Insights: Healthcare

Legislative activity around the soon-to-expire ACA enhanced subsidies (eAPTCs) accelerated this week but remains highly partisan. The Senate yesterday failed to pass separate Democratic and Republican bills on the issue. And, House Republicans are moving towards a vote next week on what is likely to be a partisan approach to addressing the issue.

Medicare Drug Price Negotiation Program

CMS has announced the results of the second round of Medicare drug price negotiations (which comprised 15 Medicare Part D drugs). According to CMS, the negotiations yielded net savings (as compared to 2024 spending) of $12b (a 44% discount taking into consideration rebates and certain fees/payments). That figure drops to $8.5b (or a 36%...

Medicare DME Competitive Bidding (CBP)

As part of the CY26 Home Health Agency (HHA) Final Rule, CMS finalized various reforms to the Durable Medical Equipment, Prosthetics, Orthotics, & Supplies (DMEPOS) Competitive Bidding Program (CBP) and confirmed the CBP’s restart.

Medicare FFS Reimbursement (Home Health)

CMS has issued the CY26 Home Health Agency (HHA) Final Rule. Under the rule, CMS will decrease payments by -1.3% (-$220m) for CY26 relative to CY25. Comprising that net update is a 2.4% market basket update, a -0.1% outlier payment decrease, a -0.9% prospective behavioral adjustment due to the continued implementation of the Patient-driven...

Medicare Advantage (CY27 Rulemaking Part I)

CMS has issued the “Part I” Proposed Rule governing Medicare Advantage (MA) plans for contract year (CY) 2027, which includes policy and technical changes to the program. The “Part II” proposed rule, which focuses on reimbursement levels, will likely be released in sometime between now and February 2026.

President Trump has continued to signal shifting positions on the soon-to-expire ACA enhanced subsidies (eAPTCs). Earlier last week, the White House backed away from releasing its plan for addressing this issue (which, reportedly, would have included a temporary and nearly as-is extension of the subsidies and a framework for a more fulsome...