Weekly Spotlight: The Federal Research Portfolio Gets Rewired
Two things happened to federal research funding this week, and they point in the same direction. The government said in court how it decided which grants to cancel, and the White House said in a blueprint what it wants funded next.
Start with the court filing. In litigation brought by the University of California, the administration acknowledged that it cut research grants using keyword searches for terms tied to DEI and vaccines, rather than reviewing each award on its merits. CalMatters reported the same mechanism applied to billions of dollars in California research grants, cancelled en masse. The admission matters because it converts a contested allegation into a described process.
The cost is now partly quantified. STAT reported that at least 78 Agency for Healthcare Research and Quality grants, worth roughly $200 million, were cut short by “non-award” notices, with an estimated $109.2 million in remaining funding affected. AHRQ funds health services research — how care is delivered, what it costs, and whether it works.
Courts are pushing back. A federal judge ruled the administration cannot cancel ongoing federal grants based solely on changed policy priorities, a limit on agency termination authority. The New York Times separately reported that the administration acknowledged canceling grants to states that did not vote for the president.
Then came the forward-looking half. The White House released a national science blueprint proposing to shift research funding from universities toward industry and toward artificial intelligence, with new return-on-investment measures applied to federal research. Researcher reaction was mixed. HHS and NIH moved in step, announcing an NIH-led “Bio Genesis Mission” aligned with the administration’s $5 billion AI Genesis Mission for biomedical research.
Read together, the week describes a redirection rather than a reduction. Money is being pulled out of investigator-initiated academic work and pointed at AI and industry partnerships, while the mechanism used to pull it back is now a matter of public record and active litigation. For anyone whose evidence base depends on NIH, NHLBI, or AHRQ portfolios — device trials, outcomes research, health services work — the question for the next budget cycle is not only how much is appropriated, but which kind of science the appropriation is meant to buy.
Centers for Medicare and Medicaid Services (CMS)
CMS Proposes Sweeping Limits on Medicaid Provider Taxes, Extending the Cap to Insurers
CMS on July 21 proposed a regulation paring back the state provider taxes that finance states’ share of Medicaid, implementing a provision of last year’s federal spending law (H.R. 1 / OBBBA). The rule revises the indirect hold-harmless threshold for health-care-related taxes — currently 6% of net patient revenue — and creates a new provider-tax class covering payers, a step Inside Health Policy reports goes beyond the statute by applying the cap to taxes on all health insurance plans, adding new state reporting requirements, and sunsetting a workaround states could have used to replace lost federal revenue. Becker’s puts the federal savings at roughly $246 billion; HFMA estimates the rule could cut Medicaid payments by $220 billion over 10 years. Every state except Alaska, plus the District of Columbia, levies these taxes on hospitals and Medicaid managed-care companies, so the proposal reaches nearly every state Medicaid program and the supplemental payments hospitals draw from them.
Modern Healthcare Healthcare Dive Becker’s Hospital Review Fierce Healthcare HFMA Inside Health Policy Federal Register
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Medicaid Coverage and Financing Tighten on Every Side
Beyond the provider-tax rule, a set of converging pressures points the same way: fewer people enrolled and less state money to cover them. States face tight deadlines to send federally required notices to enrollees subject to the new Medicaid work requirements, and new public charge policies are projected to push eligible families out of Medicaid and CHIP. KFF estimates 1.4 million uninsured people in the ten non-expansion states sit in the coverage gap, ineligible for both Medicaid and marketplace subsidies, while an Urban Institute analysis finds postpartum uninsurance gains have stalled. One year after HR-1, hospital CEOs describe adjusting to a “new game” of payment cuts and work requirements, and one rural CEO said there is “no hope in the rural health transformation funds” — the $50 billion program created to offset the Medicaid cuts — citing a structure in which states control the money and eligible uses are tightly constrained. Several state Medicaid programs are separately weighing dropping outside managed-care insurers in favor of in-house management.
