Today's News and Commentary

Read today’s Kaiser Health News

About health insurance/insurers

Do higher premiums drive more healthcare usage? : “We’re seeing a significant and disproportionate increase in utilization largely within our public sector group retiree business. This population experienced the greatest year-over-year premium increases,” UnitedHealthcare CEO Tim Noel told investors. “We did assume that we would see some care activity level increases in this population, but what we’re seeing far surpasses what we would have recently anticipated. And in that population as well, we are seeing more preventative care, more annual wellness visits, more in-home clinical assessments. The driver there is also really the follow-on care that results from that.”
Comment: The unknown is whether it is a cause and effect relationship.
What would drive more usage? People trying too get their “money’s worth.”
Or, higher premiums drive sicker people away so that the remaining sicker population skews the average usage higher.

About pharma

The 25 most expensive hospital drugs FYI

About the public’s health

Nearly Half of People in U.S. Exposed to Dangerous Air Pollution Levels: Nearly half of the people living in the U.S. breathe unhealthy levels of air pollution, according to the American Lung Association’s 2025 “State of the Air” report, which was released today. In total, the report finds that 156 million people, 25 million more than last year’s report, are living in areas that received an “F” grade for either ozone or particle pollution. Extreme heat and wildfires contributed to worse air quality for millions of people across the U.S.
Comment: Regardless of opinions about pollution causing climate change, there is no doubt about its adverse role in health. In related stories, see what the EPA has announced and Trump officials consider shrinking 6 national monuments in the West.

Funding cut for landmark study of women's health:The Trump administration is shutting down most of a landmark federal project studying women's health, stunning researchers around the country.
"It's a huge loss. I can't put into words what a huge loss it is," says Marian Neuhouser, who chairs the steering committee for the federally funded Women's Health Initiative. The study, begun in the 1990s, has produced a series of groundbreaking results and was continuing to gather valuable data about women's health.
The Department of Health and Human Services is terminating contracts with all four regional centers that have been following tens of thousands of women who have been participating in the project for decades, according to the project's coordinating center.

About healthcare personnel

What noncompete laws look like in every state FYI

About healthcare finance

9 payer M&A deals in 2025 FYI

Today's News and Commentary

Read today’s Kaiser Health News

In other news:

DOGE has access to 19 HHS systems: Report: The U.S. Department of Government Efficiency has access to sensitive information in 19 HHS databases and systems, according to a court filing obtained by Wired.
HHS submitted the filing as part of the discovery process for a lawsuit the American Federation of Labor and Congress of Industrial Organizations’ filed against the federal government, aiming to restrict DOGE’s access to federal systems. Nine such systems had not been previously disclosed as being accessed by DOGE. HHS did not respond to Wired‘s request for comment. 
[See the article for specifics of which systems are affected.] 

About health insurance/insurers

CHRAs Gain Favor Among Large Employers Due To Reduced Health Insurance Expenses: Individual Coverage Health Reimbursement Arrangements are gaining traction among large employers as a cost-effective alternative to traditional health insurance plans, offering potential savings, employee choice, and broader market adoption in the face of economic uncertainties and rising healthcare costs. 
At a Glance
-About 44% of large employers consider ICHRAs to cut health insurance costs, offering pre-tax funds for individual plans.
-ICHRAs reduce premiums by 23% on average, distributing risk across broader population segments.
-Experts predict ICHRAs will dominate the employer-sponsored health insurance market within 10 years.

Highest-paid payer CEOs in 2024 FYI

Healthcare billing fraud: 10 recent cases FYI

About the public’s health

Dose Response of Incidental Physical Activity [IPA] Against Cardiovascular Events and Mortality: Any daily IPA amount of vigorous or moderate intensity was associated with lower CVD risk in a dose-response manner. LIPA had weak associations with all outcomes. One minute of vigorous or ≈3.0 to 3.5 minutes of moderate IPA was associated with a similar degree of lower CVD risk. Our findings highlight the potential cardiovascular health value of incidental physical activity, especially for people who struggle to do structured exercise. 

Food companies agree to phase out synthetic dyes, handing MAHA a victory: Food manufacturers will phase out eight synthetic dyes from all U.S. products by the end of 2026, the federal government announced today in a move that reflects the growing reach of the Make America Healthy Again movement.

Americans unsure what to believe about the measles vaccine, poll shows: Most Americans have encountered false claims about the measles vaccine, and many aren’t sure what the truth is, according to a KFF poll released Wednesday.

