GOP-led states are likely to be most affected by expiring ACA subsidies and price transparency rules December 30, 2025 1. States facing steepest coverage losses as ACA subsidies expire Full story 2. CMS proposes new price transparency rules Full story…
Payer Issues
Federal lawmakers are weighing in on Elevance’s new 10% hospital penalty and we recap Dr. Oz’s first December 29, 2025 1. Lawmakers call for investigation of Elevance's new hospital penalty for using out-of-network providers Full story 2. Federal judge blocks…
Tenet launched a campaign amid Cigna negotiations, and CMS' BALANCE model December 26, 2025 1. Tenet, Cigna tensions heat up as contract deadline nears Full story 2. CMS kicks off GLP-1 model: 7 notes Full story 3. Autonomous & proactive…
Aetna to settle a lawsuit over fertility treatments, and BCBS of Alabama also hit with legal action December 23, 2025 1. Aetna to settle discrimination lawsuit over fertility treatments Full story 2. Hospital sues BCBS of Alabama over reimbursement amid…
UnitedHealth shares companywide audit findings, and CMS' Medicare drug-pricing models December 22, 2025 1. UnitedHealth releases companywide policy audit report: 10 things to know Full story 2. CMS proposes 2 Medicare drug-pricing models Full story 3. Autonomous & proactive —…
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Hospitals want Elevance to drop its new out-of-network penalty policy and CMS rolls out a new ACO mo December 19, 2025 1. Hospital groups call on Elevance to rescind 'punitive' 10% hospital penalty for using out-of-network providers Full story 2. CMS' long-term…
UnitedHealthcare is delaying a controversial RPM coverage policy and there may be a vote on extendin December 18, 2025 1. UnitedHealthcare delays new remote physiologic monitoring coverage policy Full story 2. 'What if we could eliminate prior authorizations?': Why this…
The House won’t be voting on extending ACA subsidies and a new report shows wide variation in price December 17, 2025 1. House GOP won't call vote on ACA subsidy extension Full story 2. California fines 3 Centene health plans…
Humana’s insurance leader is retiring and New Hampshire steps into the payer-provider AI fight December 16, 2025 1. Humana insurance president to retire, replacement named Full story 2. Health plans losing nearly half of cases that reach independent medical review:…
GOP lawmakers pitch another healthcare bill and a new study calls payers' price transparency complia December 15, 2025 1. House floats new healthcare bill after Senate proposals fail Full story 2. Insurers not fully complying with price transparency rules: Study…