- Medicaid Work Requirements: Federal Outreach Requirements and State Plans
- New Public Charge Policies Will Likely Lead to Decreased Enrollment in Medicaid and CHIP
- How Many Uninsured Are in the Coverage Gap and How Many Could be Eligible if All States Adopted the Medicaid Expansion?
- New Report Shows Coverage Gains for New Mothers—But Progress has Stalled with New Threats on the Horizon
- HR 1 at 1 year: Hospital CEOs adjust to ‘new game’ of payment cuts, work requirements
- Rural hospital CEO sees ‘no hope in the rural health transformation funds’
- For Millions in Rural America, Medicine Is Still Far Away
- Medicaid programs mull dropping insurers
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CMS Reopens How Medicare Codes, Values and Tests Payment
CMS is moving on several fronts to change the machinery of Medicare payment. The agency issued a request for information seeking alternatives to the AMA’s CPT coding system and the RUC, escalating scrutiny of the physician lobby’s role in valuing Medicare services; a senior CMMI official said July 22 the Innovation Center will expand mandatory payment models, shorten testing cycles and pursue a Medicare Advantage demonstration; and the CY2027 Physician Fee Schedule proposed rule carries significant Medicare Shared Savings Program changes. Coding and coverage decisions are moving in parallel, from broadened billing for patient navigation services to the Q2 2026 HCPCS Level II determinations that set the billing pathway for devices and supplies.
- CMS Puts AMA’s CPT, RUC In Crosshairs With RFI Seeking Alternatives
- CMMI Eyes More Mandatory Models, ‘Rapid-Cycle’ Testing, MA Demo
- The MSSP proposed changes in the CY 2027 PFS proposed rule
- CMS expands navigation coverage: What to know
- Q2 2026 HCPCS Final Determination Update
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Medicare Unbundles Maternity Billing in 2027, and Obstetric Groups Split on the Fallout
Effective Jan. 1, 2027, OB-GYN maternity billing shifts from a bundled global obstetric payment to fee-for-service coding, unbundling prenatal, delivery and postpartum charges for nearly every U.S. family with a pregnancy. ACOG and the obstetric hospitalist group OBHG welcome the new labor-and-delivery codes and higher payment but oppose the method CMS proposed for implementing them in the CY2027 Physician Fee Schedule. Other commentators warn the change will raise the cost of childbirth without any guarantee of better maternity outcomes.
- Celebrating The End Of Global Maternity Care Billing
- Eliminating Global Billing For Pregnancy May Raise Maternity Care Costs
- ACOG, OBHG Oppose CMS’ Plan For Implementing New Maternity Pay Codes Proposed In 2027 PFS
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Providers Line Up Against CMS Proposal to Bar Third-Party Remote Patient Monitoring
Health systems, physician groups and telehealth trade associations are opposing a CMS proposal that would bar Medicare payment for remote patient monitoring services delivered by third-party vendors. Opponents warn the change would pause established RPM programs and leave reimbursement unclear for the vendor-supported model most health systems use to run them. The proposal puts the payment basis for a large share of Medicare RPM volume in question.
Tags: #DEVICE #HOSPITAL #PROVIDER
Edwards Posts Strong TAVR Sales Ahead of Potential Medicare Coverage Expansion
Edwards Lifesciences posted strong second-quarter transcatheter aortic valve replacement sales ahead of a potential Medicare coverage expansion. A coverage expansion would widen the Medicare population eligible for transcatheter valve therapy, making the pending CMS decision the single largest variable in near-term TAVR volume.
Tags: #DEVICE #PATIENT
Federal Drug-Pricing Agenda Advances on Multiple Tracks
Six months in, analysts are assessing whether the TrumpRx drug-pricing initiative has delivered on the administration’s marquee prescription-drug cost effort. Separately, a new study estimates that applying most-favored-nation international reference pricing to Medicaid could save $8.6 billion, adding evidence for extending the approach beyond Medicare. Rare-disease drugmakers, meanwhile, are lobbying to have their treatments excluded from Medicare drug-price-negotiation programs — a carve-out fight that will shape the scope of the pricing pilots.
