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…
Redefining healthcare financial KPIs in a post-COVID era: A strategic imperative
The COVID-19 pandemic compelled hospitals and health systems to rethink nearly every aspect of their operations. Nowhere was the disruption more profoundly felt than in the revenue cycle. Long-standing financial key performance indicators (KPIs) such as accounts receivable (AR) days, clean claim rates and denial percentages, quickly lost their relevance amid staffing shortages, unpredictable patient…
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…
Annual Conference Day 3: Some positives for the healthcare industry, but challenges and concerns abound
Amid the challenges of the present moment, it may seem hard to find reason for optimism. But some metrics and trends represent a solid foundation on which not-for-profit hospitals and health systems can brace themselves against the headwinds. “Of the key tenets we look for in the sector, volumes are back to pre-pandemic levels and…
Annual Conference Day 2: Medicaid, AI take center stage in presentations
On the list of concerns for hospital and health system CFOs, looming cuts to Medicaid payments are at or near the top, according to a panel discussion Monday afternoon at HFMA’s Annual Conference in Denver. Cuts to projected Medicaid spending, as drafted in the budget reconciliation bill now being discussed among congressional Republicans, would have…
Insurers promise to make prior authorization processes easier for all parties
In potentially a rare dose of good news for providers about prior authorization, the health insurance industry has volunteered to scale back the process and introduce new accommodations, according to an announcement Monday. As described by the insurance lobby and the Trump administration, which convened a meeting Monday at which a large segment of the…