The Commonwealth Fund

Many middle-income families spend at least a tenth of their income on health insurance • Rhode Island Current More than half of working-age adults get their health insurance through an employer, but in many states premium contributions and deductibles take a significant bite out of household incomes. A new an...

New @commonwealthfund.org analysis finds premium contributions and deductibles for family health insurance plans totaled 10% or more of the median household income in 19 states in 2024. The calculation did not include copayments. Via @stateline.org rhodeislandcurrent.com/2026/02/11/r...

Why Rural Hospitals Are Facing a Funding Crisis — and How It Could Get Worse Since 2005, nearly 200 rural hospitals have completely or partially closed, and over 400 — more than 20 percent of rural hospitals — are at risk of closure.

From @commonwealthfund.org Why Rural Hospitals Are Facing a Funding Crisis — and How It Could Get Worse www.commonwealthfund.org/publications...

Affordability Concerns Are Driving States to Curb Hospital Prices States are developing proposals for the 2026 and 2027 legislative sessions aimed at reining in excessive hospital prices and price growth.

States are tackling unfair and excessive hospital prices. Our blog post for @commonwealthfund.org outlines 2025 actions in Indiana, Vermont, New Mexico, and Washington. bit.ly/2026-0114-af...

Medical Frailty Exemptions Will Help with Medicaid Work Requirements Medical frailty policies will allow people with disabilities and chronic illnesses to be exempted from work reporting requirements and stay enrolled in Medicaid.

As Medicaid work requirements take effect in 2027, it’s unclear how states will determine who qualifies as medically frail and exempt from the rules.

What the Decline in Medicare Part D Plan Availability Means Fewer standalone Rx plans in traditional Medicare raises questions about whether beneficiaries will have choices that align with health needs and budgets.

Drug prices continue to be a top concern for #Medicare beneficiaries, with one of five saying they use discount websites like GoodRx or Amazon, instead of their prescription drug plan.

🚨 Today at 12PM ET!

"Decoding the Moment: The $50 Billion #RuralHealth Program in Context"

Join @tradeoffs.org and @pennldi.bsky.social for this virtual event exploring the #healthcare challenges facing rural America, the evidence-based solutions, and more.

#powerofrural

An Overview of Federally Funded Contraceptive Programs With sufficient funding, states can utilize Medicaid SPAs and Section 1115 waivers, MCO contracts, and Title X grants to expand access to contraceptives.

Federal programs play a critical role in whether people can get contraceptive care, and states can shape how well those programs work.

A new analysis outlines paths states can take and what’s at risk if funding is cut.
bit.ly/3Y2mmV6

The State of Rural Primary Care in the United States Rural Americans face significant barriers to accessing adequate primary care; tailored federal and state programs can help address some of these challenges.

Bright spots in rural communities illuminate ways to expand primary care.

From mobile clinics and telehealth to community health workers, smart investments and rural-specific solutions can help make sure your zip code doesn't determine the care you get. bit.ly/44B2YlJ

🔴 Decoding the Moment: The $50 Billion #RuralHealthProgram in Context 🔴

🗓️ Tomorrow, Jan 6 @ 12pm ET

Expert virtual discussion, co-hosted w/ @tradeoffs.org

➡️ REGISTER HERE:
https://bit.ly/4964AXd

If we’re serious about affordability, and not monopolies, 2026 is our time to align incentives with patients.
bit.ly/4s5IeN3

Let's make a resolution to both protect innovation and lower drug costs as we wrap this year.

Smart patent reforms can curb abuse, speed generic competition, and make lifesaving medicines more affordable, without cutting corners on safety or science.

The State of Rural Primary Care in the United States Rural Americans face significant barriers to accessing adequate primary care; tailored federal and state programs can help address some of these challenges.

Historically, we’ve underinvested in primary care, especially in rural America.
Now, rural Americans contend with doctor shortages, long drives for care, and ERs filling gaps they weren't meant to fill. These problems won’t fix themselves.

Show of hands: who is committed to this work in 2026?

What the Decline in Medicare Part D Plan Availability Means Fewer standalone Rx plans in traditional Medicare raises questions about whether beneficiaries will have choices that align with health needs and budgets.

The average number of standalone prescription drug plans has declined by nearly two-thirds since 2021. Will Medicare beneficiaries still have choices that align with their health care needs and household budgets?

States Are Preserving Recommendations Preventive Care, Vaccines Amid concern about credibility of recent federal vaccine recommendations, states are exploring how to protect access to scientifically backed services.

Recent changes to federal preventive care and vaccine recommendations have raised concerns about their credibility, and states are looking for ways to keep science-backed services available to their residents. bit.ly/4pKZxkQ

Expiring ACA Premium Tax Credits Could Lead to Nearly 340,000 Jobs Lost Across the U.S. in 2026 Unless Congress acts quickly to extend the enhanced ACA marketplace premium tax credits, nearly 5 million people could lose health insurance coverage in 2026.

