June 23, 2025
Nona Tepper
Bridget Early
UnitedHealth Group, Elevance Health, Aetna, Cigna and more than 40 other health insurance companies on Monday jointly announced an initiative to streamline prior authorizations.
Under the auspices of leading industry groups AHIP and the Blue Cross Blue Shield Association, the coalition of for-profit and nonprofit insurers pledged to reduce what providers characterize as the ever-increasing burden of obtaining precertifications for care.
June 10, 2025
Nona Tepper
Bridget Early
Having a Republican in the White House historically has been good for Medicare Advantage insurers, and President Donald Trump’s victory in November had the sector anticipating relief after a challenging four years under President Joe Biden.
So far, it’s not working out that way. Although the Centers for Medicare and Medicaid Services gave Medicare Advantage plans a rate increase for 2026 after it cut payments for two consecutive years during the Biden administration, CMS has maintained most of the more stringent oversight Trump’s predecessor put in place.
May 22, 2025
Michael McAuliff
The House passed a sweeping tax-and-spending cuts bill Thursday that would dramatically reshape the healthcare system by slashing more than $1 trillion from Medicaid and other programs.
The majority Republican lower chamber voted 215-214 to approve the One Big Beautiful Bill Act of 2025 just before 7 a.m. EDT after an all-night floor debate. Attention now shifts the GOP-led Senate, which has not commenced public debate on its tax measure.
April 28, 2025
Lauren Berryman
Elevance Health is facing a second lawsuit accusing it of maintaining inaccurate provider directories, also known as “ghost networks.”
The plaintiffs are three people covered under New York state employee health benefits who allege that Elevance Health division Carelon Behavioral Health misrepresented providers as in-network, causing them financial harm. The attorneys are seeking class-action status.
Legal experts expect “ghost network” lawsuits to spread. Health insurers have long faced criticism for faulty provider directories.
April 09, 2025
Nona Tepper
Health insurance investors cheered after the Centers for Medicare and Medicaid Services granted Medicare Advantage carriers their largest pay increase in a long while.
Wall Street reacted enthusiastically to the 5.1% payment hike for 2026 that CMS finalized Monday, which could signal a more favorable regulatory environment under Republican President Donald Trump than during the four years Democratic President Joe Biden occupied the White House. Health insurance stocks jumped 8.4% when the markets opened Tuesday.
April 02, 2025
Bridget Early
The Health and Human Services Department is restructuring agencies that enforce regulation, handle claims disputes, and investigate potential civil rights violations as part of a department-wide reorganization.
A new assistant secretary for enforcement will oversee three parts of HHS — the Departmental Appeals Board, the Office of Medicare Hearings and Appeals and the Office of Civil Rights — as part of a sweeping overhaul announced last week. The new role raises questions about how HHS plans to handle billions of dollars in claims disputes and appeals resolutions, as well as how the offices will operate within the new structure.
March 13, 2025
Alex Kacik
Hospitals could lose billions of dollars in revenue if states roll back Medicaid expansions due to potential Medicaid cuts.
House Republicans proposed hundreds of billions of dollars in Medicaid cuts, potentially including per capita caps, work requirements and eliminating enhanced federal payments for states that expanded Medicaid coverage. Hospitals may lose $32 billion in 2026 revenue if Medicaid expansion is curtailed, an analysis released Tuesday by the left-leaning think tank Urban Institute shows. Coverage losses could also increase providers’ uncompensated care costs.
March 03, 2025
Lauren Berryman
UnitedHealth Group is taking another step to refine its prior authorization requirements as it continues to face public frustration. The healthcare giant’s insurance business, UnitedHealthcare, plans to cut nearly 10% of prior authorizations this year, the company said in a notice Saturday.
As part of the initiative, the insurer said it will remove pre-approval requirements for home health services managed by its home and community division. The changes will apply to Medicare Advantage and dual special needs plans in 36 states and Washington, D.C., starting April 1.
February 19, 2025
Nona Tepper
Health insurance customers in more parts of the country have new advocates in their battles against claims denials: state governments.
States have long had regulatory authority over the individual and small-group health insurance markets, but a growing number of agencies is taking on a greater role assisting consumers as they transition out of a federal system and take matters into their own hands.
State officials see homegrown solutions as more effective at handling large numbers of complaints. Pennsylvania, for instance, established an independent external review board in 2024 while Arizona launched a program at the start of this year.
February 11, 2025
Michael McAuliff
Lawmakers say they are confident Congress will extend expanded telehealth authorities past a looming deadline next month — but they have no idea how and could not rule out a lapse.
In 2020, Congress and President Donald Trump temporarily expanded Medicare reimbursement for services clinicians provide remotely as part of the response to the COVID-19 pandemic. Lawmakers have hailed extended telehealth rules for providing lifelines to rural and underserved populations in particular, prompting some to propose bills last year to make the changes permanent.
