Doctors Call Ozempic A Miracle Drug. Medicaid Officials Aren’t So Sure.

Breakthroughs in weight-loss medicine are presenting state Medicaid officials with what looks like a sure bet: Spend big now to cover the drugs and reap savings when diabetes, heart disease and cancer rates drop.

States are hesitating to take it.

The few states that have decided to cover drugs like Ozempic and Wegovy to help the nearly 40 percent of patients who are obese in the state-federal program for low-income people are finding they’re blowing holes in their budgets.

“It keeps us up at night,” said Jody Terranova, the medical director of Connecticut’s Medicaid program, which pared back coverage of the drugs, called GLP-1s, after they added more than $100 million to state spending last year. “We talk about it every day.”

The struggle comes as many states are course correcting after finding themselves in deficits — some in the billion-dollar-plus range — and as they brace for nearly $100 billion in annual cuts to Medicaid that President Donald Trump signed into law in July. Even though the effectiveness of the drugs suggests they’ll produce savings as diseases linked to obesity decline, state budgeting isn’t set up to take advantage of such bets when the ante is so steep.

The White House is touting a deal it reached last month with the makers of some of the most popular weight-loss treatments, reducing the price to state Medicaid programs to $245 a month. But how much that’ll save states and whether they take the offer is far from certain.

That’s because it’s unclear whether the price point is lower than what states are currently paying when rebates and discounts are taken into account. In Michigan, where Medicaid covers the obesity medications, the new price “doesn't look too different” than what the state currently pays with a rebate, said Medicaid Director Meghan Groen. Next year, Michigan is restricting coverage to Medicaid patients with severe obesity to reduce spending by $240 million.

“It's something that we're definitely taking a look at, but I think it's really too early for people to be making decisions based on it without that level of detail and how it interacts with what the state currently has in place,” she told reporters during a press conference last month.

Even a savings might not outweigh other considerations, including how many people would qualify for the drugs, how states see their cost-effectiveness and states’ unique budget circumstances.

The drugs aren’t a cure for obesity, and it’s likely many patients would need to remain on them to avoid regaining weight. Once viewed largely as a lifestyle choice, public health experts have come to see obesity as a disease caused by a number of genetic and environmental factors.

“The issue is that this is a highly, highly prevalent condition for which there is a treatment,” said Anand Parekh, an adjunct professor of health management and policy at the University of Michigan School of Public Health and a former HHS official during the Obama era. “For Medicaid, it's not even the price point, it's the fact that a huge portion of your beneficiary population has this condition.”

Doctors who treat obesity worry a major opportunity to improve public health could be lost.

They describe the medications as miracle drugs — the only treatments to date that have been so effective at suppressing appetite. Patients have at times lost more than 100 pounds within a year of beginning to use the medications and improved or eliminated other conditions they suffer from, including diabetes and sleep apnea.

“These medications decrease appetite, increase fullness, but it's almost like they intangibly increase willpower,” said Christopher Weber, an obesity medicine specialist in Wisconsin. “It's not sold as that, but I see it every day.”

Still, some states that have opted to pay for the medications are telling a different story: one where the drugs’ astronomical costs are trumping any potential long-term fiscal or public health benefits.

Medicaid is jointly funded by federal and state governments. The cost split varies depending on how much people earn in a state, but the federal government on average pays 65 percent of Medicaid costs. States have some discretion in what treatments to cover and how to cover them.

Their coverage decisions can limit who can access the life-changing — and sometimes life-saving — weight-loss medications. The setup has some patients wishing they were sicker, or that they had diabetes or heart disease in addition to obesity, so that they could access the medications under state rules.

In some cases, already obese patients are purposely gaining weight so they can reach the required body-mass index, a measure comparing weight to height, to qualify for coverage. That recommendation at times has come from their own doctors.

“I’ve actually told my patients, ‘Wow, your BMI is 39 and you don't [qualify for coverage]. I think you should go gain some weight,’ which is the most ludicrous thing a doctor can ever tell a patient,” said Susan Wolver, an obesity medicine specialist in Virginia.

States pull back. Patients suffer.

Wolver has seen firsthand what happens when a state stops covering weight-loss drugs for Medicaid patients.

