Internship-Expanding Coverage and Access: Medicare Program

The Organization

The Commonwealth Fund — among the first private foundations started by a woman philanthropist, Anna M. Harkness — was established in 1918 with the broad charge to enhance the common good. Today, the mission of The Commonwealth Fund is to promote a high-performing health care system that achieves better access, improved quality, greater equity, and increased efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, and people of color.

The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. An international program in health policy is designed to stimulate innovative policies and practices in the United States and other industrialized countries. The Commonwealth Fund has made a commitment to become an antiracist organization. That commitment extends not only to our research agenda, our grantmaking, and our communications, but also to all aspects of our internal operations.

The Commonwealth Fund envisions a health care system that values and benefits all people equally — one that combats racism and pursues equity, in treatment and outcomes as well as in leadership and decision-making. We believe this requires an alliance of people and institutions across society working together to recognize and value the lived experience of all individuals; ensure the delivery of compassionate, affordable, quality health care;

and strive for equitable outcomes for all.

We aspire to racial equity, diversity, and inclusion in how we work. We place great value on the varied backgrounds and experiences our staff bring to our organization and encourage employees to bring their full selves to the workplace. We look for talented, nimble, empathetic, and supportive team players who are ready to roll up their sleeves, create impactful change, and celebrate accomplishments.

The U.S. health system is characterized by considerable geographic variation on insurance coverage, access to care, health status, quality of care, and the cost of care. It also lags other economically advanced countries by varying degrees in most of these areas. This means that some regions of the U.S. not only lag behind other regions on health performance indicators, they lag even further behind other economically advanced countries than national averages suggest.

In the area of insurance coverage, the Affordable Care Act improved overall U.S. performance relative to other countries and narrowed differences between some states. It also narrowed historical race and income inequities in coverage and reduced state differences in people’s access to care and consumer financial problems stemming from uncovered health care encounters. In addition, there is consistent evidence that the coverage expansions led to improved reported health status in some states, a key indicator of mortality.

The law’s provisions in the area of health care quality and cost were less sweeping than those in coverage but resulted in important improvements.

Despite these ACA-related gains, the U.S. still lags significantly behind other countries on health care indicators and large differences remain between states. More than 25 million people remain uninsured, nearly a quarter of working age adults have insurance plans that are leaving them underinsured, the country has a growing consumer medical debt crisis, and health care costs are growing faster than median income in most states.

In addition, over the last decade, the U.S has experienced an unprecedented decline in life expectancy driven in large part by the COVID-19 pandemic and the…