Other Regulatory News
Centers for Medicare and Medicaid Services (CMS)
Medicaid work rules exempt the ‘medically frail.’ Deciding who qualifies is tricky.
New federal rules starting in 2027 will require more than 18 million Medicaid enrollees to work, volunteer, or attend school for 80 hours monthly to maintain coverage, with exemptions for the ‘medically frail.’ States lack federal guidance on defining medical frailty, creating uncertainty for people like 27-year-old Eliza Brader who has a pacemaker and joint disease but may need to prove ongoing eligibility.
Source(s): Medicaid work rules exempt the ‘medically frail.’ Deciding who qualifies is tricky. (Dailykos)
Tags: #PATIENT, #PAYER, #PROVIDER
CMS’s 2027 Medicare Advantage Proposed Rule Focuses on Outcomes and Competition
CMS released its Contract Year 2027 Medicare Advantage proposed rule on November 28, 2025, with a January 26, 2026 comment deadline. The rule overhauls Star Ratings by removing 12 administrative measures and adding a depression screening measure by 2029, while rolling back the planned Health Equity Index implementation. For dual-eligible special needs plans, CMS proposes allowing two annual model of care change windows and extending continuity of care requirements from 90 to 120 days during passive enrollment transitions.
Source(s): CMS’s 2027 Medicare Advantage Proposed Rule Focuses on Outcomes and Competition (Healthmanagement)
Tags: #PAYER, #PROVIDER, #PATIENT
Medicare data reveal ‘highly concerning’ TAVR trends—are hospital rankings to blame?
New research in JACC: Cardiovascular Interventions suggests hospitals may be refusing high-risk heart patients for TAVR procedures to improve their program rankings based on Medicare data. The study raises concerns about patient access when hospitals prioritize ranking metrics over treating sicker patients who need the procedure most.
Source(s): Medicare data reveal ‘highly concerning’ TAVR trends—are hospital rankings to blame? (Cardiovascularbusiness)
Tags: #HOSPITAL, #DEVICE, #PATIENT
Medicare now covers renal denervation for patients with uncontrolled hypertension
Medicare now provides coverage for renal denervation procedures to treat patients with uncontrolled hypertension. This coverage expansion follows FDA approvals in 2023 for renal denervation systems from Recor Medical and Medtronic.
Source(s): Medicare now covers renal denervation for patients with uncontrolled hypertension (Cardiovascularbusiness)
Tags: #DEVICE, #PATIENT, #PROVIDER
CMS’ outpatient rule ‘exacerbating’ hospitals’ financial challenges: AHA
CMS finalized its 2026 Hospital Outpatient Prospective Payment System rule with a 2.6% payment rate increase but expanded site-neutral payment policies that align reimbursement between hospital outpatient departments and off-campus facilities. The American Hospital Association criticized the rule, arguing the site-neutral cuts and elimination of the inpatient-only list will worsen financial pressures on hospitals serving vulnerable populations, while CMS projects $11 billion in Medicare savings over the next decade.
Source(s): CMS’ outpatient rule ‘exacerbating’ hospitals’ financial challenges: AHA (Becker’s Hospital Review)
Tags: #HOSPITAL, #PATIENT, #PAYER
DME Suppliers, Patients Ask Admin, Congress To Delay Revived Bidding Program
The American Association for Homecare is requesting that the Trump administration and Congress delay parts of CMS’s competitive bidding program for durable medical equipment that was revived in the home health final rule. The association argues that DME suppliers need time to develop a patient-centered, fraud-resistant alternative to the current bidding system.
Source(s): DME Suppliers, Patients Ask Admin, Congress To Delay Revived Bidding Program (Feedly)
Tags: #DEVICE, #PROVIDER, #PATIENT
A path to ‘fair valuation’ in spine
CMS is implementing a 2.5% ‘efficiency adjustment’ to work RVUs for non-time-based procedures in Medicare’s 2026 Physician Fee Schedule, which spine surgeons argue undermines the traditional time × intensity valuation formula. Dr. Morgan Lorio warns this policy shift represents structural movement away from procedural medicine and could drive surgeons away from specialty practice.