For years, Virginia covered GLP-1s approved to treat obesity in Medicaid according to Food and Drug Administration guidelines: Patients could access the drugs if they had a BMI of 30 or above — which is considered clinically obese — or a BMI of 27 or above with two weight-related medical conditions, like heart disease or sleep apnea. A woman of average height, 5 feet, 4 inches, has a BMI of 30 at 175 pounds; a 5 foot, 9 man with a 30 BMI weighs 203 pounds.

Virginia restricted access in July 2024 to Medicaid patients with BMIs over 40 or over 37 with one weight-related condition. That meant the average woman would need to weigh 232 pounds to qualify and man 270 pounds.

“Many of my patients, after having an incredible weight loss, completely lost coverage for these drugs, and every single one of them is currently gaining weight,” Wolver said. “It's not only harmful physically, it was harmful psychologically to my patients, who had really regained their lives. Many of them had gone back to work, and their whole lives were really different with this weight loss.”

For Virginia, where about 68 percent of adults are overweight or obese according to a 2023 report by the Virginia Joint Commission on Health Care, it was about money. The state’s Medicaid program spent $36 million on the medications for weight loss between July 2023 and June 2024, and projections showed those costs would double by 2025.

The state legislature set the stricter limits on coverage during the 2024 budget process, which Republican Gov. Glenn Youngkin approved. A few months ago, the legislature passed a budget amendment to lower the BMI requirements to help more Medicaid enrollees access the medications. Under the proposal, patients with BMIs of 35 or greater or 30 or greater with a weight-related condition would have qualified for a GLP-1.

But Youngkin vetoed the measure, saying the change would’ve stifled price negotiations between the state Medicaid program and drugmakers. He said he’ll update the public on those negotiations in December.

The governor’s office didn’t respond to a request for comment.

Virginia is just one of several states backpedaling on coverage as the drugs’ costs exceed expectations.

After the FDA approved the first GLP-1 for obesity in 2014, a trickle of states began covering the treatments for Medicaid patients. Now, 16 states cover them: California, Delaware, Kansas, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, Pennsylvania, Rhode Island, South Carolina, Tennessee, Utah, Virginia and Wisconsin.

States that once took a gamble on covering the treatments — hoping it would improve the overall health of their Medicaid populations and reduce spending on other costly conditions — are finding it’s no longer a safe bet.

That includes California, which will discontinue coverage for Medicaid patients in 2026. Democratic Gov. Gavin Newsom greenlighted the change to help close a $12 billion deficit.

When Medi-Cal, the state’s Medicaid agency, began covering GLP-1s for weight loss in 2023, spending on the drugs ballooned more than 460 percent. By 2024, it had surged more than 1,400 percent, to about $809 million, according to estimates provided by the state health department.

Ending coverage of the drugs for obesity in 2026 is expected to save the state hundreds of millions of dollars over the next few years. But the drugs have also been a lifeline for hundreds of thousands of Medi-Cal patients with obesity, who could now regress on their weight-loss.

Tessa Outhyse, a spokesperson for the state health department, said by email that the department “recognizes that this change may present challenges and raise concerns for some members who are currently using these treatments and acknowledges that many members may have experienced improvements in weight-related health conditions, like high blood pressure and diabetes, while taking GLP-1 medications.”

North Carolina Medicaid discontinued coverage on Oct. 1, a little more than a year after first offering it. The program faced a $319 million budget shortfall, prompting the health department to put weight-loss drug coverage on the chopping block.

Just a few months ago, state Health Secretary Devdutta Sangvai was bullish on covering the drugs for Medicaid patients, telling POLITICO the decision to add coverage in August 2024 was borne out of a vision of improving Medicaid patients’ health “in a way that then requires less spending downstream on obesity-related complications.” About 45 percent of North Carolinians are obese, above the national average of about 40 percent.

“We know we have some population challenges with obesity and obesity-level illness, including things like diabetes, heart disease, stroke and other vascular diseases, so it's hard not to think about the impact this can have from a population perspective,” said Sangvai in a June interview.

“We are getting really good feedback from beneficiaries on how this has been life-changing, not just clinically, but emotionally.”

Sangvai’s office declined an interview after North Carolina dropped coverage.

GLP-1 coverage for weight loss was a “forced cut” because of funding shortfalls in the state Medicaid program, a spokesperson for the North Carolina health department said in a statement. Coverage “would be reconsidered if NC Medicaid is fully funded,” the person said.