With future of gun research in question, new report finds US emergency departments see a firearm injury every 30 minutes: Every 30 minutes, an emergency department treats another firearm injury, according to a new analysis from researchers at the US Centers for Disease Control and Prevention that looked at 10 jurisdictions, including the District of Columbia.
But cuts from the US Department of Health and Human Services and proposed changes to the federal budget could threaten research that reveals these kinds of firearm injury patterns. Experts say it would be nearly impossible to replicate the scale and scope of the timely firearm research the federal government is able to conduct.

Today's News and Commentary

Read today’s Kaiser Health News

In other news:

As Trump eyes coal revival, his job cuts hobble black lung protections for miners:
Summary

  • Layoffs halt black lung protection programs for miners

  • NIOSH and MSHA programs suspended amid Trump administration cuts

  • Miners face increased risk as safety regulations enforcement weakens

About pharma

The top 20 pharma companies by 2024 revenue: For the second straight year, there was no change at the top as No. 1 Johnson & Johnson, No. 2 Roche, No. 3 Merck, No. 4 Pfizer and No. 5 AbbVie each held their positions. Each company delivered modest revenue increases in 2024 of between 3% and 7%.

About the public’s health

Annual Report to the Nation on the Status of Cancer From The National Cancer Institute:
Key Points

  • Overall, from 2018 to 2022, cancer death rates decreased an average of 1.7% per year for men and an average of 1.3% per year for women.

  • Cancer death rates decreased an average of 1.5% per year from 2001–2022 among children (ages 0-14 years).

  • Among adolescents and young adults (AYAs) ages 15-39, death rates fell by 2.9% per year from 2001–2005, 1% per year from 2005–2020, and then remained stable from 2020–2022.

  • Overall cancer mortality declined for over 20 years, even during the COVID-19 pandemic.

  • The rate of new cancer cases is higher among men than women. However, the rate has increased for women by 0.3% per year from 2003 through 2021. Rates of new cancer cases among men decreased by 1.6% – 2.2% per year from 2001 through 2013 before stabilizing through 2021.

  • Rates of new cases and deaths for tobacco-related cancers have been decreasing, but rates for cancers associated with excess body weight have been increasing.

RFK Jr. to announce intent to phase out synthetic food dyes: Robert F. Kennedy Jr. is slated to announce an intent to phase out the use of petroleum-based synthetic food dyes in a bid to ramp up pressure on an industry he has often derided. 

About healthcare personnel

Physicians and Surgeons From The U.S. Bureau of Labor Statistics: Overall employment of physicians and surgeons is projected to grow 4 percent from 2023 to 2033, about as fast as the average for all occupations.
About 23,600 openings for physicians and surgeons are projected each year, on average, over the decade. Many of those openings are expected to result from the need to replace workers who transfer to different occupations or exit the labor force, such as to retire.
[The statistics are broken down by specialty.]

Today's News and Commentary

Read today’s Kaiser Health News

In other news:

NIH moving to ban grants to universities with DEI programs, Israeli boycotts: The National Institutes of Health says it will pull medical research funding from universities with diversity and inclusion programs and any boycotts of Israeli companies, according to a policy note issued Monday.
The agency “reserves the right to terminate financial assistance awards and recover all funds” if grant recipients do not comply with federal guidelines barring diversity and equity research and “prohibited boycotts,” the notice stated

About Covid-19

Studies across 14 nations show 25% to 30% rate of long COVID: Among the 25.1% of participants who said they experienced long-COVID symptoms, 12.8% reported sleeping disorders, 9.8% reported joint pain, 8.7% had fatigue, and 8.1% noted headaches. Almost a third of participants (29.8%) from lower middle-income countries said they had long COVID, compared with 14.4% in high-income countries (adjusted odds ratio [aOR] 1.53; 95% confidence interval [CI], 1.10 to 2.14).
The highest long-COVID prevalence was seen in patients with Arab/North African ethnicity (36.1%), and hospitalized patient were also at increased risk of long COVID (aOR, 2.04; 95% CI, 1.63 to 2.54). 

About health insurance/insurers

U.S. Supreme Court appears likely to uphold ACA preventive care coverage mandate: The Supreme Court seemed likely to uphold a key preventive-care provision of the Affordable Care Act in a case heard Monday.
Conservative justices Brett Kavanaugh and Amy Coney Barrett appeared skeptical of arguments that Obamacare’s process for deciding which services must be fully covered by private insurance is unconstitutional.  