Source(s): A path to ‘fair valuation’ in spine (Becker’s Hospital Review)
Tags: #PROVIDER, #PAYER
Let CMS Reward Prevention
The article argues that CMS should create a shared savings model to reward private insurers and employers for early detection and prevention of chronic kidney disease, which affects 35 million Americans with 90% undiagnosed. Medicare currently spends $95 billion annually on CKD care, and prioritizing early intervention could save $9 billion per year for Medicare.
Source(s): Let CMS Reward Prevention (Realclearhealth)
Tags: #PAYER, #PATIENT
MGMA: Abandoning RUC Would Invite CPT Code Lobbying, Destabilize Physician Fee Schedule
MGMA’s Anders Gilberg warns that abandoning the AMA’s Relative Value Scale Update Committee (RUC) could destabilize the Physician Fee Schedule by creating a government-driven, political rate-setting process. He argues this change would invite lobbying for individual CPT codes and trigger unintended consequences across the entire fee schedule system.
Source(s): MGMA: Abandoning RUC Would Invite CPT Code Lobbying, Destabilize Physician Fee Schedule (Feedly)
Tags: #PROVIDER, #PAYER
Madrigal: Medicare Advantage long overdue for a checkup
A federal judge in Texas invalidated a Biden-era HHS rule that allowed CMS to audit Medicare Advantage plans more closely, following a lawsuit by Humana. Medicare Advantage insurers generated $19 billion in improper payments in 2024 through upcoding practices and non-physician risk assessments, with $7.5 billion specifically from Health Risk Assessments.
Source(s): Madrigal: Medicare Advantage long overdue for a checkup (Bostonherald)
Tags: #PAYER, #PROVIDER, #PATIENT
What Do Healthcare Leaders Think About CMS’ Proposed Star Ratings Overhaul?
CMS is proposing major changes to Medicare Advantage Star Ratings system, which has generated mixed reactions from healthcare industry leaders. The proposed overhaul would modify how Medicare Advantage plans are evaluated and rated for quality and performance.
Source(s): What Do Healthcare Leaders Think About CMS’ Proposed Star Ratings Overhaul? (MedCity News)
Tags: #PAYER, #PROVIDER
Food and Drug Administration (FDA)
FDA Drug Center Director Richard Pazdur Retires Amid Agency Turmoil, Tracy Beth Høeg Named Acting Director
Richard Pazdur, the respected oncologist who became FDA’s drug center director just three weeks ago, has filed paperwork to retire at the end of December after meeting with HHS Secretary RFK Jr. and raising concerns about the agency’s direction. Tracy Beth Høeg, a sports medicine doctor and COVID-19 response critic, will serve as acting director of the Center for Drug Evaluation and Research. The departure marks the fourth person to lead the FDA’s drug center this year, prompting industry leaders to warn of ‘unprecedented turmoil’ that threatens regulatory stability and public health. FDA Commissioner Marty Makary has announced plans to require just one clinical trial instead of two for medical product approvals.
Source(s): STAT+: What you need to know about the latest upheaval at the FDA (STAT)
FDA reaches tipping point after high-level departures (Axios)
Richard Pazdur, FDA drug czar, to retire from agency (Biopharmadive)
Exiting FDA Official Raised Concerns in Meeting With RFK Jr. (Bloomberg)
FDA names Tracy Beth Høeg, fresh from vaccine safety probe, as acting head of drug center (Fiercebiotech)
Unprecedented turmoil’ engulfing FDA threatens public health: mRNA coalition speaks out (Fiercebiotech)
Chutes & Ladders—Yet another CDER leadership shake-up (Fiercebiotech)
Appointment of controversial FDA official rocking agency like an atom bomb, scientists there say (Michael Kaplan/CBS News) (Memeorandum)
Tags: #ALL
FDA Policy Changes Could Endanger Seasonal Flu Shots
FDA and CDC are signaling major changes to vaccine policy that experts warn could have negative implications for seasonal influenza vaccines. The specific policy changes and their implementation timeline remain unclear, but concerns are mounting about potential disruptions to the annual flu vaccination process. Public health experts are expressing worry about how these regulatory shifts might affect vaccine availability or approval processes for seasonal flu shots.
