tragedy

United MA Troubles Cloud MA Industry Prospects The fallout from UnitedHealth Group’s poor quarterly financials is creating worry throughout the industry. While Elevance Health reaffirmed its earnings forecasts, some are wondering if United is just the first shoe to drop as investor calls for the quarter roll out. United blames some of the problems at its insurance and service entity on the new risk model that was rolled out in Medicare Advantage (MA) along with major utilization. Previously, United indicated it was not too worried about the change. The United financials and similar trends expected in some other MA plans show that the 5% hike for 2026 will not cure all ills in the industry. It helps with the financial realignment of many, but discipline will still be needed to get back to profitability. Additional article: https://www.beckerspayer.com/payer/unitedhealth-shifts-tone-on-medicare-advantage-as-cms-changes-impact-earnings/ (Some articles may require a subscription.) #medicareadvantage #unitedhealthcare #rates #margins #elevancehealth https://www.modernhealthcare.com/insurance/unitedhealth-group-medicare-advantage-earnings-2025 Trump

UnitedHealth Group Hits Financial Pothole The fiscal crisis that other insurers saw in 2024 has now hit UnitedHealth Group. Its stock dropped sharply after the insurance giant slashed its earnings outlook for 2025. Not only did United’s stock drop, but so did the stock of other big health players. And the entire market went down as well Thursday. United is now seeing the high utilization of other plans in its insurance business. This is especially explosive in Medicare Advantage (MA). MA costs have increased twice as much in 2025 as they did in 2024. United only just learned of this. Not only did its insurance business suffer, but so did its Optum services business, which saw its patient profitability drop as its health plan clients struggled with their finances. Ironically, United went into the 2025 MA enrollment season excited to enroll a large number of beneficiaries. It performed well. The

Trump Executive Order Wants Deeper Drug Price Cuts In yet another sign President Donald Trump will keep the Medicare drug price law, he issued an executive order that strives to get deeper price reductions in the second year of negotiations (2025 for an effective date of 2027). The executive order is general. But it does commit to evaluating ways to ensure prices drop more than the average 22% seen in the 2024 negotiations, increase transparency, increase generic introduction and penetration, further importation, and reform pharmacy benefits managers (PBMs) and other middlemen. It also indicates special programs would be set up for the low income. The order will solicit information from the public and stakeholders. On the other hand, Trump also said the actions would minimize any negative impacts of the maximum fair price on pharmaceutical innovation within the United States. This likely could mean protecting certain small molecule drugs longer

State AGs Want Healthcare Entities With PBMs Broken Up A bipartisan group of state attorneys general wants Congress to pass legislation that would break up healthcare entities that own both pharmacy benefits managers (PBMs) and pharmacies. This targets UnitedHealth Group, CVS Health, and The Cigna Group, which control somewhere between 68% and 80% of the PBM market. At issue, too, is co-manufacturing of specialty medications. More and more state regulation of PBMs is passing. There is a growing bipartisan consensus in Congress for the need to reform PBMs. Additional article: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/state-ags-demand-congress-ban-pbms-owning-pharmacies (Articles may require a subscription.) #pbms #drugpricing https://www.modernhealthcare.com/politics-policy/cvs-caremark-express-scripts-arkansas-vermont Fitch Says MA Rate Hike Will Help Stabilize Recovery Fitch, a rating agency, says the increased Medicare Advantage (MA) 2026 rate hike of over 5% “will likely significantly support the recovery” of MA plans as they face rising medical costs. But the rater notes that they do not resolve all the

Drug Imports Will Get Tariffs The Trump administration is preparing to levy tariffs on imported pharmaceuticals within the next month or two. This is after drugs got a reprieve recently. Lobbies for the generic and biosimilar industries say tariffs could deepen existing drug shortages, raise prices, and harm patient access. In addition, the Department of Commerce has launched an investigation to assess the impact of pharmaceutical imports on U.S. national security. Additional articles: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/commerce-says-pharmaceutical-tariffs-coming-next-month-or-two and https://www.beckershospitalreview.com/hospital-management-administration/federal-government-launches-probe-on-drug-imports-5-notes/ #tariffs #healthcare #drugpricing https://thehill.com/policy/healthcare/5245652-trump-tariffs-pharma-drug-shortages-trade-war-hhs-kennedy UnitedHealth Antitrust Suit Goes To Arbitration The Justice Department’s antitrust lawsuit aimed at blocking UnitedHealth Group’s $3.3 billion acquisition of Amedisys will go to mediation. The government alleges that United’s purchase of Amedisys would create an anti-competitive environment in the home health industry given its existing assets. Additional article: https://www.modernhealthcare.com/legal/unitedhealth-amedisys-antitrust-lawsuit-doj-mediation (Some articles may require a subscription.) #antitrust #doj #unitedhealthcare #homecare https://www.fiercehealthcare.com/payers/unitedhealth-group-amedisys-plan-divest-facilities-bid-close-33b-merger Physician Pay Jumps Medscape’s latest physician compensation report finds