New Hampshire and South Carolina are also ending Medicaid coverage of GLP-1s for weight loss at the start of next year, and Rhode Island is considering discontinuing coverage, citing similar budgetary concerns.

Wisconsin’s approach

MILWAUKEE — Wisconsin native Patrick Daly has struggled with weight gain since he hit puberty.

By the time he reached his 40s, he was over 400 pounds, and his weight hindered every aspect of his life: He’d developed Type 2 diabetes, obstructive sleep apnea and liver issues, and his energy was so low that participating in any physical activity was strenuous.

The Covid pandemic marked a turning point for Daly. He lost his job at a travel wholesaler — suddenly his work helping rebook people on canceled flights became obsolete. Unable to find full-time work, he qualified for Medicaid, giving him access to a tool that has transformed his life over the past year: Zepbound, a GLP-1 from drugmaker Eli Lilly.

His 100-pound-plus weight loss has restored his physical and mental health: His back pain has dissipated, allowing him to more easily stand and walk. His sleep apnea has improved. And his work — delivering for DoorDash and Uber Eats — is less burdensome.

“I started to feel really like I was accomplishing something, like I was really proud of myself for actually doing something right for once,” Daly told POLITICO. “Something that seemed so impossible for such a long time, and something that I'd failed at doing many times, suddenly seemed so simple and something that would be very easy to accomplish.”

Because of Wisconsin Medicaid policy, Daly will soon lose access to the medication that’s changed his life.

Among the unusual ways states have tried to pay for GLP-1s, Wisconsin's stands out.

Medicaid patients with obesity can access one of the three GLP-1s the state covers for obesity for one year before they’re required to take a six-month break. If after those six months their BMI is high enough to again qualify, they can access the medication for one additional year. Patients often qualify for the additional year of coverage because, during their six-month break, they regain weight they lost, doctors said.

After the second year of using the medication, a patient can no longer access it. They then may qualify for one of the other GLP-1s the state covers and can repeat the process of going on and off the medication until they permanently lose coverage.

That has dismayed both doctors and patients.

“It's like treating someone for depression and getting them to a point in life where they're thriving, and then taking it away and telling them, ‘Well, they should just have learned the behavioral skills to live a positive, optimistic life,’” said Leslie Golden, an obesity medicine doctor in Wisconsin.

People’s habits — including how much they eat and exercise — are key drivers of obesity, but genetics can also play a significant role. A person’s genetic makeup can influence metabolism, how and where their body stores fat, and their brain’s signals on hunger and fullness.

Toni Higgins, a Wisconsin Medicaid patient, lost nearly 70 pounds in 2024, her first year taking a GLP-1, which allowed her to come off a blood pressure medication she’d taken for years. But she became so depressed during her mandated six-month break from the medicine in early 2025, after regaining much of the weight she had lost, she had to start mental health treatments.

“You're thinking, ‘Oh, six months, I'll be fine.’ But then it hits, and you can't get it, and you start feeling it,” said Higgins, a single mom who has struggled to lose weight since giving birth to her daughter in her 40s, about 12 years ago. Hormonal imbalances contributed to that struggle, and with a family history of heart disease and diabetes, she decided to begin using the medications last year.

Wisconsin’s setup illustrates the difficult decisions states that cover the drugs have to make because of the medications’ price tag. The cost of the drugs, combined with their effectiveness treating one of the most prevalent chronic conditions plaguing Americans, is unprecedented. It has many state officials grasping at straws to find ways to offer coverage — and potentially save patients’ lives — without going broke.

In Wisconsin, spending on GLP-1s for obesity alone jumped more than 500 percent in two years, soaring from $16 million in 2022 to more than $100 million in 2024 as tens of thousands of Medicaid enrollees began taking the drugs.

“Managing costs while preserving access to care is always a consideration for state Medicaid programs,” Elizabeth Goodsitt, a spokesperson for Wisconsin's Department of Health Services, said in an email. “Wisconsin is monitoring the cost trend for these drugs and is exploring options to balance cost and access.”

Obesity is a major issue in the state known as America’s Dairyland, where 38 percent of adults struggle with the disease, according to the American Diabetes Association.