Source(s): FDA Policy Changes Could Endanger Seasonal Flu Shots (Feedly)
Tags: #DRUG, #PATIENT, #PROVIDER
STAT+: FDA to lower number of trials required for approval of drugs, other medical products
FDA Commissioner Marty Makary announced the agency will change its default requirement from two clinical trials to one clinical trial for medical product approvals. While the FDA has historically required two trials for safety and efficacy assurance, many drugmakers already submit just one pivotal trial, and the agency will still require two trials in some cases.
Source(s): STAT+: FDA to lower number of trials required for approval of drugs, other medical products (STAT)
Tags: #DRUG, #DEVICE
FDA commissioner claims Biden administration hid heart risks of COVID-19 vaccines from public
An FDA commissioner alleges the Biden administration concealed heart risks associated with COVID-19 vaccines from the public. This follows an internal FDA memo that reportedly linked the vaccines to multiple pediatric deaths, though former FDA commissioners have disputed the memo’s contents.
Source(s): FDA commissioner claims Biden administration hid heart risks of COVID-19 vaccines from public (Cardiovascularbusiness)
Tags: #ALL
FDA panel votes against approving first-of-its-kind heart failure device
The FDA’s Circulatory System Devices Panel unanimously voted (15-0) against approving Johnson & Johnson MedTech’s first-of-its-kind heart failure device, citing insufficient data to confirm effectiveness. The panel recommended collecting more data before approval, though the final FDA decision remains pending.
Source(s): FDA panel votes against approving first-of-its-kind heart failure device (Cardiovascularbusiness)
Tags: #DEVICE, #PATIENT, #PROVIDER
Health and Human Services
CDC Vaccine Panel Considers Ending Universal Hepatitis B Birth Dose Under Kennedy Leadership
Despite pleas from experts not to change a policy they say has saved thousands of lives, members of the Advisory Committee on Immunization Practices, reconstituted by HHS Secretary Robert F. Kennedy Jr. with vaccine skeptics, voted 8 to 3 to recommend a birth dose of HBV vaccine for only for infants born to mothers who test positive for HBV surface antigen, and to use shared clinical decision-making for infants born to mothers who test negative. Senate health committee chair Bill Cassidy called the panel ‘totally discredited,’ while infectious disease experts warn the change could result in over 1,000 additional infant infections annually.
Source(s): Kennedy’s vaccine advisory committee meets to discuss hepatitis B shots for newborns (Twin Cities Pioneer Press)
Cassidy: ACIP ‘Totally Discredited’ With Aaron Siri Scheduled To Speak (Inside Health Policy)
More ACIP confusion ahead (Politico)
CDC vaccine advisers appear likely to recommend delaying hepatitis B vaccine birth dose (STAT)
Aluminium in vaccines: separating RFK Jr’s claims from scientific evidence (Theconversation)
Top Senate health leader calls CDC vaccine panel ‘totally discredited’ (STAT)
CDC’s Out of Touch Advisory Committee on Immunization Practices Poised to Undermine Childhood Vaccination Schedule (Commondreams)
The Year of Vaccine Backsliding (Slate)
Chicago-based American Medical Association slams committee’s hepatitis B vaccine recommendations (Chicagotribune)
Surprise Visit From Senator Highlights AASLD President’s Push to End Hepatitis C (MedPage Today)
CDC panel makes most sweeping revision to child vaccine schedule under RFK Jr. (Washington Post) (Memeorandum)
Cassidy urges CDC director to reject vaccine panel’s hepatitis B recommendations (The Hill)
CDC panel votes to trim hepatitis B vaccine guidance (Becker’s Hospital Review)
U.S. vaccine advisers say not all babies need a hepatitis B shot at birth (Chicago)
CDC panel rolls back hepatitis B vaccine recommendation (Nbcnews)
CDC Panel Drops Recommendation That All Babies Get Hep B Shot at Birth (MedPage Today)
CDC panel says hepatitis B vaccine not necessary for all newborns (Healio)
ACIP Votes To Drop Universal Hep B Birth Dose In Combative Meeting (Feedly)
