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GOP Worried On Affordability Some Senate Republicans are worried that the GOP leadership is not doing enough on the affordability issue as the 2026 midterms approach. Right now, the House is almost assuredly going back to the Democrats, while the Senate is favored for the GOP but getting too close for comfort. Sen. John Kennedy, R-LA, has been urging Republicans to pass a second reconciliation bill to pass additional healthcare measures. President Trump has dismissed the idea of yet another bill, but House Republicans want to pass a second one as well. Lawmakers could still do so over the president’s objections. #healthcare #coverage #midterms https://thehill.com/homenews/senate/5738150-republicans-affordability-midterms FTC Loses Enhanced Disclosure The Federal Trade Commission’s (FTC’s) antitrust rule requiring parties to submit additional information to regulators ahead of a planned merger was overturned by a federal judge. The judge agreed with business interests that the FTC’s rationale that it needed additional information

2026 Medicare Advantage Enrollment Finally Published After a long delay, the Centers for Medicare and Medicaid Services finally published results for January and February for Medicare Advantage (MA). While many predicted that the program would contract, I had said that enrollment would be flat or one of the lowest growths we had seen recently. Some analysts suggested that there would be a decline because of the mass exodus of large plans from certain markets and efforts by them to shed huge enrollment. But despite the huge challenges in the program, MA showed some resiliency. Enrollment in February 2025 was 34.941 million. In December 2025, MA had 35.700 million members. In February, we saw 35.814 million. January numbers showed a contraction from December of about 400K. We know January 2025 numbers had some issues. That could also be the case for January 2026. But February 2025 to February 2026 numbers showed

Aledade Touts Primary Care and VBC Growth Value-based enablement company Aledade added more than 700 primary care practices to its network for 2026 and sees strong momentum for value-based care (VBC) growth. Aledade has more than 3,000 primary care organizations across the country with over 3 million patients in VBC programs. These include Medicare Shared Savings Program (MSSP), Medicare Advantage (MA), Medicaid, and commercial contracts. Transition to VBC from transaction payments has been slow with a mixed record on savings and better outcomes. See my blog today on VBC: https://www.healthcarelabyrinth.com/the-2027-aca-exchange-rule-the-good-and-bad/ . In other news, Humana President and CEO Jim Rechtin said the company is looking to expand its primary care footprint. He says a strategic acquisition should be announced soon. But as I noted earlier and Becker’s says in its article, the biggest national health plans are under heavy criticism about sweet-heart deals of plans and pharmacy benefits managers (PBMs)

Humana Turning Around But On A Bumpy Road Humana reported Q4 2025 results today. While the Medicare Advantage (MA) insurer is making inroads, the road remains bumpy. During the fourth quarter, Humana’s net loss grew 14.9% to $796 million. Revenue rose 11.3% to $32.5 billion. For the full year, net income declined 1.6% to $1.2 billion and revenue increased 10.1% to $129.7 billion. Humana reported an medical loss ratio (MLR) of 93% in the fourth quarter and 90.2% in 2025. Humana ended 2025 with 5.8 million MA members, a 6.3% decline since 2024. It expects enrollment to be 25% higher this year. This is in contrast to most of the other large national plans. Humana says earnings from individual MA plans will dip just below breakeven this year. Humana stock tumbled because investors fear benefits are too high for 2026, driving enrollment. This could impact margins in 2026, which investors

Unlikely Pair Attacking Vertical Integration An unlikely pair of senators, Elizabeth Warren, D-MA, and Josh Hawley, R-MO, have teamed up to pass the “Break Up Medicine Act.” The bill would seek to break up major vertically integrated healthcare behemoths due to the cozy relationships companies within the master entity have with each other. The bill proposes prohibiting parent companies from owning a medical provider or management services organization and a PBM or insurer. It also proposes prohibiting parent companies of prescription drug or medical device wholesalers from owning a medical provider or management services organization. #healthplans #verticalintegration https://thehill.com/policy/healthcare/5732189-break-up-big-medicine-act CVS Health Reports Good Financial News; Oscar Health Reports Loss CVS Health beat The Street by outperforming to close out 2025 and expects its finances to improve further this year. Still, it is citing proposed 2027 Medicare Advantage (MA) rates as inadequate. It is advocating for a hike. It did say it

Seismic Changes To ACA and Exchanges Proposed Building on changes in the One Big Beautiful Bill Act (OBBBA) and other regulatory changes in 2025, the Trump administration’s 2027 Affordable Care Act (ACA) and Exchange rule aims to make additional seismic changes in healthcare. Among the major changes include: Proponents argue the changes are needed to reduce costs and provide more affordable options. Critics argue the changes will simply erode the Exchanges financial position and increase risk. Additional articles: https://www.fiercehealthcare.com/regulatory/cms-plans-roll-back-limits-non-standard-aca-plan-options and https://www.beckerspayer.com/payer/aca/cms-proposes-aca-implementation-rule/ and https://www.cms.gov/newsroom/press-releases/cms-proposes-regulations-lower-health-care-costs-expand-consumer-choice-protect-taxpayers and https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-payment-parameters-2027-proposed-rule #exchanges #healthcare #coverage #trump #cms #regulations https://www.modernhealthcare.com/politics-regulation/mh-aca-exchange-rule-2027-standardized-coverage Kaiser Reports Good Financials Kaiser Permanente reported good financial news for Q4 and 2025. It tripled its operating income although operating expenses surged. It reported operating income of $1.4 billion last year, up from $569 million in 2024. The turnaround is tied to investments in operational improvements. Kaiser Permanente and its subsidiaries wrapped 2025 with a 10.3% bump