About pharma

Walgreens paying up to $350M as it tries to close the book on opioid lawsuits: Walgreens Boots Alliance has agreed to pay a $300 million settlement to resolve allegations that the pharmacy chain illegally filled invalid opioid prescriptions and filed false Medicare claims for the invalid prescriptions, federal agencies announced this morning.
The settlement further states that Walgreens will have to pay an additional $50 million if it is sold, merged or transferred before fiscal year 2032.
That eventuality seems likely, as Walgreens in the midst of a turnaround strategy and in March announced it is pursuing a private-equity sale. 

About the public’s health

Differential Associations of Cigar, Pipe, and Smokeless Tobacco Use Versus Combustible Cigarette Use With Subclinical Markers of Inflammation, Thrombosis, and Atherosclerosis: The Cross-Cohort Collaboration–Tobacco Working Group: Use of noncigarette tobacco products is linked to subclinical markers related to cardiovascular harm. Inflammatory markers, such as high-sensitivity C-reactive protein and interleukin-6, have the potential for assessing early cardiovascular harm from using these products and aiding regulatory authorities in evaluating their associated risks. 

China’s restrictions on rare earths could hurt U.S. health care Among these metals used for healthcare applications are gadolinium, lutetium and yttrium.

Today's News and Commentary

Read today’s Kaiser Health News

In other news:

Medical journal receives U.S. attorney letter seeking information about alleged bias: This week, at least one scientific journal has received an unexpected inquiry from a top government official requesting that it detail some of the thinking behind its editorial practices. 
“It has been brought to my attention that more and more journals and publications like CHEST Journal are conceding that they are partisans in various scientific debates,” reads the letter, sent by the interim U.S. attorney for the District of Columbia, Edward R. Martin Jr., to the editor in chief of the American College of Chest Physicians journal.  
The letter goes on to ask six questions of the journal, largely about alleged bias in the decision to publish content. 

Access to SNAP-Authorized Retailers and Diet Quality Among SNAP Recipients: This cross-sectional study, including 5041 SNAP recipients, found that living closer to SNAP-authorized retailers, particularly superstores and grocery stores, was associated with higher Healthy Eating Index-2015 scores among participants.

NIH said to have halted awarding of new grants to more top universities: Internal email instructs agency staff not to communicate with institutions about the decision. Embattled universities whose funding from the National Institutes of Health has been frozen may face further financial strain as the agency holds off awarding new grants to at least half a dozen of them, according to an email obtained by STAT.

And in a related article: DOGE begins to freeze health-care payments for extra review: The U.S. DOGE Service is putting new curbs on billions of dollars in federal health-care grants, requiring government officials to manually review and approve previously routine payments — and paralyzing grant awards to tens of thousands of organizations, according to 12 people familiar with the new arrangements.
The effort, which DOGE has dubbed “Defend the Spend,” has left thousands of payments backed up, including funding for doctors’ and nurses’ salaries at federal health centers for the poor. Some grantees are waiting on payments they expected last week.  

About health insurance/insurers

Patient-Reported Characteristics Across Dual-Eligible Medicare Advantage Plan Types: This cross-sectional study including 147 923 dual-eligible beneficiaries found differences in the characteristics of full-benefit dual-eligible beneficiaries across MA plan types. Older dual-eligible individuals and those with multiple functional limitations were more likely and those in highly socioeconomically disadvantaged neighborhoods were less likely to enroll in fully integrated dual-eligible Special Needs Plans compared with less integrated plan types.
 
About hospitals and healthcare systems

One-quarter of small employers ditch health premiums every year, analysts find: About 27% of the small employers that were paying health insurance premiums in 2022 stopped paying the premiums in 2023, according to a new report from a research arm of JPMorgan Chase.  

About pharma

FDA to limit pharma employees from serving on adcoms, citing 'undue influence' The FDA announced on Thursday a new policy to limit employees of pharmaceutical companies from serving on advisory committees (adcoms), as part of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr.'s initiative to introduce "radical transparency" into the department. Instead, the agency will prioritise appointing patients and caregivers to review panels.
According to the FDA, the goal is to "mitigate perceived industry influence and conflicts of interests" while increasing the public's trust in the US regulator and its decisions.  