GOP senator calls CDC’s hepatitis B vaccine change ‘a mistake’ that will make America sicker (Foxnews)
‘Discredited’ CDC panel weakens endorsement for newborns’ hepatitis B shot (Biopharmadive)
CDC vaccine panel votes to stop recommending Hepatitis B vaccine birth dose (Cbsnews)
CDC’s ACIP votes to change long-standing hepatitis B vaccine guidance for newborns, prompting backlash (Fierce Pharma)
Cassidy calls ACIP ‘totally discredited’ ahead of vaccine guidance votes (The Hill)
RFK Jr.’s vaccine panel says not all newborns need Hep B shots (Politico)
RFK Jr. ally, anti-vaccine lawyer to brief CDC vaccine meeting (Politico)
RFK Jr.’s vaccine panel is just getting started (STAT)
Trump Hails Vaccine Panel’s Hep B Vote (Realclearhealth)
Trump orders review of international immunization schedules: 3 federal vaccine updates (Becker’s Hospital Review)
Yes, Some Children May Have Died From COVID Shots (Theatlantic)
How the CDC’s decision on the Hepatitis B vaccine at birth could impact infants (Cbsnews)
Tags: #PATIENT, #PROVIDER
HHS Releases AI Strategy as CMS Launches Technology-Supported Chronic Care Model
The Department of Health and Human Services unveiled a comprehensive AI strategy led by acting chief AI officer Clark Minor, featuring five pillars including governance, infrastructure, workforce development, research, and care modernization. Simultaneously, CMS announced the ACCESS Model (Advancing Chronic Care with Effective, Scalable Solutions) for Medicare patients with chronic diseases, which will launch July 1, 2026, with applications opening January 12. The strategy fulfills Trump administration directives and employs a ‘OneHHS’ approach involving CDC, CMS, FDA, and NIH collaboration. HHS is also encouraging staff to adopt Claude Government AI tool alongside ChatGPT for internal operations.
Source(s): HHS unveils AI strategy (Becker’s Hospital Review)
AMA praises CMS’ tech-supported care model (Becker’s Hospital Review)
Building Smarter, Safer Healthcare: The Role of Tech Partners in AI Adoption (MedCity News)
Hospitals Under Pressure: How Technology Can Transform Operations (MedCity News)
HHS Tells Staff To Adopt Claude Government In Addition To ChatGPT (Feedly)
HHS out with bold AI strategy to ‘unleash a new era of wellbeing for a healthier America’ (Healthexec)
Stuck in the fax lane: How legacy workflows are straining healthcare operations (Healthcare Dive)
AHA urges FDA to tighten AI device oversight (Becker’s Hospital Review)
Tags: #ALL
States Pledge Policy Changes to Win Share of $50B Rural Health Fund
The Trump administration is awarding $50 billion in Rural Health Transformation Program funding to states based partly on their willingness to enact White House-favored policies, including restrictions on food benefit use and telehealth expansion. State applications were due in November with awards expected by December 31, as nearly 40 states have submitted proposals for initiatives ranging from medication-delivering drones to mobile food markets. Health advocates call the policy-contingent funding criteria highly unusual, describing it as leveraging federal dollars to push state-level policy changes.
Source(s): Feds Promised ‘Radical Transparency’ but Withhold $50B Rural Fund Details (Kffhealthnews)
‘Sort of blackmail’: Billions in rural health funding hinge on states passing Trump-backed policies (Yahoo)
States battle for rural health funding (Politico)
Tags: #ALL
HHS Releases AI Strategy to Centralize Tools Across Departments as Rural Health Program Applications Under Review
HHS released a strategy to deploy and centralize AI adoption across its departments through a “OneHHS” plan following Trump administration directives to accelerate federal AI use. The FDA will begin using agentic AI for premarket reviews while CDC started using AI for public health data analysis in September. Meanwhile, CMS is reviewing state applications for the $50 billion Rural Health Transformation Program, with funding allocations to be announced by December 31 after the November 5 application deadline.
