By Timothy Stoltzfus Jost, J.D., Robert L. Willett Family Professor of Law, Washington and Lee University School of Law

Many small employers—which make up the vast majority of American businesses—struggle to afford and manage health insurance for their employees. They pay higher insurance premiums and have much less bargaining power with insurers than larger businesses. The Affordable Care Act’s Small Business Health Options Program (SHOP) was designed to address this problem by creating state-based insurance marketplaces, or exchanges, for small employers. The SHOP exchanges, set to open in January 2014, will make it easier for small employers to offer an array of comprehensive, affordable plans to their workers.

By Pamela Riley and Cara Dermody

Equity is a core goal of a high performance health system. However, in the United States, vulnerable populations, including low-income people, the uninsured, and disadvantaged racial and ethnic minorities, have more difficulty obtaining health care, receive worse care, and experience poorer health outcomes than other groups.

To ensure that these groups have access to health care capable of meeting their particular needs, The Commonwealth Fund has created the Vulnerable Populations Program, which includes both fellowship and grantmaking activities. The newly renamed Mongan Commonwealth Fund Fellowship Program (formerly The Commonwealth Fund/Harvard University Fellowship in Minority Health Policy) is designed for physicians interested in improving health care systems for vulnerable populations. The grantmaking program seeks to foster a health system capable of providing care that is patient-centered, population-based, comprehensive, high-quality, accountable, and integrated across the full continuum of care.

By Karen Davis, Ph.D.

Health care spending in 2009 and 2010 grew at the slowest rates in 50 years. This startling news, published in an article by staff of the Centers for Medicare and Medicaid Services (CMS) in Health Affairs, was largely attributed to the shrinking economy.¹ Loss of jobs and insurance, slow growth in wages and family incomes, and greater out-of-pocket health care costs have undoubtedly caused uninsured, underinsured, and low-wage workers and their families to forgo care, contributing to the slowdown in health spending. An estimated 9 million people became uninsured when they lost a job with benefits over 2008–10, and they were much more likely than those who did not lose coverage to report delaying needed care.²