About the public’s health

Nicotine and Toxicant Exposure among Individuals using both Combustible Cigarettes and E-cigarettes Based on Level of Product Use: In this population-based cross-sectional study, individuals reporting dual use appear to have nicotine and toxicant exposure at least at the same level as those using cigarettes alone and higher than exclusive e-cigarette use (except for metals). Given the adverse health consequences of dual use, including potential cancer risk, our findings highlight the need for clinicians and public health practitioners to increase awareness of the potential risks associated with dual use. A

Analysis of USAID’s Active and Terminated Awards List: How Many Are Global Health?:
—Global health awards account for 12% of all awards on the list but the majority (53%) of all unobligated funding.
—80% of global health awards are listed as terminated, totaling $12.7 billion in unobligated funding.
—Many global health awards are multi-sectoral, spanning more than one global health area, with HIV/AIDS accounting for the greatest number.

RFK Jr.’s cuts to CDC eliminate labs tracking STIs, hepatitis outbreaks:Lab scientists at the Centers for Disease Control and Prevention had been analyzing blood samples for weeks to determine how dozens ofpatients across six states had become infected with viral hepatitis, a disease that can cause serious liver damage.
But their DNA detective work stopped abruptly last week. Widespread layoffs across federal health agencies earlier this month had resulted in the firing of all 27 lab scientists who worked in the only U.S. facility that could perform the sophisticated genetic sequencing needed to investigate hepatitis outbreaks, lab experts said.
Another lab, the only one in the United States capable of testing for and tracking antibiotic-resistant gonorrhea, often called “super gonorrhea,”was also recently effectively shut down. 

Today's News and Commentary

Note: Due to technical site problems, yesterday’s blog was not transmitted. Appologies.

Read today’s Kaiser Health News

In other news:

Estimated Impact Of Medically Tailored Meals On Health Care Use And Expenditures In 50 US States: Medically tailored meals (MTMs) can reduce health care use among high-risk patients with diet-related conditions. However, the potential impact of providing coverage for MTMs across fifty US states remains unknown…Assuming full uptake among eligible people, MTMs were net cost saving in the first year in forty-nine states, with the largest savings seen in Connecticut ($6,299 per patient). The exception was Alabama, where MTMs were cost-neutral. The number of treated patients needed to avert one hospitalization ranged from 2.3 (Maryland) to 6.9 (Colorado). These findings can inform state-level policy makers and health plans considering MTM coverage through state-specific strategies. 

States with the highest, lowest health equity scores FYI. The results are not obvious.

Internal budget document reveals extent of Trump’s proposed health cuts:

  • The proposal would reduce the more than $47 billion budget of the NIH to $27 billion — a roughly 40 percent cut. It would consolidate NIH’s 27 institutes and centers into just eight. Some of its institutes and centers would be eliminated, including the National Institute on Minority Health and Health Disparities and the National Institute of Nursing Research.

  • Many of NIH’s institutes would be fused. A National Institute on Body Systems, for example, would absorb three separate institutes: the institute focused on heart and lung diseases; the institute focused on diabetes, kidney and digestive disorders; and a third focused on muscle, skeletal and skin diseases.

  • A new, $20 billion agency named the Administration for a Healthy America would be created. AHA would include many pieces of other agencies that are being consolidated — such as those focused on primary care, environmental health and HIV.

  • AHA would have $500 million in policy, research and evaluation funding to be allocated by Kennedy to support “Make America Healthy Again” initiatives, including a focus on chronic childhood diseases. But many specific programs would be eliminated under AHA, according to the document, including programs focused on preventing childhood lead poisoning, bolstering the health-care workforce, advancing rural health initiatives and maintaining a registry of patients with amyotrophic lateral sclerosis, or ALS.

  • The proposal would fund the Food and Drug Administration at a level that allows it to continue to collect drug and medical device fees from the industries the agency regulates. Unless the agency is funded at a certain level, the FDA’s ability to use these funds, which help expedite safety reviews for devices, drugs and other products, would be limited.

  • The proposal would cut the CDC’s budget by about 44 percent, from $9.2 billion to about $5.2 billion, and would eliminate all of the agency’s chronic disease programs and domestic HIV work. The chronic disease programs being eliminated include work on heart disease, obesity, diabetes and smoking cessation.

  • Rural programs formerly under the Health Resources and Services Administration appear to be hard-hit. The rural hospital flexibility grants, state offices of rural health, rural residency development program and at-risk rural hospitals program grants are listed as eliminations under AHA.