Source(s): HHS outlines strategy to expand AI adoption (Healthcare Dive)
Tracking Applications for Rural Health Transformation Funds (Kffhealthnews)
Tags: #ALL
NIH Implements New Grant Termination Powers and Award Process Changes Amid Funding Cuts
The NIH announced new policies in November allowing grants to be terminated if they no longer align with agency priorities, reducing legal barriers for mid-stream cancellations. The agency also introduced a ‘unified strategy’ for award decisions that moves away from standard peer review processes. These changes come as Trump administration funding cuts have forced lab closures and layoffs across research institutions, with Harvard’s John Quackenbush lab serving as a prominent example after losing most of its staff and research capacity.
Source(s): New NIH Policies Make It Easier to End Grants, Ignore Peer Review (MedPage Today)
The ‘Agony’ of Working for RFK Jr.; CDC Telework Drama; NIH Grant Funding Shakeup (MedPage Today)
His lab was humming with discovery. After one year under Trump, it’s almost silent (STAT)
STAT+: Harvard lab hollowed out by Trump cuts (STAT)
NIH updates grant policies: 7 notes (Becker’s Hospital Review)
NIH shut out hundreds of young scientists from funding to start their own labs (STAT)
Tags: #ALL
Hospital groups, safety net providers sue HHS to halt 340B rebate plan
Hospital groups including the American Hospital Association have filed a federal lawsuit to block HHS’s 340B rebate pilot set to begin January 1, 2026, which would require 340B hospitals to pay full wholesale acquisition costs upfront instead of receiving immediate discounts. The lawsuit argues this change would force hospitals to advance an estimated $72 million annually and drain resources from safety-net care for vulnerable populations.
Source(s): Hospital groups, safety net providers sue HHS to halt 340B rebate plan (Healthcare Finance News)
Tags: #HOSPITAL, #PROVIDER, #PATIENT
Trump’s Silence on World AIDS Day Revives a New Lavender Scare
The State Department warned employees not to commemorate World AIDS Day through official accounts, while Trump’s administration proposed ending all CDC HIV prevention programs in June and remained silent on World AIDS Day. Trump’s budget cuts target HIV programs while over 700,000 Americans have died from HIV/AIDS-related causes since 1981, with over 6,000 deaths in 2019 alone.
Source(s): Trump’s Silence on World AIDS Day Revives a New Lavender Scare (Msmagazine)
Tags: #PATIENT, #PROVIDER
Former CDC official returns to local health care after resigning
Demetre Daskalakis, former CDC director who resigned in summer 2024 after Robert F. Kennedy Jr. led mass layoffs and reversed the agency’s stance that vaccines don’t cause autism, will become chief medical officer at Callen-Lorde Community Health Center in February. Daskalakis, who previously directed CDC’s Division of HIV Prevention and National Center for Immunization and Respiratory Diseases, cited Kennedy’s undermining of vaccine policy and unilateral decisions as reasons for leaving federal service.
Source(s): Former CDC official returns to local health care after resigning (STAT)
Tags: #PROVIDER, #PATIENT
HHS Releases ‘OneHHS’ Plan To Expand AI Within Health Agencies
HHS announced its ‘OneHHS’ artificial intelligence plan on December 4, 2025, designed to integrate machine learning technologies across federal health agencies’ workforce, internal operations and research. The initiative aims to coordinate AI implementation throughout the health care system via inter-agency collaboration.
Source(s): HHS Releases ‘OneHHS’ Plan To Expand AI Within Health Agencies (Feedly)
Tags: #ALL
Heard on the Hill
ACA Premium Subsidies Set to Expire, Threatening Coverage for Millions as Congress Stalemates
Enhanced ACA premium tax credits that help over 90% of marketplace enrollees are set to expire December 31, 2025, which would double premiums on average and cause an estimated 4 million Americans to lose coverage. Senate Republicans and Democrats agree action is needed but cannot reach consensus on extending the subsidies, with Democrats seeking a straight extension while Republicans oppose the measure. Individual enrollees like Virginia’s Dinam Bigny already face monthly premiums of $900 that will rise by $200 next year, forcing many to seek cheaper coverage or go without insurance entirely. The subsidies, expanded during the Biden administration, currently benefit tens of millions of Americans including contractors, freelancers, and those with chronic conditions who rely on marketplace coverage.
