Health Care US-News: Difference between revisions

Line 1:

===Scholarly / Policy Research / Institutional Analysis===

=====Strengthening Original Medicare=====

[https://www.cms.gov/newsroom/blog/strengthening-original-medicare | Center for Medicare | Centers for Medicare & Medicaid Services | July 16, 2026]

This CMS overview describes efforts to reinforce Original Medicare while balancing access, affordability, beneficiary choice, accountable care, and responsible program spending. It is useful for tracking the agency’s broader direction on Medicare delivery and payment reform.

=====A Profile of Dual-Eligible Individuals=====

[https://www.kff.org/medicare/a-profile-of-medicare-medicaid-enrollees-dual-eligibles/ | Abby Wolk, Nancy Ochieng, Jeannie Fuglesten Biniek, and Alice Burns | KFF | July 15, 2026]

This KFF brief profiles people enrolled in both Medicare and Medicaid, including their income, disability, health status, long-term care needs, and difficulty navigating two coverage systems. It provides important context for understanding how Medicaid changes can affect low-income Medicare beneficiaries.

=====Five Key Facts About Spending and Enrollment for People with Medicare and Medicaid (Dual-Eligible Individuals)=====

[https://www.kff.org/medicaid/five-key-facts-about-spending-and-enrollment-for-people-with-medicare-and-medicaid-dual-eligible-individuals/ | Abby Sachar, Abby Wolk, Alice Burns, and Jeannie Fuglesten Biniek | KFF | July 15, 2026]

This issue brief analyzes enrollment, chronic conditions, and spending among dual-eligible individuals. It shows why this population accounts for a disproportionate share of Medicare and Medicaid spending and why coordinated coverage is central to access and affordability.

=====States Are Using Creative Strategies to Help Older Adults and Individuals with Disabilities Live Independently=====

[https://www.commonwealthfund.org/blog/2026/states-are-using-creative-strategies-help-older-adults-and-individuals-disabilities-live | Lisa Shugarman, Cecelia Templeton, Natalia McCormick, and Laura Wagstaff | Commonwealth Fund | July 15, 2026]

This article examines state strategies for preserving home- and community-based services for older adults and people with disabilities. It highlights workforce investments, caregiver support, Medicaid waivers, and planning approaches that can protect access during fiscal and policy changes.

=====CMS Proposes Transformational Medicare Reforms to Expand Accountable Care, Modernize Physician Payment, and Shift from Sick Care to Healthcare=====

[https://www.cms.gov/newsroom/press-releases/cms-proposes-transformational-medicare-reforms-expand-accountable-care-modernize-physician-payment | Centers for Medicare & Medicaid Services | CMS | July 14, 2026]

CMS outlines proposed changes to Medicare physician payment and accountable care programs, with a stronger emphasis on primary care, prevention, technology, and value-based payment. The announcement is useful for following how federal reimbursement policy may reshape access to routine care.

=====Improving Access to Medicare Home Health Care: Key Policy Considerations=====

[https://www.commonwealthfund.org/publications/issue-briefs/2026/jul/improving-access-medicare-home-health-care-policy-considerations | Barbara Lyons and Jane Andrews | Commonwealth Fund | July 9, 2026]

This issue brief examines declining use of Medicare home health services and identifies barriers involving payment incentives, Medicare Advantage practices, provider availability, referrals, and workforce shortages. It offers policy options for expanding access to care at home.

=====Improving Medicare’s Home Health Benefit: Beneficiary Experiences and Priorities=====

[https://www.commonwealthfund.org/publications/issue-briefs/2026/jul/improving-medicare-home-health-beneficiary-experiences | Barbara Lyons and Jane Andrews | Commonwealth Fund | July 9, 2026]

Based on interviews with beneficiaries and caregivers, this report describes confusion about Medicare home health coverage, limited provider choice, care-coordination gaps, and the value of home-based nursing and therapy. It centers patient experience in the debate over improving the benefit.

=====How Much and Why ACA Marketplace Premiums Are Going Up in 2027=====

[https://www.healthsystemtracker.org/brief/how-much-and-why-aca-marketplace-premiums-are-going-up-in-2027/ | Matt McGough, Jared Ortaliza, Ashley Ferguson, Imani Telesford, Shameek Rakshit, Emma Wager, Lynne Cotter, and Cynthia Cox | Peterson-KFF Health System Tracker | July 8, 2026]

This analysis reviews preliminary insurer filings and finds another year of proposed double-digit ACA Marketplace premium increases. It connects the increases to medical prices, labor costs, changing enrollment, subsidy expiration, and a less healthy insurance risk pool.