Senate In A Quandary Over Spending Cuts Conservatives and more moderate members are at odds in the upper chamber after President Trump and the House GOP held firm with a target of at least $1.5 trillion in spending cuts in the budget reconciliation process. Commitments by Trump and Johnson to rightists in the House was the only reason the bill passed. But Senate Majority Leader John Thune says he has a number of moderates and pragmatic conservatives who have warned that deep spending cuts in healthcare and other areas could mean they are off any final budget bill. Two of the members are in tight re-election campaigns in 2026, which could significantly erode the Senate GOP majority if they lose. That said, insufficient cuts could doom the bill in the House and perhaps even in the Senate. #budgetreconciliation #spending #trump #congress https://thehill.com/homenews/senate/5243579-senate-republicans-divided-budget-cuts/?tbref=hp United Bullying Physicians To Pay Back Cyberattack Loans

House Passes Senate Version Of Budget Reconciliation Framework The House passed the Senate’s watered-down budget reconciliation framework on a party-line 216-214 vote. While the spending threshold in the bill did not change (it is de minimis), enough conservative Republicans jumped back on the bill after meetings with and pressure from House Speaker Mike Johnson, Senate Majority Leader Jon Thune, and President Trump. Conservatives are distrusting but got commitments from Trump and Johnson that as much as $1.5 trillion in cuts will be in the bill. Senate Leader Jon Thune gave a much softer commitment on levels of cuts. The House vote likely means that Congress will go after deeper cuts than not. Also controversial is the Senate bill assumes “current policy” not “current law” for budget scoring, which many, including I, call a gimmick that could lead to huge increases in deficits and debt in the future. The ongoing process

House GOP Abandons Budget Reconciliation Vote Tonight House Speaker Mike Johnson, R-LA, abandoned a vote on Senate reconciliation bill framework after rebellion by conservatives would have sunk the vote. Conservatives are upset by the Senate framework that has almost no spending reductions. In addition, the bill adopts a current-policy vs. current-law scoring of spending and taxes. The conservatives say the budget gimmick is disingenuous and would set a horrible precedent and drive up deficits and the national debt. The conservatives said they couldn’t move forward as they do not believe the Senate will agree to deep cuts if they pass the framework. The House GOP will now regroup on the issue and see if they can gather votes later in the week to pass the framework. Additional article: https://www.modernhealthcare.com/politics-policy/house-budget-resolution-medicaid-tax-cuts (Some articles may require a subscription.) #budgetreconciliation #congress #trump #spending #medicaid #healthcare https://thehill.com/homenews/house/5241418-johnson-vote-trump-budget-blueprint-conservative-opposition Study Pushes Back On MedPAC Assertions A new

Trump Backs Deep Spending Cuts Emerging from a meeting with Speaker Mike Johnson, R-LA, and House Republicans, President Trump declared he is supportive of major spending cuts. The meeting was meant to allay concerns of rightists in the House GOP caucus. Trump wrote on Truth Social: “I let them know that, I AM FOR MAJOR SPENDING CUTS! WE ARE GOING TO DO REDUCTIONS, hopefully in excess of $1 Trillion Dollars, all of which will go into ‘The One, Big, Beautiful Bill.’” Trump urged the House GOP to support a watered-down budget reconciliation framework from the Senate in the meantime but promised to help assemble meaningful reductions, most of them likely from healthcare. Trump said he would “be pushing very hard” to get deeper cuts. The budget bill looks to be a battle of the House and conservatives against the Senate and some more moderates who disagree on the level of

Medicare Advantage Plans Getting Higher Rates For 2026 The 2026 Medicare Advantage (MA) Final Notice was released this evening by the Centers for Medicare and Medicaid Services (CMS). After the Advance Notice in January, MA plans complained about a paltry rate hike of 2.23%. They asked the Trump administration to intervene and either tweak the risk model change phase-in or the one related to medical education reductions. Well, the Trump administration didn’t have to really do anything to drive up the 2026 rate. CMS did not change any policies on rates between the advance notice and final one. But the rate hike surged to 5.06% because the rate setting growth factor increased dramatically between the two notices. The change is projected to result in an increase of 5.06%, or over $25 billion, in MA payments to plans in CY 2026. MA plans and actuaries warned that trends in the program