  • Money for the Head Start program, which provides early child care and education for low-income families and is funded by HHS’s Administration for Children and Families, would be eliminated. “The federal government should not be in the business of mandating curriculum, locations and performance standards for any form of education,” the document says.

About health insurance/insurers

Supreme Court to hear challenge to ACA rule requiring free preventive care, cancer screenings: or a decade and a half, Americans have been guaranteed that no matter their health insurer, certain preventive care like cancer screenings are free of charge. That’s because an Affordable Care Act provision has required insurers to fully cover services given an A or B recommendation by an expert task force.That may soon change. On Monday, the U.S. Supreme Court will hear a challenge to this statute in the case of Kennedy v. Braidwood Management. Either way the court decides, legal and medical experts told STAT, the ruling could have profound ramifications for the future of preventive health care in the United States.

In a related article: Use of No-Cost Preventive Services Jeopardized by Kennedy v Braidwood: This cross-sectional study presented a detailed, comprehensive assessment of ACA-mandated no-cost preventive service use potentially jeopardized by Braidwood and future challenges. Among ESHI enrollees in 2018 aged 18 to 64 years, nearly 1 in 3 (and nearly half of women) received no-cost preventive services from 2018 to 2022 covered under the ACA mandate but threatened by Braidwood. While results varied across states, proportions were higher than 20% in every state.

UnitedHealth cuts earnings guidance amid rising Medicare Advantage costs: UnitedHealth Group posted nearly $6.3 billion in net income during the first quarter of 2025, but the company reduced its year-end earnings outlook amid rising use of physician and outpatient services among its Medicare Advantage membership and “unanticipated changes in the profile of Optum Health members.”
UnitedHealth stock decreased 20% on the morning of April 17 following “an overall performance that was frankly unusual and unacceptable,” CEO Andrew Witty told investors. In its earnings report, the company also cited “a greater-than-expected impact to current and new complex patients from the ongoing Medicare funding reductions enacted by the previous administration.” 

About hospitals and healthcare systems

10 Things to Know About Rural Hospitals FYI. One reason this study is important is that “Rural hospitals account for about one third of all community hospitals nationwide and at least a third of all hospitals in most states.” 

About pharma

Eli Lilly’s 1st GLP-1 pill shows favorable results in late-stage trial:Eli Lilly completed a phase 3 trial for its weight loss drug, orforglipron, which showed promising results in evaluating its safety and efficacy for adults with Type 2 diabetes and inadequate glycemic control. 
The once-daily oral GLP-1 receptor agonist significantly reduced blood sugar and body weight in adults with Type 2 diabetes and had a safety profile consistent with injectable therapies, according to an April 17 news release from the drugmaker. 
Comment: If the results hold up, this medication could replace the injectables in its class, probably at lower cost.

Trump Seeks to Lower Drug Prices Through Medicare and Some Imports: President Trump signed an executive order on Tuesday outlining a series of actions intended to lower drug prices, including helping states import drugs from Canada.
The policies were more modest than proposals to reduce drug prices that Mr. Trump offered in his first term.
And one of his new directives could increase drug prices. It calls for the Trump administration to work with Congress to change a 2022 law in a way that could defang a negotiation program meant to reduce Medicare’s spending on commonly used or costly drugs.
Such a change has the potential to increase costs for the government, because it would most likely delay the existing timetable for some drugs to become eligible for Medicare price cuts.

Arkansas first state to ban PBMs from owning pharmacies: Arkansas has become the first state to ban pharmacy benefit managers from owning pharmacies after Gov. Sarah Huckabee Sanders signed House Bill 1150 into law April 16. 
The legislation, sponsored by state Rep. Jeremiah Moore and state Sen. Kim Hammer, prohibits state pharmacy permits from being issued to PBMs beginning Jan. 1, according to an Jan, 16 press release from the governor’s office.  

About healthcare IT

Evolving Remote Monitoring: An Evidence-Based Approach to Coverage and Payment Not all remote monitoring programs are effective. Look at page 9of this report for a summary of evidence.

 About healthcare personnel

40% of nurses eye exit by 2029: 5 findings from NCSBN’s new workforce report  Worth skimming the report’s main findings.

About health technology

Device maker that helped UnitedHealth collect billions offers to settle fraud claims with DOJ United used a device from this company to document decreased peripheral blood flow-allowing the company to claim a higher patient severity and get more Medicare Advantage payments.

