Paragon Says Over 6 Million Improper Exchange Enrollments
The influential conservative Paragon Health Institute says a quarter of all Exchange enrollments were improper in 2026, adding fodder for those arguing healthcare has rampant fraud and improper enrollments. Paragon argues taxpayers will improperly subsidize the program by nearly $25 billion.
In other news, Colorado Democratic Gov. Jared Polis signed into law funding for healthcare insurance affordability. Colorado’s health insurance affordability enterprise already collects fees from health plans and hospitals to reduce premiums in the individual market. The new law would issue bonds to generate up to $100 million beginning in 2027. In addition, another $40 million will be earmarked from the marijuana tax cash fund. The law also establishes a premium reduction target of 18% for the reinsurance program.
Further, according to JD Power, national average satisfaction scores for commercial plans are down one point from a year ago and down three points from 2024. More than half of commercial plan members saw their premiums increase in 2026.
Additional articles: https://thehill.com/policy/healthcare/5908600-obamacare-improper-enrollments-report/?tbref=hp and https://www.healthcaredive.com/news/consumer-satisfaction-health-plans-low-jd-power/821851/
#exchanges #fwa #enrollment #affordability #employercoverage #commercial
Work Requirement Pushback
Despite early coverage that said the work requirement rule was softer than anticipated, plans, providers, and advocates are now lining up to attack the regulation for being extremely onerous. They now say:
- Rules regarding the medically frail exclusion are tougher than needed and states will need to revisit verification processes.
- The rule is inconsistent with the statute.
- Documentation requirements are added.
- Criteria for exemptions are harsher.
In other news, investors are concerned that the Trump administration’s directive to states to attack fraud may impact plan revenue when coupled with tightening state finances.
Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-cms-medicaid-work-requirements-rule-exemptions/ and https://www.fiercehealthcare.com/regulatory/industry-groups-say-final-medicaid-work-requirements-rule-imposes-onerous-documentation and https://thehill.com/policy/healthcare/5906718-medcaid-work-requirements-rule/ and https://www.medpagetoday.com/publichealthpolicy/medicaid/121560
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#medicaid #workrequirements #fwa
https://www.modernhealthcare.com/insurance/mh-unitedhealth-centene-elevance-medicaid-budget-states
OIG Calls Out MA Overpayments On Strokes
The Department of Health and Human Services Office of Inspector General (HHS OIG) says Medicare Advantage (MA) plans may have earned millions in overpayments tied to unsupported stroke diagnoses. The OIG examined 240,401 MA enrollees who were at high risk for an inaccurate diagnoses code for acute stroke and pulled a 97-member sample. Across all individuals, high-risk acute stroke diagnoses were not supported by the patients’ medical records.
Additional article: https://www.modernhealthcare.com/insurance/mh-presbyterian-healthcare-services-medicare-advantage-plans/
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#medicareadvantage #fwa #riskadjustment #overpayments
— Marc S. Ryan
