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The Commonwealth Fund Connection

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




October 28, 2022

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How State Marketplaces Achieved Record Health Plan Enrollment
Enrollment for health insurance through the Affordable Care Act’s marketplaces soared during last year’s registration window. A report by Georgetown University’s Rachel Schwab and colleagues finds that the marketplaces themselves, seeking to leverage the American Rescue Plan Act’s enhanced premium subsidies, played a crucial role. The researchers believe that highlighting the increased affordability of marketplace plans, in tandem with linguistically and culturally appropriate outreach to historically underserved populations, could again be a blueprint for state marketplaces seeking to build on their coverage gains.

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Where Do the States Stand on Medicaid Expansion?
The ACA gives states the option of expanding Medicaid eligibility to people with incomes up to 138 percent of the federal poverty level. But after more than a decade, 12 states have yet to take this step. In their post for To the Point, the Commonwealth Fund’s Akeiisa Coleman and Sara Federman say that if the holdout states were to expand Medicaid, more than 3.5 million Americans — mostly people of color — would gain coverage nationwide.

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Supreme Court Could Strip Medicaid Beneficiaries of Civil Rights
For more than 50 years, Medicaid beneficiaries and providers have been able to turn to the federal courts when states violate their rights, whether related to coverage or the assurance of competitive payment rates. But this vital protection will soon hang in the balance when it comes under the scrutiny of the Supreme Court. Sara Rosenbaum explains what’s at stake for beneficiaries and providers in Health and Hospital Corporation of Marion County v. Talevski.

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Should COVID-Era Mental Health Policies Be Made Permanent?
Many COVID-era Medicare policies for mental health and substance use care are set to expire at the end of the public health emergency. While they were created to address short-term needs, their longer-term viability is now an area of interest. Should they be made permanent? A team of researchers led by Beth McGinty of Weill Cornell Medicine asked experts to assess a range of Medicare policy changes made in response to the pandemic, focusing on their potential to improve the accessibility, quality, and affordability of care long-term for patients with mental health and substance use disorders.

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More Benefits or More Choice? How Medicare Enrollees Choose
As Medicare open enrollment begins, millions of Americans will be assessing their coverage options. Should they choose a Medicare Advantage plan or opt for traditional Medicare? To find out how older beneficiaries make their coverage choices, Commonwealth Fund researchers examined survey data about what drove people to pick one option over the other and what sources of information helped them in their decision-making.

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How Should Medicare Determine a Drug’s Value?
The Inflation Reduction Act empowered Medicare to negotiate directly with pharmaceutical companies on prices for certain high-cost drugs. The law, however, left the process for determining value an open question. How should Medicare go about setting fair prices for these drugs? In a Commonwealth Fund explainer, Daniel Ollendorf and Dominic Voehler of Tufts Medical Center review the options for assessing a drug’s value and describe how, using one or more of these methods, Medicare could pay prices for drugs that correspond more closely with the clinical value they deliver.

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How to Reduce Death and Suffering from Opioid Addiction
Drug overdoses are now claiming the lives of more than 100,000 Americans each year, with opioids involved in nearly 75 percent of deaths. Despite this crisis, stringent regulations limit people’s ability to get effective medications to treat opioid addiction. Moreover, many states have fewer than two opioid treatment programs for every 10,000 residents with opioid use disorder. On To the Point, the Commonwealth Fund’s Jesse Baumgartner and Celli Horstman explain why these treatment deficits exist and describe innovative models for improving treatment capacity.

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How States Are Enforcing the No Surprises Act
The No Surprises Act shields people from medical bills they receive for care delivered by an out-of-network provider during an emergency visit or in other circumstances beyond the patient’s control. How well the law works, however, depends in part on the states, which are tasked with enforcing its protections. Jack Hoadley and colleagues from Georgetown’s Health Policy Institute explain how states are partnering with the federal government to implement the law, including their decisions around enforcement, payments to out-of-network providers, and additional protections that go beyond federal standards.

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Why the Midterm Elections Matter for Health Care
The midterm elections are around the corner, and health care is likely to be a major factor in how Americans vote. Abortion and reproductive health access will motivate many people, as will inflation (which impacts the cost of care). On The Dose podcast, Georgetown University’s Katie Keith talks about the most pressing health care battles to watch, how access to abortion may play out at the federal and state level, legal challenges to the guarantee of free preventive care, and what happens when the public health emergency ends.

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How Can Hospitals Protect Patients from Climate Change?
As the climate crisis intensifies, health care organizations have a critical role to play in protecting the most vulnerable. The latest issue of Transforming Care profiles hospitals and safety-net clinics that are working to make their operations — and their communities — more climate resilient. In addition to helping patients cope with the health effects of a changing climate, these providers are building systems to fill treatment gaps during disasters and creating community hubs that go beyond emergency shelters.

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How We Can Better Support Nurses
For decades the American Association of Critical Care Nurses has surveyed nurses about their workplaces. The latest survey
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found work environments have deteriorated dramatically since the last survey in 2018. Double the number of nurses reported experiencing moral distress and two-thirds are planning to leave their jobs within the next three years. A
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recent Transforming Care feature reflects on similar findings from an American Nurses Association survey and showcases programs that are trying to better support and empower nurses.





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