- TrumpRx at 6 months: Has the drug-pricing experiment delivered?
- Most-favored-nation pricing could save Medicaid $8.6B: Study
- Rare Disease Drugmakers Seek Exclusion From Medicare Pricing Plans
Tags: #DRUG #PAYER
ACA Marketplace Rules in Litigation as Operators Report Coverage Losses
A federal judge paused CMS’s ACA catastrophic-plan expansion along with seven other provisions, injecting fresh uncertainty into marketplace coverage rules, while HHS is appealing a separate ruling that invalidated the 2025 ACA marketplace integrity rule and its shortened open enrollment windows and tougher eligibility verification. The operational effect is already visible: HCA executives told analysts that patients who dropped marketplace coverage after premium increases “migrated almost one for one” into uninsurance. That is operator-level evidence that the expiration of enhanced marketplace subsidies is converting directly into coverage loss and uncompensated care.
- Judge pauses ACA catastrophic plan expansion, 7 other provisions
- HHS appeals invalidation of 2025 ACA rule
- HCA Execs: ACA Dropoffs ‘Almost One For One’ Became Uninsured
Tags: #PAYER #PATIENT #HOSPITAL
Surprise-Billing Arbitration Paid Providers Nearly $15B in 2025 as CMS Says the System Is Being ‘Gamed’
No Surprises Act independent dispute resolution awarded providers nearly $15 billion in 2025, more than triple the prior year, according to federal data analyzed by The Wall Street Journal, with radiology, anesthesiology and emergency medicine groups among the top winners. The Trump administration acknowledged problems with the surprise-billing law, saying doctors are “gaming” the arbitration system to win large payments — a signal that a federal rework of IDR is now in play. New CMS data show filings continued to climb, rising 16% in the second half of 2025 over the first half, though arbiters are closing cases faster and drawing down the backlog. CMS separately issued guidance on the remittance-advice remark codes payers must use for NSA-related payments, a technical directive that governs how disputed out-of-network claims are documented.
The Wall Street Journal The New York Times Healthcare Dive Fierce Healthcare KFF Health News CMS
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Food and Drug Administration (FDA)
MDUFA VI Draft Commitment Letter Sets Device Review Terms Through FY 2032
FDA published the MDUFA VI draft commitment letter in July 2026, setting review timelines, user fees and program structure for 510(k), De Novo and premarket approval (PMA) submissions from fiscal year 2028 through fiscal year 2032. Negotiators wrapped the reauthorization commitment letter in talks one regulatory expert described as the smoothest user-fee negotiation yet. The agreement fixes the Center for Devices and Radiological Health (CDRH) device-review funding level and performance goals, which govern how quickly device submissions move through review. For device sponsors, the letter is the operative document for planning submissions across the next five-year cycle.
Tags: #DEVICE
FDA Leadership Vacancy and Center Attrition Raise Review-Capacity Questions
Two FDA centers overseeing drug and biologics evaluation lost a combined 354 employees in 2026 while hiring far fewer, amid leadership turnover — a staffing gap that raises concerns about agency capacity and review timelines. At the top of the agency, the commissioner’s seat could sit empty for months. A leaderless FDA slows the device guidance, review-program and user-fee work that governs how devices reach patients, compounding the effect of the center-level attrition.
Becker’s Hospital Review MedTech Dive
Tags: #DRUG #DEVICE
Philips Wins FDA Clearance for Pulse Oximeter Designed to Read Across Skin Tones
Philips won FDA clearance for an updated pulse oximeter designed to read accurately across skin tones, addressing documented accuracy gaps in patients with darker pigmentation. The clearance carries weight given pulse oximetry’s role as a frontline screening tool, where a misread saturation value can change triage and treatment decisions.
