wyoming to 161.4 in Minnesota (200.5 in Washington, DC). DiscussionThe growth of Medicare-serving radiologists and Medicare enrollees was stable nationally and demonstrated tremendous variations by US region and state. These variations bring to light potential implications for patient access to care and distribution of health care resources.