Today's News and Commentary

Read today’s Kaiser Health News

In other news:

FTC probes antitrust regulations after Trump’s executive order: 7 things to know FYI

Impacts of Communication Type and Quality on Patient Safety Incidents: A Systematic Review: Four studies investigated whether poor communication was the only identified cause of a patient safety incident; here, poor communication caused 13.2% (IQR, 6.1% to 24.4%) of safety incidents. Forty-two studies investigated whether poor communication contributed to patient safety incidents alongside other causes; here, poor communication contributed to 24.0% (IQR, 12.0% to 46.8%) of safety incidents. Study heterogeneity was high in terms of setting, continent, health care staff, and safety incident type. The strength of the evidence was low or very low. 

About health insurance/insurers

Medicare Advantage rate boost likely to ‘significantly support’ payers’ financial recovery: Fitch: CMS’ payment increase of 5.03% in 2026 “will likely significantly support the recovery” of Medicare Advantage plans as they continue to face rising medical costs, according to Fitch Ratings.
Increased government scrutiny, reduced base payments and rising utilization in the last couple of years has put pressure on the program, leading plans to reduce benefits or pull back from unprofitable markets. CMS’ rate hike will increase payments to MA plans by more than $25 billion in 2026. 

Around 1 in 4 small businesses are dropping insurance coverage: 5 notes:
Here are five findings to note: 

  1. The share of businesses dropping employees varied by industry. Among personal service businesses with employees, 33% discontinued insurance coverage between 2022 and 2023. Among real estate businesses, the share was 25%. 

  2. A 10% hike in premiums cost was associated with a higher likelihood of discontinuing coverage, the analysts found. 

  3. Most small businesses that stopped paying health insurance premiums continued to operate in the following years, according to the report. This indicates that discontinuing health insurance is often a “strategic move to manage expenses, rather than an indication of financial distress or impending closure.” 

  4. In 2023, small businesses spent an average of 4.2% of total operating expenses on health insurance, a 3.1% jump from 2023. 

  5. Policies to keep premiums affordable and predictable could help small businesses retain consistent coverage, according to JPMorganChase. 

Read the full report here.  

About the public’s health

RFK Jr. plans changes to vaccine injury reporting system: Health secretary Robert F. Kennedy Jr. said Tuesday that he plans to roll out changes to the vaccine injury monitoring system that would automate and increase data collection as well as look for negative impacts of the shots.  

About healthcare IT

The Healthcare AI Adoption Index 
Top takeaways
—AI adoption is accelerating,
driven by internal teams co-developing with Big Tech and cloud providers—not just startups (i.e., healthcare AI applications).
60% of execs report AI budgets outpace IT spend, with funding decisions centralized within the C-suite.
Only 30% of AI pilots reach production, held back by security, data readiness, integration costs, and limited in-house expertise.
Startups have significant growth opportunities ahead: As of now, only 15% of AI projects involve vertical AI applications, and just 32% of executives believe GenAI solutions from startups are superior to those from large tech incumbents. Yet 48% of executives say they prefer working with startups over established players, highlighting the potential for startup founders to co-build and serve emergent AI strategies.
Trust and outcomes matter most—procurement is shifting toward co-development as 64% of execs are open to co-developing with early-stage partners, particularly with those startups that show clear and attributable ROI.

Today's News and Commentary

Read today’s Kaiser Health News

In other news:

About health insurance/insurers

CMS Cuts Medicaid Funding For Some Non-Medical In-Home Services: The Centers for Medicare & Medicaid Services (CMS) announced Thursday that it would no longer approve funding for some services previously covered by state section 1115 demonstrations, including some in-home non-medical services.
In a letter addressed to state Medicaid directors, CMS stated that the organization “did not anticipate” approving new federal funding for designated state health programs (DSHP) and designated state investment programs (DSIP) under section 1115 demonstration authority.
Among the examples of expenditures that would not be approved moving forward, CMS cited $241 million for a program in New York dedicated to non-medical in-home services, including housekeeping.

CMS drops 5 proposed payment rules for 2026: 25 things to know A great review of the proposed changes across provider types.

About hospitals and healthcare systems

Hospital M&A plummets amid market volatility: Hospital mergers and acquisitions dropped in the first quarter as the economic and political climate changed, according to Kaufman Hall’s “M&A Quarterly Activity Report: Q1 2025.
There were five transactions in the first quarter and no mega-mergers where the smaller party had $1 billion revenue or more. Comparatively, the first quarter of 2024 had 20 transactions and the first quarter of 2020 had 29. 