We know making health coverage affordable works to keep people insured, support local economies, and strengthen our care systems. Choosing to let premium subsidies expire risks major disruptions to the marketplaces that will be difficult to overcome, despite having been easy to avoid. bit.ly/4ajXsaT

Lessons from the ACA: Simplifying Choices to Optimize Health Coverage Additional standards in the Affordable Care Act for plan design, marketing, and enrollment could improve consumer satisfaction and health care affordability.

Choice works best when people understand their options.
Evidence shows simpler, standardized health plans protect consumers & lower costs, without limiting real options.
If we want to build a health system people can trust, we need clear rules, fair choices, and coverage that does what it promises.

An Overview of Federally Funded Contraceptive Programs With sufficient funding, states can utilize Medicaid SPAs and Section 1115 waivers, MCO contracts, and Title X grants to expand access to contraceptives.

Gaps in contraceptive access persist across the U.S. — and federal funding cuts could make them worse.

Full report:

Expiring ACA Premium Tax Credits Could Lead to Nearly 340,000 Jobs Lost Across the U.S. in 2026 Unless Congress acts quickly to extend the enhanced ACA marketplace premium tax credits, nearly 5 million people could lose health insurance coverage in 2026.

Let’s be clear: the enhanced ACA tax credits worked.

They helped millions afford coverage and kept uninsured rates down.

Now, as they near expiration, nearly 5 million people could lose coverage, while jobs vanish and economic stability emerges.

🛜 Telehealth is expanding across the country, but not evenly.

Nationally, 29% of adults have received primary care via telehealth, compared to only 19% in rural areas.

More here: bit.ly/3Xie1we

Prescription drug prices in the United States are higher than in other countries; one contributing factor is the number of patents some drugmakers file to maintain monopolies on their brand-name drugs.
bit.ly/4rgHXql

43% of U.S. primary care physicians report burnout — one of the highest rates in a new 10-country survey. The report explores what’s driving it and how to better support clinicians.
bit.ly/3LYwb3A

The Causes and Impacts of Burnout Among Primary Care Physicians in 10 Countries This survey brief examines factors contributing to burnout among primary care physicians in 10 countries and strategies to combat it and improve system performance.

Why primary care physicians report burnout varies by country:
🗂️ Administrative burden (top reason in the U.S.)
🏥 Patient load & complexity (higher in Sweden)
😞 Feeling undervalued (more common in the U.K. & Australia)

The State of Rural Primary Care in the United States Rural Americans face significant barriers to accessing adequate primary care; tailored federal and state programs can help address some of these challenges.

New analysis on rural primary care finds:

🏥 Demand for rural primary care physicians is projected to exceed supply by 2037
🚑 Nearly 1 in 4 rural adults used the ER for needs that could be treated in primary care
💻 Only 19% received primary care via telehealth, compared to 29% nationally

Details ⤵️

Today at 11 AM PT!
🎙️ Live Webinar: The Coming Revolution: Equity in the Age of AI
🔗 Register Here: bit.ly/RegEquityAgeofAI

Join Dr. Joseph Betancourt, president of @commonwealthfund.org, Dr. Tina Hernandez-Boussard, professor of medicine at @stanforduniversity.bsky.social, and @katiepalmer.bsky.social, health tech correspondent at @statnews.com... (1/2)

How Drugmakers Use the Patent Process to Keep Prices High Patent reforms could address a problem that’s been driving rising prescription drug costs and create a more competitive pharmaceutical market.

From “patent thickets” to “product hopping,” drugmakers have developed a host of strategies for blocking competition. Learn how some policymakers are hoping to stop patent abuse and end the drug monopolies that lead to high prices.

How Will States Implement the Behavioral Health Exemption to Medicaid Work Requirements? A proactive approach to implementing the behavioral health exemption to work requirements can help minimize impacts for Medicaid enrollees.

A proactive approach to implementing the behavioral health exemption to work requirements can help minimize impacts for Medicaid enrollees, the behavioral health crisis, and related long-term costs.

🩺 New international survey of primary care physicians: U.S. doctors report some of the highest burnout rates among 10 high-income countries.

Some countries are streamlining administrative tasks and supporting clinician well-being, offering lessons for U.S. leaders.
bit.ly/3LYwb3A

Revisiting the Orphan Drug Act The Orphan Drug Act has catalyzed innovation in rare disease treatments, but the law’s shortcomings — particularly around pricing — have prompted calls for reform.

The Orphan Drug Act has helped spur the development of drugs targeting rare diseases for which no treatment exists, but the law’s loopholes have impeded further progress since the law’s enactment in 1983.

How Will States Implement the Behavioral Health Exemption to Medicaid Work Requirements? A proactive approach to implementing the behavioral health exemption to work requirements can help minimize impacts for Medicaid enrollees.

During a time of national #mentalhealth and substance use crises, how can states ensure consistent coverage for people with behavioral health conditions?