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Oscar, Clover Have Good Financial Results

Exchange-dominant Oscar Health reported strong Q2 results, with a profit of $362 million compared with a loss of $228.4 million a year ago. The company saw record profitability in 1H 2026, generating $1.1 billion in earnings from operations and $1 billion in net income.

Clover Health’s Medicare Advantage (MA) membership grew 48% year-over-year in Q2 to 157,309 members. The company posted $153 million in profit, up 54% from Q2 2025, and revenue of $743 million, up 56% from Q2 2025. It was also buoyed by its Star lawsuit win.

Additional article: https://www.fiercehealthcare.com/finance/oscar-health-boosts-2026-earnings-outlook-after-record-profitability-during-first-half-year

#healthplans #margin

https://www.fiercehealthcare.com/finance/clover-health-reaffirms-ai-commitments-discusses-star-rating-amid-strong-q2-performance

CVS Health Reports Good Q2 News But Signals Disappointing 2027 Guidance

CVS Health reported good financial performance in Q2, but signaled caution for 2027. This led to a decline in its stock price. CVS reported higher revenues across all segments but said its pharmacy benefits manager (PBM) was facing headwinds due to 340B and other market trends.

Aetna was the star for CVS as the insurer showed a stunning recovery from a few years ago. Like United and Cigna, it called out the deleterious impact of the out-of-control No Surprises Act arbitration process. Medicare Advantage’s (MA) recovery drove a great deal of earnings.

Net income for CVS rose 196% to almost $3 billion.  Income increased 7% year over year to $106.1 billion. 

In other news, Becker’s Payer ranks payers by Q2 2026 profit.

As well, UnitedHealthcare may end MA sales in 34 counties in 12 states next year. This would impact 20,000 enrollees, some of whom may not have any MA alternatives.

Additional articles: https://www.modernhealthcare.com/insurance/mh-cvs-earnings-aetna-caremark-membership/ and https://www.modernhealthcare.com/insurance/mh-cvs-earnings-guidance-medicare-advantage/ and https://www.beckerspayer.com/rankings-ratings/payers-ranked-by-q2-2026-profits/ and https://www.modernhealthcare.com/insurance/mh-unitedhealth-medicare-advantage/

(Some articles may require a subscription.)

#cvshealth #aetna #margins #healthplans

https://www.healthcaredive.com/news/cvs-triples-net-income-q2-2026-raises-outlook/827041/

Fireworks At Senate Committee Meeting On Medicaid

Explosive remarks at a Senate Finance Committee this week on Medicaid. Democrats attacked the recent One Big Beautiful Bill Act (OBBBA), especially the impact of work requirements, reductions in coverage, and impacts on providers and hospitals. The bill reduces Medicaid expenditures from its baseline by about $1 trillion.

Republican senators on the other hand focused on Medicaid’s potential fraud. Brian Blase, PhD, founder and president of the Paragon Health Institute, said his organization finds that improper enrollment of certain Medicaid beneficiaries cost the federal government about $33 billion in 2024.

#medicaid #obbba #coverage #healthcare #congress

https://www.medpagetoday.com/publichealthpolicy/medicaid/122489

The Big Debate Over Dropping Exchange Enrollment

The Trump administration recently went on the offensive, arguing a drop in Exchange enrollment should be credited to its ongoing efforts to crack down on improper and fraudulent enrollment. A recent administration report says 5.6 million people were fraudulently enrolled in Exchange plans in 2025, and that it removed 2.9 million through various initiatives.

But critics argue the drop in enrollment is tied to rising premium costs, including the expiration of enhanced premium subsidies passed and extended during the COVID years. They argue more will drop throughout 2026 due to affordability issues.

The truth is likely somewhere in the middle. For sure, rising premiums have led many to disenroll. But the Trump administration is likely also right. There is little question in my mind that zero premiums led many to be fraudulently enrolled.

#exchanges #enrollment

https://kffhealthnews.org/medicaid/aca-fraud-crackdown-skyrocketing-prices-enrollment-decline/

HRSA Finalizes 340B Rebate Pilot

The Health Resources and Services Administration (HRSA) finalized a revamped version of its contentious 340B Rebate Model Pilot Program after public comment. Earlier, a judge had struck the pilot due to regulatory deficiencies. The new pilot would move from upfront discounts to retrospective rebates for some drugs. Another Trump proposals would reduce Medicare drug reimbursement for 240B providers to ensue no double-dipping on discounts. The revised pilot is now set to begin on Jan. 1, 2027 and will run for at least a year.

In other news, a Health Affairs Forefront blog says there could be duplication of discounts between the Medicare drug price negotiation program and 340B as well.

Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-340b-drugs-rebate-pilot-hrsa-safety-net/

(Some articles may require a subscription.)

#340b #drugpricing #hospitals #providers

https://www.fiercehealthcare.com/providers/revised-340b-rebate-model-pilot-program-moves-forward-despite-provider-pushback

Senate Dems Float RFI For Healthcare Reform

Senate Democrats released a white paper detailing their goals for reforming healthcare. Some of the document gives hope that Democrats may abandon their more radical “Medicare for All” persona in favor of reforming the current private delivery system. It is especially focused on affordability and lowering costs.

At the same time, there are the normal political attacks and positions, including a rehash of expired Exchange subsidy enhancements, Medicaid cuts in the One Big Beautiful Bill Act (OBBBA), and a proposal for a public health plan option to run side-by-side with private plans.

