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    CMS finalizes rule cracking down on Medicaid provider taxes

    The rule puts limits on states levying higher taxes on Medicaid businesses. The CMS argues the tax arrangements allow states to shift costs onto the federal government, but providers say they’re integral for covering the cost of care.

    By Emily Olsen • Jan. 30, 2026
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    Labor Department wants to strong-arm PBMs into being more transparent with employers

    The DOL proposed a rule that would force pharmacy benefit managers to share a broad range of pricing and compensation information with their employer clients, calling it the most significant proposed PBM reform in decades.

    By • Jan. 30, 2026
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    Trendline

    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
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    Medicaid contractors strike deals with CMS to help states execute work requirements

    Ten Medicaid systems vendors have agreed to provide low- or no-cost services to states over the next two years. The Trump administration said the agreements would save $600 million.

    By • Jan. 29, 2026
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    ACA enrollment backslides to 23M in 2026

    That’s down 5% from last year. But it’s not the nosedive some market watchers predicted, and a handful of states — notably, Texas — saw robust growth.

    By • Jan. 28, 2026
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    Drugs for cancer, arthritis and HIV on Medicare’s list for 2028 price cuts

    Still, the medications in the latest round of negotiations — which now includes Part B drugs given in doctor’s offices — draw very limited revenue from Medicare, an analyst pointed out.

    By Jonathan Gardner • Jan. 28, 2026
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    Deep Dive

    Health insurers brace for impact in 2026

    Profits will start to tick up after reaching trough levels. Washington will play nice. M&A and AI adoption will accelerate. We asked experts to look into their crystal balls on what the coming year means for a beleaguered industry.

    By • Jan. 28, 2026
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    CMS official defends flat Medicare Advantage rate proposal for 2027

    Medicare director Chris Klomp said the Trump administration is “massively” in support of MA as health insurers cry foul over the meager rate update.

    By • Jan. 27, 2026
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    CMS proposes excluding chart reviews from MA risk scoring in 2027 payment rule

    The proposal would eliminate the financial motivation insurers have to mine their members’ charts for additional diagnoses. Regulators also proposed a flat rate update for 2027, prompting anger from insurers.

    By • Jan. 27, 2026
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    Surprise Billing

    No Surprises disputes increasing even as arbiters catch up, CMS says

    The agency released new data on independent dispute resolution in the first half of 2025. Roughly 1.2 million cases were filed in that period, mostly by the same private equity-backed providers.

    By • Jan. 26, 2026
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    CVS accused of shutting out rival pharmacy hubs in House Judiciary investigation

    The company’s massive pharmacy benefit manager changed its rules and weaponized audits to ensure independent pharmacies couldn’t work with competing pharmacy service companies, House Republicans said.

    By • Jan. 26, 2026
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    Rebecca Pifer Parduhn/Healthcare Dive
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    Insurance CEOs’ no good, very bad day on the Hill

    The chief executives of UnitedHealth, CVS, Cigna and Elevance were pilloried for care denials, vertical consolidation and sky-high executive compensation during two House hearings Thursday.

    By • Jan. 23, 2026
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    Express Scripts considering settlement in FTC insulin price lawsuit

    The antitrust agency paused its lawsuit against the pharmacy benefit manager while the two discuss a proposed consent agreement.

    By Emily Olsen • Jan. 23, 2026
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    Congress eyes tackling healthcare consolidation

    “I think there’s common ground here,” one Republican congressman said during a House Budget Committee hearing. Squaring up against healthcare monopolies would be a major pivot for the GOP.

    By • Jan. 22, 2026
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    UnitedHealth pledges to return ACA profits to customers

    The announcement came one day before CEO Stephen Hemsley testified on healthcare affordability in front of two congressional committees.

    By • Jan. 21, 2026
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    Healthcare False Claims settlements reached record $5.7B in 2025

    The healthcare fraud settlements under the False Claims Act last year more than tripled the amount from 2024.

    By • Jan. 21, 2026
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    Medicare Advantage overpayments will total $76B this year: MedPAC

    The findings are “very depressing,” one commissioner said. Still, it’s a smaller sum than in 2025, thanks to the continued phase-in of a new risk adjustment model.

    By • Jan. 16, 2026
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    Hospital-at-home programs face uncertainty as another deadline looms

    The Acute Hospital Care at Home Program could lapse on Jan. 30 without congressional action, creating significant administrative complexity for providers, experts say.

    By Emily Olsen • Jan. 15, 2026
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    Trump unveils healthcare affordability plan

    The “Great Healthcare Plan” is vague, but would send money directly to ACA enrollees and entrench Trump’s drug pricing deals.

    By • Jan. 15, 2026
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    Kaiser affiliates to pay $556M to resolve Medicare Advantage fraud allegations

    The Justice Department claims some Kaiser health plans submitted invalid diagnostic codes to reap higher reimbursement from Medicare. It’s the largest settlement linked to MA upcoding to date, according to one law firm.

    By • Jan. 15, 2026
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    Utilization, intensity drove US health spending to $5.3T in 2024: CMS

    The U.S. spent 7.2% more on healthcare in 2024. Most of the acceleration was because of greater use and intensity of medical goods and services, not growth in healthcare prices, CMS actuaries said.

    By • Jan. 14, 2026
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    HHS reverses layoffs at CDC’s work safety research division

    Workers at the National Institute for Occupational Safety and Health affected by the layoffs last spring received emails yesterday that their reduction-in-force notices have been revoked. Hundreds of NIOSH employees had been let go.

    By • Jan. 14, 2026
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    Joe Raedle via Getty Images
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    ACA signups lag as enrollment deadline nears

    Some 22.8 million people have signed up for Affordable Care Act plans through early January, slower than last year’s pace but more robust than some experts predicted. Still, the CMS data paints an incomplete picture of the market.

    By • Jan. 13, 2026
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    UnitedHealth ‘aggressively’ gaming Medicare Advantage, Senate investigation finds

    Staffers for Sen. Chuck Grassley, R-Iowa, dove into 50,000 pages of documentation from UnitedHealth for the new report, which accuses the company of maintaining a workforce dedicated to upcoding.

    By • Jan. 12, 2026
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    Powerful PBM lobby names new CEO

    David Marin will become president and chief executive of the Pharmaceutical Care Management Association effective Jan. 30.

    By • Jan. 9, 2026
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    House votes to revive enhanced ACA subsidies

    The House voted 230-196 to extend the financial assistance, which lapsed on Dec. 31, for three years. The measure is not expected to pass the Senate.

    By • Jan. 8, 2026