October 13, 2025

More Star Rating News

Modern Healthcare has done a follow-up Star rating article. It notes that several provider-owned insurers saw big drops in the percentage of Medicare Advantage (MA) members in plans rated at least four Stars. Some Blue Cross and Blue Shield companies also reported declines. Startup insurers also had mixed reviews.

Among the plans getting hit:

Blue Bross and Blue Shield of Alabama
Clover Health
Excellus Blue Cross Blue Shield
Devoted Health (but it also had success in other areas)
Sanford Health Plan
Sharp Health Plan
CommunityCare Senior HealthPlan
Blue Cross and Blue Shield of Nebraska

Big Blue winners included:

Blue Shield California
Florida Blue
Elevance Health
Independence Blue Cross

(Article may require a subscription.)

#cms #medicareadvantage #stars #quality

https://www.modernhealthcare.com/insurance/mh-medicare-advantage-ratings-2026-bcba-clover-health

Government Shutdown Politics

As the government shutdown continues, there is both public jockeying as well as quiet deliberation on the issue of Exchange healthcare subsidy extensions. Vice President JD Vance said that the enhanced subsidies fuel waste and fraud in the insurance industry. Sen. Mark Kelly, D-AZ, said a hypothetical commitment from Republicans to hold a vote by the end of the year on extending the subsidies would not be sufficient to secure Democratic support for reopening government. Sen. Linday Graham, R-SC and chair of the Appropriations Committee, said the government shutdown will not change his opposition to extending subsidies and that reform would be needed if and when they are extended.

Beyond the scenes, moderate Republicans have had discussions and a potential compromise has been circulated. Notwithstanding all this, Speaker Mike Johnson, R-LA, predicts Congress is headed for a record shutdown.

Additional articles: https://thehill.com/policy/healthcare/5553486-aca-tax-credits-expire/ and https://thehill.com/homenews/senate/5551961-kelly-demands-aca-subsidy-fix/ and https://thehill.com/homenews/senate/5551921-graham-opposes-aca-subsidies/ and https://www.modernhealthcare.com/politics-regulation/mh-aca-subsidies-deal-government-shutdown-end/ and https://thehill.com/policy/healthcare/5550233-republicans-defensive-healthcare-shutdown/

(Some articles may require a subscription.)

#governmentshutdown #congress #trump #healthcare #coverage #exchanges

https://thehill.com/homenews/house/5552958-mike-johnson-government-shutdown

CA Enacts PBM And Private Equity Reforms

A new California law prescribes tougher restrictions on private equity in healthcare. It prohibits financial firms from having a hand in medical decisions, including determining how many patients clinicians see per hour or what diagnostic tests are appropriate.

A new law in the Golden State also requires all pharmacy benefits managers (PBMs) to be licensed by its Department of Insurance and prohibits multiple business practices, including spread pricing, certain fees, and steerage to affiliated pharmacies. It also mandates that PBMs pass all rebates through to the payer or patient and bars these companies from making exclusivity deals with drug makers. Any untrue, deceptive, or misleading statements are barred.

Additional articles: https://www.healthcaredive.com/news/california-latest-state-enact-tougher-restrictions-private-equity-healthcare/802517/ and https://www.beckerspayer.com/policy-updates/california-reins-in-pharmacy-benefit-managers/

#drugpricing #pbms

https://www.fiercehealthcare.com/regulatory/california-governor-signs-bill-cracks-down-pbms