Elon Musk’s DOGE gains access to CMS

The CMS said it’s working to find “opportunities for more effective and efficient use of resources in line with meeting the goals of President Trump.” The agency could be a big — and politically delicate — target for DOGE.

By Emily Olsen • Feb. 6, 2025

New contract wins ding Molina’s earnings outlook for 2025

Medicaid and dual-eligible contracts fuel growth for the California-based insurer, but also come with upfront implementation costs that will lower its earnings this year, executives said.

By Rebecca Pifer Parduhn • Feb. 6, 2025

Express Scripts, Kroger reach new pharmacy network agreement

The two have mended fences after a nasty contract dispute in 2022 caused Kroger pharmacies to go out of network with Express Scripts’ members.

By Rebecca Pifer Parduhn • Feb. 5, 2025

Oscar Health reports first profitable year

The insurer lost $153.5 million in the fourth quarter but still eked out a $25.4 million profit for the full year thanks to snowballing growth in ACA plans.

By Rebecca Pifer Parduhn • Feb. 5, 2025

Molina closes ConnectiCare acquisition

The deal adds $1.4 billion in annual premiums to Molina’s topline and 140,000 additional Medicare, Affordable Care Act marketplace and commercial members to the insurer’s rolls.

By Rebecca Pifer Parduhn • Feb. 4, 2025

Centene sets itself up for ‘equilibrium’ in 2025

The insurer also reported notable ACA growth for this year, though membership could tick back down through the second quarter due to program integrity efforts.

By Rebecca Pifer Parduhn • Updated Feb. 5, 2025

Cigna to tie executive compensation to customer satisfaction

Cigna is one of a handful of national insurers that pledged to ameliorate customer pain points with healthcare, but the first to release a specific plan. 

By Rebecca Pifer Parduhn • Feb. 3, 2025

ACA plans denied one-fifth of in-network claims in 2023, KFF finds

Insurers poked holes in KFF’s methodology — a spokesperson for UnitedHealth called the study “grossly misleading” — to argue that they approve most of the claims they receive.

By Rebecca Pifer Parduhn • Jan. 31, 2025

RFK Jr. fumbles Medicare basics during second confirmation hearing

Robert F. Kennedy Jr., nominee for HHS secretary, seemed unfamiliar with the massive insurance program during last week’s hearing, mistakenly saying Medicare Part A mainly paid for primary care or physicians.

By Emily Olsen • Jan. 30, 2025

Cigna pledges changes to pharmacy, medical benefits following ‘messy’ close to 2024

Fresh off underperforming Wall Street’s expectations in the fourth quarter, Cigna said it would work to lower costs for its customers amid widespread discontent with the healthcare system.

By Rebecca Pifer Parduhn • Jan. 30, 2025

RFK Jr. appears confused about Medicaid, Medicare during confirmation hearing

Robert F. Kennedy Jr. incorrectly said that Medicaid was fully funded by the federal government and that Medicare is a fee-for-service program during a hearing in front of the Senate Finance Committee last week.

By Emily Olsen • Jan. 29, 2025

White House rescinds memo pausing federal funding following pushback

The Office of Management and Budget rolled back a memo halting federal funding that caused widespread confusion and alarm. But “this is NOT a rescission of the federal funding freeze,” Trump’s top press secretary said.

By Rebecca Pifer Parduhn • Jan. 29, 2025

Healthcare’s outlook in 2025: New administration spells uncertainty, but hope remains

Although experts predict payers, providers and health technology companies will grapple with uncertainty in a second Trump administration, some hope that yearslong headwinds could begin reversing course in 2025.

By Sydney Halleman • Jan. 29, 2025

Judge halts Trump freeze on grants as states report healthcare payment portals back online

States and providers regained access to a key healthcare payments portal amid widespread backlash over the Trump administration’s decision to halt federal aid.

By Rebecca Pifer Parduhn • Jan. 29, 2025

Main Line Health threatens to go out of network with Cigna over contract dispute

Main Line Health says Cigna hasn't updated its reimbursement rate since 2016. Cigna says it is negotiating in good faith to find a solution that keeps healthcare affordable for patients.

By Susanna Vogel • Jan. 29, 2025

Lawmakers report states shut out of Medicaid payment portals following Trump funding freeze

Other payment systems also appear to be offline, suggesting a broader shutdown of federal portals related to grants and funding.

By Rebecca Pifer Parduhn • Updated Jan. 28, 2025

UnitedHealth names Tim Noel to replace slain insurance CEO

UnitedHealthcare has a new chief executive seven weeks after former CEO Brian Thompson was shot and killed in New York City.

By Rebecca Pifer Parduhn • Jan. 24, 2025

Elevance’s fourth-quarter profit slashed in half amid higher Medicaid costs

In a call with investors, CEO Gail Boudreaux didn’t directly address the killing of UnitedHealthcare’s top executive but spent more time than usual arguing Elevance is working to improve healthcare.

By Rebecca Pifer Parduhn • Jan. 23, 2025

Americans mixed on potential Trump healthcare priorities: KFF poll

About half of respondents said the nation should spend more on Medicaid and Medicare — a potential challenge for the Trump administration looking to cut costs.

By Emily Olsen • Jan. 22, 2025

ACA enrollment breaks records again in 2025

About 24.2 million people signed up for Affordable Care Act plans during the open enrollment period for 2025, with huge increases in major Republican-led states.

By Rebecca Pifer Parduhn • Jan. 21, 2025

Ozempic among drugs picked by Medicare for price talks

Announcing the 15 medicines chosen for the second round of negotiations is one of the Biden administration’s final health policy acts.

By Ned Pagliarulo • Updated Jan. 17, 2025

UnitedHealth reaches record revenue in 2024, though profit falls

UnitedHealth’s net income plummeted to its lowest level since 2019 amid hefty costs, including some from the Change cyberattack. CEO Andrew Witty also remembered slain executive Brian Thompson on a Thursday morning call.

By Rebecca Pifer Parduhn • Jan. 16, 2025

Alignment Healthcare names new president as insurer eyes growth

Medicare Advantage payer Alignment has named longtime insurance executive Dawn Maroney president.

By Rebecca Pifer Parduhn • Jan. 15, 2025

CMS expands enforcement power over shady ACA brokers

A rule finalized Monday makes it easier for regulators to suspend agents and brokers from selling Affordable Care Act plans if they pose a risk to the exchanges.

By Rebecca Pifer Parduhn • Jan. 14, 2025

FTC releases second report slamming pharmacy benefit managers

Agency commissioners voted unanimously on Tuesday to publish the report, which makes similar allegations against the controversial drug middlemen as the agency’s first report released last summer — but relies on more data.

By Rebecca Pifer Parduhn • Updated Jan. 15, 2025