Tags: #DEVICE #PATIENT
FDA Names Dexcom First Participant in TEMPO Digital Health Device Pilot
FDA selected Dexcom as the first participant in its TEMPO digital health device pilot. The Dexcom Glucose Health Program is aimed at care expected to be covered under the Centers for Medicare and Medicaid Services (CMS) ACCESS chronic care model — an explicit link between an FDA device pathway and a CMS payment model. That pairing is the notable part: it lines up regulatory review and reimbursement in the same program rather than leaving sponsors to clear them sequentially.
Tags: #DEVICE #PATIENT
Department of Health and Human Services (HHS)
Cassidy Backs CDC Nominee Erica Schwartz, but Senate HELP Delays Votes on CDC and ASPR Picks
Senate Health, Education, Labor and Pensions (HELP) Committee Chair Bill Cassidy said on July 23 that he will support Erica Schwartz to lead the Centers for Disease Control and Prevention (CDC) after the agency modified its website page on vaccines and autism to address his objections, removing a key obstacle to confirmation. The committee vote was nonetheless postponed to the following week over attendance problems, with Cassidy citing low Republican turnout needed to secure the votes for Schwartz; the panel also held up the administration’s nominee to lead the Administration for Strategic Preparedness and Response (ASPR). HELP had been expected to advance Schwartz to the Senate floor. The delay extends the leadership vacuum at CDC, the agency that sets federal posture on vaccines and public health. A MedPage Today opinion column argued Schwartz performed poorly at her confirmation hearing.
The Hill The New York Times STAT Inside Health Policy Inside Health Policy MedPage Today
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HHS Rewrites Vaccine Advisory Panel Charters as States and Public Health Groups Back ACIP Lawsuit
HHS rewrote the governing charters for the Advisory Commission on Childhood Vaccines (ACCV) and the National Vaccine Advisory Committee, with the July 21 ACCV charter stripping the standalone designated federal officer section that had vested agenda-setting and meeting authority in a full-time federal employee. A separate new charter was issued quietly for the department’s vaccine advisory committee, part of the same pattern of governance changes. Meanwhile, public health groups and a bipartisan coalition of governors joined medical organizations’ lawsuit against HHS Secretary Robert F. Kennedy Jr.’s overhaul of the Advisory Committee on Immunization Practices (ACIP), with the First Circuit weighing oral argument and the Massachusetts proceedings stayed through Sept. 3. ACIP recommendations determine what vaccines insurers must cover without cost sharing, so the outcome reaches coverage and provider practice directly.
Becker’s Hospital Review STAT Inside Health Policy
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HHS Experts Say Administration Funding Levels Are Too Low for Public Health Threats
An HHS coordinating body concluded that Trump administration funding levels are insufficient for NIH and CDC to adequately prepare medical countermeasures against public health emergencies over the next five years. The group cited needs such as Ebola response among the gaps left by the proposed funding levels. The finding comes from inside the department itself, giving hospitals and public health agencies a documented basis for gauging federal countermeasure readiness.
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CDC Ends Direct HIV Prevention Funding to Community Groups, Routing Money Through States
The Trump administration will not renew direct federal funding for community-based HIV prevention organizations, and the CDC will instead route HIV prevention grants through state and local health departments. Advocates say the shift amounts to cutting federal funding from the community groups doing frontline prevention work, leaving those organizations at risk even as some money moves to states. The change is a significant retrenchment in domestic HIV policy, transferring responsibility for prevention infrastructure to state and local governments.
