Payer

  • The top of the U.S. Capitol Building's dome is pictured on a cloudy day.
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    Senate rejects competing health bills, setting up ACA subsidy lapse

    The failure of both bills means enhanced subsidies for Affordable Care Act plans will likely expire at the end of the year. Healthcare groups urged lawmakers to extend the subsidies, noting premiums could skyrocket.

    By • Dec. 11, 2025
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    Democrats’ ACA subsidy extension adds $83B to deficit, boosts insured: CBO

    The plan to extend the more generous financial assistance for three years is expected to go up for a vote in the Senate Thursday, alongside a Republican alternative that would replace the subsidies. 

    By • Dec. 11, 2025
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    Trendline

    Payer/provider relationships

    As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.

    By Healthcare Dive staff
  • Elevance headquarters is a large white and brown building surrounding a grassy quad.
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    Ex-Pfizer executive joins Elevance’s board as insurer pursues pharmacy experience

    Amy Schulman is the second veteran of the pharmaceutical industry that Elevance has added to its board this year.

    By • Dec. 11, 2025
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    Rebecca Pifer/Healthcare Dive
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    CVS to launch ‘engagement’ platform in gamble on consumer, industry interest

    CVS is bringing together its disparate businesses onto one platform, and giving its rivals the option to add their products and services as well. The goal is to improve consumers’ health engagement while generating more revenue.

    By • Dec. 10, 2025
  • A sign reading OBAMACARE hangs outside a storefront.
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    Early ACA enrollment holds steady despite subsidy turmoil

    Some 5.8 million people have signed up for 2026 ACA plans so far, up about 7% year over year. Still, enrollment tends to shift over signup periods, so it’s too early to conclude that the Obamacare exchanges won’t shrink next year.

    By • Dec. 10, 2025
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    Rebecca Pifer/Healthcare Dive
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    Crapo, Cassidy propose enhanced ACA subsidy alternative

    The legislation, which is scheduled for a vote Thursday, would send funds directly to health savings accounts paired with bronze or catastrophic plans offered on the Affordable Care Act exchanges.

    By • Dec. 10, 2025
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    1 in 4 ACA enrollees could go uninsured if subsidies lapse: KFF

    Nearly 60% of survey respondents said they wouldn’t be able to afford a $300 annual increase in healthcare costs without significantly disrupting their finances.

    By • Dec. 8, 2025
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    Aetna updates on prior authorization reform

    The CVS-owned payer is working to bundle multiple prior authorizations for certain conditions into one single review.

    By • Dec. 5, 2025
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    Kevin Dietsch/Getty Images via Getty Images
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    Senators agree they need to act on expiring ACA subsidies. But they can’t nail down how.

    Hidden in Republicans’ ACA bashing during a health committee hearing last week were some signs that a clean extension of more generous subsidies isn’t completely off the table — though one still doesn’t look likely.

    By • Dec. 4, 2025
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    Covert watchdog testing finds ACA vulnerable to subsidy fraud

    The Government Accountability Office successfully enrolled 18 out of 20 fake applicants in subsidized ACA plans. Republicans jumped on the report as ammunition in the debate over expanded subsidies.

    By • Dec. 4, 2025
  • CVS pharmacy sign outside of Miami, Florida on Feb. 7, 2024
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    CVS agrees to pay $38M to settle insulin fraud claims

    For a decade, CVS knew it was skirting rules meant to limit overprescribing but did nothing to stop, according to the Department of Justice.

    By • Dec. 3, 2025
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    Humana appeals Medicare Advantage star ratings loss to 5th Circuit

    The insurer continues to try to prove that regulators acted arbitrarily in downgrading its quality scores for 2025, despite numerous setbacks in the courts to date.

    By • Dec. 1, 2025
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    Why Medicare Advantage contract negotiations are getting heated

    “There’s simply more at stake in these negotiations for payers and providers than there used to be,” one expert said.

    By Michael Brady • Nov. 26, 2025
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    CMS proposes overhauling Medicare Advantage star ratings

    The agency suggested cutting a dozen quality measures where health plan performance is high and beneficiaries can’t easily distinguish between offerings.

    By • Nov. 26, 2025
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    Scott Olson via Getty Images
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    CMS sets 2027 Medicare prices for Wegovy, Trelegy and 13 other drugs

    The second round of negotiations cuts spending an aggregate 44% over 2024 list prices as the federal government extends restraints over more medicines.

    By Jonathan Gardner • Nov. 26, 2025
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    Trump administration appeals decision vacating Medicare Advantage audit rule

    A federal judge struck down the rule that would have clawed back billions of dollars in overpayments in September. Now, the HHS wants to take the case to the Fifth Circuit Court of Appeals.

    By • Nov. 25, 2025
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    CMS finalizes 2.6% outpatient pay bump, site-neutral policies

    Hospitals lambasted the final rule as inadequate, arguing the sector is facing significant financial pressures.

    By • Nov. 24, 2025
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    Crapo, Wyden to reintroduce bipartisan PBM package

    Republicans and Democrats couldn’t be further apart on how to address the looming ACA affordability cliff. But there seems to be a path forward on curbing pharmacy benefit managers.

    By • Nov. 20, 2025
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    Employers, workers to face healthcare ‘affordability crunch,’ Mercer warns

    A “sharp growth” in prescription drug spending, including pricey GLP-1 weight-loss medications, helped fuel the increase, the consulting firm said.

    By Ginger Christ • Nov. 19, 2025
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    Urban safety-net hospitals vulnerable to Medicaid cuts: analysis

    Though the impact on rural facilities has received more focus from lawmakers, the majority of hospitals that are most susceptible to the funding cuts operate in urban communities, according to the report.

    By • Nov. 19, 2025
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    Republican antipathy during key Senate hearing darkens outlook for ACA subsidy extension

    More generous subsidies for Affordable Care Act plans have helped millions of Americans afford insurance. Chances are becoming slimmer that the assistance will survive the year.

    By • Nov. 19, 2025
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    UnitedHealth adds former FDA commissioner Scott Gottlieb to board

    UnitedHealth declined to comment on Gottlieb’s appointment, which comes as the company works to improve its relationship with federal regulators.

    By • Nov. 19, 2025
  • Epic's logo on top of its booth at HIMSS23.
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    Rebecca Pifer/Healthcare Dive
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    Epic, Humana partner to speed patient check-in and coverage verification

    The new features automatically share insurance details from more than 800,000 Medicare Advantage enrollees with providers to streamline check-in and verification.

    By • Nov. 18, 2025
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    States project flat Medicaid enrollment, increased spending as cuts loom: KFF

    Total spending in the safety-net insurance program is expected to grow 7.9% in fiscal year 2026, according to the survey. Meanwhile, states are facing significant federal cuts in the wake of the One Big Beautiful Bill Act.

    By • Nov. 18, 2025
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    CMS issues guidance on Medicaid provider tax overhaul

    The agency has started to lay out how it’ll implement restrictions on the arrangements, which are used by states to finance their share of Medicaid funding, enacted in the One Big Beautiful Bill Act.

    By • Nov. 17, 2025