The Connection
A roundup of recent Fund publications, charts, multimedia, and other timely content.
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December 22, 2025
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New Vaccine Guidance Raises Concerns for States
Recent shifts in how the federal government develops recommendations for vaccines and preventive care have disrupted longstanding scientific processes. They’ve left states questioning what guidance to rely on and how they can ensure their residents continue to receive evidence-based services. On To the Point, Georgetown University’s Amy Killelea and colleagues explore how states are responding, whether it’s anchoring their policies to Biden-era recommendations, leaning on state health boards for updated guidance, or forming regional collaboratives. While these offer workable paths forward, they also risk creating a “patchwork of standards” ensuring access varies depending on where you live.
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Disabled Adults Face Coverage Loss Under Work Requirements
Beginning in 2027, new Medicaid work requirements will apply to adults enrolled through the Affordable Care Act’s Medicaid expansion. Those who don’t meet the requirements risk losing their coverage. While people who are considered medically frail or have special health care needs are exempt, it’s unclear how states will decide who qualifies, says George Washington University’s MaryBeth Musumeci and colleagues. Although medical frailty has been part of Medicaid policy for two decades, processes for determining it vary widely across states and are often driven by policy choices.
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FEATURED CHART
Medicare Patients Struggle to Find Affordable Drug Plans
People with Medicare face dwindling drug coverage options, report the Commonwealth Fund’s Faith Leonard and Gretchen Jacobson. In examining the decline in Medicare standalone prescription drug plans, the researchers find that while enrollees in traditional Medicare can choose from a variety of private drug plans, their number has declined by nearly two-thirds since 2021. This raises questions about why there are fewer options and whether beneficiaries are typically able to find a plan that meets their needs.
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QUIZ
In how many states do health plan deductibles exceed 5 percent of workers’ median income?
- 0 states
- 4 states
- 14 states
- 24 states
Scroll down to see if you got it right.
What Prevents Insured People from Getting Health Care?
Having to choose between health care and groceries. Waiting months to get care because there aren’t enough providers. Going without a needed medication while waiting on insurance company approval. These are just some of the barriers to care that people in Kentucky with health coverage say they’re facing. Writing on To the Point, Susan Bornstein, M.D., founder and CEO of the Asclepius Initiative, explores the factors that contribute to poor health outcomes in a state that has one of the nation’s lowest uninsured rates. “Coverage is necessary for people to gain access to the health system but alone it isn’t sufficient for ensuring better health,” Bornstein writes.
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Explained: How H.R. 1 Changed Medicaid Funding
Medicaid is supported by a blend of federal and state funding. Taxes on health care providers are a vital part of that mix. Historically, states have been able to use these taxes to obtain a match in federal dollars, as long as the amount did not exceed 6 percent of a provider’s revenue from patients. But H.R. 1, the recently passed tax and spending law, places new limits on states’ ability to use provider taxes to fund their Medicaid programs. No states are allowed to raise these tax rates, and some will even be forced to reduce them over time. Our new explainer outlines what these changes mean for the future of Medicaid, including: how provider tax changes will impact patients, hospitals, and state budgets; which provider taxes are affected; and why states that expanded Medicaid eligibility will be the hardest hit.
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Protecting Contraceptive Access as Funding Shrinks
Contraceptive access is closely tied to people’s health, autonomy, and economic security and has long enjoyed bipartisan support. Yet the federal programs that make access to birth control possible for millions of Americans are increasingly under threat. A Commonwealth Fund brief provides an overview of how federal financing for contraceptive access works, focusing on Medicaid, the Title X Family Planning Program, and the Title V Maternal and Child Health Services Block Grant Program. As Zara Day and colleagues at Waxman Strategies explain, even though states can tailor existing federal tools to protect and expand access to contraceptive care, gaps in access will persist. Moreover, they say “efforts to streamline programs through cuts, restrictions, and consolidations will only result in poorer access and outcomes.”
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Three Health Care Lessons for the U.S. in 2026
The past year has been marked by profound upheaval in the U.S. health care system. With uninsured rates projected to spike and health care costs continuing to climb, solving these seemingly intractable problems may require policymakers, researchers, and health policy leaders to look for solutions beyond the country’s borders. In 2025, the Commonwealth Fund’s International Insights team has written about how countries such as Cyprus, Ethiopia, Japan, and Malaysia — with fewer financial resources than the United States — have managed to expand access to health coverage, reduce costs, improve service delivery, and achieve more equitable health outcomes. These health policy innovations offer three key lessons for 2026 and beyond.
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2026 AHCJ U.S. and International Fellows Announced
The Association of Health Care Journalists is pleased to announce the 2026 recipients of two fellowship programs, each designed to empower journalists in advancing the public’s understanding of health care systems: the U.S. Health System Reporting Fellowship and the International Health Study Fellowship. Supported by the Commonwealth Fund, these programs offer unparalleled opportunities for journalists to explore pressing health care issues with depth and impact. The international fellowship will allow four journalists to investigate and compare health care approaches in other countries with those of United States. These projects will highlight lessons that can shape U.S. health policy.
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The $50 Billion Rural Health Program in Context
All 50 states have submitted proposals to the Trump administration for a piece of the new $50 billion Rural Health Transformation Program. Passed as part of the H.R. 1 bill last summer, the program was included in the legislation to address concerns about the potential impact of nearly $1 trillion in federal health spending cuts over the next decade. The Trump administration is expected to announce awards by the end of 2025, but experts worry that the fund will fail to deliver meaningful results for rural communities.
In the next virtual event in the “Decoding the Moment” series presented by Tradeoffs and the University of Pennsylvania’s Leonard Davis Institute of Health Economics, national experts will discuss the challenges facing health care access in rural America, evidence-based solutions to those issues, and how states and the federal government are looking to use this new pot of money.
REGSITER HERE ([link removed] )
Understanding the 2026 ACA Premium Increases
Benchmark premiums in the second-lowest-cost silver plans sold in the Affordable Care Act marketplaces will increase by 21.7 percent in 2026. This stands in sharp contrast to the average 2.0 percent growth between 2020 and 2025. With support from the Commonwealth Fund, John Holahan and colleagues at the Urban Institute attempt to understand the large increase in 2026 ACA premiums, given that premium increases for people with employer-sponsored insurance are projected to be in the 6 percent to 7 percent range. Read their new report.
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Protecting Health Facilities from Climate Shocks
Columbia Memorial, a rural hospital in an Oregon seaside town, is building a new facility with an elevated tsunami shelter ([link removed] ) where as many as 2,000 people can wait out a flood. In Transforming Care, you can learn what other strategies hospitals have employed to protect their buildings and patients from climate shocks ([link removed] ) .
QUIZ: Answer
The answer is D. In 24 states, workers’ deductibles exceed 5 percent of the median income.
U.S. employers are grappling with surging health care costs as prices and service volumes rise. In Harvard Business Review ([link removed] ) , David Blumenthal, M.D., Lovisa Gustafsson, and Sara R. Collins say that employers have largely responded by shifting expenses to workers, “hollowing out of employer-sponsored insurance” — with underinsurance, out-of-pocket costs, and deductibles increasing greatly. The big question is whether employers have the will to become more aggressive in pursuing remedies. The outlook is not promising, the authors write.
Affordable, quality health care. For everyone.
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