Source(s): ACA Premiums Are Set to Spike. A New Poll Shows Enrollees Are Already Struggling. (MedPage Today)
Momentum Is Building for Medicare for All (Jacobin)
Senators agree they need to act on expiring ACA subsidies. But they can’t nail down how. (Healthcare Dive)
For Many Contractors, Losing ACA Subsidies Means Losing Health Care (Motherjones)
This new poll shows Obamacare enrollees are struggling, as premiums are set to surge (Fastcompany)
Trump wants a health care deal. He’s leaving the details to Congress. (Politico)
Obamacare Premium Spikes Could Drive off Enrollees, Most Want Subsidy Extension, KFF Finds (Usnews)
Chances Dwindling for Renewal of ACA Subsidies, Risking Premium Spikes for Millions (MedPage Today)
ObamaCare anxiety rising among House GOP centrists: ‘To do this is buffoonery’ (The Hill)
Sen Paul’s Idea to Replace Obamacare (Realclearhealth)
ObamaCare Anxiety Rising Among House GOP Centrists (Realclearhealth)
Johnson Races to Finalize Elusive GOP Health Care Plan (Realclearhealth)
AHIP presses for ACA subsidy extension, further program integrity measures (Fierce Healthcare)
Poll Suggests Voters May Blame Republicans More if Affordable Care Act Subsidies Go Away (New York Times)
A new, bipartisan ACA subsidy plan has emerged in the House: media reports (Fierce Healthcare)
ACA Marketplaces at a Crossroads: New Analysis Compares Out-of-Pocket by Major Payers (Healthmanagement)
STAT+: Lawmakers are still far apart on a deal to extend ACA tax credits, and time is running out (STAT)
New Dems Unveil Health Care Action Plan (Feedly)
House GOP Pounces On GAO Fraud Findings, AHIP Says Data Predate ACA Fixes (Inside Health Policy)
At the 11th hour, an Affordable Care Act subsidy accord remains elusive (HFMA)
Congress faces holiday crunch as health care fix collides with shrinking calendar (Foxnews)
Republicans have an affordability problem. They can’t agree on how to fix it. (Politico)
Health care fight hits critical juncture (The Hill)
Watch: What Do Republicans Really Want on Health Care? (Kffhealthnews)
ACA approval hits new high: Gallup (The Hill)
Obamacare Users Face Higher Deductibles, Higher Premiums (New York Times)
GOP struggles on affordability message (Politico)
Trump’s Proposal to Clean Up Obamacare Mess (Realclearhealth)
Independents Drive Approval of ACA to New High of 57% (News)
Biggs Delivers Healthcare Framework to GOP Leadership (Realclearhealth)
Health care fight heads to fever pitch (The Hill)
Hillary Clinton: ‘Congress Has Abdicated Its Responsibility’ (Foreignpolicy)
House GOP seeks off-ramp to sky-high health insurance costs for millions of Americans (Foxnews)
ACA approval hits new high as subsidies set to expire: 7 things to know (Becker’s Hospital Review)
List of House Republicans Pushing to Extend Obamacare Subsidies (Newsweek)
Health insurers appeal to Republicans (Politico)
Tags: #ALL
Cuban-Humana Drug Partnership Emerges as Senate Advances PBM Reform Bill
Senate Finance Committee Chair Mike Crapo and ranking Democrat Ron Wyden introduced the PBM Price Transparency and Accountability Act on December 4, reviving bipartisan reform efforts that nearly passed last year. Separately, Mark Cuban’s Cost Plus Drugs and Humana are exploring a partnership to lower employer prescription drug costs, with early-stage discussions about allowing Medicare Advantage patients to buy drugs directly from manufacturers. Healthcare executives emphasize that expanding pharmacist roles beyond traditional dispensing is becoming essential as health systems face rising costs and declining reimbursements under value-based care models.