Democrats would take a hard line on health plans and corporate greed.

Additional article: https://www.beckerspayer.com/policy-updates/senate-democrats-eye-public-option-in-insurance-reform-push/

#healthcarereform #coverage #congress

https://www.axios.com/2026/07/30/senate-democrats-health-insurance-overhaul

Humana Will Exit More Counties In 2027

At a Q2 earnings call, Humana executives said it is planning additional Medicare Advantage (MA) market exits for 2027 to continue its road to financial recovery. Humana has been the biggest enroller in 2026 (expected 25% growth) and that could be part of the contraction plans. The county exits will impact about 600,000 but Humana expects to make up a good deal of that in more profitable counties.

Humana’s medical loss ratio (MLR) was a high 91.1% in the quarter and the membership growth caused that. Humana downgraded its earnings guidance in part due to smaller quality bonuses, another struggle. Humana says it is on track to reach its goal of achieving top quartile Stars in the 2028 Star year.

The company reported $694 million in profit for the quarter, up from $545 million in Q2 2025. Profits through the first half of 2026 were $1.9 billion, compared with $1.8 billion in H1 2025. Revenue was $40.9 billion in the quarter, growing from $32.4 billion in Q1 2025.

Additional articles: https://www.fiercehealthcare.com/payers/humana-still-track-25-medicare-advantage-membership-growth-year and https://www.modernhealthcare.com/insurance/mh-humana-medicare-advantage-markets-2027/ and https://www.beckerspayer.com/financial/humana-turns-694m-q2-profit-amid-medicare-advantage-centerwell-growth/ and https://www.beckershospitalreview.com/finance/humana-to-exit-medicare-advantage-plans-covering-600000-members-in-2027/

(Some articles may require a subscription.)

#humana #medicareadvantage #healthplans #margins

https://www.healthcaredive.com/news/humana-2027-medicare-advantage-plan-exits-q2-2026/826441

ACHP Urges “Better Of” Approach for Star Year 2027

In a letter sent to the Centers for Medicare and Medicaid Services (CMS), the Alliance of Community Health Plans (ACHP) requested that CMS continue its hold harmless methodology for 2027 Medicare Advantage (MA) Star Ratings.

The non-profit plan trade group asked that CMS calculate the “better of” the 2025 measurement year original ratings and a version that removes measures affected by Clover Health’s litigation.

The letter appears purposefully ambiguous on what the second scenario would be – CMS’ view used in SY 2026 or other possibilities that could result from lawsuits. Overall, the proposal makes sense.

Additional article: https://achp.org/wp-content/uploads/ACHP-re-Clover-Litigation_Request-to-Apply-the-2026-Hold-Harmless-Methodology-to-the-2027-Medicare-Advantage-Star-Ratings_July-27-2026.pdf

#medicareadvantage #stars #quality #cms

https://www.beckerspayer.com/payer/medicare-advantage/achp-urges-cms-to-use-higher-of-2-ma-star-ratings-scores-in-2027-amid-clover-lawsuit/

MA’s Value Underscored In New Study

A new ATI Advisory analysis conducted on behalf of the Better Medicare Alliance finds that Medicare Advantage (MA) enrollees spend less on average than those in traditional Medicare fee-for-service (FFS) and yet have similar satisfaction rates.

Looking at files from 2021 to 2023, ATI found that MA enrollees spent $2,824, or 36%, less out-of-pocket on average in 2023 compared to those in FFS. That difference has increased over time, with savings 16% higher in 2023 than in 2022. Just 12% of MA enrollees said they faced a significant cost burden, or spent more than 20% of their income on healthcare, compared to 24% of those in FFS.

MA too cares for more lower income people – 54% in MA are at or below 200% of the federal poverty level vs. 30% in FFS. More than three-quarters of MA members have three or more chronic needs.

On the quality front, MA enrollees were 15% more likely than those in FFS to have had an annual wellness visit.

#medicareadvantage #medicare #quality

https://www.fiercehealthcare.com/payers/industry-survey-finds-ma-enrollees-have-lower-out-pocket-costs-those-traditional-medicare

Warning Signs For Hospitals On Exchange Enrollment Falloff

For-profit hospital chains HCA and Tenet reported earnings for Q2 2026 and within the disclosures are tough news on Exchange revenue that could impact all hospitals.

HCA reported that its overall loss due to Exchange enrollment declines will go from an estimated $1 billion to a new projection of $1.2 billion in 2026. HCA says volume declines of 15% are in line with original guidance estimates, but its assumption that 80% to 85% of the patients who lose Exchange coverage would become uninsured has been off. The number is closer to 100%. HCA’s admission decline for Exchange enrollees has been between 25% and 28% for the first half of the year. The Exchange issues alone have caused a $400 million impact on adjusted EBITDA in Q2.

Similarly, Tenet Healthcare saw a 17% year-over-year decrease in Exchange-related revenue in Q2 and a 13.5% decrease in Exchange admissions.

Additional article: https://www.beckershospitalreview.com/finance/hcas-1-2b-aca-hit-raises-red-flag-for-nonprofit-health-systems

#hospitals #margins #exchanges

https://www.beckershospitalreview.com/finance/tenets-aca-exchange-revenue-falls-17-as-uninsured-volumes-rise/