Wisconsin’s policy is creating headaches for doctors and patients who have observed the life-saving benefit of the treatments. Doctors said the policy ignores clinical evidence — that most patients need to stay on the drugs to maintain weight loss. They also argue there’s no fiscal benefit because covering the drugs only for a short time likely won’t help reduce rates of costly diseases like diabetes and heart disease in the future.

“To pay for patients to have two years of a medication and know that there's likely to be weight recurrence afterwards, you're not realizing your return on investment, you're just allowing the patient to get sicker again,” said Golden.

Patients like Daly and Higgins still count themselves lucky to live in one of only 16 states that offers coverage of the anti-obesity medications to Medicaid patients. They’re grateful to have had access to the medications, if only for a short time.

They also worry about losing access.

“I try not to think about it too much, because when I do, it gets me down,” Daly said. “I am concerned about that. It's always kind of in the back of my mind: What's going to happen when that day comes?”

Drugmakers profit

Millions of Medicaid patients with obesity in 34 states across the country have little to no access to GLP-1s for weight-loss.

That’s partly because of a decades-old federal law, which obesity doctors argue is rooted in stigma.

In 1990, Congress passed legislation that excluded weight-loss medications from mandatory coverage in Medicaid and Medicare, the federal health insurance program for seniors. The law was geared at containing costs.

At the time, the prevailing view was that obesity should be treated with lifestyle changes, and many of the weight-loss drugs on the market had raised safety concerns. Some were linked to life-threatening heart and lung conditions. The FDA banned some of the medications.

“It’s based on an outdated thinking about obesity,” said John Cawley, a professor of public policy and economics at Cornell University who researches the costs of obesity and believes it should be considered a chronic disease. “It's based on a world when there wasn't an effective and safe option.”

GLP-1s, which have been used for years to treat diabetes, are safe and perhaps the most effective nonsurgical option to treat obesity, according to doctors who specialize in the disease. The medications work by mimicking a hormone in the body that helps control insulin and blood glucose levels, which makes people feel full.

Doctors say the federal policy carving out coverage of weight-loss treatments unfairly punishes patients who struggle with obesity, particularly people on Medicaid, who the disease disproportionately affects and who might have limited access to healthy foods and other resources to help lose weight.

“It's a misunderstanding of the chronicity of the disease,” said Weber, the obesity medicine specialist in Wisconsin. “A lot of it's financial, because they're expensive medicines. But [Medicaid covers] other expensive medications.”

Medicaid pays for high-cost drugs that treat other conditions, including gene therapies for cancer, antivirals for hepatitis C and biologics for autoimmune disorders.

Late last year, the outgoing Biden administration proposed a rule that would have required both Medicare and Medicaid to cover obesity treatments approved by the FDA. In April, the Trump administration scrapped the rule because it was "not appropriate at this time," citing cost concerns. But the administration also left the door open to revisiting the issue in the future.

When asked for comment, the Centers for Medicare and Medicaid Services, the federal agency in charge, pointed to the White House announcement last month of its deal with drugmakers to lower the price of GLP-1s. The agency also pointed to its new drug payment model for Medicaid programs — a voluntary option for states to purchase certain drugs at lower prices charged in some other wealthy countries.

The agency didn’t respond to questions about whether coverage of weight-loss treatments would remain optional for states.

Medicaid patients living in states that don’t cover the drugs for weight loss could opt to pay for the drugs out-of-pocket. But most low-income patients enrolled in the program, who in most states have to make less than $22,000 a year to qualify for the free government health insurance, can’t afford the drugs at their current prices.

A 28-day course of Wegovy currently costs more than $1,300, while a course of Zepbound runs nearly $1,100. Saxenda is listed at about $1,350 for a 30-day course, and Mounjaro at $1,080 for a 28-day course.

Because of drug manufacturer savings programs, patients without insurance coverage for the medications pay about $500 out of pocket per month now for some of the drugs. Novo Nordisk in late November began offering a limited price of $199 per month for the lowest doses of Wegovy and Ozempic, available to new patients until March. After two months, those patients will pay $349 a month for the medications.

Trump’s agreement with drugmakers could help, but probably not enough for people with incomes low enough to qualify for Medicaid. His direct-to-consumer site, TrumpRx.gov, is set to offer an initial monthly course for new patients at $149 next year. But the medications will then cost an average of $350 a month with the goal of reaching $245 in two years.