Source(s): Sen Tillis on Drug Pricing & the Future of Innovation (Realclearhealth)
Mark Cuban’s Cost Plus Drugs, Humana exploring partnership to tackle employer drug costs (Fierce Healthcare)
The pharmacy shift ‘essential for the future of US healthcare’ (Becker’s Hospital Review)
New Senate Finance Bill Aims To Bring PBM Reform Closer To Passage (Inside Health Policy)
Trump Scores Big Win on Drug Prices, Trade (Realclearhealth)
Killing Drug Ads Won’t Lower Prices. It Will Kill Innovation (Realclearhealth)
Mark Cuban, Humana CEO announce drug pricing partnership during Forbes panel (Healthexec)
How Care Transitions Complicate Medication Management — and How to Fix Them (MedCity News)
Tags: #DRUG, #PAYER, #PROVIDER
New face of GOP healthcare is senator linked to largest Medicare fraud scheme in history
Senator Rick Scott (R-Fla.), former CEO of Columbia/HCA which paid the largest Medicare fraud settlement in U.S. history, is leading GOP efforts to develop ACA alternatives including his ‘More Affordable Care Act’ proposal. Scott’s plan would replace ACA premium tax credits with ‘Trump Health Freedom Accounts’ and allow states to waive ACA requirements including preexisting condition protections, potentially causing marketplace collapse according to KFF analysis.
Source(s): New face of GOP healthcare is senator linked to largest Medicare fraud scheme in history (Alternet)
Tags: #ALL
Until Health Care Is Fixed, Expect More Shutdowns
The article references Justice Antonin Scalia’s 2015 criticism of the Supreme Court’s decision to uphold Obamacare, which he called ‘SCOTUScare.’ The author suggests that current healthcare system issues may lead to more government shutdowns, dubbing this phenomenon ‘Shutdowncare.’
Source(s): Until Health Care Is Fixed, Expect More Shutdowns (Realclearhealth)
Tags: #ALL
It’s Time to Restore and Reform 340B
The Senate HELP Committee, led by Chair Bill Cassidy (R-LA), concluded a year-long investigation into the 340B prescription drug program, revealing that hospitals purchase drugs at substantial discounts but charge patients full price, with much revenue going to for-profit middlemen. The Congressional Budget Office found 340B drug spending increased nearly 20% from 2010-2021, far exceeding overall drug spending growth, while only 5 of 20 Government Accountability Office reform recommendations since 2011 have been implemented.
Source(s): It’s Time to Restore and Reform 340B (Realclearhealth)
Tags: #DRUG, #HOSPITAL, #PATIENT
Notable Notes
Aetna merges prescriptions, procedures into single prior authorization
Aetna has merged pharmacy prescriptions and medical procedures into a single prior authorization process as of November, eliminating the need for providers to submit separate reviews. The insurer launched a musculoskeletal bundle that includes X-rays, knee arthroplasty procedures, pain medications, and medical equipment under one approval process.
Source(s): Aetna merges prescriptions, procedures into single prior authorization (Beckerspayer)
Tags: #PROVIDER, #PAYER, #HOSPITAL
2025 KFF Marketplace Enrollees Survey
A KFF survey of 24 million ACA Marketplace enrollees found that 32% would shop for lower-premium plans and 25% would go uninsured if premiums doubled due to expiring enhanced tax credits. 84% of enrollees support extending the tax credits, including 70% of Republicans, while 61% already struggle to afford deductibles and out-of-pocket costs.
Source(s): 2025 KFF Marketplace Enrollees Survey (KFF)
Tags: #PATIENT, #PAYER
Startups at AHA tout innovative tech for tracking heart, brain health
Three MedTech Innovator startups presented their diagnostic technologies at the American Heart Association’s 2025 Scientific Sessions conference in New Orleans. The companies showcased innovations focused on tracking heart and brain health conditions.
Source(s): Startups at AHA tout innovative tech for tracking heart, brain health (Fiercebiotech)
Tags: #DEVICE, #PROVIDER
Pediatric care grows more complex, concentrated: 6 notes
A JAMA Network Open study analyzing 26 million pediatric hospital discharges from 2000-2022 found that children with complex chronic conditions increased from 78% to 95% of discharges at urban teaching hospitals, while children with three or more complex conditions increased by 340%. Despite representing only 21.9% of discharges in 2022, these complex patients consumed 44.1% of bed days and 59.5% of hospital charges, with Medicaid reimbursement failing to cover full care costs.
