December 17, 2025
Obamacare Subsidy Developments: Lots of Movement but Still in Same Place for Now; Path Remains for Subsidy Deal in 1Q
Today’s news that four House Republicans joining House Minority Leader Hakeem Jeffries’ (D-NY) discharge petition for a straight three-year extension of the enhanced Obamacare subsidies – and with House GOP leadership narrowly passing its own…
December 4, 2025
ACA Situation Stuck in Place but We Remain Optimistic of Eventual HIX Deal with a Slipping Timeline
The recent fits-and-starts for around a compromise to avert expiration of the ACA enhanced premium tax credits (eAPTCs) at year-end unsurprisingly remains stalled, with no meaningful concessions from either side’s leaders. As we head into…
November 24, 2025
ACA HIX Fix: Enactment Odds Improve But Details TBD [OSCR, CNC, ACHC, THC, CYH, UHS, DVA, HQY]
Media reports (here, here, here) indicate that an ACA compromise may be imminent, with President Trump reportedly offering to support extension of the enhanced premium tax subsidies (with limitations) while channeling a portion into health…
November 23, 2025
ASC Wins in Final CMS Rate Rule, Slight Hospital Wins but Lingering Concerns
Ambulatory surgery centers (ASCs) [SGRY, AmSurg, THC, HCA, UNH] secured some policy wins in the final CY26 Medicare outpatient prospective payment system (OPPS) rule, consistent with the July proposal (notably a broadened covered procedure list,…
November 19, 2025
Finance Committee Hearing: Still Think ACA Subsidy Deal is More Likely Even If Late [OSCR, CNC, CYH, UHS, DVA, FMS, HQY, WBS]
This morning’s Senate Finance Committee hearing on rising healthcare costs did little to break the stalemate on Obamacare, but no one expected a breakthrough today. The hearing primarily served as a venue for both sides…
November 17, 2025
CMS Provider Tax Guidance: More Details, But Not Necessarily Stricter or More Aggressive Interpretation [ARDT, CYH, HCA, THC, UHS, CNC, MOH, ELV]
CMS’s preliminary guidance to states on its interpretation of the One Big Beautiful Bill’s (OBBB) Medicaid provider tax provisions does not appear to tighten the screws on states, and thereby threaten hospitals [ARDT, CYH, HCA,…
October 21, 2025
Rural Health Transformation Program (RHTP): Seems Less About Hospitals and More About Systemic Change [CYH, ARDT, THC, municipal facilities, OMDA, TDOC, RDNT]
As the November 5 deadline approaches for state submissions to the highly anticipated $50 billion Rural Health Transformation Program (RHTP), uncertainty remains about whether – or even how – these funds will reach hospitals [CYH,…
October 6, 2025
Still Optimistic on Obamacare Subsidy Fix with Reforms, But Less So on Age Rating and Reinsurance [OSCR, CNC, ELV, CYH, THC, HCA, UHS, ACHC]
Nearly a week into the government shutdown, with the parties dug in, we continue to expect Congress to “fix” the enhanced Obamacare subsidy cliff, benefiting exchange insurers, hospitals, and behavioral health providers. The questions remain…
September 10, 2025
Status of Medicaid Work Requirements Among States [CNC, MOH, CYH, HCA, THC, UHS, ACHC, MMS]
Headline risk to Medicaid insurers [CNC, MOH], hospitals [CYH, HCA, THC], behavioral providers [UHS, ACHC], and Medicaid contractors [MMS] is likely to ramp up in the coming months as 15 states take affirmative steps toward…
September 9, 2025
[Hospitals, Nursing Homes, Medicaid Providers] CMS Guidance on SDPs Fleshing Out OBBB; Possible Negative Bias?
Late Tuesday, CMS released a letter to state Medicaid offices with its preliminary interpretations of the One Big Beautiful Bill (OBBB) Act’s provision placing total payment limits on hospitals, nursing homes, and certain practitioners at…