Roll Call Government Executive STAT
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Appeals Court Backs HHS on 340B Rebate Models as Agencies Weigh Overhaul of the $100 Billion Program
The U.S. Court of Appeals for the D.C. Circuit ruled July 21 that drugmakers — including Novartis, Johnson & Johnson, Bristol Myers Squibb and Eli Lilly — cannot implement proposed 340B rebate models without approval from the HHS secretary, affirming lower-court rulings for the agency. In a separate track, two federal agencies are weighing sweeping changes to the 340B drug discount program, now roughly $100 billion in size, escalating the fight between manufacturers and hospitals over rebate mechanics and program scope. Five major hospital associations also urged a D.C. district judge to reject AbbVie’s suit challenging HHS’s interpretation of who counts as a 340B “patient,” a case that governs how broadly the discounts apply. 340B margins underwrite safety-net and children’s hospital operations, so a rebate-model or eligibility overhaul hits those institutions directly.
Fierce Healthcare Becker’s Hospital Review The Washington Post Inside Health Policy
Tags: #HOSPITAL #DRUG
Courts and OMB Reshape the Terms of Federal Health Grants
Two separate developments this week changed how federal health research and program grants can be awarded and revoked. A federal judge ruled the administration cannot cancel ongoing federal grants based solely on changed policy priorities, while a proposed OMB rule would centralize grant review at NIH — a shift critics say would politicize grantmaking and erode NIH’s ability to manage scientific risk. Together they bracket the question of who controls the federal grant pipeline, on the front end and the back end.
- Judge Rules Trump Admin Cannot Cut Grants Based On Policy Changes
- Opinion: How a controversial rule could hurt the NIH’s ability to manage risk
Tags: #PROVIDER #HOSPITAL
HHS Opens Two Fronts on Clinical Artificial Intelligence
HHS is building out its artificial intelligence agenda on both the innovation and the standards side. On July 22 the department announced a partnership with the White House Office of Science and Technology Policy (OSTP) to launch science and technology challenges aimed at developing AI health care solutions and transforming drug discovery. Separately, STAT reports HHS will convene experts to set standards for clinical AI; the convening’s scope, timing and participating agencies are not yet confirmed.
- HHS Partners With OSTP To Launch AI Health Care Challenges
- HHS to convene experts on standards for clinical AI
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HHS Rescinds Portions of Its Title VI Civil Rights Regulations
HHS filed a rule for public inspection rescinding portions of its Title VI civil rights regulations to conform them to the statutory text and Executive Order 14281. The change narrows the nondiscrimination obligations that attach to providers and institutions receiving federal health funding. Any provider or hospital operating under Title VI assurances should review how the revised regulatory text alters its compliance obligations.
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Heard on the Hill
Democrats Roll Out Coverage-Expansion Bills
Congressional Democrats introduced a cluster of coverage-expansion proposals this week, centered on children’s coverage and on shoring up the Affordable Care Act (ACA) marketplaces as the enhanced premium tax credits approach expiration. Sen. Andy Kim (D-N.J.) introduced the MediKids bill July 21 to make everyone under 26 eligible for Medicaid and require states to automatically enroll newborns. Separate bills would create a public option and a Medicare-style plan on the ACA marketplaces and make the enhanced subsidies permanent.
- Democratic-led bill pitches guaranteed health coverage for children (also covered by The Hill)
- New Bill Seeks to Create Public Option on ACA Marketplaces
- Proposed bill would create Medicare exchange plan, make enhanced ACA subsidies permanent
Tags: #PATIENT #PAYER
Price Transparency Bills Advance in Both Chambers
House and Senate committees each advanced health care price transparency legislation this week that would expand disclosure mandates beyond hospitals and payers to ambulatory surgery centers (ASCs) and labs, and add new reporting requirements. Two House committees and one Senate committee approved transparency bills over the past two weeks, positioning the issue for possible year-end health legislation with significant bipartisan support. Codifying the requirements would move mandatory price disclosure into statute rather than leaving it to executive-branch rulemaking. For patients and payers, the practical effect would be seeing what a high-cost procedure actually costs before it happens.
