The U.S. Department of Health and Human Services last week released its final health insurance marketplace rule for the 2019 plan year. In a post on To the Point, the Commonwealth Fund’s Sara Collins says that although the stated goal is simplification, the rule is likely to add more complexity. And by reducing the number of enrollment navigators each state must have, it will leave people with less help.

There is growing concern about the affordability of health insurance for middle-income consumers who lack health benefits through their jobs and aren’t eligible for tax subsidies or other federal assistance. On To the Point, Washington and Lee University School of Law’s Timothy S. Jost reviews actions taken by the Trump administration and certain states that are likely to make coverage more expensive for people remaining in the individual insurance market.

Under a recently approved waiver, Kentucky will require an estimated 350,000 able-bodied Medicaid beneficiaries to work, complete job training, or volunteer in order to maintain their coverage. Kentucky argues that the program will increase labor force participation and makes economic sense. However, New York University’s Sherry Glied and Sara Snowden say on To the Point that not only are such work requirements unlikely to lead to any meaningful increase in people who work, they are likely to hurt the state’s economy.

Are recent state Medicaid waiver proposals, including those for work requirements, consistent with Medicaid’s mission to provide access to health care for poor and disabled Americans? A new explainer from the Commonwealth Fund provides answers to basic questions about Section 1115 waivers: what they are and how they work, how they’ve been used in the past, and how they’re changing under the Trump administration.

Legislation included in the congressional budget deal makes great strides in improving care for the most vulnerable patients, who account for a large proportion of health care spending, say Commonwealth Fund President David Blumenthal, M.D., and Denver Health CEO Robin Wittenstein in a new op-ed in The Hill. The CHRONIC Care Act gives Medicare managed care plans new flexibility to better care for patients with complex health needs and offers opportunities to expand telehealth services, for example. Blumenthal and Wittenstein underscore that while these policies are a great start, their implementation will be important to monitor.

A Commonwealth Fund–supported research team led by Daniel Jung and Eva DuGoff recommends that Medicare Advantage plan administrators develop local interventions to address functional limitations, which they found occur among more than a third of older plan enrollees (Journal of the American Geriatric Society, April 12). Beneficiaries with multiple chronic conditions and those in disadvantaged neighborhoods were the most likely to report having a functional limitation.

Maryland’s global budget for rural hospitals specifies the total amount of revenue acute-care hospitals can receive from all public and private payers. But despite hopes it would reduce hospital use as well as spending, a Commonwealth Fund–supported study in Health Affairs (Apr. 2018) by the University of Pittsburgh’s Eric T. Roberts and colleagues found it did neither, when compared to a control group. Learn the possible reasons why, and read a companion post by the Commonwealth Fund’s Arnav Shah, Shawn Bishop, Christina Ramsay, and Eric Schneider, M.D., to understand global budgets in the context of other payment reform initiatives.

The U.S. spends nearly double the amount other high-income countries spend per person on prescription drugs. In a post on To the Point, the Commonwealth Fund’s Shawn Bishop describes policy options for getting pharmaceutical prices under control, drawing on three recent Health Affairs papers supported by the Commonwealth Fund.

In a new study, Commonwealth Fund grantee Sara J. Singer of Stanford University and colleagues (Medical Care Research and Review, Apr. 2018) present a comprehensive model of what constitutes integration in health care delivery and how to measure it.

Maryland and Louisiana both recently submitted Section 1332 “innovation” waivers under the Affordable Care Act (ACA). These waivers allow states to modify key parts of the law, so long as they stay true to its goals and consumer protections. According to the ACA, a waiver can’t be granted unless the health insurance that results is at least as comprehensive and affordable as before, while covering a comparable number of residents. The waiver also cannot add to the federal deficit.