August 7, 2025
Health Insurer / Provider Legislative Agenda: Band-Aid Likely in September CR, More Substantial Package Potentially Later in the Year
With the August recess in full swing for the next few weeks, the various healthcare-related legislative items on Congress’s to-do list (see below) remains lengthy for the rest of the calendar year. We are still…
August 3, 2025
Hospices, IRFs, IPFs: Thoughts on Final FY26 Medicare Payment Rules
Medicare’s final FY26 payment regulations for hospices [CHE, AMED, ADUS, PNTG, BTSG, Gentiva, Compassus, Elara], inpatient rehab facilities (IRFs) [EHC, SEM], and inpatient psych facilities (IPFs) [UHS, ACHC] aligned with expectations for: 1) slightly higher aggregate spending…
July 22, 2025
Obamacare Enhanced Subsidy Debate – Where We Stand [OSCR, CNC, ELV, THC, CYH, UHS]
While exchange insurers (OSCR, CNC, ELV) and hospitals (THC, CYH, ARDT, UHS, HCA) try to figure out their Obamacare businesses for next year with the various regulatory and reconciliation-related changes leading to anticipated enrollment declines…
July 16, 2025
Medicare CY26 OPPS Proposal: Hospital Outpatient Departments a Loser While ASCs a Winner
Hospitals [CYH, ARDT, UHS, THC, HCA] were on the losing end of the stick under CMS’s proposed CY26 Medicare reimbursement rule for hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs) for a variety of…
July 9, 2025
Reconciliation: Final Healthcare Provisions; Clarifying Tweaks to DPP Language and Overlooked Parts of Work Requirements
While we still agree with consensus about the negative bias towards hospitals and Medicaid insurers from the One Big Beautiful Bill Act (OBBA) signed into law last Friday, we note a few tweaks in the…
June 30, 2025
Healthcare and Reconciliation: Where Things Stand Amid Floor Debate
We expect the Senate to pass the reconciliation bill within the next 24 hours, despite the current reconciliation drama (parliamentarian rulings, CBO projection of deficits post-2034, Senator Thom Tillis’s (R-NC) retirement announcement, House member opposition,…
June 26, 2025
Hospitals, Obamacare, Medicaid: Parliamentarian Decisions Likely to Force Rewriting on Provider Tax, Uncertain about CSR and Enhanced FMAP Policies
The sizable hole left by the Senate parliamentarian decisions on various Medicaid and Obamacare provisions, which were reported this morning by Senate democrats (here and here) injects uncertainty for hospitals, Obamacare insurers, Medicaid managed care,…
June 22, 2025
Obamacare: Program Integrity Rule Meets Overall Expectations, Though Relative Slight Improvement; Risk Remains
Amidst the behind-the-scenes Senate debate of its draft reconciliation bill, CMS made good on its threat to jettison improper and fraudulent Obamacare enrollment, impacting ACA insurers [OSCR, CNC, ELV, MOH] and hospitals / behavioral facilities…
June 8, 2025
[HCA, THC, CYH, hospitals] White House Memo Adds Another Wrinkle to State-Directed Payment Programs in Medicaid
A new complication has arisen for hospitals [HCA, THC, CYH, ARDT, UHS, non-profit / municipally-backed facilities] – and to a lesser extent nursing homes, behavioral providers, and certain physicians – in the debate over payment…
May 12, 2025
Healthcare & Reconciliation: Worst Case Avoided
The House Energy & Commerce Committee’s (E&C) reconciliation draft (text and summary) seems to largely align with our expectations regarding cuts / risks in Medicaid, Obamacare, and pharmacy benefit managers (PBM). While there were still…