By Amanda Gabrielle Concepcion and Shiva Ranganathan
As fall leaves turn golden, and with the midterms behind us, we look at the latest in health policy research. This month, CHIR reads about rising uninsured rates and access to health care, fragmented vaccination guidance, and provider-sponsored health plans.
The State of Health Insurance Coverage in 2026
Sara R. Collins, Gulcan Cil, Carson Richards. The Commonwealth Fund, October 2026. Available here.
Commonwealth Fund researchers conducted their 2026 Biennial Health Insurance Survey to describe trends in uninsured rates and access to care. The analysis examines three years of data (2022, 2024, and 2026).
What it Finds
- Between 2024 and 2026, uninsured rates rose for working-age adults, young adults, and working-age adults with low incomes. All of these increases were statistically significant and coincided with a decline in Affordable Care Act (ACA) marketplace and individual market coverage.
- Coverage declines were due to increased average annual marketplace premiums, the end of a special enrollment period for low-income people, and new barriers for legal immigrants.
- Cost and medical debt are prominent barriers for uninsured adults getting medical care. One in three working-age adults with marketplace or individual insurance had outstanding medical bills or debt. More than half of ACA marketplace users reported they did not get necessary medical care due to cost.
Why it Matters:
A lack of consistent coverage and high medical costs prevent people from accessing the care they need to maintain their health. According to the Congressional Budget Office, these and projected future coverage losses could push the number of uninsured people to 37 million by 2036, which will likely result in poorer health outcomes for Americans. The report advocates for solutions that cap price increases and protect consumers from medical debt.
Holding the Line: Primary Care’s Response to Fragmented Immunization Guidance
Rebecca S. Etz, Conor M. C. Duffy, Brooke Bishop, Martha M. Gonzalez, Bernard Ewigman, Kurt C. Stange. Milbank Memorial Fund, October 2026. Available here.
Researchers from the Milkbank Memorial Fund analyzed findings from a rapid-cycle national survey of primary care clinicians. The survey was fielded from March 5-12, 2026 and collected responses of 632 clinicians from 49 states and the District of Columbia.
What it Finds
- Patients are increasingly questioning the safety and legitimacy of vaccines. Clinicians report that vaccine conversations are taking considerably more time, and there are tensions with patients about changing federal vaccine recommendations.
- Forty-three percent of the 463 clinicians who see pediatric patients reported that parents are less interested in vaccinating their child. Forty-two percent of clinicians report that parents are delaying or refusing childhood vaccines they previously accepted.
- Primary care clinicians are gravitating towards professional society and board recommendations, rather than from federal guidance. Sixty-seven percent of clinicians who see children report that their practices are following the American Academy of Pediatrics (AAP) immunization schedule, and 12% of clinicians report that their staff are uncertain about which immunization schedule to follow.
- An inadequately vaccinated population increases the risk of a rapid spread of infectious disease. Measles vaccination data from 2025 show that national two-dose MMR [measles, mumps, and rubella] vaccine coverage among kindergartners is 92.5%, below the 95% threshold for herd immunity.
- Primary care clinicians are reporting higher levels of moral injury and burnout from seeing preventable diseases return and increasing mistrust in public institutions and medical professionals.
Why it Matters:
Rapidly shifting federal guidance and declining public trust are leading more people to question and forego vaccinations. Without a reliable, authoritative source for guidance, communities face heightened risk of infectious disease outbreaks, while primary care physicians face growing challenges guiding patients through conflicting information.
Do Provider-Sponsored Health Plans Negotiate Lower Prices Than Traditional Insurers?
Mitchell Mead, Cody Lendon Mullens, Adrian Diaz, and Andrew M. Ibrahim. Health Affairs, October 2026. View here.
Researchers from the University of Michigan conducted a national analysis to compare price differences between provider-sponsored health plans (insurance plans run by health systems) and insurers unaffiliated with health systems. They used about 9.4 million prices reported under the Hospital Price Transparency Rule across highly utilized hospital services, plus emergency room department fees. Data came from Turquoise Health, the 2023 Agency for Healthcare Research and Quality (AHRQ) Compendium of U.S. Health Systems, and the 2023 Centers for Medicare and Medicaid Services (CMS) Provider of Services file.
What it Finds
- More than one in four health systems offered an insurance plan in 2023. Over 70% of the time, they offered Medicare Advantage plans; they offered marketplace plans 45.8% of the time.
- Systems with an insurance plan offered were larger than those without. They averaged 16.8 hospitals versus 6.6 hospitals per system. Hospital systems with a health plan offering had 2,649 employed physicians versus 1,027 employed physicians for systems without.
- Forty-four of 46 services had lower negotiated prices under provider-sponsored plans. The largest gap was observed in level 1 emergency department facility fees, which were 22% lower in the plans.
- Provider-sponsored plans were only 8.3% of reported prices, and for-profit and small hospitals were less likely to report them.
Why it Matters
Vertical integration across the health system has contributed to rising health care costs. However, this study suggests that provider-owned health plans are able to garner lower reimbursement rates from affiliated providers than their commercial market competitors. It is unclear, however, whether these savings meaningfully reduce costs for policyholders, or are simply redistributed within the vertically integrated health system. Greater transparency and expanded reporting requirements for provider-owned health plans would help policymakers seeking to improve health care affordability for commercial market policyholders.
