From sweeping federal healthcare policy proposals to upheaval at the nation’s largest insurer, these are the most impactful stories within the health insurance industry since the start of 2025.
Medicaid proposals
Republicans’ “One Big Beautiful Bill,” passed by the House on May 22 and now under Senate consideration, proposes major changes to Medicaid and the ACA that the CBO says would dramatically reduce health coverage. Combined with other scheduled policy changes, total coverage losses are projected to reach 16 million by 2034.
The 1,116-page bill includes restrictions on federal loans for medical students and a permanent inflation-based formula for Medicare physician payment updates, drawing growing concern from hospitals, physician groups and other healthcare stakeholders. Work requirements (80 hours per month) would lead to 4.8 million adults losing Medicaid coverage. Tighter redeterminations every six months — instead of annually — would result in 700,000 disenrollments.
AHIP has warned the legislation could lead to ‘unprecedented’ coverage losses, raise premiums in the individual market and set back efforts on chronic disease.
Revisions are likely as lawmakers work to unify support and advance the legislation to President Trump’s desk before July 4.
Challenges at UnitedHealth
From leadership changes to a pulled earnings outlook, it has been a challenging year for UnitedHealth Group.
In May, CEO Andrew Witty stepped down and was replaced by board chairman and former CEO Stephen Hemsley.
On the same date Mr. Witty announced his resignation, UnitedHealth suspended its 2025 earnings outlook as “care activity continued to accelerate while also broadening to more types of benefit offerings than seen in the first quarter,” especially in the Medicare Advantage business. Mr. Hemsley addressed investors in June, acknowledging the company’s recent shortcomings and detailing his plan to restore the high performance that investors and customers expect moving forward.
At the same time, the company is facing at least three investigations from the Justice Department involving Medicare Advantage billing and antitrust concerns.
Smaller insurers stumble
Nonprofit, regional, or provider-owned insurers are struggling. Several Blue Cross Blue Shield plans reported losses in 2024, and health systems are scaling back or shuttering their insurance operations altogether. The rising costs of medical care, increasing regulatory demands, and a focus on clinical operations over insurance offerings have driven these decisions.
In contrast to these setbacks, some small insurers have reported major gains in membership and revenue this year.
Major changes at CMS
CMS Administrator Mehmet Oz, MD, is charting an ambitious course for the agency, pledging to align federal healthcare policy with President Donald Trump’s “Make America Healthy Again” agenda while pushing for sweeping reforms across Medicaid, Medicare and the ACA marketplace.
In April, CMS published its final rule for Medicare Advantage and Part D in 2026, which aims to streamline prior authorization, tighten oversight of supplemental benefits and codify provisions from the Inflation Reduction Act.
While the agency plans to increase payments to MA plans by more than $25 billion in 2026, it is also looking to audit every MA plan annually as part of what it calls an “aggressive” effort to strengthen oversight and address potential overpayments.
Justice Department sues brokers
The Department of Justice is suing Humana, Aetna, and Anthem, along with Medicare Advantage brokers eHealth, GoHealth, and SelectQuote, alleging a multi-year scheme involving unlawful kickbacks and discriminatory practices against disabled MA enrollees.
According to the May complaint, the insurers paid hundreds of millions of dollars from 2016 through at least 2021 to the brokers in exchange for preferential treatment, including steering enrollees toward their MA plans and away from competitors, regardless of the quality of the plans.
