The Connection
A roundup of recent Fund publications, charts, multimedia, and other timely content.
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November 17, 2025
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Rural Hospitals to Lose $1.6 Billion If Tax Credits Expire
The expiration of the Affordable Care Act’s enhanced premium tax credits at the end of the year has been in the headlines and on the minds of many Americans. If Congress doesn’t extend them, hospitals will feel the impact as their revenues fall and costs spike. Rural hospitals will be hit particularly hard: experts estimate that not extending the enhanced credits will result in $1.6 billion in lost revenue, a 10 percent increase in uncompensated care costs, and the elimination of services by some hospitals.
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How Drugmakers Use Patents to Maintain Monopolies
What do patents have to do with prescription drug prices? As it turns out, drugmakers use the U.S. patent system to maintain monopolies and high prices on their brand-name drugs. From “patent thickets” and “evergreening” to “product hopping,” drugmakers have developed a host of tactics to block competition from generic drugs and raise prices. Read our new explainer to learn how drug companies obtain patents, how some companies misuse patents, and what changes policymakers have proposed to address patent misuse.
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FEATURED CHART
Kids Are Falling Behind on Vaccinations
Routine childhood vaccinations have prevented hundreds of millions of illnesses and more than a million deaths over the past 30 years. Yet many young children — especially those in families with lower incomes — are falling behind on their shots. On To the Point, the Commonwealth Fund’s Kristen Kolb shows how early childhood vaccination rates vary widely across the country. Potential disruptions to the federal Vaccines for Children program — which has helped millions of families get routine vaccines at no cost — could widen these disparities, she writes.
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QUIZ
How many women of reproductive age are enrolled in Medicaid in rural America?
- One in 10
- One in eight
- One in six
- One in four
Scroll down to see if you got it right.
Why It’s Harder to Get COVID Vaccines at Pharmacies
During the COVID-19 pandemic, pharmacies emerged as critical vaccine access sites. By 2024, they were delivering more than 70 percent of COVID boosters and just under half of flu shots. Pharmacists had become trusted and convenient providers, particularly in rural areas. But with winter virus season beginning, new federal vaccine recommendations have created confusion for states, pharmacists, and the public. On To the Point, George Washington University’s MaryBeth Musumeci and Jenna Xavier explore pharmacies’ role in providing vaccines and dispelling misinformation, as well as the challenges they now face in serving people seeking vaccinations.
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European Medical Schools Combat Climate Change
Last year, 42 medical schools across Europe formed the European Network on Climate and Health Education, a faculty network that supports the integration of sustainable health care delivery into medical curricula and advocates for making climate change a mandatory component of medical education. In the latest edition of International Insights, the Commonwealth Fund’s Munira Gunja points out that no similar requirement for climate and health training exists at U.S. universities. She says interventions at the federal and state level could help health systems standardize strategies, collaborate across institutions, and train medical staff.
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A Doula Network That’s Saving Lives
Across Oklahoma, a community-powered doula network is reshaping what equitable maternal care looks like. On The Dose podcast, Dr. Joel Bervell talks with Omare Jimmerson of the Oklahoma Birth Equity Initiative about how culturally rooted doulas, smart policies, and practical supports — from rides to diapers — are helping hundreds of families thrive each year.
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Reimagining Birth, Restoring Trust
A new movement in the United States is taking shape in maternal care, one that seeks to restore trust, center women, and protect lives. Author and advocate Elaine Welteroth talks about her own struggle finding patient-centered care during pregnancy on The Dose. She explains how the organization she founded, birthFUND, is supporting midwifery care and new mothers while reimagining what safe, empowering birth can look like in America.
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Helping Those with Health-Related Social Needs
Essentia Health, an integrated care delivery system headquartered in Minnesota, has been encouraging people experiencing hunger because of the disruption in SNAP food benefits to leverage a free online tool ([link removed] ) that connects people to food banks and other local resources. Recently Transforming Care described the health system’s efforts to incorporate social needs screenings into clinical practice ([link removed] ) and support patients facing food insecurity and other challenges.
QUIZ: Answer
The answer is D. In rural areas, nearly one in four women of reproductive age are enrolled in Medicaid.
Changes to Medicaid provisions under the recently passed tax and spending law could leave millions of women across the U.S. without access to vital contraceptive care ([link removed] ) , experts warn on To the Point. Waxman Strategies’ Anna Britt and colleagues say that federal cuts will strain Title X family planning centers like Planned Parenthood, federally qualified health centers, rural health centers, and hospitals. Nationally, one of five women of reproductive age rely on Medicaid. The law, H.R. 1, could also block Planned Parenthood health centers, which serve more than 2 million patients, from participating in Medicaid.
Affordable, quality health care. For everyone.
The Commonwealth Fund, 1 East 75th Street, New York, NY 10021
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