The Affordable Care Act (ACA) required most Americans to enroll in a health insurance plan or pay a financial penalty — until Congress got rid of the penalty as part of last year’s tax law. But what would happen if every state followed the lead of Massachusetts and New Jersey by enacting its own individual mandate to replace the ACA’s version? According to a new Commonwealth Fund/Urban Institute report, close to 4 million Americans would gain health insurance and premiums would drop nearly 12 percent.

Brett Kavanaugh, President Trump's Supreme Court nominee, has served on the Court of Appeals for the District of Columbia Circuit for over a decade. Writing on To the Point, Timothy S. Jost of the Washington and Lee University School of Law analyzes Judge Kavanaugh's opinions in the five major health law cases in which he has been involved.

"In none of these cases did Kavanaugh stake out a strong ideological position," Jost says. But Kavanaugh has made it clear he supports a more expansive role for the courts and might be open to dramatically expanding the power of the executive branch.

In a new post on To the Point, the Commonwealth Fund's Don Moulds, Susan Hayes, Sara Collins, and Rachel Nuzum look at states where Medicaid expansion advocates have used or plan to use the ballot initiative process. They include Maine, Utah, Idaho, Nebraska, and Montana, a state where supporters seek permanent reauthorization of the expansion.

The Trump administration nearly eliminated federal funding for the "navigator" program that assists people in choosing a health plan. Moreover, it has directed navigators to inform consumers about insurance policies that don't comply with Affordable Care Act standards and can leave enrollees exposed to high costs. In a new post, the Commonwealth Fund's Sara Collins explains why the changes are bad for consumers. Commonwealth Fund surveys have found that getting personal assistance makes a significant difference in whether someone enrolls in a health plan.

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) halted the risk-adjustment program that spreads the expense of covering high-cost enrollees across health insurers in the individual and small-group markets. In a new post, Georgetown University's Dania Palanker and JoAnn Volk say the Trump administration's action could lead to higher premium rates and fewer plan choices in those markets.

Recent developments in Congress and actions by the Trump administration are likely to make it harder for individuals — particularly those who aren't in perfect health — to afford adequate health coverage. But as Justin Giovannelli, Kevin Lucia, and Sabrina Corlette of Georgetown University's Center on Health Insurance Reforms explain, some states are taking action to safeguard their residents. The Commonwealth Fund’s interactive map shows where key state policy choices are likely to affect access to individual market coverage.

Medicare is testing new ways to encourage providers to keep down costs, improve quality of care, and increase accountability. One program, the Bundled Payments for Care Improvement (BPCI) initiative, pays participating hospitals not for each service they provide to a patient but for the entire "bundle" of services included in an episode of care -- whether it's a surgical procedure or hospital treatment for a chronic medical condition. While bundled payments applied to surgical procedures have yielded promising results, a Commonwealth Fund-supported study led by Karen E. Joynt Maddox, M.D., of the Washington University School of Medicine indicates that, so far, they don't appear to be producing comparable benefits for chronic medical conditions such as heart disease.

Last month, legislation intended to help remove barriers preventing generic drugmakers from bringing affordable medicines to market cleared an important hurdle when the Senate Judiciary Committee passed the CREATES (Creating and Restoring Equal Access to Equivalent Samples) Act. Although Sen. Orrin Hatch (R-Utah) withdrew his amendment seeking to inhibit generic drug manufacturers from challenging the validity of brand-name manufacturers' patents (through inter partes review), he has indicated it would be a "top priority" in his remaining months in Congress.

Writing on To the Point, Henry Waxman, Bill Corr, and Kristi Martin explain that, if implemented, Hatch’s amendment would enable brand-name drug manufacturers to maintain "low-quality" patents and delay price competition from generic drugs.

The Commonwealth Fund is recruiting for a new program officer in its New York City office to lead our vulnerable populations grant portfolio. The new position will support the Commonwealth Fund's Health Care Delivery System Reform program and will feature responsibility for managing current grants, developing new grants, refining the portfolio's strategy, and ensuring the continued success of the Fund's minority health leadership and policy fellowships. The job description can be found here.

Whether it’s installing a wheelchair ramp or grab bar for the bathroom, people with complex health and social needs often benefit from interventions beyond medicine. Bruce Chernof, M.D., President and CEO of The SCAN Foundation, explores what health plans, providers, and consumer advocates need to know about the new services and programs covered by the CHRONIC Care Act.

When a patient shows up in a hospital with chest pain, there’s an established, step-by-step pathway for how physicians, nurses, and other clinicians direct their cardiac care. Unfortunately, the same isn’t true for people grappling with addiction. Corey Waller, M.D., Better Care Playbook Faculty and Principal at Health Management Associates, says a change in practice is needed.