=====What H.R. 1’s Changes to Medicaid Payment Error Rules Mean for States=====

[https://www.commonwealthfund.org/publications/issue-briefs/2026/jul/what-hr1-changes-medicaid-payment-error-rules-mean-states | Dawn Joyce and Akeiisa Coleman | Commonwealth Fund | July 8, 2026]

This brief explains how new Medicaid payment-error rules could expose states to financial penalties and encourage stricter documentation, eligibility, and prior-authorization practices. It is relevant to concerns about administrative burdens, delayed care, coverage losses, and state budget pressure.

=====CMS Acts to Strengthen Care Quality, Cut Drug Costs, and Slash Out-of-Pocket Expenses for Medicare Beneficiaries=====

[https://www.cms.gov/newsroom/press-releases/cms-acts-strengthen-care-quality-cut-drug-costs-slash-out-pocket-expenses-medicare-beneficiaries | Centers for Medicare & Medicaid Services | CMS | July 2, 2026]

CMS describes a proposed 2027 outpatient payment rule intended to reduce beneficiary drug and service costs, encourage care in lower-cost settings, and change reimbursement for hospitals and ambulatory surgical centers. It is a key institutional source on site-neutral payment and Medicare affordability.

=====What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles=====

Line 39:

Line 79:

===Ephemeral / Fast-Moving News===

=====Insurers Hedge on Trump-Backed Pledge To Improve Denials Process=====

[https://kffhealthnews.org/insurance/prior-authorization-insurance-denials-reform-pledge-year-later/ | Lauren Sausser and Renuka Rayasam | KFF Health News | July 17, 2026]

This investigation finds that some insurers are backing away from parts of a voluntary pledge to simplify prior authorization and coverage denials. Patients, clinicians, and advocates describe continuing delays, confusing explanations, retroactive denials, and weak federal accountability.

=====Despite Earnings Celebration, UnitedHealth Signals More Financial Pain for Employers=====

[https://www.statnews.com/2026/07/16/unitedhealth-employer-insurance-costs-medical-spending/ | Bob Herman | STAT | July 16, 2026]

STAT reports that medical costs for UnitedHealthcare’s employer clients rose sharply, suggesting additional premium pressure for businesses and workers. The article connects insurer earnings to the growing affordability crisis in employer-sponsored health coverage.

=====A Sales Tax on Doctor Visits and Medicine? In Missouri, Some Worry=====

[https://kffhealthnews.org/health-care-costs/sales-tax-healthcare-services-missouri-state-amendment-revenue/ | Bram Sable-Smith | KFF Health News | July 16, 2026]

This article examines fears that a Missouri tax-system overhaul could eventually expose prescriptions, doctor visits, or other health services to sales taxes or trigger cuts to state-funded care. It illustrates how state fiscal policy can directly affect medical affordability and access.

=====Hospital Chain HCA Warns of Lower Profits as More Patients Go Uninsured=====

[https://www.statnews.com/2026/07/14/hca-predicts-treating-uninsured-patients-will-trim-1-billion-in-profits/ | Tara Bannow | STAT | July 14, 2026]

STAT reports that HCA Healthcare is treating more uninsured patients than expected after the expiration of enhanced ACA subsidies. The story offers an early indication of how coverage losses may increase uncompensated care and strain hospital finances.

=====CMS Proposes Major Medicare Physician Payment Overhaul to Boost Primary Care=====

[https://www.reuters.com/legal/litigation/cms-proposes-major-medicare-physician-payment-overhaul-boost-primary-care-2026-07-14/ | Reuters | Reuters | July 14, 2026]

Reuters reports on a proposed Medicare physician-payment overhaul designed to strengthen primary and preventive care. The plan is relevant to longstanding concerns that payment policy favors procedures and specialty services over accessible routine care.

=====Patients Face a Thicket of Red Tape Trying To Maintain Consistent Health Coverage=====

[https://kffhealthnews.org/health-care-costs/priced-out-red-tape-insurance-costs-health-system-plan-switching-disruptions/ | Renuka Rayasam | KFF Health News | July 8, 2026]

This article follows patients struggling with administrative obstacles when changing or maintaining insurance coverage. It shows how paperwork, eligibility rules, plan transitions, and fragmented systems can interrupt treatment even when people are trying to remain insured.

