The Connection
A roundup of recent Fund publications, charts, multimedia, and other timely content.
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December 9, 2024
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As Costs Rise, Even Insured Americans Find It Harder to Afford Care
Thanks to the Affordable Care Act, the U.S. uninsured rate has dropped to a record low. Yet persistently high health care costs are making it hard for millions of Americans to afford the care they need — even when they have coverage, whether private or public. According to a new Commonwealth Fund survey, nearly one in four working-age adults are underinsured, and two-thirds of these individuals are in employer plans. More than half of uninsured or underinsured adults skip recommended treatments or don’t fill prescriptions because of the cost.
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Older U.S. Adults More Likely to Struggle to Afford Health Care
Although nearly all older Americans have Medicare coverage, they still pay more for health care than their counterparts in many other countries, according to a new Commonwealth Fund survey. The findings highlight the burden that high out-of-pocket costs — in both traditional Medicare and private Medicare Advantage plans — place on older adults. Nearly one in four older Americans spent at least $2,000 out of pocket on health care last year, and older U.S. adults skip or forgo needed medical treatment at some of the highest rates in the survey.
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FEATURED CHART
Why Medicare Beneficiaries Change Coverage
Choosing Medicare coverage can be challenging for beneficiaries. On To the Point, the Commonwealth Fund’s Faith Leonard, Arnav Shah, and Gretchen Jacobson analyze survey data to find out who’s switching their Medicare coverage, what their reasons are, and the types of changes they’re making — whether it’s enrolling in a new plan or moving between traditional Medicare and Medicare Advantage.
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QUIZ
What proportion of Medicare beneficiaries say they struggle to afford copayments, deductibles, and costs for services not covered by the program?
- 10%
- 20%
- 25%
- 33%
Scroll down to see if you got it right.
Medicare Beneficiaries Unaware of Enrollment Assistance
People with Medicare have more coverage choices than ever, but they also face a flood of information about those options — not all of which are accurate or even in beneficiaries’ best interests. To help them make an informed plan selection, beneficiaries should consider looking to the State Health Insurance Assistance Programs (SHIPs), say Melissa Garrido and colleagues at the Boston University School of Public Health. “Systematic communications, coordinated at the federal level” may be needed to improve awareness of the programs, the authors write on To the Point.
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Community-Driven Approach to Improving Maternal Health
The United States has the highest rate of maternal mortality of any high-income nation. This crisis disproportionately affects Black women, who die of pregnancy-related causes at nearly three times the rate of white women. In a new Commonwealth Fund report, Anne Morris Reid and colleagues show how two community-based partnerships, in Baltimore and in Cincinnati, are driving improvements in maternal and infant health. A key to their success, the authors say, is a life-course approach that “emphasizes the need to support improved health outcomes before, throughout, immediately after, and between pregnancies.”
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Birth Centers Improve Maternal Health Outcomes
Cook County Health ([link removed] ) in Chicago and Mass General Brigham ([link removed] ) in Boston recently launched programs that offer free doula services to pregnant people at risk of poor outcomes, including preterm births, according to CBS News. Transforming Care described an alternative model of improving maternal health outcomes: freestanding birth centers ([link removed] ) in low-income communities. Often led by midwives, these birth centers aim to provide unimpeded access to providers who look like the patients they serve.
Medicaid’s Renewed Focus on Children’s Health
Medicaid covers nearly 40 percent of U.S. children, including four-fifths of those living in poverty and more than half of all Black and Latino children. Writing on To the Point, Cindy Mann and Zoe Barnard of Manatt Health note that updated federal guidance on coverage rules through Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) covers a range of strategies that states may use to meet the needs of children and comply with program requirements. The guidance also addresses issues such as medical necessity, service limits and prior authorization, scope of services, and community-based health services.
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Burnout Affecting Many U.S. Primary Care Physicians
The United States is experiencing a primary care crisis. With more and more physicians opting for higher-paying specialties, the number of primary care providers is failing to match patient demand. Using data from the 2022 International Health Policy Survey of Primary Care Physicians, the Commonwealth Fund’s Celli Horstman reports on To the Point that nearly half of U.S. physicians surveyed say they are feeling burned out, and about a third of those plan to stop seeing patients within the next three years. Addressing the primary care crisis, she writes, will require greater investment in primary care, starting with changing the way physicians are paid.
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U.S. Health Outcomes Lag Those in Other Wealthy Nations
In the Commonwealth Fund’s Mirror, Mirror 2024 report, the United States falls short of its peers on key measures of health care system performance. But is it really fair to compare the larger and much more populous U.S. with Germany and Switzerland, two of the nine comparison countries in the study? In Harvard Business Review, David Blumenthal, M.D., Evan D. Gumas, and Reginald D. Williams II take on this issue by comparing health care outcomes in all 50 U.S. states individually with the same nine countries. Their findings reveal that health outcomes in each state fail to match those achieved in the other nine nations.
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AHCJ Awards 2025 Fellowships
The Association of Health Care Journalists has awarded its U.S. Health System Reporting Fellowships and International Health Study Fellowships for 2025. Both programs are supported by the Commonwealth Fund. The U.S. awards go to five journalists who will pursue yearlong reporting projects examining health care systems and health equity: Anissa Durham of Word in Black; Kelly Hooper of Politico; Mohana Ravindranath of STAT; Heerea Rikhraj of New Mexico In Depth; and Manasi Vaidya of GlobalData.
The international awards go to four journalists to investigate comparative health care approaches in Europe and the U.S.: Karen Brown of New England Public Media; Drew Hawkins of Gulf States Newsroom/NPR; Cecilia Nowell of the Guardian; and Sandhya Raman of CQ Roll Call.
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Joel Bervell Named to Forbes’ “30 Under 30” List
Fourth-year medical student Joel Bervell, host of The Dose, the Commonwealth Fund’s podcast, and known online as the “Medical Mythbuster,” is an honoree on this year’s Forbes “30 Under 30” list. Bervell uses social media to educate his 1 million followers about racial disparities in medicine. In 2023, Bervell was a TED Fellow, a recipient of a TikTok Changemaker Award, and one of the United Nations’ Most Influential People of African Descent for health and wellness.
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QUIZ: Answer
The answer is D. According to the Commonwealth Fund 2023 Health Care Affordability Survey, one-third (33%) of Medicare beneficiaries said it was very difficult or somewhat difficult to afford health care costs.
Most Americans with Medicare live on fixed incomes, which means health care costs can pose a threat to their financial stability. Our new fact sheet on Medicare affordability ([link removed] ) draws on recent Commonwealth Fund survey data to highlight the financial barriers to care that beneficiaries face and the groups most adversely impacted. You’ll find information on trends within a range of demographics, including adults with disabilities, people over age 65, and those living below the poverty level.
Affordable, quality health care. For everyone.
The Commonwealth Fund, 1 East 75th Street, New York, NY 10021
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