The Connection
A roundup of recent Fund publications, charts, multimedia, and other timely content.
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May 19, 2025
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Medicaid Offers States a Big Return on Investment
Medicaid is a lifeline for many people with low income, including pregnant women, children, and people with disabilities. In our new explainer, Celli Horstman and colleagues highlight the value that states reap from the program. They show how Medicaid investment has a multiplier effect: every dollar spent generates more than a dollar’s worth of economic activity. Learn how Medicaid boosts state and local economies, improves employment rates, and strengthens job retention.
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Even Children Aren’t Safe from Medicaid Cuts
Congress is expected to consider unprecedented cuts to Medicaid funding that could force states to eliminate certain Medicaid services — or even drop coverage for certain populations, including some children. Deep Medicaid spending cuts would set up a chain reaction, say Sara Rosenbaum and colleagues on To the Point. “With everything on the table, children whose eligibility is not required by federal law are at risk of losing coverage.” Learn how these cuts could alter Medicaid’s central role in children’s health.
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FEATURED CHART
How Medicaid Cuts Would Affect Mental Health Care
Medicaid is the primary source of funding for mental health and substance use care in the United States, covering 26 percent of adults and 43 percent of children with mental health needs. In our new explainer, Nathaniel Counts reports that enrollees relying on Medicaid for these services often can’t afford other health insurance or pay for this care out of pocket. Medicaid cuts, he says, would leave millions of children and adults with mental health needs without access to critical services.
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Work Requirements Don’t Work
Adding work requirements to Medicaid would require a massive investment of states’ time and money, says Robert Gordon, former head of Michigan’s Department of Health and Human Services. He should know: it was his job to implement work requirements when they were previously approved in 2018. On To the Point, Gordon recounts his experience trying to smooth implementation of work requirements and discusses the costs and coverage losses that can come from tying Medicaid eligibility to work.
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QUIZ
How many U.S. adults get their prescription drug coverage through Medicare Part D?
- 15 million
- 35 million
- 55 million
- 75 million
Scroll down to see if you got it right.
Seniors Are Skipping Essential Vision and Hearing Care
For older people, timely access to eye exams, hearing aids, and related services is crucial to avoiding vision and hearing problems, which put them at risk for falls, social isolation, and depression. On To the Point, Acumen’s Janet Sutton and Julie Lee report that while more than half of Medicare beneficiaries 65 and older said they didn’t receive vision care because they believed it wasn’t needed, about one-fifth of beneficiaries with vision coverage through Medicare Advantage didn’t seek vision care because it wasn’t affordable. Traditional Medicare, meanwhile, includes no vision or hearing benefits. Learn more about access to this coverage and insights on why beneficiaries use, or don’t use, it.
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Americans Could Soon Pay More for Less Coverage
A record 24 million Americans are covered by Affordable Care Act marketplace plans, including many working families and people with low or moderate incomes. But consumers could soon be paying more for less coverage, says the Commonwealth Fund’s Sara Collins. As she explains on To the Point, the Trump administration has proposed changes that would raise out-of-pocket maximums and increase how much people contribute to their plan premiums. At the same time, if Congress fails to extend enhanced tax credits, families could see additional premium hikes.
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“Data Silence” Holds High Stakes for People’s Health
We’re in a pivotal moment for health care equity and public health. Systems for tracking data on maternal mortality and chronic disease are being dismantled, with consequences that could last generations. On The Dose podcast, Dr. Marcella Nunez-Smith joins host Joel Bervell to talk about who’s represented in the health data we collect, and who isn’t, and why it’s so important for “people to feel safe in sharing” their data and “to have trust that it’s protected.”
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In Age of AI, Health Innovation Requires Human Stories
The engine of health care innovation runs on data. But too often, data can’t tell the full story. On The Dose, Dr. Sema Sgaier talks about the future of equitable health care: how we collect data, who’s included, and what it means for clinical trials, mental health, and the role of AI. She explains why solving health care’s toughest challenges starts with understanding the human side of health.
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Hospital Capital Spending Affects Prices, Market Share
Hospitals making large capital investments — in new services, upgraded facilities, or expanded capacity — tend to gain market share and raise prices. Those that invest less lose patients and see smaller price increases. As Michael E. Chernew and colleagues write in Health Affairs, this dynamic creates a cycle: expanding hospitals grow stronger, while others decline financially, with real consequences for patient access and market competition. Read more on what’s driving hospital consolidation and what policymakers can do to respond.
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High Rates of Dementia in a Texas Border County
In Starr County, Texas, escaping dementia can feel impossible. The condition affects about one in five adults with Medicare coverage, more than double the national rate. In The Atlantic, Cheney Orr and Marion Renault present their stunning photojournalism essay exploring dementia rates in this community on the U.S.–Mexico border. The piece was made possible through a partnership between the Commonwealth Fund and the Magnum Foundation.
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Are Medicare Advantage’s Star Ratings Useful?
Modern Healthcare reports that the Center for Medicare and Medicaid Innovation may soon revise the Medicare Advantage Star Ratings program ([link removed] ) to emphasize preventive care. A Commonwealth Fund series highlighted other strategies for making Star Ratings more impactful ([link removed] ) , and more useful to consumers.
QUIZ: Answer
The answer is C. There are 55.5 million adults enrolled in Medicare Part D. In 2023, Part D prescription drug spending totaled nearly $145 billion.
The Medicare Drug Price Negotiation Program is doing something that’s never been done before: determining the “maximum fair price” that Medicare will pay for some of the most commonly prescribed medications. With the first negotiated prices set to take effect in 2026, the program could play a significant role in combating rising drug costs. To better understand how the process works, and the key controversies surrounding it, read our new explainer ([link removed] ) .
Affordable, quality health care. For everyone.
The Commonwealth Fund, 1 East 75th Street, New York, NY 10021
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