‘A missed opportunity’: Payers lash out against surprise billing final rule

A highly anticipated rule finalized Thursday meaningfully improves how insurers and providers settle disputes over out-of-network bills. But payers say it doesn’t go far enough to curb alleged provider abuse.

By Rebecca Pifer Parduhn • May 29, 2026

Uninsurance rate holds flat in 2025: CDC

The percentage of Americans without insurance last year remained relatively flat compared to 2024. However, more people are likely to lose coverage in the years to come due to healthcare spending cuts from the “Big Beautiful Bill.”

By Emily Olsen • May 29, 2026

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Surprise Billing

Federal legislation banning surprise bills has hit a barrage of roadblocks, complicating efforts to protect consumers from unexpected out-of-network charges.

By Healthcare Dive staff

Trump administration reforms surprise billing dispute resolution

The industry has been waiting for regulators to finalize the rule amid snowballing concerns about how insurers and providers settle out-of-network claims. The regulation is aimed at making that process more efficient.

By Rebecca Pifer Parduhn • May 28, 2026

CVS sues to challenge new Tennessee PBM-pharmacy breakup law

The law, which would prohibit PBM conglomerates from owning or operating pharmacies, illegally boots out-of-state companies from Tennessee’s pharmacy market, CVS argued in a suit filed Friday.

By Rebecca Pifer Parduhn • May 27, 2026

HHS launches AI-backed health fraud crackdown

The department will use AI to examine audits from states and other federal grant recipients, and potentially withhold funds if they aren’t able to fix errors.

By Emily Olsen • May 22, 2026

Vertical integration doesn’t appear to lead to higher drug costs in Medicare, HHS OIG finds

However, data was limited, so it’s too early to make firm conclusions, the watchdog clarified. That didn’t stop the largest PBM lobby from jumping on the report as concrete proof that consolidation doesn’t drive up prices.

By Rebecca Pifer Parduhn • May 21, 2026

Trump administration proposes crackdown on Medicaid state-directed payments

The proposed rule codifies cuts outlined in the GOP’s “One Big Beautiful Bill,” but also takes other steps to restrict supplemental Medicaid payments. The CMS said it would save the federal government over $500 billion if finalized.

By Sydney Halleman • May 21, 2026

Lawmakers mull Medicare physician pay reform to tamp down consolidation

Physician pay hasn’t kept up with the costs of providing care, pushing independent practices to sell to health systems and likely increasing costs, witnesses said during a House subcommittee hearing.

By Emily Olsen • May 21, 2026

ACA deductibles reach record high as membership losses slated to continue: KFF

A fuller picture is emerging of how the expiration of enhanced subsidies is affecting the Affordable Care Act exchanges and the millions of Americans who rely on them for coverage.

By Rebecca Pifer Parduhn • May 20, 2026

Senate Democrats move to roll back Medicare AI prior authorization pilot

Lawmakers introduced a resolution to end the WISeR model, which Democrats say is delaying and denying care to seniors.

By Emily Olsen • May 20, 2026

HHS reorganizes Office for Civil Rights with religious bent

The civil rights enforcement arm of the HHS will reinstate a division dissolved during the Biden administration that focuses on conscientious objections and religious issues in health and social programs.

By Sydney Halleman • May 20, 2026

Employer to pay $4.25M to settle claims it failed to consider vaccine exemptions

Recent enforcement involving COVID-19 vaccines appears to go hand in hand with the Trump administration’s broader prioritization of Christian issues.

By Emilie Shumway • May 19, 2026

Tenet hospitals, Leapfrog spar over legal fees in hospital ratings case

The Tenet-owned hospitals want Leapfrog to pay $10.5 million in legal fees after a judge agreed that the nonprofit unfairly deflated their ratings. The penalty would “cast a specter of financial ruin” over the nonprofit, Leapfrog said.

By Sydney Halleman • May 19, 2026

CMS finalizes major changes to ACA exchanges, including greater access to catastrophic plans

The Trump administration continues to open the doors to the cheap, high-deductible coverage, to the worry of insurance experts and stakeholders in the healthcare industry.

By Rebecca Pifer Parduhn • May 18, 2026

Employer groups, unions urge Trump administration to reform No Surprises dispute resolution

Providers are reaping high award amounts, and arbiters have “structural conflicts of interest” that incentivize a high volume of disputes, driving up healthcare costs for employers and patients, the groups wrote.

By Emily Olsen • May 18, 2026

Supreme Court preserves access to abortion pill by mail

The ruling maintains access to mifepristone while litigation continues. The drug can still be prescribed at pharmacies or by mail without requiring in-person visits.

By Sydney Halleman • May 15, 2026

CMS launches initiative to speed electronic prior authorization adoption

The effort, part of the agency’s ambitious Health Tech Ecosystem, aims to accelerate the industry’s progress before requirements on electronic prior authorization go into effect next year.

By Emily Olsen • May 14, 2026

Physicians skeptical of insurer pledges to reform prior authorization: survey

Only 33% of physicians surveyed by the American Medical Association said they believed voluntary pledges made by major insurers last year to reform prior authorization would result in any meaningful difference to the industry.

By Sydney Halleman • May 14, 2026

CMS suspends new Medicare enrollment of hospice, home health providers

The agency is halting enrollments for six months as part of the Trump administration’s broader attempt to crack down on fraud. Hospice and home health groups said they largely supported the moratorium.

By Emily Olsen • May 13, 2026

FDA chief Marty Makary resigns from agency, ending tumultuous tenure

Makary’s exit ends a turbulent run marred by leadership upheaval, mass layoffs, political pressure and public spats with drugmakers.  

By Ben Fidler • May 12, 2026

Feds propose rule to help employers expand fertility benefit coverage

The proposal addresses a key plank in President Donald Trump’s labor agenda and would exempt fertility benefits from the requirements of some federal health coverage laws.

By Ryan Golden • May 11, 2026

MACPAC calls for increased transparency in Medicaid AI prior authorization

The influential advisory group is recommending policies to boost human oversight and visibility into how Medicaid plans are using the technology, in a bid to prevent risks like inaccuracies or data bias.

By Emily Olsen • May 11, 2026

Federation of American Hospitals taps new government relations head

Elizabeth Schwartz will head up government relations at the for-profit hospital trade association as health systems brace for federal funding cuts.

By Sydney Halleman • May 8, 2026

Healthcare sector continues to buoy job growth

“Remove healthcare from the equation, and the US labor market is actually losing more than it is gaining,” one economist said.

By Kathryn Moody • May 8, 2026

FDA warns of neurosurgical supply disruptions

Interruptions in the supply of neurosurgical patties, sponges and strips are expected to continue through 2026.

By Elise Reuter • May 6, 2026