ACA marketplace enrollment decline puts coverage affordability in focus
The Trump administration released updated 2026 enrollment figures for Affordable Care Act (ACA) marketplace plans, arguing that the year-over-year decrease resulted from efforts to crack down on fraud. Enrollment fell from 22.1 million at the end of 2025 to 19.2 million in February 2026.a The drop-off largely reflects reductions in improper enrollment rather than in…
340B bill would levy various restrictions on participating hospitals
Legislative language overhauling the 340B Drug Pricing Program faces a long and uncertain path in Congress but would have significant implications if some of the provisions become law. A preliminary bill draft released by Sen. Bill Cassidy (R-La.) would tighten oversight of hospitals and contract pharmacies, increase transparency and require 340B discounts to be transferred…
Update: Litigation about the 340B program’s ‘patient’ definition could affect hospital savings
Note: This story is an update to prior coverage. Providers weighing in on potentially disruptive litigation involving the 340B Drug Pricing Program say a ruling in favor of the drug manufacturer would have substantial implications for the program. In a case brought by AbbVie Inc. against the federal government, the central question concerns the definition…
Hospital drug and supply expenses push finance teams to rethink cost strategy
With drug and supply costs continuing to strain margins, hospitals are searching for strategic approaches to mitigate the impact. Drug costs are surging, driven by specialty drugs ranging from GLP-1 products to cell and gene therapies. Citing industry data, Emad Rizk, MD, who recently moved into the top position with Premier Inc., pointed to pharmaceutical…
Medicare funding projections sharpen concerns over access and payment rates
The latest annual report on the state of Medicare funding reflects a conundrum for healthcare industry stakeholders. Medicare spending on healthcare services is on an increasingly difficult fiscal track, projected to rise from $1.2 trillion in 2025 to $2 trillion in 2035. Yet as acknowledged in the report issued this month by the Medicare trustees,…
Dispute resolution likely to be more disruptive as a result of new rule
A recently released CMS final rule concerning independent dispute resolution (IDR) mediation likely will cause a further bottleneck of No Surprises Act-based appeals, experts said. In the final rule, the fees were set at $15, down from $115 paid before the proposed rule came out. CMS in its proposed rule had originally set the revised…
FY27 HHS budget proposal includes rural health gains, CDC cuts
HHS discretionary funding in FY27 would decrease by close to 4% from current appropriations, according to a budget proposal that advanced out of the House Appropriations Committee this month. The $110.8 billion allocation would be roughly $4 billion lower than FY26 enacted funding. The budget appears to preserve more funding for traditional programs, relative to…
DOJ’s OhioHealth antitrust settlement affects payer contracts
The U.S. Department of Justice and OhioHealth have settled antitrust litigation that hinged on allegations concerning the health system’s contracting practices. A June 16 filing with the Southern District of Ohio federal court states that the parties, which also include the state of Ohio, reached a consent decree in which OhioHealth does not admit wrongdoing…
No Surprises Act arbitration may raise premiums and healthcare costs, CBO says
The Congressional Budget Office (CBO) may need to rethink its original projection that the No Surprises Act would save money for the federal government, the agency said this week in a recommendation for additional research on the issue. In 2021, the CBO estimated that the newly signed law would lower provider payments, especially out-of-network rates,…
340B rebate model pilot advances as providers warn of added costs
The Health Resources and Services Administration (HRSA) continues to take steps toward implementing a rebate model for the 340B Drug Pricing Program. After soliciting comments on a planned model over a two-month period, HRSA sent an updated notice May 27 to the Office of Management and Budget (OMB) for a review that remains ongoing. That…