In the U.S., uninsured and low-income adults face significant health and health care inequities as compared to insured and higher-income individuals. An issue brief analyzing the Commonwealth Fund 2010 Biennial Health Insurance Survey finds that when low-income adults have access to health insurance coverage and a medical home, they are less likely to report cost-related access problems, more likely to be up-to-date with preventive screenings, and report greater satisfaction with the quality of their care. Moreover, the gaps in health care between them and higher-income populations are significantly reduced. The Affordable Care Act (ACA) includes numerous provisions that will significantly expand health insurance coverage, especially to low-income patients, as well as provisions to promote medical homes. Along with supporting the full implementation of coverage expansions, it will be important for public and private stakeholders to create opportunities that enhance access to medical homes for vulnerable populations.

The Commonwealth Fund debuted the "National Scorecard on U.S. Health System Performance, 2011" in a press briefing at the Kaiser Family Foundation on October 18, 2011. Cathy Schoen, the Senior Vice President for Research and Evaluation at Commonwealth, summarized the report, which updates a series of comprehensive assessments of U.S. population health and health care quality, access, efficiency, and equity. The report notes substantial improvement on several care quality indicators. However, the U.S. fell short on key measures as well. Across 42 performance indicators, the U.S. achieved a total score of 64 out of a possible 100, when comparing national rates with domestic and international benchmarks. Costs rose sharply, access to care declined, health system efficiency remained low, health disparities persisted, and heath outcomes also fell below target. The Affordable Care Act (ACA) targets many of the important gaps identified by the Commonwealth Scorecard.

The Commonwealth Fund Commission on a High Performance Health System's report "Ensuring Equity: A Post-Reform Framework to Achieve High Performance Health Care for Vulnerable Populations" examines the continuing problems facing vulnerable populations and offers a policy framework for moving forward. The framework features three overarching strategies to close the health care divide: 1) ensure that insurance coverage affords adequate health care access and financial protection; 2) strengthen the care delivery systems serving vulnerable populations; and 3) coordinate health care delivery with other community resources, including public health services.