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Payer Issues

The quiet math behind growing OON fights | Inside Optum's Minn. Medicaid audit | BCBS Mich. to halve some E/M payments | Ind. to seek bids for $68B Medicaid contracts | ACO enrollment grows to 14.3M

Contracting fights are becoming more public and Optum releases first findings from its Minnesota Med February 9, 2026 1. 'Sometimes these things defy all business logic': Inside the calculus of going out-of-network Full story 2. Optum flags $1.7B in potential…

By: Nikhil Gaikwad

ACA subsidy extension efforts 'effectively over' | Cuban casts doubt on FTC, Cigna deal | Optum's provider acquisitions tied to price increases | What Renown sees in Kaiser partnership | Centene posts $6.7B loss in '25

Senate efforts to expand ACA subsidies have collapsed and Centene recorded big losses in 2025 February 6, 2026 1. 'Meh': Mark Cuban casts doubt on FTC, Cigna PBM settlement Full story 2. Optum's provider acquisitions tied to price increases for rival insurers:…

By: Nikhil Gaikwad
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Elevance sues 4 execs over noncompetes | Aetna names Medicaid president | Fitch issues proposed MA rate warning | One-third of insured adults: Prior auth is ‘major burden’ | HDHPs linked to lower cancer survival

Elevance is suing former execs again over noncompetes and a new poll reveals prior auth burden February 3, 2026 1. Elevance sues 4 former execs over noncompete violations Full story 2. Aetna COO tapped to lead Medicaid division Full story…

By: Nikhil Gaikwad

Mangione won’t face death penalty | DOL pitches PBM pay transparency | BCBS profit margins fall | CMS rule to phase out Medicaid provider taxes | 53 million MA prior auths in '24: 6 notes

Luigi Mangione won’t face the death penalty and the Labor Dept. is targeting PBM transparency January 30, 2026 1. Luigi Mangione won't face death penalty, judge rules Full story 2. Labor Department proposes PBM compensation disclosure rule for self-insured plans…

By: Nikhil Gaikwad
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