Health care in the United States has long been in crisis, underperforming for all Americans. Quite simply, compared to our peer nations across the world, we spend the most and have the least to show for it — as illustrated by our lagging life expectancy and high rates of infant and maternal mortality and chronic disease. Despite incredible advancements in science and technology, we fail the basic test of assuring that all people across our nation can live healthy lives, and can get the care they need, when they need it, at a price they can afford.
Sadly, this is poised to get worse.
Health insurance coverage, which had hit record highs over the past few years, is now under threat due to policy actions impacting Medicaid and changes to the Affordable Care Act. Millions will likely lose coverage.
Health care costs are skyrocketing, with many Americans unable to afford even basic care for themselves and their families.
Access to care itself — for even basic primary care — is an almost insurmountable challenge everywhere, including urban and rural settings.
Longstanding disparities in health outcomes and quality of care by class, geography, gender, and race persist and grow every day.
The challenge is how to respond in this time of disruption, uncertainty, and upheaval. The short answer is simple: we can, and must, act decisively now to ensure a more promising future.
The Commonwealth Fund was created to lead in a time of uncertainty and improve the health and well-being of all Americans — especially those most vulnerable. Founded in 1918 by Anna Harkness, a visionary woman from Ohio, the Fund built hospitals in underserved rural areas in America’s Southern and Plains states and supported advances in public health, clinical research, and medical education. Unimaginably, more than 100 years later, the progress we’ve made is at great risk.
Over the past year, we’ve spent time taking stock of where we’ve been as a philanthropy, the challenges of today, and our collective aspirations for tomorrow. We asked ourselves: where can we best focus our expertise, assets, and resources to have meaningful impact on the health and health care of all Americans?
This question, along with our century of experience with health systems — here and abroad — allowed us to come to three main conclusions.
First, health insurance coverage and high-quality, affordable care is what we all want. These three pillars — coverage, care, and cost — remain as important as ever, and we must address the challenges impacting all three to create a health system that works for everyone.
Second, undergirding these pillars is the basic principle that everyone, no matter who they are, where they live, or how much money they have, deserves affordable, high-quality health care. In America, that should be a given, but it is far from our reality.
Third and finally, when you focus on improvement for those most in need, we all benefit.
Going forward, the Commonwealth Fund will sharpen its focus on expanding access and coverage, improving health care delivery, making health care affordable, all while achieving equitable outcomes. We will address some key challenges inherent to those areas: meeting the health care needs of rural communities; building a true primary care system that is accessible and affordable; improving maternal health to reduce disparities; and optimizing the deployment of technology and innovation so that no one is left behind. Of course, promoting international learning and exchange and leadership development also will remain core to what we do.
And we will focus on increasing our impact by working on the ground, in states across the country — by listening, collaborating, and taking actions together — to address the challenges of today while building a blueprint for a better tomorrow.
To this end, at the start of 2026, we will formally launch two major new initiatives:
The first will bring together a collaborative of states — including rural and underserved, and those with strengths, and those with gaps — to focus on sharing, learning, action, and improvement, building on the findings of the Commonwealth Fund’s long record of health care tracking in our state scorecards.
The second will focus on creating a new design for the future of coverage and health care by engaging people and health care leaders in different regions across the nation to capture the best ideas and lessons to create a health care system that meets the needs of all Americans.
These new initiatives will bring forward the Fund’s history, its assets, and most importantly, its commitment to listening, learning, and charting a path for better health and health care for all. In focusing on the key pillars of health care and in launching these initiatives, we will honor our founder, Anna Harkness, who created the Commonwealth Fund to “do something for the welfare of mankind.”
Everyone agrees we need change. What we need is the right change, evidence-based change, and change that meets the needs of Americans across the country.
Amidst today’s divisions, we strongly believe in the power of coming together to focus on solving the challenges we face now with solutions and decisive actions to create a better future. This is our charge, this is how we will make a difference, and this is our plan for the future. Stay tuned for more about our initiatives; we hope you will join us.