Source(s): Pediatric care grows more complex, concentrated: 6 notes (Becker’s Hospital Review)
Tags: #HOSPITAL, #PATIENT, #PAYER
Medtronic names Jeb Denny as chief medical officer for acute care and monitoring
Medtronic appointed Jeb Denny as chief medical officer for its acute care and monitoring business, which generated $1.9 billion in fiscal 2025 sales and produces pulse oximeters, patient monitors and airway management tools. Denny joins from BD where he led medical affairs for urology, critical care and other device segments, filling a key role after the previous CMO left when Medtronic cancelled plans to spin out the patient monitoring business.
Source(s): Medtronic names Jeb Denny as chief medical officer for acute care and monitoring (Medtechdive)
Tags: #DEVICE, #PROVIDER
Beyond the treatment: Innovation on the human side of medicine
Learn how a company’s focus on understanding the patient journey is making healthcare more intuitive and equitable across the spectrum of medicine.
Source(s): Beyond the treatment: Innovation on the human side of medicine (Fierce Pharma)
Tags: #ALL
We’re Stuck With Health Insurance—But We Can Improve It
The article proposes allowing employers to provide pretax funds for employees to purchase their own health insurance plans rather than employer-selected group plans. This approach would enable individuals to choose more cost-effective insurance options that better suit their personal needs.
Source(s): We’re Stuck With Health Insurance—But We Can Improve It (Realclearhealth)
Tags: #PAYER, #PATIENT
Open Enrollment: Why Rising Premiums Are Forcing Healthcare Organizations to Bet on AI and Automation
Open enrollment 2026 represents a structural shift in U.S. healthcare cost pressures rather than cyclical challenges. Healthcare payers and providers are turning to AI and automation as necessary tools to modernize operations beyond traditional cost management approaches.
Source(s): Open Enrollment: Why Rising Premiums Are Forcing Healthcare Organizations to Bet on AI and Automation (MedCity News)
Tags: #PAYER, #PROVIDER
The Patient Overwhelm Problem: 70% Are Tuning Out Communications
A CSG-commissioned Wakefield Research study found that 70% of patients tune out healthcare communications due to message saturation. Hospitals that improved discharge communications reduced readmissions from 13.5% to 9.1% according to a JAMA study, while fragmented tech systems create duplicate alerts and inconsistent patient instructions.
Source(s): The Patient Overwhelm Problem: 70% Are Tuning Out Communications (Becker’s Hospital Review)
Tags: #HOSPITAL, #PATIENT, #PROVIDER
The unexpected factor that boosts health engagement: Cigna
Cigna’s survey of 5,000 Americans found that individuals with a strong sense of purpose had vitality scores of 90.2 (no chronic conditions) and 88.2 (with chronic conditions) compared to the overall average of 69.3. Those with strong purpose showed higher health engagement rates: 76% attended annual physicals, 61% had dental exams, and 68% regularly wake up rested.
Source(s): The unexpected factor that boosts health engagement: Cigna (Beckerspayer)
Tags: #PAYER, #PATIENT
Why device developers shouldn’t pass over pediatrics
Kolaleh Eskandanian from Compremium argues that medical device companies should not avoid pediatric markets despite perceived limited ROI, citing important regulatory and strategic benefits for developing pediatric medical devices.
Source(s): Why device developers shouldn’t pass over pediatrics (Medicaldesignandoutsourcing)
Tags: #DEVICE, #PATIENT
Healthcare data breach: 100% unencrypted PHI
The American Hospital Association reported 364 healthcare hacking incidents as of October 2025, with 100% of breached data being unencrypted either due to stolen credentials bypassing encryption or data stored in plain text outside protected systems. Much unencrypted data existed outside EHR systems on analytics servers, imaging platforms, email systems and vendor integrations where encryption enforcement was inconsistent or absent.
Source(s): Healthcare data breach: 100% unencrypted PHI (Healthcare Dive)
Tags: #ALL