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Policy Digest — August 17, 2026

Introduction

Trump narrowed the childhood vaccine schedule and ordered an MMR split, the Fifth Circuit voided the No Surprises payment benchmark, and new data showed insurers denying up to 18% of prior authorization requests.

Weekly Spotlight: Trump Order Narrows the Childhood Vaccine Schedule and Directs an MMR Split

President Trump signed an executive order on Aug. 10 that narrows the federally recommended childhood immunization schedule to 11 core vaccines and directs that the combined measles, mumps and rubella (MMR) shot be split into three separate doses. The World Health Organization (WHO) counts the change as a reduction from 17 recommended vaccines to 11. The order also repeats a suggested link between vaccines and autism that major medical groups reject.

The order routes the work around the established advisory process. It assigns a revived vaccine safety task force, led by National Institutes of Health (NIH) Director Jay Bhattacharya, to report within 90 days on options for splitting MMR and on procedures for revising the childhood and adolescent schedules. One day later, the Department of Health and Human Services (HHS) opened nominations for the National Vaccine Advisory Committee after rewriting the committee’s charter. The solicitation ran in the Federal Register on Aug. 12. The committee’s makeup will determine who conducts the evidence review the order calls for.

Manufacturers say they are unlikely to comply. No licensed single-antigen measles, mumps or rubella products exist in the United States, and the Associated Press reports that vaccine makers are unlikely to split the shot, because each new product would require its own manufacturing, licensure and clinical work. STAT reviews the history: separated components used abroad were withdrawn because they left children unprotected between doses and drove completion rates down.

Medical and industry opposition was immediate. Physician groups and vaccine manufacturers are pushing back rather than cooperating. Two infection prevention societies said the order, titled Gold Standard Childhood Vaccine Recommendations, is based on anything but gold-standard science. The American Academy of Pediatrics issued its own schedule, recommending the 2026-27 flu vaccine for all children 6 months and older. Pediatric and medical groups warn the order will add visits, create confusion and raise access barriers, and experts told MedPage Today that the financial and logistical burden on parents, providers and drugmakers may be the biggest obstacle of all.

Political and international criticism followed. Senate Health, Education, Labor and Pensions Chairman Bill Cassidy (R-La.), a physician, said the President lacks the expertise to make these changes, called the order crazy and stupid and predicted it will raise insurance costs. The Hill reports the order puts vaccines at the center of the midterm campaign for vulnerable Republicans. WHO leadership called the overhaul not aligned with decades of evidence, and an epidemiologist argued in STAT that the order erodes rather than restores confidence in immunization.

States are not following. California will keep its childhood vaccination recommendations and its requirement that insurers cover the shots, and legal experts told Medscape that other states are unlikely to change policy. KFF concludes the order is unlikely to have an immediate sweeping effect, noting that courts have blocked similar actions and that states increasingly set immunization policy on their own. Georgetown’s Center for Children and Families argues the order undermines child health.

The response now falls to incoming Centers for Disease Control and Prevention (CDC) Director Erica Schwartz, who is confirmed but not yet sworn in and must decide how to respond before her first day. The order reached an agency managing active Ebola, measles and cyclosporiasis outbreaks after significant staff losses. At her confirmation hearing Schwartz pledged she will never betray the science. Cassidy says he expects her to do the right thing, and Bhattacharya says I trust the science on childhood vaccines. The task force report is due within 90 days of the Aug. 10 order.

Centers for Medicare and Medicaid Services (CMS)

Fifth Circuit Strikes Down the No Surprises Act Payment Benchmark

The Fifth Circuit ruled Aug. 11 that insurers cannot include ghost rates or exclude bonus payments when calculating the qualifying payment amount (QPA), the No Surprises Act benchmark for out-of-network reimbursement. The court struck down key parts of the government’s methodology, siding with the Texas Medical Association’s argument that the formula skewed payments toward insurers. Insurers may have to recalculate QPAs, which is expected to raise out-of-network payments to providers.