=====Affordable Care Act Insurers Want More Premium Increases as Enrollment Sags=====

[https://www.statnews.com/2026/07/08/affordable-care-act-insurers-premium-increases-enrollment-dips/ | Rachel Spears | STAT / KFF Health News | July 8, 2026]

This report says ACA insurers are seeking another round of substantial premium increases for 2027 as enrollment declines and medical costs rise. It explains how subsidy expiration and a worsening risk pool could further increase costs for consumers and the federal government.

=====Copay Assistance Is Meant To Defray Patient Drug Costs. Some Insurers Keep It Instead.=====

[https://kffhealthnews.org/health-care-costs/copay-accumulator-adjustment-programs-patient-assistance-insurance-pharma-drugs/ | Daniel Chang | KFF Health News | July 7, 2026]

This article investigates copay accumulator programs that prevent manufacturer assistance from counting toward patients’ deductibles or out-of-pocket limits. It is useful for understanding why people can still face large prescription costs despite receiving financial assistance.

=====Obamacare Rolls Shrank Dramatically in Many States Over the Past Year, New Federal Data Shows=====

[https://apnews.com/article/189b9b197edbc3c6883d77691dd894b7 | Associated Press | Associated Press | July 6, 2026]

AP analyzes federal data showing steep state-level declines in ACA Marketplace enrollment after enhanced subsidies expired. The article links the losses to higher premiums, nonpayment, affordability pressures, and differences between federal and state-run marketplaces.

=====Trump Administration Proposes a Rule It Says Could Save Medicare Patients $1.1 Billion on Drugs=====

[https://apnews.com/article/5126a1e044ffe48f8a6a27710eb00293 | Associated Press | Associated Press | July 2, 2026]

AP reports on a proposal to reduce Medicare reimbursement for drugs purchased by hospitals through the 340B discount program. The administration says patients could save on copayments, while hospitals warn that reduced revenue could threaten services and access.

=====Affordable Care Act Enrollment Projected to Plunge by 5 Million as Costs Spike, Analysis Shows=====

Health Care US-News: Difference between revisions

Kirk (talk | contribs)

