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

Healthcare industry outlook for 2026: Providers, insurers, IT companies look to stability

Companies are hoping to reshore finances and double down on efficiency initiatives this year as several policy sea changes threaten to upend the industry.

By Healthcare Dive staff • Jan. 30, 2026

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 Rebecca Pifer Parduhn • Jan. 30, 2026

The healthcare claims system is ready for transformation. Here are 5 ways to prepare in 2026.

Artificial intelligence could rework the claims and reimbursement process, allowing faster decision-making, reduced errors and billions in savings, according to an Optum executive.

By Puneet Maheshwari • Jan. 29, 2026

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 Rebecca Pifer Parduhn • Jan. 29, 2026

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 Rebecca Pifer Parduhn • Jan. 28, 2026

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 Rebecca Pifer Parduhn • Jan. 28, 2026

Elevance expects lower revenue, earnings, membership in 2026

This year should see improvements in Medicare Advantage and Affordable Care Act plans but continued pressure in Medicaid, Elevance executives warned investors.

By Rebecca Pifer Parduhn • Jan. 28, 2026

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 Rebecca Pifer Parduhn • Jan. 27, 2026

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 Rebecca Pifer Parduhn • Jan. 27, 2026

UnitedHealth revenue climbs in 2025, though profit continues to fall

The healthcare behemoth posted its lowest profits since 2018 last year, largely thanks to continued Medicare Advantage challenges. Executives warned how regulators’ “disappointing” rate update might further contract MA.

By Rebecca Pifer Parduhn • Jan. 27, 2026

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 Rebecca Pifer Parduhn • Jan. 26, 2026

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 Rebecca Pifer Parduhn • Jan. 26, 2026

The case for transparent pricing: Making pharmacy benefits work for health plans

CVS Caremark TrueCost® is the industry’s first pricing model that gives insight into drug-level costs.

By CVS Caremark • Jan. 26, 2026

Why cover GLP-1s? They’ll lower employer healthcare costs, study says

While the medications may be pricey, a multi-year study by Aon found consistent use correlates with lower medical cost growth and fewer hospitalizations for cardiovascular events.

By Caroline Colvin • Jan. 23, 2026

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 Rebecca Pifer Parduhn • Jan. 23, 2026

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

Small business health insurance coverage at risk as costs rise, EBRI finds

Even as overall employer-based coverage increased in the U.S., small companies pulled back.

By Ginger Christ • Jan. 22, 2026

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 Rebecca Pifer Parduhn • Jan. 22, 2026

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 Rebecca Pifer Parduhn • Jan. 21, 2026

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 Sydney Halleman • Jan. 21, 2026

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 Rebecca Pifer Parduhn • Jan. 16, 2026

MedPAC steps away from advocating doctor pay be tied to inflation

The advisory group wants Congress to approve a 0.5 percentage point increase for doctors in Medicare next year. But some commissioners dissented over MedPAC’s about-face on underlying payment reform.

By Rebecca Pifer Parduhn • Jan. 16, 2026

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 Rebecca Pifer Parduhn • Jan. 15, 2026

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 Sydney Halleman • Jan. 15, 2026