CMS weighs dropping some quality measures: What to know: The agency outlined the changes April 11 as part of its 2026 proposed rule for the Medicare payment systems that cover inpatient and long-term care hospitals. 

Under the hospital inpatient quality reporting program, hospitals that fail to meet requirements or submit quality data face a 25% reduction in their annual payment update.
The agency has proposed modifying four current quality measures:
Total hip arthroplasty/Total knee arthroplasty complication rate and 30-day stroke mortality rate: CMS is proposing to include Medicare Advantage patients, shortening the performance period from three to two years, and revising the risk adjustment methodology for both measures (including a refinement for stroke severity in the latter).
Hybrid, hospitalwide readmission and mortality measures: CMS is proposing allowing up to two missing lab results and two missing vital signs per case, and reducing the submission thresholds for core clinical data elements and linking variables to 70% of discharges for both hybrid measures.

About the public’s health

Not Just Measles”: Whooping Cough Cases Are Soaring as Vaccine Rates Decline:
Reporting Highlights
Vaccine Hesitancy:
Texas’ measles outbreak has been blamed on vaccine hesitancy. But parents are not getting their children other vaccines as well.
Not Just Measles: Vaccine rates for other childhood diseases have fallen, contributing to rising cases of whooping cough and other illnesses.
Government Failure: The Trump administration’s cuts to public health jobs and funding make it harder for agencies to fight outbreaks and prevent disease with vaccines. 

About healthcare personnel

Physician pay growth stalls: Physicians are seeing slower pay growth in the last year amid economic uncertainty, according to Medscape’s “Physician Compensation Report 2025.”
The company surveyed 7,322 physicians across 29 specialties from Oct. 3, 2024 to Jan. 15, 2025, and found compensation increased around 3.6% on average for physicians, which was the lowest growth rate since 2011 when Medscape first began reporting compensation.
Pay gains were around 1.4% for primary care physicians, hitting $281,000 last year, and 1% for specialists, hitting $398,000. Pay growth was the lowest since 2021 at the height of the pandemic. The pay figures cover base salary, incentive bonus and other income including profit-sharing. 

The state of the physician workforce in 2025 A nice summary of trends.

Today's News and Commentary

Read today’s Kaiser Health News

In other news:

RFK Jr.: If you eat doughnuts or smoke, should society pay for your health care?: Robert F. Kennedy Jr. asked whether society should pay for the health care of Americans who eat doughnuts or smoke when they know those habits can contribute to poor health outcomes.
“If you’re smoking three packs of cigarettes a day, should you expect society to pay when you get sick?” the nation’s top health official asked in an interview released Wednesday with CBS News chief medical correspondent, physician Jon LaPook. 
Comment: This remark raises the ever-present question: to what extent are we responsible for our own health behaviors and is there is a monetary cost to bad habits?
Society covers some cost of individual bad behaviors through taxation, such as tobacco taxes. But what about untaxed items and taxes that do not pay for the costs of care?

Health Spending Issues to Watch This Year Great overview from KFF.

About health insurance/insurers

Trump to end federal funding of certain non-medical services in Medicaid The Trump administration said Thursday that it will no longer help states fund non-medical services that often are aimed at improving housing and nutrition for people in the Medicaid program. The change is a departure from the Biden administration’s efforts to improve the health of Medicaid enrollees by paying for non-medical services.
The Centers for Medicare and Medicaid Services sent a letter to states notifying them that it no longer intends to let states use federal matching funds for two types of programs: designated state health programs (DSHP) and designated state investment programs (DSIP). It said it won’t take new applications for these programs, or renew existing efforts as they expire.  

About healthcare IT

Lack of Financial Resources, Determining a Cohesive Enterprise Strategy Cited as Top Implementation Concerns  
Key results from the survey include:
Payer Responses:
• For the API requirements, 43% have not yet started work and 31% are one quarter completed.
• The top three challenges reported are: 1) determining a cohesive enterprise strategy for interoperability; 2) digitizing prior authorization policies; and 3) sufficient funding.
• The majority (35%) estimate a cost of $1 million - $5 million for implementing the API components of the rule.  
Provider Responses:
• For the API requirements, 52% reported they had not yet started work.
• The top three implementation issues reported are: 1) sufficient funding; 2) determining a cohesive enterprise strategy for interoperability; and 3) sorting out the various networks and how they interplay (e.g., TEFCA, QHIN, HIE, etc.).
• A majority (44%) are unsure of the total cost for implementing the final rule requirements and training their employees.
• Most (79%) view having the majority of their payers supporting the prior authorization requirements as very important or extremely important.
Clearinghouse Responses:
• A strong majority (84%) intend to assist payers and providers with the API requirements of the rule.
• For the Prior Authorization API, 81% plan to implement both the FHIR and X12 solutions.
Vendor Responses:
• Eighty-one percent plan to assist payers and providers comply with the requirements of the rule.
• Thirty-six percent plan to support consumers with the Patient Access API, while 32% do not.  

