Stars Redo Boosts 47 Contracts’ Ratings
Centers for Medicare and Medicaid Services’ (CMS) data show that 47 contracts received recalculated 2026 Medicare Advantage that are higher than the original calculation. Thirty-six of those contracts secured at least four out of five stars to qualify for a quality bonus of 5%. Aetna and United Healthcare are two big plans that collected more revenue from the rescoring.
The CMS Recalculation has driven several lawsuits. Elevance Health argues some of its contracts should be calculated based on what Clover Health was (CMS’ recalculation differed for other plans). Scan and Alignment Healthcare argue that they should be rated on an even more steamlined set of measures because CMS ignored part of the Clover ruling.
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#cms #stars #quality #medicareadvantage
https://www.modernhealthcare.com/insurance/mh-aetna-unitedhealthcare-medicare-advantage-star-ratings
Congress Moves Healthcare Changes
House and Senate committees approved a series of bills that would strengthen transparency requirements for providers and Medicare Advantage (MA) plans, limit prior authorizations in MA, and regulate pharmacy benefit managers (PBMs).
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#healthcare #transparency #pbms #medicareadvantage #providers #priorauthorization
https://www.modernhealthcare.com/politics-regulation/mh-congress-hospital-insurer-transparency-bills
Molina News Mixed; Will Shed More Exchange Lives’
Molina reported earnings of $60 million in Q2 2026, down $255 million from Q2 2025. Profits through 1H 2026 were $74 million, down $553 million from 1H 2025. At the same time, it increased its guidance due to very conservative projections earlier.
Revenue declined from $11.4 billion in Q2 2025 to $10.9 billion in Q2 2026. Revenues for 1H 2026 were $21.7 billion, down from $22.6 billion in 1H 2025.
Molina reported an overall medical loss ratio (MLR) for Q2 of 92.2%.
Molina Healthcare is planning further reductions in its Exchange line of business.
Additional articles: https://www.healthcaredive.com/news/molina-plans-aca-cuts-q2-2026-moh/825934/ and https://www.modernhealthcare.com/insurance/mh-molina-healthcare-aca-exchange-coverage/
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#molina #healthplans #margins #exchanges
Healthcare Regulatory News
A series of regulatory news and administrative analysis.
- The Congressional Budget Office (CBO) expects Exchange enrollment to drop by almost 10 million people from 2025 – 2029. That is a big number compared to earlier estimates and reflects the ongoing premium hikes and unaffordability in the Exchanges.
- The Trump Administration finalized a rule that would reimpose the public charge rule. The public charge rule allows immigration offices to deny green cards to applicants who use or receive public assistance. This could lead to millions disenrolling from welfare and healthcare benefits for fear of having their path to citizenship impaired.
- President Donald Trump announced a plan to impose a 100%, later 200%, tariff on generic drugs starting in August 2028 to push pharmaceutical production in the United States.
- The administration also appealed a partial invalidation of an Exchange program integrity rule.
- Brand drug makers won at the appellate court level on their fight to stop drug makers from converting 340B discounts to rebates. The administration wants to pilot such a thing.
- New administration data shows the backlog of No Surprises Act disputes growing.
Additional articles: https://www.politico.com/news/2026/07/21/trump-says-he-will-impose-tariffs-on-generic-drugs-starting-in-august-2028-01007137 and https://www.modernhealthcare.com/politics-regulation/mh-hhs-appeal-aca-enrollment-eligibility-rule/ and https://www.fiercehealthcare.com/regulatory/judge-tosses-multiple-provisions-cms-2025-aca-program-integrity-rule and https://www.fiercehealthcare.com/regulatory/dc-appeals-court-sides-hhs-340b-drug-discount-program-rebate-challenge and https://www.modernhealthcare.com/politics-regulation/mh-cms-no-surprises-act-billing-disputes/ and https://www.healthcaredive.com/news/no-surprises-act-disputes-increase-arbiters-progress-speed-backlog-cms/826011/
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#healthcare #regulations #drugtariffs #exchanges #340b #nsa
— Marc S. Ryan
