CMS Announces Final Exchange Enrollment
The Centers for Medicare and Medicaid Services (CMS) announced final Exchange enrollment nationwide as well as premium hike statistics. Total enrollment fell nationwide from 24.3 million in 2025 to 23.1 million in 2026. This is far less than anticipated, but some say rolls will slip further due to the inability to afford the surges in premiums as well as lower subsidies. Current 2026 enrollment is still 1.7 million higher than in 2024.
About 15.8 million enrollees obtained coverage through the HealthCare.gov platform, while 7.4 million were enrolled through a state-based Exchange. New customers dropped 13% year over year. Enrollees with an advanced payment premium tax credit dipped from 92% to 87%, while the portion with cost-sharing reductions dropped from 51% to 37%. The latter figure may indicate that many low-income individuals dropped coverage.
Average premiums increased 58% for those on subsidies because enhancements expired. This is lower than a healthcare policy group projection that premiums would jump 114%. KFF indicated its projection was based on everyone staying in current plans. Consumers are paying on average $780 per year more for coverage in 2026.
As CMS noted, enrollment in low-premium, high-deductible bronze plans jumped due to premium surges. Enrollment in bronze plans jumped from 30% in 2025 to 40% in 2026. Silver plans dropped from 56% in 2025 to 43% in 2026.
Additional articles: https://www.fiercehealthcare.com/payers/cms-years-open-enrollment-brought-fewer-signups-higher-premiums-fewer-silver-sign-ups and https://www.healthcaredive.com/news/aca-premiums-enrollment-bronze-plans-2026-cms-data/816067/
(Some articles may require a subscription.)
#exchanges #coverage #healthcare
https://www.modernhealthcare.com/insurance/mh-aca-customers-2026-cms-data/
DOJ Sues New York Hospital On Anti-Competition
The Justice Department has filed a lawsuit against New York-Presbyterian Hospital, accusing the non-profit health system of using its market power to negotiate anticompetitive contracts with health insurers. The department says the hospital forces insurers into “all-or-nothing”contracts, meaning insurers must include all facilities in nearly every network or forgo including them at all. In addition, Justice alleges the hospital forces insurers to include them in narrow network plans meant to reduce consumer costs as well as barring lower cost-sharing at competitor facilities or other ambulatory sites of care. The suit is similar to one against Ohio Health.
In other news, a good Health Affairs Forefront blog offering ten considerations as states approach regulation of hospital and healthcare costs.
Additional articles: https://www.healthcaredive.com/news/justice-department-sues-newyork-presbyterian-in-second-hospital-antitrust-c/815891/ and https://www.healthaffairs.org/content/forefront/challenges-confronting-state-regulation-health-care-prices-ten-questions
(Some articles may require a subscription.)
#hospitals #healthplans #antitrust #doj
https://www.modernhealthcare.com/providers/mh-doj-antitrust-new-york-presbyterian-ohiohealth
Pharmacies Allege FTC Settlement Perilous
What was celebrated by the Federal Trade Commission as a major win for independent, smaller pharmacies may not be all it is cracked up to be. The pharmacies are now complaining that the provisions designed to curb anti-competitive behavior may have the opposite effect.
As part of the FTC deal, Express Scripts will “delink” compensation from list prices and transition away from rebate guarantees and spread pricing. In addition, it will pay pharmacies the cost of drugs plus a dispensing fee.
Pharmacies say amended contract terms lack specificity and lend themselves to creative interpretations, which could udnermine their fiscal health. Dislcosure requirements may be unreasonable as well. They have little time to opt out.
(Article may require a subscription.)
#ftc #expressscripts #pharmacies #drugpricing
https://www.modernhealthcare.com/insurance/mh-ftc-express-scripts-pbm-pharmacies
— Marc S. Ryan
