The Connection

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

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September 2, 2025

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New Policies Will Make More People Uninsured and Coverage Less Affordable

More than 24 million Americans buy their health coverage through the Affordable Care Act marketplaces. Recent policy changes enacted by Congress and the Trump administration will likely make it harder to enroll in these plans, experts say, and could lead to higher premiums and more out-of-pocket costs. On To the Point, the Commonwealth Fund’s Sara R. Collins and Carson Richards discuss the impact of new policies that will also result in increased scrutiny of eligibility for people with low incomes, shorter open-enrollment periods, and the end of guaranteed coverage for people with any past premium debt. Together, the changes could lead to 11 million fewer people enrolling in marketplace plans.

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ACA Marketplace Changes Will Lead to Higher Costs for States and More Uninsured

States that run their own health insurance marketplaces under the Affordable Care Act will soon face tough challenges, as federal policy changes dramatically alter how the marketplaces operate. On To the Point, Georgetown University researchers examine how the budget reconciliation law and new federal regulations will impose substantial new costs and burdens on states and the many residents who rely on the marketplaces for coverage. Making and communicating changes to enrollment and eligibility will require significant time, planning, staff resources, and funding, the authors say. These efforts could cost states millions of dollars, while weakening the marketplaces and endangering health coverage for many Americans.

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FEATURED CHART

Premium Tax Credit Loss May Undo Coverage Gains

Premium tax credits, which make health insurance more affordable for millions of Americans, are under threat. At the end of this year, key enhancements of these credits will expire unless Congress acts. Proposals on the table could slash subsidy amounts, end zero-premium health insurance plans, and redirect funds to other programs — changes that will likely increase health care spending and the number of uninsured. A new Commonwealth Fund report by Jeanne Lambrew and Aviva Aron-Dine explains how premium tax credits have helped drive health coverage rates to record highs, and how they could form the basis for further coverage gains. The authors also show that “failing to extend current enhanced premium tax credits, otherwise lowering tax credit values, and shifting taxpayer dollars to savings accounts rather than coverage” could undo 15 years of progress.

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QUIZ

By how much would President Trump’s proposed 2026 budget cut funding for the Department of Health and Human Services?

- $11 billion
- $31 billion
- $51 billion
- $71 billion

Scroll down to see if you got it right.

Explained: The Shake-Up in America’s Vaccine Guidelines

For 60 years, the Advisory Committee on Immunization Practices (ACIP) has set the nation’s vaccine guidelines, informing policy about which shots Americans get and when. In addition to changes in COVID-19 vaccine recommendations, the Trump administration replaced ACIP’s membership with vaccine skeptics and cut key staff positions. These moves are raising concerns about ACIP’s future as a trusted, evidence-based voice in public health. Read our new explainer to learn: what ACIP does and why it matters; how vaccine recommendations are made; who’s shaping vaccine decisions now; and how the administration’s actions could affect vaccine access, affordability, and the nation’s readiness for future public health crises.

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The Future of Primary Care May Depend on AI

Many Americans are having a difficult time finding a primary care physician, while others are contending with long wait times for appointments. Writing in Modern Healthcare, two physicians say the solution to the intensifying crisis in U.S. primary care lies in redirecting health care resources toward “effective and efficient models of primary care.” They believe artificial intelligence can help do that. “One of the main benefits of AI is that it enables primary care clinicians to practice at the top of their license,” say Joseph Betancourt, M.D., the Commonwealth Fund’s president, and Eric Schneider, M.D., executive vice president at the National Committee for Quality Assurance. They note that digital technologies like clinical decision support, wearables, and early monitoring systems are soon “going to radically change the way primary care is delivered.” A key question, however, is “how to finance these technologies in ways that strengthen primary care, integrate them seamlessly into clinical workflows, and democratize access so everyone can benefit.”

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Impacting Health Outcomes Through Civic Engagement

In the U.S., communities with the lowest voter turnout rates correlate precisely with the zip codes experiencing the worst health outcomes and highest social vulnerability scores. In a piece published on the Grantmakers In Health website in conjunction with August’s Civic Health Month, Alister Martin, M.D., emergency physician at Massachusetts General Hospital, and Joseph R. Betancourt, M.D., president of the Commonwealth Fund, say that when patients become voters, health care settings become civic hubs, and community health centers address social drivers of health, we will see transformational change in health care and outcomes. “The evidence shows that civic engagement improves health outcomes. The opportunity is now — and it may not last. The question is whether we’ll take it,” they write.

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Pozen-Commonwealth Fund Fellowship Application Open

The application for the Pozen-Commonwealth Fund Fellowship ([link removed] ) in Health Equity Leadership at Yale University is now open. This 22-month, degree-granting program covers the cost of the MBA for Executives ([link removed] ) program and gives health care professionals the leadership skills and the deep understanding of teams, markets, and organizations necessary to tackle major inequities in the U.S. health care system. You can learn more about the current cohort of Pozen-Commonwealth Fund fellows here ([link removed] ) . The application deadline for round 1 is October 27, 2025. If you have any questions, you may reach out to the team at [email protected] (mailto:[email protected]) or request a preassessment ([link removed] ) to determine your fit for the program.

Employers Battle Health Care and Drug Cost Increases

The Business Group on Health reports that employers are predicting a 9 percent increase in health care costs ([link removed] ) in 2026, as well as pricier pharmaceuticals due to tariffs and changes to the Medicare and Medicaid programs. The findings suggest employers should focus on increasing transparency in pharmaceutical purchasing to contain costs. Transforming Care described how public-sector unions in New Jersey compelled pharmacy benefit managers to clearly define drug formularies and compete on price ([link removed] ) , saving at least $2.5 billion.

QUIZ: Answer

The answer is B. The president’s budget calls for a total of $31 billion in discretionary spending to be cut from the Department of Health and Human Services budget.

On To the Point, the Kennedy Forum’s Nathaniel Counts details the wide-ranging effects of the Trump administration’s proposed budget ([link removed] ) , which includes $31 billion in cuts to the Department of Health and Human Services. The budget also would combine certain agencies, including those focused on behavioral health. Together, these changes could threaten access to lifesaving care, Counts says, leading to gaps in coverage and hampering the discovery of innovative behavioral health treatments. “This country demands and deserves a budget that meets the needs of the moment.”

Affordable, quality health care. For everyone.

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

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