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 9, 2025
Obamacare HIX Fix: HSAs for All or Compromise on Subsidy Changes? We Still Think the Latter [OSCR, CNC, ELV, MOH, UNH, HQY, WBS, EHTH]
President Trump’s Truth Social posts over the weekend, along with that of other Republicans, suggest an existential threat for Obamacare insurers [OSCR, CNC, ELV, MOH, UNH] and potentially other commercial health insurers [CI, CVS] while…
November 7, 2025
Obesity Drug Pricing Deal: Devil in the Details
As outlined by the Trump administration, we view yesterday’s obesity drug pricing deal with NVO and LLY as a modest near-term positive (potentially better for LLY), with the $245 / mo. price point for Medicare…
November 5, 2025
Medicare Advantage: Still Expecting Light Regulatory Touch for CY27 [HUM, ALHC, AGL, UNH, CVS, ELV, CNC, PRVA]
Listening to recent earnings calls held by various Medicare Advantage (MA) insurers and value-based care providers [HUM, ALHC, AGL, UNH, CVS, ELV] leaves us with the following thoughts on the MA regulatory policy environment for…
October 15, 2025
PBMs: Policy Headwinds Persist with Some New Developments [CVS, CI, UNH, ELV]
Policy headwinds facing pharmacy benefit managers (PBMs) [CVS, CI, UNH, ELV] remain entrenched despite shifting details since this spring. Recent developments, like California’s PBM law, White House drug pricing efforts, and the FTC litigation, underscore…
October 14, 2025
[HUM] Stars Rating Litigation Likely Brings Chapter to Close
We think this morning’s court ruling against Humana (HUM) in its Medicare Advantage (MA) Stars litigation is likely the end of the road in its efforts to secure a higher score for its 2026 payment…
October 8, 2025
[EHAB, PNTG, ADUS, BTSG, UNH, AVAH]: Medicare Home Health Expectations
We remain optimistic that home health companies [EHAB, PNTG, ADUS, BTSG, UNH, AVAH] will secure some mitigation in the final CY26 Medicare reimbursement rule, which may be released as early as month’s end and as…
September 29, 2025
Medicare Advantage: CMS’ Stable Message Eclipsed by Falling Enrollment Forecast, But A Wait and See Attitude Is Appropriate
While reports over the weekend about CMS’s Friday release of the Medicare Advantage (MA) and Part D Plan (PDP) premium, deductible and other information for the 2026 plan year focused on the 2.6% projected cut…
September 26, 2025
Medicare Advantage RADV Audits in Legal Limbo, But Don’t Discount Its Resurrection [HUM, UNH, CVS, CNC, ELV, ALHC]
Medicare Advantage (MA) insurers [HUM, UNH, CVS, CNC, ELV, ALHC] received some positive legal news that for now neutralizes the concern of widespread Medicare audits and potential concomitant recoupments. However, yesterday’s federal district court ruling…
August 18, 2025
[CVS, CI, UNH, ELV]: CA’s PBM Reform Bill Appears Next Up in PBM Fight
With California’s legislature coming back Monday from its summer recess for its final few weeks of the regular session, pharmacy benefit manager (PBM) legislation is still on the docket and likely to invite headline risk…