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 23, 2026
Hospital DPPs: Less Dependable, Though Still Relevant Post-OBBB: Questions of Where and How Much Remain? [HCA, THC, CYH, ARDT, UHS, MPT, SGRY, govt hospitals]
While Medicaid funding from state directed payment programs (DPPs) cannot be relied upon as much a key revenue driver – and has received less attention on recent earnings calls – these incremental dollars are still…
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…
February 3, 2026
Hospices: Heightened CMS Scrutiny, Targeted CMS Enforcement, and Limited Sector-Wide Risk [CHE, BTSG, PNTG, ADUS, Elara Caring, Compassus]
The recent public clash between CMS Administrator Mehmet Oz and California Governor Gavin Newsom (D-CA) over Medicare fraud has renewed questions about whether the hospice industry [CHE, BTSG, PNTG, ADUS, AVAH, UNH, private Elara Caring…
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,…
January 21, 2026
Insurer Policy Concessions, Political Theater, & the Limits of Cost Reforms [UNH, CI, CVS, ELV]
While UNH’s announcement this morning that it will rebate its expected 2026 ACA profits has drawn the most attention – and may pressure other Obamacare insurers [ELV, CI, HUM, CNC, OSCR, MOH] to make similar…
January 20, 2026
CORRECTED: PBMs: Latest Spending Draft’s Watered-Down Reforms Are Incremental, Not Transformational [UNH, CVS, CI, CNC, ELV, HUM]
The latest draft of the government spending bill, released early this morning, presents an even more manageable policy outcome for pharmacy benefit managers (PBM) [UNH, CVS, CI, CNC, ELV, HUM] than previously expected; it revives…
January 16, 2026
MedPAC Thoughts, Congress Unlikely to Listen
We expect the Medicare Payment Advisory Commission’s (MedPAC) FY/CY27 provider payment recommendations to meet the same fate as in prior years: largely ignored by Congress, though selectively cited by CMS to justify future regulatory tightening…
January 15, 2026
Trump’s Great Healthcare Plan – We’ve Seen and Heard It Before
President Trump’s long-teased “Great Healthcare Plan”, released this morning, does little to meaningfully move the needle on healthcare redesign or cost containment beyond our prior expectations for legislative action affecting Obamacare insurers, non-ACA managed care…