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CBO asks for more No Surprises research
The No Surprises Act “might not have the effects that CBO anticipated,” the agency wrote in petitioning for more research into the 2020 law’s effect on healthcare prices and other trends. It’s a welcome development for payers.
By Rebecca Pifer Parduhn • June 17, 2026 -
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Fewer insurers participating in ACA marketplaces amid policy turmoil, KFF finds
The average number of issuers fell from a record high of 9.6 per state in 2025 to just nine this year, according to the health policy research group.
By Emily Olsen • June 17, 2026 -
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TrendlinePayer/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 -
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Express Scripts, PCMA sue to block Tennessee law breaking up PBMs and pharmacies
Express Scripts and the PBM lobby are following in CVS Caremark’s footsteps in filing complaints challenging the FAIR Rx Act, which was passed earlier this year despite vehement opposition from PBMs.
By Rebecca Pifer Parduhn • June 16, 2026 -
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Centene offers employee buyouts amid membership losses
Most of Centene’s 61,000 employees will be eligible to apply for voluntary separation. But the program doesn’t amount to a complete overhaul of the company, a spokesperson said.
By Rebecca Pifer Parduhn • June 16, 2026 -
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Judge vacates most of controversial 2025 ACA enrollment, eligibility rule
Friday’s decision is a victory for insurance advocates. But, given many of the rule’s provisions were codified in the GOP’s “Big Beautiful Bill,” it’s not a panacea for the ACA.
By Rebecca Pifer Parduhn • June 15, 2026 -
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Sponsored by Milliman MedInsightData analytics for payers: Improving maternal health outcomes while reducing total cost of care
How health plans can use analytics to improve maternal care and reduce avoidable utilization
June 15, 2026 -
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UnitedHealth, FTC reach proposed settlement in insulin case
The tentative deal comes months after CVS reached a proposed settlement in the lawsuit alleging major PBMs are inflating insulin costs. Cigna has already settled with the FTC.
By Emily Olsen • June 12, 2026 -
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Major Medicare Advantage insurers appear to deny care for profit, federal watchdog finds
MA insurers commonly deny requests for post-acute care — but none more frequently than UnitedHealth, Humana and CVS, the HHS OIG said. Insurers were not happy about the findings.
By Rebecca Pifer Parduhn • June 12, 2026 -
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CMS creates office dedicated to health technology
The Office of Health Technology and Products is the latest technology development from the CMS as it doubles down on digital tools.
By Emily Olsen • June 12, 2026 -
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CMS increases oversight of state Medicaid demonstrations
States will have to provide more rigorous financial analyses for their Medicaid demonstrations beginning in 2027, according to new federal guidance.
By Sydney Halleman • June 12, 2026 -
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Health plans say AI is pushing healthcare costs higher
Nearly 70% of surveyed health plans said providers’ use of AI documentation and coding tools was a top three trend inflating commercial healthcare costs next year, according to a new report from PwC.
By Emily Olsen • June 11, 2026 -
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Medicare insolvency date creeps forward thanks to ‘Big Beautiful Bill,’ trustees find
The trust fund underpinning Medicare’s hospital benefit is set to run out of money one quarter earlier than previously expected as tax cuts in the GOP’s reconciliation legislation shrink Medicare’s revenue.
By Rebecca Pifer Parduhn • June 11, 2026 -
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Humana divests interest in end-of-life provider Gentiva valued at $900M
The insurer is offloading its interest in the massive end-of-life care provider to an undisclosed group of investors, amid widespread concern about private investors’ activity in healthcare.
By Rebecca Pifer Parduhn • June 11, 2026 -
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Americans mostly blame insurers for rising healthcare costs, survey finds
AHIP argued the survey, which was commissioned by a pro-hospital advocacy group, is a blatant attempt by hospitals to deflect the blame for ever-higher spending.
By Rebecca Pifer Parduhn • June 10, 2026 -
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House committee takes step toward blocking Medicare AI prior authorization pilot
It’s another sign of lawmakers’ concern about the pilot, which has been lambasted for delaying care to seniors.
By Emily Olsen • June 10, 2026 -
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Illinois awards new Medicaid contracts
The state said it intends to divvy out new contracts, which represent tens of billions of dollars in revenue for each awardee, to six insurers. Winners are mostly incumbents, except for Humana.
By Rebecca Pifer Parduhn • Updated June 10, 2026 -
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Cities sue to block ACA rule for increasing uninsured rate
City leaders said the regulation risks undermining the Affordable Care Act exchanges and adding new costs for local governments. Now, they’re suing to overturn the rule.
By Sydney Halleman • June 8, 2026 -
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Over half of Medicaid enrollees say they’re unaware of upcoming work requirements
Many enrollees don’t know they’ll need to report work, education or volunteer hours starting in less than six months in order to stay covered, according to a recent survey from the Health Management Academy.
By Emily Olsen • June 8, 2026 -
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Sponsored by ParadigmWhy health plans are leaving surgical cost savings on the table
Surgery avoidance isn’t enough. Outcomes optimization is critical to your cost of care efforts.
By Nicola Merryman, Senior Vice President, Healthcare Solutions, Paradigm • June 8, 2026 -
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1 in 5 U.S. adults denied doctor-recommended care: Commonwealth Fund
Americans are increasingly frustrated about being blocked off from care, which results in worse health outcomes and financial stress, per the new study. Still, insurers generally defend their claims review processes.
By Rebecca Pifer Parduhn • June 5, 2026 -
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Consumers are less satisfied with their health plans: JD Power
Rising costs are eroding Americans’ trust in their commercial plans despite an industry-wide push to increase consumer satisfaction, the analytics firm found.
By Rebecca Pifer Parduhn • June 3, 2026 -
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CMS releases Medicaid work requirements guidance for states
The highly anticipated interim final rule weighs in on key issues for states hustling to operationalize work requirements before the 2027 deadline. But there’s still some gray area — and lots of critics.
By Rebecca Pifer Parduhn • Updated June 2, 2026 -
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Massachusetts sues UnitedHealthcare for alleged Medicaid fraud
The state claims UnitedHealthcare inflated the sickness of seniors enrolled in MassHealth managed care plans to reap at least $100 million in improper payments.
By Emily Olsen • June 1, 2026 -
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Elevance again avoids Medicare Advantage sanctions, but threat remains
The CMS pushed back sanctions until July 1 after Elevance made progress on fixing faulty data submissions for its privatized Medicare plans. But the company still has more to do, regulators said.
By Rebecca Pifer Parduhn • June 1, 2026 -
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‘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
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