Exchange Enrollment Likely To Decline By Millions This Year
Healthcare policy group KFF finds that enrollment in Exchanges could decline to 17.5 million people this year. About 23.1 million enrolled as of January 1, which was already down from 2025 by 1.2 million. KFF used data from a Wakely Consulting study.
Just 86% of people enrolled in an individual market plan as of January 2026 paid their first month’s premium. If such trends continue, enrollment in the Exchanges could decrease between 17% to 26% over the course of 2026. The fall would include future unpaid premiums, mid-year attrition, and other impacts.
KFF also looked at all the cost impacts of expiring premium studies. Earlier it estimated that premiums would increase 114% if all enrollees stuck with their same plan. The new analysis finds that premiums in the aggregate actually increased by 58% for enrollees, which accounts for people switching to lower cost plans. That includes subsidized and unsubsidized individuals. The average actual filed premium hike from 2025 to 2026 as 26%.
Additional articles: https://www.fiercehealthcare.com/payers/aca-exchange-enrollment-likely-decline-least-17-year-kff and https://thehill.com/homenews/5885476-aca-marketplace-tax-credit-loss-enrollments/ and https://www.modernhealthcare.com/insurance/mh-aca-marketplace-enrollment-premiums-2026-kff/ and https://kffhealthnews.org/insurance/eroding-aca-enrollment-higher-insurance-rates/
(Some articles may require a subscription.)
#exchanges #healthcare #coverage
Vertical Integration Impact In Part D In Doubt
A new analysis from the Office of Inspector General (OIG) at the Department of Health and Human Services (HHS) finds that the net cost for drugs through vertically integrated Part D plans compared to other plans are similar. Vertically integrated firms accounted for 35% of Part D contract volume in 2023, with 11 of the 300 organizations offering Part D coverage considered vertically integrated (the sponsor also owns a pharmacy benefit manager — PBM).
#partd #antitrust #healthplans #pbms #drugpricing
https://www.fiercehealthcare.com/payers/oig-jury-still-out-impacts-vertical-consolidation-part-d
Employer Hospital Costs Surge
A healthcare policy group KFF analysis finds that private insurance prices for hospital care rose 30% from April 2019 to April 2026 compared to a 21% increase in Medicare rates. That is 47% more. Private rates are much higher than Medicare and consolidation have also helped drive the cost crunch employers are feeling from hospital contracts.
See my related blog on the topic here: https://www.healthcarelabyrinth.com/hospital-price-reform-may-be-mounting/
Additional article: https://www.kff.org/health-costs/hospital-prices-have-risen-much-faster-for-private-insurance-than-medicare-since-2019/
#hospitals #employergroups #healthcare
Groups Urge No Surprises Reforms
Nearly 50 groups representing employers, unions and patients are urging the Trump administration to reform the independent dispute resolution or arbitration process under the No Surprises Act (NSA). They sent a letter to Health and Human Services (HHS), Treasury and Labor departments arguing that bad provider actors are filing large numbers of payment disputes and driving up healthcare costs for payers and patients.
#nosurprisesact #employergroups #healthcare
Broker Commission In MA Soared
A good research study by researchers at the Brown University School of Public Health finds that payments to Medicare Advantage (MA) brokers grew from $3.9 billion to $10.1 billion per year from 2014 and 2022. The study was published in JAMA Internal Medicine.
The 2014 to 2022 window saw 22 million new and 112 million renewing enrollees. The percentage of new enrollees coming from a broker referral was 43.7% in 2022 versus 35.8% in 2014. The share of maintained enrollees with a renewal fee was 69.4% in 2022, up from 50.1% in 2014.
MA plans and big broker groups are being investigated for potentially illegal deals to steer seniors to plans.
#fwa #brokers #compendation #medicareadvantage
Who Will Follow Cassidy?
Sens. Rand Paul, R-KY, and Roger Marshall, R-KN, are among the leading contenders to lead Republicans on the Senate Health, Education, Labor and Pensions (HELP) committee after Bill Cassidy, R-LA, lost his primary this week. Whether one of them chairs the committee or is ranking member will be determined in November. Control of the Senate, once comfortably assured for the GOP, is now in doubt.
#help #midterms
https://www.medpagetoday.com/washington-watch/washington-watch/121347
Blues Anti-Trust Suits Explained
Becker’s Payer does a great job outlining the two Blue Cross and Blue Shield company settlements over anti-trust allegations. One was to compensate employers and the other for providers. Lawsuits continue. The awards in total are about $5.5 billion.
#bcbsa #blues #healthplans #employercoverage #providers
https://www.beckerspayer.com/payer/the-2-67b-bcbs-antitrust-settlement-payout-6-things-to-know/
— Marc S. Ryan
