taxcuts

Congress Inches Toward Site Neutral Payments Congress didn’t pass site neutral payments in Medicare but did make some incremental progress toward the reform in the FFY 2026 appropriations bill that was recently passed. This could lead to cuts to the tune of billions of dollars in hospital reimbursements in the future. The bill requires health systems to obtain unique National Provider Identifiers, or NPIs, for their outpatient departments by 2028. This will have the effect of giving the government detailed information about outpatient care provided at hospital-owned facilities — and its cost — to support broader site-neutral policies. The Trump administration did implement site neutral payments for drug administration via regulation this year. That follows some other modest reforms several years ago. Site neutrality pays the same rate to provider regardless of the site the service is performed at – physician office, ambulatory surgery center, off-campus hospital outpatient department, or

SNPs Up; Major Plan Terminations In MA Two new articles on the 2026 open enrollment season in Medicare Advantage (MA). A Modern Healthcare analysis says membership in Special Needs Plans, or SNPs, is now 8.2 million as of Feb. 1, up 12.2% from a year before. While enrollment growth overall slowed from 2025 to 2026, SNP growth actually went up. SNP growth was 10.1% in 2025. About a quarter of all enrollees are now in SNPs. A study in JAMA examined the major contraction in MA and rates of forced moves. It found that one in 10 MA enrollees were forced to disenroll from their current product choice heading into 2026 due to insurer exits or contractions. That is a ten-fold increase from historic averages and is up from 6.9% in 2025. Among the 28.6 million MA enrollees that were part of the study sample, 2.9 million were forced to

More Bad News On Affordability Front A new Commonwealth Fund report finds that middle-income workers and their families are spending an average of 10.1% of median income on their health premiums and deductibles. The 2024 data from the employer-sponsored insurance market show that premium contributions for family coverage ranged from an average of $5,584 in Oregon to $9,148 in California. In 19 states, the average premium and deductible contribution topped 10% of that state’s median income. Costs varied by region, industry, and employer size. Five states’ costs breached the affordability metric under the Affordable Care Act (ACA), which could trigger coverage in the Exchanges. The researchers recommend employers adjust out-of-pocket requirements and premiums based on the income of employees. The report also notes one of my key reform recommendations – a shift in the broader trends around healthcare pricing and spending. #healthcare #coverage #affordability https://www.fiercehealthcare.com/payers/family-premiums-account-10-income-19-states-commonwealth-fund Payers Continue Convincing Investors All

UHG Still Made The Most Despite major financial challenges, UnitedHealth Group still made the most of the major national health plan vertically integrated behemoths in 2025. UHG brought in just over $12 billion in earnings for 2025. That was followed by Cigna at about $6 billion, with Elevance Health at almost $5.7 billion. CVS Health was at about $1.8 billion and Humana at about $1.2 billion. Centene lost $6.7 billion. Most of the plans see 2026 as yet another transition year with improving results. #healthplans #margins https://www.fiercehealthcare.com/payers/unitedhealth-group-was-most-profitable-payer-difficult-2025-industry Rural Providers Criticize End To Reform Pilot A program to enhance primary care, especially in rural areas, is being shuttered just a year into its launch due to early savings efforts by the Trump efficiency program DOGE. The model, Making Care Primary (MCP), was supposed to improve primary care at nearly 700 practices in eight states by providing flexible and quality bonus payments

GOP Worried On Affordability Some Senate Republicans are worried that the GOP leadership is not doing enough on the affordability issue as the 2026 midterms approach. Right now, the House is almost assuredly going back to the Democrats, while the Senate is favored for the GOP but getting too close for comfort. Sen. John Kennedy, R-LA, has been urging Republicans to pass a second reconciliation bill to pass additional healthcare measures. President Trump has dismissed the idea of yet another bill, but House Republicans want to pass a second one as well. Lawmakers could still do so over the president’s objections. #healthcare #coverage #midterms https://thehill.com/homenews/senate/5738150-republicans-affordability-midterms FTC Loses Enhanced Disclosure The Federal Trade Commission’s (FTC’s) antitrust rule requiring parties to submit additional information to regulators ahead of a planned merger was overturned by a federal judge. The judge agreed with business interests that the FTC’s rationale that it needed additional information

