The Connection

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

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October 20, 2025

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Medicare Experiences Vary Across States

With Medicare’s annual open enrollment underway, a new Commonwealth Fund report finds dramatic differences in how beneficiaries across states experience the program — from provider access to the affordability of care. The new State Scorecard on Medicare Performance shows that while Medicare is a federal program, the strength of a state’s health care system and the coverage provided by Medicare private plans can have a major impact on how well the program serves people. The scorecard looks at variation in rates of preventable hospitalizations, out-of-pocket spending on prescription drugs, and much more.

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Expiring Tax Credits Could Lead to 340,000 Lost Jobs

You’ve probably heard that the federal government shutdown is linked to an impending big cut in financial assistance for Americans who buy their health insurance through the Affordable Care Act marketplaces. Commonwealth Fund–supported analysis by Leighton Ku and colleagues finds that not renewing the enhanced tax credits, set to expire after December 31, will result in state economies shrinking by $40.7 billion, the loss of some 339,000 jobs in 2026, and a $2.5 billion drop in state and local tax revenues. The projections account for the broader economic effects of health care funding cuts.

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FEATURED CHART

How People Enroll, and Stay Enrolled, in Coverage

The Affordable Care Act made health care coverage more accessible and affordable for Americans. But new federal policies aimed at curbing spending and tightening enrollment rules could reverse this progress. Health policy experts Jeanne Lambrew and Ellen Montz explain that gaps in health coverage are likely to widen in 2026 as recent changes make it harder for people to enroll in and retain coverage. In their report, they outline strategies to prevent coverage losses and close remaining gaps, including extending continuous eligibility for people with low incomes, simplifying and aligning enrollment rules across insurance programs, and creating a single, nationwide eligibility system.

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QUIZ

How many Americans buy their health insurance on the Affordable Care Act marketplaces?

- 9 million
- 15 million
- 23 million
- 34 million

Scroll down to see if you got it right.

Explained: New Limits on Immigrant Health Coverage

For many years, immigrants who are not yet citizens but are lawfully present in the United States have had access to certain benefits, including financial assistance for purchasing health insurance. But new federal rules, along with changes to eligibility requirements included in H.R. 1, the recently passed tax and spending law, will greatly impact immigrants’ ability to qualify for public coverage programs and buy health plans through the insurance marketplaces. Our new explainer clarifies what health coverage is available to lawfully present immigrants and how this will soon change.

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America Will Pay the Price for Deep Cuts to Medicaid

Over the next 10 years, federal Medicaid spending will drop by $900 billion, the largest funding cut in the program’s history. The reduction will not only affect the lives of the 70 million Americans who rely on Medicaid but also will ripple through state budgets and health systems. State officials are already warning of shortfalls, write the Fund’s Celli Horstman and Akeiisa Coleman on To the Point. Some states are scrambling to cover gaps while others prepare to cut provider payments, eliminate benefits, or introduce cost sharing for enrollees early.

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How Cyprus Slashed Out-of-Pocket Health Care Spending

Prior to 2020, the island nation of Cyprus had a fragmented health care system where gaps in coverage had left many residents facing significant out-of-pocket costs. After a major overhaul, Cyprus had consolidated coverage through a new universal health system in which out-of-pocket spending were reduced by more than half. In the latest edition of International Insights, the Commonwealth Fund’s Evan Gumas discusses how Cyprus was able to make care more affordable — and discusses lessons for the U.S.

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An Opening for States to Improve Rural Health Care

When Congress approved more than $900 billion in cuts to Medicaid, it also offered states funding to improve rural health care and advance President Trump’s policy priorities. On To the Point, Lena Marceno and colleagues discuss the new Rural Health Transformation Program, which will invest $50 billion over five years in efforts aligned with the administration’s Make America Healthy Again initiative. While these funds will only offset a fraction of the cuts, they offer an opportunity for states to invest in new collaborations, technologies, payment models, and other initiatives that could improve rural health care delivery.

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Letting Physicians Spend Time on Patients, Not Paperwork

Over the past two decades, primary care physicians have been performing an increasing number of administrative tasks that neither require their expertise nor improve health outcomes for patients. Coupled with the nation’s chronic underinvestment in primary care, these growing demands on their time are contributing to the current U.S. shortage of primary care clinicians. In a new Commonwealth Fund brief, Ann O’Malley and colleagues explore the causes of increasing administrative burden in primary care and offer a range of practical solutions centered on streamlining documentation, simplifying regulations, easing use of electronic health records, reducing inbox overload, and improving compensation.

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When Politics Collides with Science, Public Health Suffers

Science, and medical science in particular, is under attack. Many of our nation’s leaders are choosing politics over facts and prioritizing profit over public health. Online, misinformation about vaccines and medications is spreading at an alarming rate. On The Dose podcast, host Dr. Joel Bervell discusses these big challenges with Dr. Francis Collins, who served as director of the National Institutes of Health under three different presidents. They talk about how to assess the trustworthiness of an information source, why every person deserves access to their DNA sequence, and much more.

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Obesity Medicine in the Age of GLP-1s

Medical care for people with obesity is changing rapidly. While body mass index, or BMI, was once considered the gold standard for diagnosis, it has proven to be less accurate than once thought. Meanwhile, the advent of GLP-1 drugs has provided patients with treatment options that were unimaginable a short time ago. Dr. Fatima Cody Stanford, an obesity medicine physician, joins The Dose podcast to talk about the state of obesity care in the United States. She discusses why insurers are hesitant to cover medications like Ozempic, why BMI fails to capture real health risks, and what the future of obesity treatment looks like.

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Webinar: Coverage at a Crossroads

The Commonwealth Fund is hosting the webinar “Coverage at a Crossroads: Marketplace Affordability and the End of Enhanced Premium Tax Credits,” on Monday, October 20, from 3:00 p.m. to 4:00 p.m. Panelists will discuss the anticipated effects of allowing the Affordable Care Act’s enhanced premium tax credits to expire as well as policy options for protecting affordable coverage. Panelists include the Fund’s Sara Collins, Justin Giovannelli from the Georgetown Center on Health Insurance Reforms, Lynn Cowles from Every Texan, and Devon Trolley from the Pennsylvania Health Insurance Exchange Authority. The Fund’s Rachel Nuzum will moderate.

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Webinar: The 2025 Health Care Wrap-Up

Join “The 2025 Health Care Wrap-Up: A Bipartisan Outlook” on Wednesday, October 22, from 1:15 p.m. to 2:00 p.m., for a review of the current legislative landscape potential near-term opportunities for bipartisan action in Congress. Webinar panelists include Yvette Fontenot from Impact Health Policy Partners, Chris Jennings from Jennings Policy Strategies, Amy Jensen from SplitOak Strategies, and Rodney Whitlock from McDermott+ Consulting. The Fund’s Rachel Nuzum will give opening remarks.

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QUIZ: Answer

The answer is C. More than 23 million working Americans buy health insurance on the ACA marketplaces.

Employer coverage may be the backbone of the U.S. health insurance system, but not all companies offer coverage, and not all workers are eligible for their firm’s health benefits. On To the Point, the Commonwealth Fund’s Avni Gupta and Sara Collins examine how the recently passed tax and spending law, the looming expiration of enhanced premium tax credits, and the Trump administration’s final rule on the marketplaces could disrupt access to health coverage for working people ([link removed] ) . Ultimately, they say, these changes could sharply increase the number of uninsured Americans.

Affordable, quality health care. For everyone.

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

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