The Connection

A roundup of recent Fund publications, charts, multimedia, and other timely content.

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October 6, 2025

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How Climate Impacts Health Care in Your State

Extreme weather and air pollution are putting patients’ health — and the hospitals and clinics they depend on — at risk. A new Commonwealth Fund scorecard compares all 50 states and the District of Columbia on their exposure to climate threats and states’ policies to address them. The scorecard evaluates states on eight indicators, including extreme heat, flood risk to health care facilities, and air quality, as well as clean energy policies and health sector greenhouse gas emissions. Get the scorecard to learn how your state ranks.

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Explained: National Work Requirements for Medicaid

Medicaid, the state and federal health insurance program for people with low income, has typically not tied eligibility to employment. This is set to change following the passage of H.R. 1, which added the first national work requirements to Medicaid. Coverage will be contingent on working, volunteering, or engaging in educational activities for at least 80 hours each month. Read our new explainer to learn what work requirements mean for people’s coverage and access to health care; how people have fared in states that have implemented work requirements; and the impact of work requirements in other safety-net programs, like SNAP food assistance.

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FEATURED CHART

Maternal/Child Mortality: How States Compare Globally

Maternal and child mortality rates in the United States are among the highest in the world, according to a new Commonwealth Fund analysis. They also vary dramatically by state, driven by policy choices on Medicaid, reproductive health, and social supports. In a new report, we compare U.S. national and state maternal and child mortality rates against 200 countries, broken down by race and ethnicity. Among the findings: in 2023, the U.S. had 5.6 infant deaths per 1,000 live births, similar to rates in Qatar and Romania.

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QUIZ

What’s the median premium increase for individual-market coverage that health insurers propose for 2026?

- 5%
- 9%
- 14%
- 18%

Scroll down to see if you got it right.

Workers Face Higher Out-of-Pocket Health Costs

New policy changes will make it harder for Americans to buy coverage in the Affordable Care Act (ACA) marketplaces, including workers who use employer-funded accounts to purchase their plans. On To the Point, Georgetown University experts take look at these accounts, known as individual coverage health reimbursement arrangements. New regulations and policy changes in H.R. 1, the massive tax and spending law, are likely to weaken the ACA market, leaving workers who have these accounts with higher premiums and cost-sharing expenses.

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Finding Mental Health Services for Young People

A recent national poll found that the majority of people ages 13 to 24 consider themselves to be happy and in good mental health ([link removed] ) . But there are disparities between groups: roughly a quarter of youth who identify as LGBTQ+ and nearly a third facing financial hardship reported poor mental health, compared to about one in 10 youth overall. Transforming Care explores innovative programs and tools for helping young people find mental health services ([link removed] ) and build resilience.

QUIZ: Answer

The answer is D. The median proposed premium increase for 2026 is 18 percent nationally, more than twice the increase insurers proposed for 2025 and triple the change for 2024.

More than 20 million people get their health insurance from the ACA marketplaces. Recent rate filings from insurers show premiums for those plans will surge in 2026 — in some states, to as much as three times their current level. These increases are being driven by an overall rise in health care costs and by the expiration of the enhanced premium tax credits ([link removed] ) , say Georgetown University researcher Stacey Pogue and colleagues. With open enrollment beginning in November, millions of people will soon learn they must pay significantly more to keep their coverage next year.

Affordable, quality health care. For everyone.

The Commonwealth Fund, 1 East 75th Street, New York, NY 10021

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