Modern Healthcare Healthcare Dive MedCity News

Tags: #PROVIDER #PAYER #HOSPITAL

First Public Prior Authorization Data Shows Denial Rates From 2% to 25%

Insurers denied at least one in eight standard prior authorization requests in 2025, according to a KFF analysis of the first denial data the Centers for Medicare and Medicaid Services (CMS) required insurers to disclose. Denial rates were 12% in Medicare Advantage, 14% in Medicaid managed care and 18% in Affordable Care Act (ACA) marketplaces, with plan-level rates ranging from 2% to 25% across roughly 71 million enrollees. Becker’s separately assessed the first year of Medicare’s WISeR prior authorization model, which proceeded after a Senate resolution to block it failed 46-50 on July 16.

Tags: #PAYER #PROVIDER #PATIENT

Waivers, Directed Payments and a Budget Rule Squeeze Medicaid Financing

CMS is paring back policies enacted through Medicaid Section 1115 waivers, changes expected to increase enrollee churn, raise administrative costs and strain provider and state finances. In Arkansas the administration invoked a budget-neutrality rule to refuse renewal of a key waiver, leaving coverage for hundreds of thousands of enrollees in question. A KFF analysis finds at least 37 states have Medicaid state directed payments that could be reduced by the 2025 reconciliation law’s limits, with the largest cuts falling on payments to hospitals.

Tags: #ALL

CMS Proposes New 340B Reporting Duties as Courts Leave Contract Pharmacy Unsettled

CMS proposed two new obligations for hospitals in the 340B drug pricing program through its hospital outpatient and physician fee schedule rules: off-campus outpatient departments would file a formal attestation starting in 2028, and hospitals would submit 340B data to a centralized system. Drug manufacturers and states are meanwhile fighting state 340B contract pharmacy protection laws in parallel federal courts. AbbVie and Novartis sued Illinois days before a South Dakota judge dismissed near-identical challenges there, a split that pushes the question toward appellate review.

Tags: #HOSPITAL #DRUG #PATIENT

Medicare’s New-Technology Payments for AI Devices Draw Overuse Warnings

Medicare pays hospitals add-on amounts for using newly authorized devices that rely on artificial intelligence (AI). STAT reports the payments create a revenue stream technology companies are actively courting, and researchers warn the incentives could drive overuse of the devices. STAT paired its examination of the incentives with an investigation of Commure, a health technology company backed by General Catalyst.

STAT (subscription) STAT (subscription)

Tags: #DEVICE #HOSPITAL

Patient Advocacy Group Sues the AMA to Void Its Copyright on CPT Billing Codes

PatientRightsAdvocate.org sued the American Medical Association (AMA) on Aug. 13, asking a court to void the association’s copyright over the Current Procedural Terminology (CPT) code set, which governs billions of dollars in health care billing. The group argues the AMA holds no valid copyright over the codes and wants to republish them free and searchable. The suit follows a letter from Sen. Bill Cassidy (R-La.) accusing the AMA of charging exorbitant fees for the code set.

Becker’s Hospital Review The Washington Post (subscription) MedCity News

Tags: #PROVIDER #HOSPITAL #PAYER

Eleven Insurers Exit ACA Marketplaces as Employers Move to Individual Coverage HRAs

Eleven insurers are exiting ACA marketplaces after the 2026 plan year, thinning carrier participation and narrowing plan choice on the exchanges. More than 20,000 employers moved to individual coverage health reimbursement arrangements (ICHRAs) in 2026, up 53% year over year, as companies faced the largest group-plan price increases in 15 years, according to the HRA Council. A new study examines whether ICHRA adoption could help stabilize marketplace risk pools.

Tags: #PAYER #PATIENT

Mandatory Value-Based Programs Added More Than $3 Billion in Hospital Administrative Costs

Four mandatory Medicare value-based payment programs generated more than $3 billion in added administrative costs for participating hospitals relative to non-participants, according to a JAMA Health Forum study of Medicare cost reports covering 4,332 hospitals. The finding cuts against the premise that mandatory models are administratively lighter than voluntary ones, and it lands as CMS expands mandatory model design. Orthopedic device executives separately said Medicare’s shift of joint replacement cost responsibility onto hospitals is unlikely to squeeze implant prices, arguing that hospitals have limited leverage on device line items.