The FDA is also fast-tracking approval of a new Eli Lilly GLP-1 pill, which is less expensive to produce. Patients must currently inject the drugs. If Eli Lilly wins approval, the lowest-dose pill would cost $149 a month through TrumpRx.

Under the White House deal, some Medicare patients with obesity will also be able to access GLP-1s with a $50 co-pay. Separately, last week, the federal insurance program for seniors announced lower prices for Novo Nordisk’s diabetes and weight-loss drugs under a program Congress authorized in 2022’s Inflation Reduction Act. The new negotiated prices — $274 for Ozempic and $385 for Wegovy — will take effect in 2027. It’s unclear how that might impact Medicaid’s prices.

If the price comes down significantly — more than in the White House deal — covering the medications for Medicaid patients would be a no-brainer for some states.

“If we had the same questions about long-term benefit, but it costs $5 for treatment, I don't think states would be hesitating to cover it,” said Pete Croughan, deputy secretary of the Louisiana Department of Health. The state, where about 48 percent of adults are obese, has so far opted not to cover GLP-1s for obesity because it would force the Medicaid program to pull funding from other areas, like combatting opioid use or maternal mortality.

Researchers have found a one-month supply of GLP-1s could cost less than a dollar to produce, and drug companies would still make a significant profit selling the drugs at a much lower price point.

Some lawmakers, including Sen. Bernie Sanders (I-Vt.), have called out pharmaceutical companies and grilled their CEOs during congressional hearings for charging more for the drugs in the U.S. than they do in Europe, where national health systems negotiate prices directly with manufacturers.

A monthlong course of Ozempic costs about $59 in Germany, $83 in France and $93 in the U.K. Wegovy is listed at about $140 in Germany and $92 in the U.K.

Unprecedented demand for the injections has driven the high list prices in the U.S. In 2023, the estimated global market for GLP-1s was about $44 billion, and it’s projected to be near $200 billion by 2032.

It’s not clear yet how Trump’s new discounted prices might change those projections, but if access to the medications greatly expands as a result, it could be a profit booster for the drugmakers.

“We are excited about the opportunity to engage with states on the expansion of Medicaid access for people living with obesity,” said Novo Nordisk spokesperson Allison Schneider in an email.

A spokesperson for Eli Lilly said the agreement builds on the company’s “commitment to finding solutions that improve access to obesity medicines.”

Rising rates of both obesity and diabetes across the world are also driving the boom. Buzz on social media and a spate of celebrity endorsements, including from Oprah Winfrey, Serena Williams and Elon Musk, have fueled it.

There’s also little generic competition — which usually helps drive prices down — because of patent protections. Most of those patents won’t expire in the U.S. until 2031, and even then, drug companies can file for extensions.

Patents incentivize drugmakers to invest in costly research and development of new and transformative drugs, Cawley said.

“It's necessary for those windfall profits to exist if we're going to keep getting new and better drugs,” he said. “But it's in conflict with the idea of a health insurance system that offers a minimum standard of coverage for low-income people.”

Last year, Novo Nordisk brought in nearly $30 billion in GLP-1 sales. That compares to about $18 billion in 2023 and $12 billion in 2022.

In late October, Eli Lilly recorded a record $5.58 billion profit for the third quarter of 2025 — which was largely driven by its GLP-1 sales as revenue for Zepbound jumped 184 percent over the same time last year.

The companies’ CEOs, when asked about higher drug prices in the U.S. compared to Europe, have publicly argued it’s not their fault.

They blame pharmaceutical middlemen, who manage prescription benefits for health plans, for the higher prices, claiming the drug companies only keep a small portion of the sales while the rest is passed through via rebates to the pharmacy benefit managers.

The PBMs maintain they are focused on negotiating lower costs for health plans and patients and that it’s the drugmakers that are setting the high prices for GLP-1s.

The cost question

As states explore whether it makes sense financially and medically to cover weight-loss medication for Medicaid patients, they’re wading through a sea of conflicting evidence.

Obesity doctors, drug companies and some independent researchers are touting the long-term economic benefits of paying for the drugs to treat obesity: Patients will lose weight and that will lead to reduced risks of costly conditions like heart disease and diabetes, they say.

Novo Nordisk is reportedly lobbying Medicaid programs with that sales pitch.