Centene Reports Financial Results Centene Corporation posted a $1.1 billion loss in Q4 2025 and $6.7 billion loss for 2025 as it sees elevated costs overall and shrinking membership in Medicaid. It had $3 billion in profit in 2024. Its medical loss ratio was 94.3% in Q4, up from 89.6% a year ago. Adversity is increasing. While it did post a loss in Q4, results still surpassed Wall Street analysts’ predictions. Centene issued a higher earnings outlook for 2026 than analysts expected as well. As with Molina, which reported negative results for 2025 and financial expectations in 2026 that are half of analyst forecasts, Centene said states’ Medicaid payment rates haven’t kept pace with costs. Acuity is also rising in the Exchanges. Both Centene and Molina stock dropped. Additional articles: https://www.modernhealthcare.com/insurance/mh-molina-medicaid-acquisitions-medicare-advantage/ and https://www.modernhealthcare.com/insurance/mh-centene-earnings-medicare-medicaid/ and https://www.healthcaredive.com/news/centene-loss-q4-2025-2026-outlook-cnc/811564/ and https://www.beckerspayer.com/financial/centene-posts-6-7b-loss-in-2025/ (Some articles may require a subscription.) #healthplans #margins #centene #molina #medicaid #exchanges https://www.fiercehealthcare.com/payers/centene-reports-11b-loss-q4-elevated-medical-costs-continue-strain-finances Cheering

TrumpRx Unveiled; Novo Nordisk Reports Bad 2026 Guidance TrumpRx was unveiled Thursday. The president negotiated deals with 16 of the 17 largest brand drug makers and part of the arrangement includes steep discounts on TrumpRx for self-pay Americans. The initial launch includes discounted products from AstraZeneca, Eli Lilly, EMD Serono, Novo Nordisk and Pfizer. Additional manufacturers that have signed agreements will have products added to the platform over time. Right now, 43 prescription drugs treating various different conditions at varying discounts are on the website. Medications for asthma, infertility and obesity are among those available. The savings range between 33 and 93 percent off the list price of the drugs. Trump has been driving other changes as well, including deploying models for most-favored-nation (MFN) pricing in Medicaid and Medicare. The deals he struck already gained MFN in Medicaid and such pricing on new drugs that come to market. Some criticize

FTC Settles With Cigna’s Express Scripts The Federal Trade Commission (FTC) and Cigna’s Express Scripts pharmacy benefits manager (PBM) reached a settlement that resolves allegations that the PBM artificially drove up prices for insulin. Cases continue against CVS Caremark and OptumRx. Express Scripts will implement a number of reforms, including: The FTC expects the settlement to lower out-of-pocket costs for drugs by $7 billion over a decade. Additional articles: https://www.fiercehealthcare.com/regulatory/ftc-evernorth-near-settlement-case-over-insulin-prices and https://www.healthcaredive.com/news/express-scripts-ftc-reach-settlement-insulin-lawsuit/811369/ and https://www.beckerspayer.com/legal/ftc-deal-over-insulin-prices-forces-cignas-express-scripts-to-overhaul-policies/ (Some articles may require a subscription.) #pbms #drugpricing #employers https://www.modernhealthcare.com/insurance/mh-cigna-express-scripts-ftc-pbm-lawsuit CMS Hypes ACO Growth And Potential The Centers for Medicare and Medicaid Services (CMS) issued a fact sheet regarding latest statistics around Medicare Accountable Care Organizations (ACOs). As of January 2026, 14.3 million Medicare beneficiaries are estimated to receive care coordinated by ACOs, up from 13.7 million in 2025 or a 4.4% increase. This includes those in Medicare Shared Savings Program ACOs and entities participating in

Partial Shutdown Over The House voted 217-214 to approve a final spending package for FFY 2026 — 21 Republicans defected from and 21 Democrats supported the bipartisan measure. President Trump has already signed the bill. A number of key healthcare reforms are included. I reported on a list of them in the Newsfeed on January 30. Among the big items are a set of pharmacy benefit manager (PBM) reforms, including extensive reporting, transparency, and government oversight as well as requirements to pass rebates earned from drug makers to health plans, employers, and patients. PBMs will now have to charge a set fee for services. The bill requires the groups to report detailed data on drug pricing, rebates, pharmacy reimbursement, and payments retained by PBMs and their affiliates and authorizes audits and enforcement/recoupment actions. In addition, telehealth was extended for two years and acute hospital-at-home by five years. Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-congress-government-funding-bill-pbm-telehealth/