Politico MedPage Today Becker’s Hospital Review HFMA
Tags: #HOSPITAL #PAYER #PATIENT
House Clears Health Bills Ahead of Recess
The House moved a batch of health legislation before leaving town, alongside a continuing resolution to avert a government shutdown. Members passed the FDA Modernization Act 3.0 and an import-destruction measure, plus a package of Energy and Commerce Committee bills on July 22, 2026 aimed at strengthening public health programs and expanding patient access to medical innovation. The Rules Committee advanced the continuing resolution and a reconciliation package that carried no health care add-ons.
- House Passes FDA Modernization, Import Destruction, Other Health Bills
- House Passes Energy and Commerce Bills to Strengthen Public Health Efforts and Expand Access to Medical Innovation for American Patients
- House Set To Vote After Rules Advances CR, Reconciliation 3.0 Without Health Add-Ons
- STAT+: What’s in the last-minute flurry of health care bills?
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Committee Markups Move Drug and Public Health Bills
Committee activity on both sides of the Capitol fed the pre-recess floor push. The House Energy and Commerce Committee reconvened a full-committee markup of 29 bills spanning multiple health measures. The Senate Health, Education, Labor and Pensions (HELP) Committee on July 22 advanced bills on generic access, country-of-origin drug labeling, and standardizing compounded-drug manufacturing to a floor vote.
- TUNE IN: Committee on Energy and Commerce Reconvenes Markup of 29 Bills
- Senate HELP Sends Bills On Drug Labels, Biosimilars, Compounding To Floor Vote
Tags: #DRUG #PROVIDER #PATIENT
Cassidy Health Privacy Bill Rescheduled for Markup
Senate HELP Chair Bill Cassidy’s health privacy legislation is now set for markup Thursday, July 30, after the committee quietly pulled it from an earlier markup. The bill’s return to the calendar puts health data privacy back in play in the same window as the committee’s pending nomination votes.
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Notable Notes
TAVR Outcomes Research: Anesthesia Strategy and Failure to Rescue
Two new studies examine how transcatheter aortic valve replacement (TAVR) is delivered rather than which valve is used. One links less invasive anesthesia strategies during TAVR to a key clinical benefit; the other tracks failure-to-rescue rates at high- versus low-volume hospitals, testing whether the known TAVR volume-outcome relationship extends to rescuing patients after complications. Volume-outcome evidence is what the Centers for Medicare and Medicaid Services (CMS) has historically used to set TAVR facility requirements in its national coverage determination, so the second study bears directly on program-level policy.
- Less invasive anesthesia strategies during TAVR linked to a key benefit
- Failure to rescue after TAVR: New study tracks outcomes at high- and low-volume hospitals
Tags: #DEVICE #PROVIDER #HOSPITAL
Edwards Lifesciences Recruiting for COMPASSION S3 Pulmonary Valve Trial
Edwards Lifesciences is recruiting for COMPASSION S3, evaluating the SAPIEN 3 and SAPIEN 3 Ultra RESILIA transcatheter heart valve in patients with dysfunctional right ventricular outflow tract (RVOT) conduits and pulmonary valve disease. A transcatheter pulmonary valve option means fewer repeat open-heart operations over a patient’s lifetime.
Tags: #DEVICE #PATIENT
Transcatheter Valve Pipeline: New Platforms and New Procedures
Activity around Edwards’ core transcatheter valve field continues on two fronts — competitive device development and procedural firsts at academic centers. Venus Medtech completed enrollment in the pivotal trial of its Venus-PowerX transcatheter aortic valve replacement system, moving another TAVR platform toward regulatory submission. Separately, OU Health in Oklahoma City performed what it says is the world’s second bilateral transcatheter pulmonary valve placement, which the health system says makes it one of two centers globally to complete the procedure.
- Venus Medtech finishes enrollment for TAVR trial
- OU Health performs world’s 2nd double-pulmonary valve replacement
Tags: #DEVICE #PROVIDER
Cardiac Innovation Pipeline: Sutureless Bypass and Gene Therapy
Two cardiac technologies advanced outside the transcatheter valve space. AMT Medical’s redesigned ELANA device for sutureless coronary anastomosis is being promoted as simplifying coronary artery bypass grafting (CABG) and widening patient access to minimally invasive and robotic bypass surgery; one surgeon calls it a “technical breakthrough.” Separately, Lexeo Therapeutics is recruiting for a trial of LX2006 gene therapy versus usual care in Friedreich ataxia cardiomyopathy, a genetic cardiac condition.