2026 Medicare Advantage Enrollment Finally Published After a long delay, the Centers for Medicare and Medicaid Services finally published results for January and February for Medicare Advantage (MA). While many predicted that the program would contract, I had said that enrollment would be flat or one of the lowest growths we had seen recently. Some analysts suggested that there would be a decline because of the mass exodus of large plans from certain markets and efforts by them to shed huge enrollment. But despite the huge challenges in the program, MA showed some resiliency. Enrollment in February 2025 was 34.941 million. In December 2025, MA had 35.700 million members. In February, we saw 35.814 million. January numbers showed a contraction from December of about 400K. We know January 2025 numbers had some issues. That could also be the case for January 2026. But February 2025 to February 2026 numbers showed

Aledade Touts Primary Care and VBC Growth Value-based enablement company Aledade added more than 700 primary care practices to its network for 2026 and sees strong momentum for value-based care (VBC) growth. Aledade has more than 3,000 primary care organizations across the country with over 3 million patients in VBC programs. These include Medicare Shared Savings Program (MSSP), Medicare Advantage (MA), Medicaid, and commercial contracts. Transition to VBC from transaction payments has been slow with a mixed record on savings and better outcomes. See my blog today on VBC: https://www.healthcarelabyrinth.com/the-2027-aca-exchange-rule-the-good-and-bad/ . In other news, Humana President and CEO Jim Rechtin said the company is looking to expand its primary care footprint. He says a strategic acquisition should be announced soon. But as I noted earlier and Becker’s says in its article, the biggest national health plans are under heavy criticism about sweet-heart deals of plans and pharmacy benefits managers (PBMs)

Humana Turning Around But On A Bumpy Road Humana reported Q4 2025 results today. While the Medicare Advantage (MA) insurer is making inroads, the road remains bumpy. During the fourth quarter, Humana’s net loss grew 14.9% to $796 million. Revenue rose 11.3% to $32.5 billion. For the full year, net income declined 1.6% to $1.2 billion and revenue increased 10.1% to $129.7 billion. Humana reported an medical loss ratio (MLR) of 93% in the fourth quarter and 90.2% in 2025. Humana ended 2025 with 5.8 million MA members, a 6.3% decline since 2024. It expects enrollment to be 25% higher this year. This is in contrast to most of the other large national plans. Humana says earnings from individual MA plans will dip just below breakeven this year. Humana stock tumbled because investors fear benefits are too high for 2026, driving enrollment. This could impact margins in 2026, which investors

Unlikely Pair Attacking Vertical Integration An unlikely pair of senators, Elizabeth Warren, D-MA, and Josh Hawley, R-MO, have teamed up to pass the “Break Up Medicine Act.” The bill would seek to break up major vertically integrated healthcare behemoths due to the cozy relationships companies within the master entity have with each other. The bill proposes prohibiting parent companies from owning a medical provider or management services organization and a PBM or insurer. It also proposes prohibiting parent companies of prescription drug or medical device wholesalers from owning a medical provider or management services organization. #healthplans #verticalintegration https://thehill.com/policy/healthcare/5732189-break-up-big-medicine-act CVS Health Reports Good Financial News; Oscar Health Reports Loss CVS Health beat The Street by outperforming to close out 2025 and expects its finances to improve further this year. Still, it is citing proposed 2027 Medicare Advantage (MA) rates as inadequate. It is advocating for a hike. It did say it

Seismic Changes To ACA and Exchanges Proposed Building on changes in the One Big Beautiful Bill Act (OBBBA) and other regulatory changes in 2025, the Trump administration’s 2027 Affordable Care Act (ACA) and Exchange rule aims to make additional seismic changes in healthcare. Among the major changes include: Proponents argue the changes are needed to reduce costs and provide more affordable options. Critics argue the changes will simply erode the Exchanges financial position and increase risk. Additional articles: https://www.fiercehealthcare.com/regulatory/cms-plans-roll-back-limits-non-standard-aca-plan-options and https://www.beckerspayer.com/payer/aca/cms-proposes-aca-implementation-rule/ and https://www.cms.gov/newsroom/press-releases/cms-proposes-regulations-lower-health-care-costs-expand-consumer-choice-protect-taxpayers and https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-payment-parameters-2027-proposed-rule #exchanges #healthcare #coverage #trump #cms #regulations https://www.modernhealthcare.com/politics-regulation/mh-aca-exchange-rule-2027-standardized-coverage Kaiser Reports Good Financials Kaiser Permanente reported good financial news for Q4 and 2025. It tripled its operating income although operating expenses surged. It reported operating income of $1.4 billion last year, up from $569 million in 2024. The turnaround is tied to investments in operational improvements. Kaiser Permanente and its subsidiaries wrapped 2025 with a 10.3% bump