But the drugs are also relatively new — the first GLP-1 was approved for weight loss 11 years ago. And health insurance plans haven’t covered them long enough to know for sure whether there will be meaningful savings down the road.

There’s an added layer for Medicaid: Even if there are savings, states might not benefit from them. That’s because people might move off the program to private insurance or age into Medicare. Those other health plans might be the ones to benefit.

“There's always that danger that even if folks do well, you may not reap the financial benefit,” said Parekh. “So long-term, it's a really tricky proposition.”

An independent drug pricing review organization, the Boston-based Institute for Clinical and Economic Review, has found that Novo Nordisk’s and Eli Lilly’s weight-loss drugs offer value and are cost effective even with their price tags, because of their potential to improve the health of patients. The institute is a foundation-backed group founded at Massachusetts General Hospital in 2006.

Studies have shown GLP-1s can cut a patient’s risk of a major cardiovascular event, including stroke, heart attack and death, by about 20 percent.

“We need to have conversations about how costly it will be to continue to do nothing,” said Golden, the Wisconsin obesity medicine specialist.

Still, the potential budget impact of the medications “is large,” according to the institute. It estimated that fewer than 1 percent of patients eligible for the medications could be treated at the drugs’ current prices before passing what the group has determined is unaffordable from a budgetary standpoint, at $880 billion a year.

“This raises serious concerns about affordability,” the group said in its Oct. 29 report.

Studies have shown that patients need to continue taking the medications to maintain weight loss. And studies have also shown that most patients stop taking a GLP-1 within one year of starting, sometimes because of cost and sometimes because of the drugs’ side effects, including gastrointestinal issues like nausea and vomiting.

For state officials managing tight budgets, that means the promise of eventual cost savings feels far from guaranteed.

Meanwhile, states that are rethinking coverage, such as California, New Hampshire and North Carolina, are scaring off others.

Connecticut officials are proceeding with caution. Instead of covering GLP-1s, the state recently added coverage of two pills that are FDA-approved for weight loss — which are cheaper, and generally less effective, alternatives to GLP-1s. The program is also now covering nutrition counseling.

State officials said they eventually hope to cover GLP-1s for weight loss, but they’ve also seen how coverage has drained other states’ budgets.

“We don't want to set people up for having to pull something away,” said Terranova, the medical director of Connecticut’s Medicaid program. “We want to make sure that when we're ready to do it, we're able to sustain it.”

Connecticut is hoping that offering less expensive alternatives to Medicaid patients first will lessen the pool of people who would be eligible for a GLP-1 if and when the state adds coverage.

“We wanted to at least try to move people through a continuum because we're trying to also be responsible and sustain the Medicaid program from a cost perspective,” said Terranova’s boss, Connecticut Medicaid Director William Halsey.

Even in states that do offer coverage, conversations are ongoing about the sustainability of paying for the medications as information about the drugs’ benefits and drawbacks is evolving.

In Wisconsin, where limits on GLP-1 coverage have baffled both patients and doctors, an obesity advisory group — made up of doctors, policy experts, employers and insurers — meets monthly with Medicaid officials to discuss coverage rules.

The conversations are nuanced. Doctors provide evidence of the drugs’ effectiveness while policy experts acknowledge Medicaid programs are “trying to make sure they don't bankrupt their system,” said Gabrielle Rude, the CEO of the Wisconsin Collaborative for Healthcare Quality, the nonprofit organization that convened the advisory group.

“We're trying to make sure when the coverage decisions are made that it includes the perspective of clinicians that have the right answers, and it includes a longer-term view, not just on how many pounds this person lost, but what disease states can we actually move into remission and over what time frame,” she said. “That's a challenge, because [the drugs are] really expensive right now.”

Eventually, as more clinical information on the drugs becomes available, as drug patents expire and more competition enters the market, states’ decisions on coverage could become easier.

But for now, cost-effectiveness remains a question mark for state officials. That means states are likely to continue landing in different places on coverage, widening the gaps between states where Medicaid patients can and can’t access the medications.

“This is new territory we're entering,” said Liz Williams, senior policy manager with the Program on Medicaid and the Uninsured at KFF, a health policy research group. “States are going to do whatever they can to make sure that people who really need these drugs get them but they contain their costs at the same time.”

This story is part of a reporting fellowship sponsored by the Association of Health Care Journalists and supported by The Commonwealth Fund.