- Surgeon hails new CABG technology as a ‘technical breakthrough’
- Study of LX2006 Gene Therapy in Friedreich Ataxia Cardiomyopathy
Tags: #DEVICE #DRUG #PATIENT
Medical Devices Get No Tariff Exemption While Drug Ingredients Do
New tariffs exempt drug active pharmaceutical ingredients (APIs) but grant no exemption for medical devices, landing directly on the cost of implants, catheters and monitoring equipment. On the drug side, consumer and generic-drug groups warn that President Trump’s threatened 100% tariff on generics made abroad would deepen reliance on foreign production rather than reshore it, and are urging regulatory and pricing reforms instead. For device manufacturers and the hospitals that buy from them, the absence of a carve-out is the newsworthy half of the policy.
- Drug APIs Exempt From New Tariffs; No Exemptions For Medical Devices
- Consumer Groups: Trump’s Generics Tariff Plan Would Hurt, Not Boost Domestic Production
Tags: #DEVICE #DRUG #HOSPITAL
AI at the Bedside and Inside the Device: Who Owns the Risk
Artificial intelligence (AI) is arriving in clinical care from two directions, and each raises a different accountability question. A Medical Design & Outsourcing commentary examines who bears clinical-risk liability as AI is embedded into Class II and Class III medical devices. At the point of care, NPR reports on an AI decision-support tool that flagged an elevated heart rate in a four-month-old at a Nairobi clinic, prompting the clinician to listen again and hear a murmur suggesting a congenital heart defect she says she would have missed.
- AI is moving inside the device. Who owns the clinical risk?
- This AI Tool Promises A ‘Second Pair Of Eyes’ To Clinicians
Tags: #DEVICE #PROVIDER #PATIENT
AMA President Calls for Lifting Limits on Physician-Owned Hospitals
American Medical Association (AMA) President Willie Underwood argues Congress should repeal the Affordable Care Act’s restriction on creating and expanding physician-owned hospitals, calling it a brake on specialty-care access and a driver of hospital-system consolidation. The op-ed puts a statutory Medicare participation limit back in play as a legislative target.
Tags: #PROVIDER #HOSPITAL
Billing and Payment Administration Under Pressure
Two items look at how payment mechanics shape access. In a STAT opinion, the American College of Obstetricians and Gynecologists (ACOG) argues new maternal billing codes replacing bundled “global” maternity billing should create a more transparent payment system for patients and clinicians. Separately, a MedCity News analysis argues prior authorization has moved from an administrative burden to a revenue and access problem requiring automation, as payer review delays push patients to abandon care.
- Opinion: Good riddance to bundled ‘global’ maternal care billing
- Prior Authorization Is Draining Revenue: Why Automation Has Become a Strategic Imperative
Tags: #PROVIDER #PAYER
Commentary: Where the US Health System Is Headed
Three commentaries this week take aim at the direction of the US health system from different angles. Former Food and Drug Administration (FDA) Commissioner Robert Califf used his SCCT 2026 keynote to warn that the US health system is losing ground, expanding on where it is headed in a follow-up interview. A Bloomberg opinion column argues the No Surprises Act — the 2022 bipartisan ban on balance billing for out-of-network emergency care — is now raising system costs through its arbitration design. And Vox examines Democrats’ avoidance of the Medicare-for-all question, framed around Michigan Senate frontrunner Abdul El-Sayed’s single-payer platform covering all necessary care without cost sharing.
- Former FDA commissioner warns that US healthcare system is falling behind
- No Surprises Act Could Be A Shock To The Healthcare System
- The big healthcare fight Democrats keep dodging
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