The latest on providers’ landmark antitrust suit alleging price fixing by MultiPlan and healthcare insurers
Billions of dollars are at issue in an ongoing lawsuit in which providers allege price fixing by a vendor and a large segment of the health insurance industry. Providers bringing the suit maintain that the healthcare technology solutions company MultiPlan and roughly 700 health plans conspired to suppress reimbursement for out-of-network services over a decade…
In Medicare’s latest hospital-focused rule, CMS pushes new proposals for price and quality transparency
Medicare’s 2026 proposed rule for hospital outpatient care includes the Trump administration’s latest effort to augment price transparency requirements. Two months after updated guidance featured a mandate to immediately start posting actual prices rather than estimates in machine-readable files (MRFs), among other directives, the proposed rule contains further steps in the name of specificity. The…
Proposed Medicare hospital payment rule includes a surprising cut
Although payment rates technically would increase under Medicare’s 2026 proposed rule for hospital outpatient care, various provisions would chip away at the finances of hospitals and health systems. Specifically, key provisions would equalize certain site-based payments and also accelerate a planned across-the-board payment decrease related to 2022 remedy payments that were made to 340B Drug…
In proposed Medicare physician payment rule, CMS emphasizes Trump administration priorities
Medicare’s 2026 proposed rule for physicians is a key early chance for the Trump administration to shape U.S. healthcare policy in alignment with HHS Secretary Robert F. Kennedy Jr.’s Make America Healthy Again approach. Some of the most noteworthy provisions thus represent an effort to shift resources to primary care and prevention and to crack…
Constriction looms for a key segment of healthcare coverage
The reverberations for Medicaid have drawn most of the recent headlines, but federal policy developments also portend a big contraction of the individual-insurance market in 2026 and beyond. Although group coverage remains the predominant form in the U.S., the market for individual plans has been growing amid recent surges in Affordable Care Act (ACA) enrollment.…
How the reconciliation bill will shake out for hospitals and the healthcare industry
Note: The opening section of this article was rewritten July 23 to account for an updated estimate by the Congressional Budget Office. Declines in coverage and spending await the healthcare industry under the budget reconciliation bill signed into law by President Donald Trump on July 4, but the immediate consequences could be muted. Since passage…
Reconciliation bill with substantial Medicaid cost-cutting is set to become law
Note: The headline and some information in this story were updated July 3 in response to events in Congress. July 3 update The House passed the reconciliation bill by a party-line 218-214 vote (with two Republicans voting “no”), teeing it up for President Donald Trump to sign into law July 4. See the original story…
Supreme Court retains the Affordable Care Act’s mandate to waive cost sharing for preventive care
The status quo prevailed Friday for coverage of preventive care under the Affordable Care Act, with the Supreme Court backing a mandate for preventive services to be cost-free if supported by an expert panel. With a 6-3 decision in Kennedy v. Braidwood, the court overruled an appeals court’s finding that members of the U.S. Preventive…
Medicaid funding restrictions hit a roadblock in budget reconciliation bill
A Senate official put at least a temporary halt to one of the most contentious sources of Medicaid savings in the budget reconciliation bill. The chamber’s parliamentarian, Elizabeth MacDonough, ruled that provisions to reduce Medicaid provider taxes cannot be included in the bill in their current form. If Republicans retain the tax limits or other…
Annual Conference Day 4: Expert panel discusses Medicaid and other crucial policy developments
Hospital leaders and healthcare policy analysts are keeping a wary eye on potentially large Medicaid funding cuts that could be imminent. As Congress decides what level of spending retrenchment to include in the budget reconciliation bill, hospital executives are left to anticipate just how big the impact will be. For Gordon Edwards, CFO of Akron’s…