Fierce Healthcare Becker’s Hospital Review MedTech Dive

Tags: #HOSPITAL #DEVICE #PAYER

Ten Pharmacy Benefit Managers Agree to Post Plan Prices Alongside TrumpRx

Ten pharmacy benefit managers (PBMs) agreed to display commercial, Medicare and Medicaid plan prices alongside the direct-to-consumer prices on the White House TrumpRx site. The change adds plan-level price comparisons to a federal portal that had carried only direct-to-consumer prices, and it extends the administration’s pricing initiative into channels run by PBMs.

Inside Health Policy STAT (subscription)

Tags: #DRUG #PAYER #PATIENT

Also in CMS

A most favored nation drug pricing policy could add $200 billion to projected Medicare savings, according to AARP.

Tags: #DRUG #PAYER

Food and Drug Administration (FDA)

Draft PDUFA VIII Agreement Adds Rare Disease Review and Engagement Commitments

Negotiators from the Food and Drug Administration (FDA) and industry proposed new rare disease initiatives in the draft eighth reauthorization of the Prescription Drug User Fee Act (PDUFA VIII), the agreement that sets FDA’s review commitments for the coming cycle. Sponsors would get more chances to engage the agency on development challenges in small, hard-to-study populations, and patient groups would get more opportunities to weigh in.

Inside Health Policy

Tags: #DRUG #PATIENT

Also in FDA

FDA advisers are set to weigh a cancer blood test.

Tags: #DRUG #PATIENT

Department of Health and Human Services (HHS)

HRSA Rebuilds the Review Process for Adding Conditions to Newborn Screening

The Health Resources and Services Administration (HRSA) announced a modernized framework for reviewing evidence on conditions proposed for the national newborn screening panel, which determines the conditions every newborn in the country is tested for. HRSA says the change will streamline evidence review, speed evaluation of emerging conditions and strengthen national screening recommendations.

HRSA

Tags: #PATIENT #PROVIDER

ARPA-H Funds Agentic AI Systems to Deliver Cardiovascular Care

The Advanced Research Projects Agency for Health (ARPA-H) is funding development of agentic artificial intelligence systems intended to deliver continuous cardiovascular care. The program aims for Food and Drug Administration (FDA) authorization, an early federal test of whether autonomous AI can be authorized as a care-delivering medical product rather than as decision support for clinicians.

Inside Health Policy

Tags: #DEVICE #PROVIDER #PATIENT

Heard on the Hill

Also on the Hill

Senators introduced bipartisan legislation to further antimicrobial resistance research.

Tags: #DRUG #PROVIDER

Notable Notes

Hospital Consolidation Rises While Private Equity Retreats From Physician Practices

Hospital market concentration is pushing up health care costs, KFF Health News reports, with wide price variation for a standardized knee replacement. Hospital merger and acquisition activity kept rising in 2026 as operating and supply costs climbed and Medicare and Medicaid reimbursement fell. Private equity deals for physician practice management firms are declining sharply, and STAT reports that state laws restricting corporate control of medical practices may be curbing the takeovers.

Tags: #HOSPITAL #PROVIDER #PATIENT

TAVR Research Turns to Risk Prediction, Anchoring Technique and Bicuspid Anatomy

Incidental lung findings on pre-procedure computed tomography (CT) predict mortality after transcatheter aortic valve replacement (TAVR), meaning scans already obtained for procedural planning can flag which patients need closer follow-up. Specialists in China reported a new anchoring technique intended to improve outcomes in patients with pure aortic regurgitation and an enlarged left ventricular outflow tract. A Patient-Centered Outcomes Research Institute trial recruiting at Cedars-Sinai, Mount Sinai and Laval will compare TAVR with surgery in severe bicuspid aortic stenosis, an anatomy excluded from the pivotal TAVR trials. An expert panel at CRT 2026 reviewed TAVR’s open questions on durability and expanding indications.