The Connection
A roundup of recent Fund publications, charts, multimedia, and other timely content.
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November 3, 2025
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Coverage Under Threat for Many Health Center Patients
Community health centers serve people regardless of their ability to pay, making them a vital source of primary care for millions of Americans with low incomes. But big changes coming to the Affordable Care Act marketplaces next year will have serious implications for health centers and their patients. If Congress does not extend the enhanced premium tax credits, their expiration, along with other changes, will lead to nearly 2 million health center patients losing their coverage, say George Washington University’s Feygele Jacobs and colleagues. Those living in the 10 states that have not expanded Medicaid eligibility will have few coverage options, but new work requirements will pose challenges for people even in expansion states.
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Contraceptive Access Through Title X Could End
President Trump’s 2026 budget proposal would eliminate the Title X Family Planning Program, the nation’s only federal program dedicated to providing contraception, pregnancy testing, treatment for sexually transmitted infections, and other preventive care. Experts from Waxman Strategies explain that the move would strip access to family planning care for millions of people, mainly those with low incomes. “Without the support of Title X and other sources of public funding, access to family planning care will be at risk for the patients and communities who need it most,” they say.
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FEATURED CHART
Medicare Advantage’s Extra Benefits Go Unused by Many
Medicare Advantage plans offer extra benefits not included in traditional Medicare, such as dental, vision, and hearing coverage. Some also offer services like meal delivery or transportation. In 2025, the federal government paid these plans $39 billion to provide the added benefits, and one in four enrollees said they chose their plan because of them. But as Commonwealth Fund researchers report, three in 10 plan enrollees don’t know what benefits they have or how to use them, and two in five don’t expect to use certain benefits.
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QUIZ
In 2025, the Medicare Inflation Rebate Program began invoicing manufacturers for rebates to Medicare when they increase certain drug prices faster than inflation. How much money will Medicare save over the next 10 years due to the rebates?
- $11 billion
- $31 billion
- $51 billion
- $71 billion
Scroll down to see if you got it right.
Maintaining Rural Access to Maternity Care
Rural communities across the United States are rapidly losing access to maternal health services. In just the past five years, more than 100 rural hospitals have closed their labor and delivery units, and only two in five rural hospitals now have the staff, expertise, and equipment to safely deliver babies. Sarah Klein and Molly Castle Work tell the story of how some rural providers have maintained access to maternity care in states such as Alabama, Mississippi, Oklahoma, and Texas.
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Philanthropy’s Role in Improving Maternal Health
Community-based primary care models are well positioned to help reduce maternal mortality, particularly for the historically marginalized populations disproportionately impacted by the crisis. Writing on the Grantmakers In Health blog, Mahabuba Masud, a 2025 Michael Drake Philanthropy Fellow at the Commonwealth Fund, says that philanthropic support of community-based models can help local organizations develop and sustain maternal care outcomes. By addressing gaps in public systems through strategic grantmaking, operational support, and convening opportunities, “they can leverage their financial and social capital to be agents of change and ensure health equity initiatives benefit underserved populations,” she writes.
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Fixing How We Pay for Care
“The proportion of energy and resources that goes into getting paid instead of taking care of patients is out of whack.” That’s Dr. Mai Pham’s assessment of how we pay for health care in the United States, where all too often the imperative is volume over value, and billing over better care. On The Dose podcast, host Dr. Joel Bervell talks with Pham about how we can deliver on the promise of equitable, person-centered care.
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A New Approach to Youth Mental Health
AI therapy for children with anxiety, mental health training for staff at nonprofits that work with young people, and an “art pharmacy” that prescribes free museum tickets to kids — these are just some of the things Dr. Kevin Simon and his team are doing to help meet the mental health care needs of Boston’s children. Speaking on The Dose podcast, Simon, the city’s first chief behavioral health officer, discusses America’s youth mental health crisis and the innovative things states and cities are doing for struggling children.
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Rethinking Insurers’ Use of Prior Authorization
Insurers often require clinicians to seek approval for a procedure or medication before providing treatment. Although prior authorization is intended to encourage the efficient use of health care resources and keep health spending under control, many patients and clinicians say it delays care and potentially puts health at risk. The University of Minnesota’s Hannah Neprash and colleagues recently explored the limits and appropriateness of prior authorization and proposed a three-level “traffic light” framework to ensure its use aligns with clinical evidence.
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States Respond to ACA Marketplace Threats
With federal policy changes expected to make it harder for people with Affordable Care Act marketplace insurance to enroll in and maintain their coverage, states will play an important role in ensuring coverage is stable and affordable for the self-employed, workers in small businesses, and early retirees. To understand what states are doing to protect access to individual-market coverage, Georgetown University researchers have teamed up with the Commonwealth Fund to develop a new interactive tool. Select a state to see its current strategies, and then explore the policies that state leaders have adopted to protect consumers and strengthen the market.
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Acute Hospital Care at Home Reduced
More than half of health care organizations delivering acute care in patients’ homes as a part of Medicare’s Acute Hospital Care at Home initiative have permanently or temporarily shut down the service ([link removed] ) , according to reporting in Becker’s Hospital Review. More than 400 hospitals across 39 states had been approved to offer the care under a waiver from the Centers for Medicare and Medicaid Services; that waiver expired on Sept. 30, just before the government shutdown. Transforming Care described how hospitals leveraged the model during the pandemic ([link removed] ) to avoid bringing frail, immunocompromised, or otherwise vulnerable patients needing acute care to the hospital.
QUIZ: Answer
The answer is D. The Congressional Budget Office estimates Medicare will save $71 billion over the next 10 years from the rebates.
For the first time, drug manufacturers are being billed for rebates under a federal policy to discourage price increases that outpace inflation. In a Commonwealth Fund explainer, Kristi Martin describes how the Medicare Inflation Rebate Program works ([link removed] ) , how it differs from Medicaid’s longstanding rebate system, and what its implementation could mean for prescription drug pricing overall. Observers will be watching to see whether it also helps slow the overall growth in drug prices.
Affordable, quality health care. For everyone.
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