Plans, Providers Urge Rejection Of State-Directed Payments Rule
Health plan and provider groups are joining together to oppose the Trump administration’s draft regulation implementing state-directed payment reforms and limitations in Medicaid. Changes were made in the One Big Beautiful Bill Act (OBBBA), but opponents say the draft rule goes well beyond what the statute outlines.
The plans and providers may be right about the rule exceeding statutory authority. At the same time, the use of state-directed payments have been abused and do need to be reined in.
#medicaid #obbba #coverage
NSA Dispute Costs $22 Billion
A new analysis from Georgetown University finds that total costs associated with the No Surprises Act’s dispute resolution process reached $22.4 billion at the end of 2025 after four years of the law. About $15.6 billion came from payments to providers that exceeded in-network rates. In addition, $4.2 billion came from administrative costs. About $2.7 billion was attributed to fees and costs for the dispute entities.
In 2025, total dispute resolution costs were $16.6 billion, an amount nearly 3.5 times higher than 2024 alone. The costs are stunning, with providers winning 85% of cases at rates that far exceed payments before the NSA was passed. The law needs to be reformed.
Additional articles: https://www.fiercehealthcare.com/regulatory/costs-tied-no-surprises-acts-idr-process-hit-22b-2025-study-finds and https://www.healthcaredive.com/news/no-surprises-idr-created-22-billion-costs-georgetown-surprise-billing/828817/ and https://www.healthaffairs.org/content/forefront/spending-idr-process-pushes-no-surprises-act-costs-more-than-22-4-billion-over-just
#nsa #nosurprisesact #employercoverage #providers #healthplans
Two More Surveys Show Surging Employer Costs
Consistent with others, two new surveys show employer coverage costs are expected to surge again in 2027. A Business Group on Health survey finds employers are expecting a median 9.2% increase in medical spending next year. Rates will still increase 8% after benefit changes.
A survey from WTW forecasts an even higher 11.1% increase. This would be the highest in two decades.
#employercoverage #costs
https://www.healthcaredive.com/news/employers-2027-health-costs-bgh-survey/828734/
Mississippi Wants Limited Duration Plans
Mississippi Insurance Commissioner Mike Chaney is developing a state-sponsored short-term health plan with UnitedHealthcare, set to launch in January. The limited plans would cost roughly 40% less than Exchange-compliant plans but would exclude pre-existing condition coverage in its first year. Supporters say the new option will help thousands of middle-class residents who can’t afford the premiums for health insurance Exchange policies.
#coverage #healthcare
— Marc S. Ryan
