Insights: Healthcare

Medicare Outpatient/ASC Reimbursement

CMS has issued the CY26 Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) final rule. Under the rule, CMS will increase OPPS and ASC payments by an aggregate 2.6% for CY26 relative to CY25 ($8b and $450m increases, respectively). That rate update is comprised of 3.3% market basket update reduced by a proposed...

It’s been reported that the White House was yesterday planning to release a legislative proposal for addressing the ACA enhanced subsidies (eAPTCs) that expire at the end of this year. The proposal will apparently extend the subsidies for two years, but with modest revisions around eligibility (700% income threshold) and various waste/fraud/abuse...

Medicare Dialysis Reimbursement

CMS has issued the CY26 End-Stage Renal Disease (ESRD or dialysis) final rule. Under the rule, CMS will increase the dialysis base rate to $281.71, increasing aggregate payments to dialysis facilities by approximately 2.2% compared to CY25. For hospital-based dialysis facilities, CMS projects an increase in total payments of 1.5%, and for...

Affordable Care Act (eAPTCs)

With the shutdown behind them – and a promised Senate vote on the matter coming up on ~12/12 – lawmakers continue to debate (largely in partisan fashion) whether and how to address the ACA enhanced subsidies that expire at the end of this calendar year. In general, Republicans are increasingly, though not exclusively, pushing for alternatives to...

Healthcare, Macro

Government Shutdown, ACA

The Senate last night passed a procedural motion 60-to-40 that will allow for a vote in the coming days on legislation to end the government shutdown. The motion passed with the support of eight Democratic Senators. The legislation includes a “continuing resolution (CR)” to fund the government through 1/30/26, three full-year FY26 appropriations...

340B Drug Discount Program

The Health Resources and Services Administration’s (HRSA) Office of Pharmacy Affairs (OPA) announced it has approved eight drugmakers for participation in the 340B Rebate Model Pilot Program. The model – which will start January 1, 2026, and run for at least a year – will allow drugmakers to provide 340B-discounted drug prices using a rebate...