May 7, 2026
Medicare Advantage: Policy Risk Panoply
With 1Q26 earnings now largely complete for the major Medicare Advantage (MA) insurers [UNH, HUM, ALHC, CVS, ELV, CNC, MOH], near-term MA policy risks remain less acute, though far from extinguished. Congressional cuts remain unlikely…
May 1, 2026
Medicaid Work Requirements: Despite Certain Restrictive Actions, Overall State Flexibility Likely Limits Risk [CNC, MOH, HCA, THC, UHS]
A wave of state actions (AR, IA, ID, IN, MO, MT, NC, NE, NH) on Medicaid community engagement requirements (aka work requirements), spanning both accelerated implementation like today’s launch in NE and in some cases,…
April 21, 2026
Being Coy on BALANCE – How Could CMS and Insurers Get to Yes [UNH, ELV, HUM, CVS, CNC, CI, MOH]
UnitedHealth’s (UNH) comments on its earnings call this morning, responding to a question about potential participation in CMS’s BALANCE obesity drug model, suggest that further design changes will be required for it – and likely…
March 30, 2026
Hospitals, Insurer, Home Care, HSAs, PBMs: What Is a Realistic Federal Healthcare Savings Target in Reconciliation?
As the prospects have risen for another budget reconciliation bill, so has the risk for another legislative round of healthcare spending cuts, pressuring insurers, hospitals and home care and hospice agencies as a partial pay-fors…
March 16, 2026
Medicare Advantage: Final CY27 Rates Expectations of 1%-3% Increase [HUM, ALHC, UNH, CVS, ELV, CNC, PRVA, ASTH, EVH, DVA, FRE.DE]
We continue to expect CMS’s final CY27 rate announcement for Medicare Advantage (MA) insurers [HUM, ALHC, UNH, CVS, ELV, CNC], affecting their contracted value-based care providers [PRVA, ASTH, EVH], to produce a low single-digit increase…
March 10, 2026
Medicaid Expansion Levels – Thoughts on Potential 2027 Enrollment Declines [MOH, CNC, ELV]
With Medicaid insurers [MOH, CNC, ELV] projecting more muted Medicaid enrollment changes for 2026 compared with the sizable attrition during the post-pandemic Medicaid unwinding – and little guidance on what comes next – investors are…
March 2, 2026
CMS’s ELV Sanction Warnings Sends MA Risk Adjustment Message, But Does It Up the Ante on a Broader Crackdown?
CMS’s warning letter against ELV of potential sanctions on new Medicare Advantage (MA) enrollment underscores another enforcement lever the agency can deploy to curb improper risk adjustment behaviors and overpayments. As the agency remains committed…
February 10, 2026
Ongoing Obamacare Market Evolution: Lower-Cost Plans Mix Shift Amidst Design Changes and Program Integrity Focus [OSCR, CNC, HQY, HCA, CYH]
Recent Obamacare developments (ACA proposal, House committee subpoenas, and OSCR’s earnings) reinforce this market’s durability and clear directional shift toward more-streamlined, lower-cost coverage and greater encouragement of enrollees to be more involved in their healthcare,…
February 4, 2026
CI Proposed FTC Settlement: What Might It Mean for PBMs? [CI, UNH, CVS, ELV, PGNY, CNC, HUM]
Cigna’s (CI) proposed settlement with the FTC over antitrust allegations regarding its PBM pricing, rebating and formulary practices around insulin likely establishes the basic framework that UNH and CVS will have to match to resolve…
January 26, 2026
Medicare Advantage: CMS’s Negative Surprise of Flat Rates and Risk Adjustment Changes – What Now?
CMS’s negative surprise to Medicare Advantage (MA) insurers [HUM, UNH, ALHC, CVS, ELV, CNC] – which is also likely to spill over into weakness among insurers less or not exposed to this market [MOH, OSCR,…