Navigation menu

Page actions

Page actions

Personal tools

Navigation

Search

Tools

@@ Line 1: / Line 1: @@
 ===Scholarly / Policy Research / Institutional Analysis===
+=====Strengthening Original Medicare=====
+[https://www.cms.gov/newsroom/blog/strengthening-original-medicare | Center for Medicare | Centers for Medicare & Medicaid Services | July 16, 2026]
+ This CMS overview describes efforts to reinforce Original Medicare while balancing access, affordability, beneficiary choice, accountable care, and responsible program spending. It is useful for tracking the agency’s broader direction on Medicare delivery and payment reform.
+=====A Profile of Dual-Eligible Individuals=====
+[https://www.kff.org/medicare/a-profile-of-medicare-medicaid-enrollees-dual-eligibles/ | Abby Wolk, Nancy Ochieng, Jeannie Fuglesten Biniek, and Alice Burns | KFF | July 15, 2026]
+ This KFF brief profiles people enrolled in both Medicare and Medicaid, including their income, disability, health status, long-term care needs, and difficulty navigating two coverage systems. It provides important context for understanding how Medicaid changes can affect low-income Medicare beneficiaries.
+=====Five Key Facts About Spending and Enrollment for People with Medicare and Medicaid (Dual-Eligible Individuals)=====
+[https://www.kff.org/medicaid/five-key-facts-about-spending-and-enrollment-for-people-with-medicare-and-medicaid-dual-eligible-individuals/ | Abby Sachar, Abby Wolk, Alice Burns, and Jeannie Fuglesten Biniek | KFF | July 15, 2026]
+ This issue brief analyzes enrollment, chronic conditions, and spending among dual-eligible individuals. It shows why this population accounts for a disproportionate share of Medicare and Medicaid spending and why coordinated coverage is central to access and affordability.
+=====States Are Using Creative Strategies to Help Older Adults and Individuals with Disabilities Live Independently=====
+[https://www.commonwealthfund.org/blog/2026/states-are-using-creative-strategies-help-older-adults-and-individuals-disabilities-live | Lisa Shugarman, Cecelia Templeton, Natalia McCormick, and Laura Wagstaff | Commonwealth Fund | July 15, 2026]
+ This article examines state strategies for preserving home- and community-based services for older adults and people with disabilities. It highlights workforce investments, caregiver support, Medicaid waivers, and planning approaches that can protect access during fiscal and policy changes.
+=====CMS Proposes Transformational Medicare Reforms to Expand Accountable Care, Modernize Physician Payment, and Shift from Sick Care to Healthcare=====
+[https://www.cms.gov/newsroom/press-releases/cms-proposes-transformational-medicare-reforms-expand-accountable-care-modernize-physician-payment | Centers for Medicare & Medicaid Services | CMS | July 14, 2026]
+ CMS outlines proposed changes to Medicare physician payment and accountable care programs, with a stronger emphasis on primary care, prevention, technology, and value-based payment. The announcement is useful for following how federal reimbursement policy may reshape access to routine care.
+=====Improving Access to Medicare Home Health Care: Key Policy Considerations=====
+[https://www.commonwealthfund.org/publications/issue-briefs/2026/jul/improving-access-medicare-home-health-care-policy-considerations | Barbara Lyons and Jane Andrews | Commonwealth Fund | July 9, 2026]
+ This issue brief examines declining use of Medicare home health services and identifies barriers involving payment incentives, Medicare Advantage practices, provider availability, referrals, and workforce shortages. It offers policy options for expanding access to care at home.
+=====Improving Medicare’s Home Health Benefit: Beneficiary Experiences and Priorities=====
+[https://www.commonwealthfund.org/publications/issue-briefs/2026/jul/improving-medicare-home-health-beneficiary-experiences | Barbara Lyons and Jane Andrews | Commonwealth Fund | July 9, 2026]
+ Based on interviews with beneficiaries and caregivers, this report describes confusion about Medicare home health coverage, limited provider choice, care-coordination gaps, and the value of home-based nursing and therapy. It centers patient experience in the debate over improving the benefit.
+=====How Much and Why ACA Marketplace Premiums Are Going Up in 2027=====
+[https://www.healthsystemtracker.org/brief/how-much-and-why-aca-marketplace-premiums-are-going-up-in-2027/ | Matt McGough, Jared Ortaliza, Ashley Ferguson, Imani Telesford, Shameek Rakshit, Emma Wager, Lynne Cotter, and Cynthia Cox | Peterson-KFF Health System Tracker | July 8, 2026]
+ This analysis reviews preliminary insurer filings and finds another year of proposed double-digit ACA Marketplace premium increases. It connects the increases to medical prices, labor costs, changing enrollment, subsidy expiration, and a less healthy insurance risk pool.
+=====What H.R. 1’s Changes to Medicaid Payment Error Rules Mean for States=====
+[https://www.commonwealthfund.org/publications/issue-briefs/2026/jul/what-hr1-changes-medicaid-payment-error-rules-mean-states | Dawn Joyce and Akeiisa Coleman | Commonwealth Fund | July 8, 2026]
+ This brief explains how new Medicaid payment-error rules could expose states to financial penalties and encourage stricter documentation, eligibility, and prior-authorization practices. It is relevant to concerns about administrative burdens, delayed care, coverage losses, and state budget pressure.
+=====CMS Acts to Strengthen Care Quality, Cut Drug Costs, and Slash Out-of-Pocket Expenses for Medicare Beneficiaries=====
+[https://www.cms.gov/newsroom/press-releases/cms-acts-strengthen-care-quality-cut-drug-costs-slash-out-pocket-expenses-medicare-beneficiaries | Centers for Medicare & Medicaid Services | CMS | July 2, 2026]
+ CMS describes a proposed 2027 outpatient payment rule intended to reduce beneficiary drug and service costs, encourage care in lower-cost settings, and change reimbursement for hospitals and ambulatory surgical centers. It is a key institutional source on site-neutral payment and Medicare affordability.
 =====What We Know So Far About 2026 ACA Marketplace Enrollment, Premiums, and Deductibles=====
@@ Line 39: / Line 79: @@
 ===Ephemeral / Fast-Moving News===
+=====Insurers Hedge on Trump-Backed Pledge To Improve Denials Process=====
+[https://kffhealthnews.org/insurance/prior-authorization-insurance-denials-reform-pledge-year-later/ | Lauren Sausser and Renuka Rayasam | KFF Health News | July 17, 2026]
+ This investigation finds that some insurers are backing away from parts of a voluntary pledge to simplify prior authorization and coverage denials. Patients, clinicians, and advocates describe continuing delays, confusing explanations, retroactive denials, and weak federal accountability.
+=====Despite Earnings Celebration, UnitedHealth Signals More Financial Pain for Employers=====
+[https://www.statnews.com/2026/07/16/unitedhealth-employer-insurance-costs-medical-spending/ | Bob Herman | STAT | July 16, 2026]
+ STAT reports that medical costs for UnitedHealthcare’s employer clients rose sharply, suggesting additional premium pressure for businesses and workers. The article connects insurer earnings to the growing affordability crisis in employer-sponsored health coverage.
+=====A Sales Tax on Doctor Visits and Medicine? In Missouri, Some Worry=====
+[https://kffhealthnews.org/health-care-costs/sales-tax-healthcare-services-missouri-state-amendment-revenue/ | Bram Sable-Smith | KFF Health News | July 16, 2026]
+ This article examines fears that a Missouri tax-system overhaul could eventually expose prescriptions, doctor visits, or other health services to sales taxes or trigger cuts to state-funded care. It illustrates how state fiscal policy can directly affect medical affordability and access.
+=====Hospital Chain HCA Warns of Lower Profits as More Patients Go Uninsured=====
+[https://www.statnews.com/2026/07/14/hca-predicts-treating-uninsured-patients-will-trim-1-billion-in-profits/ | Tara Bannow | STAT | July 14, 2026]
+ STAT reports that HCA Healthcare is treating more uninsured patients than expected after the expiration of enhanced ACA subsidies. The story offers an early indication of how coverage losses may increase uncompensated care and strain hospital finances.
+=====CMS Proposes Major Medicare Physician Payment Overhaul to Boost Primary Care=====
+[https://www.reuters.com/legal/litigation/cms-proposes-major-medicare-physician-payment-overhaul-boost-primary-care-2026-07-14/ | Reuters | Reuters | July 14, 2026]
+ Reuters reports on a proposed Medicare physician-payment overhaul designed to strengthen primary and preventive care. The plan is relevant to longstanding concerns that payment policy favors procedures and specialty services over accessible routine care.
+=====Patients Face a Thicket of Red Tape Trying To Maintain Consistent Health Coverage=====
+[https://kffhealthnews.org/health-care-costs/priced-out-red-tape-insurance-costs-health-system-plan-switching-disruptions/ | Renuka Rayasam | KFF Health News | July 8, 2026]
+ This article follows patients struggling with administrative obstacles when changing or maintaining insurance coverage. It shows how paperwork, eligibility rules, plan transitions, and fragmented systems can interrupt treatment even when people are trying to remain insured.
+=====Affordable Care Act Insurers Want More Premium Increases as Enrollment Sags=====
+[https://www.statnews.com/2026/07/08/affordable-care-act-insurers-premium-increases-enrollment-dips/ | Rachel Spears | STAT / KFF Health News | July 8, 2026]
+ This report says ACA insurers are seeking another round of substantial premium increases for 2027 as enrollment declines and medical costs rise. It explains how subsidy expiration and a worsening risk pool could further increase costs for consumers and the federal government.
+=====Copay Assistance Is Meant To Defray Patient Drug Costs. Some Insurers Keep It Instead.=====
+[https://kffhealthnews.org/health-care-costs/copay-accumulator-adjustment-programs-patient-assistance-insurance-pharma-drugs/ | Daniel Chang | KFF Health News | July 7, 2026]
+ This article investigates copay accumulator programs that prevent manufacturer assistance from counting toward patients’ deductibles or out-of-pocket limits. It is useful for understanding why people can still face large prescription costs despite receiving financial assistance.
+=====Obamacare Rolls Shrank Dramatically in Many States Over the Past Year, New Federal Data Shows=====
+[https://apnews.com/article/189b9b197edbc3c6883d77691dd894b7 | Associated Press | Associated Press | July 6, 2026]
+ AP analyzes federal data showing steep state-level declines in ACA Marketplace enrollment after enhanced subsidies expired. The article links the losses to higher premiums, nonpayment, affordability pressures, and differences between federal and state-run marketplaces.
+=====Trump Administration Proposes a Rule It Says Could Save Medicare Patients $1.1 Billion on Drugs=====
+[https://apnews.com/article/5126a1e044ffe48f8a6a27710eb00293 | Associated Press | Associated Press | July 2, 2026]
+ AP reports on a proposal to reduce Medicare reimbursement for drugs purchased by hospitals through the 340B discount program. The administration says patients could save on copayments, while hospitals warn that reduced revenue could threaten services and access.
 =====Affordable Care Act Enrollment Projected to Plunge by 5 Million as Costs Spike, Analysis Shows=====