Today's News and Commentary

Read today’s Kaiser Health News

In other news:

RFK Jr. suggests some vaccines are risky or ineffective, downplays measles threat: In an interview with CBS News that aired Wednesday, the nation’s top health official said that “people should get the measles vaccine,” a more direct assertion than has been typical from Kennedy, who has a long history of questioning vaccine safety. 
At the same time, however, he appeared to minimize the threat of a growing outbreak centered in Texas and New Mexico and sent mixed signals about vaccines, saying many vaccines “aren’t safety tested.” He went on to argue they’re not tested against placebo groups or only over short periods of time. Public health officials across independent bodies have repeatedly approved vaccines based on their safety and efficacy evidence, including placebo-controlled trials and long-term studies.

Government shuts CDC office focused on alcohol-related harms and prevention: A small office that produced data on alcohol-related deaths and harms, and worked on policies to reduce them, has been shuttered by the Trump administration. Those involved with the work say it was the only group in the federal government focused on preventing excessive drinking and the many problems associated with it, including chronic diseases.
At least 11 states directly relied on the Alcohol Program in the Centers for Disease Control and Prevention for funding, data assistance and other guidanc 

About hospitals and healthcare systems

The 24 hospitals fined for price transparency violations, by state FYI

About pharma

41% of drug shortages span more than 2 years: More than one-third (41%) of active drug shortages began in 2022 or earlier, according to a new report from the American Society of Health-System Pharmacists. 
The report tracks national drug shortage trends from January 2001 through March 2025. So far this year, the ASHP has reported 26 new drug shortages. Since an all-time high of 323 active drug shortages in early 2024, the number of active shortages is now 270.   

About the public’s health

Routine medical appointments and cancer screenings head in the wrong direction: The Prevent Cancer Foundation’s 2025 Early Detection Survey…revealed just 51% of U.S. adults 21 years of age and older say they have had a routine medical appointment or routine cancer screening in the last year.1 This is a 10-percentage point drop from the 2024 survey.

Today's News and Commentary

About health insurance/insurers

CMS rebrands Medicare Advantage health equity program: CMS is rebranding its Health Equity Index reward program to the Excellent Health Outcomes for All (EHO4all) reward, which is set to take effect for 2027 Medicare Advantage star ratings.
The new name “better captures the goal of ensuring exceptional care for all enrollees,” the agency wrote April 7 in its 2026 final rate notice.
Comment: Obviously the real reason was to get rid of a name that had the word “Equity” in it.

Judge tosses MultiPlan, UnitedHealthcare antitrust lawsuit: A New York federal judge dismissed an antitrust lawsuit against UnitedHealthcare and MultiPlan that alleged the companies conspired to reduce reimbursement rates for an anesthesia services provider.
The lawsuit from Long Island Anesthesiologists alleged that UnitedHealthcare and MultiPlan conspired to lower rates by more than 80% after the federal No Surprises Act took effect in January 2022. The lawsuit alleges that MultiPlan acted on UnitedHealthcare’s behalf, using repricing tools and aggressive negotiation tactics to pressure providers into accepting reduced payments.  

About pharma

Trump says ‘major’ pharmaceutical tariffs on the way: “We’re going to be announcing very shortly a major tariff on pharmaceuticals,” he said at a dinner of the National Republican Congressional Committee. “And when they hear that, they will leave China. They will leave other places because they have to sell — most of their product is sold here and they’re going to be opening up their plants all over the place.”
Domestic drug manufacturing has shrunk dramatically in recent decades. Most production of active pharmaceutical ingredients has moved to China and other countries, according to the Food and Drug Administration.

Reporting of Noninferiority Margins on ClinicalTrials.gov-A Systematic Review: In this systematic review, we identified a concerning issue regarding the poor reporting of noninferiority margins at registration on ClinicalTrials.gov. This lack of transparency may allow for untraceable changes to the noninferiority margins, potentially distorting conclusions toward more favorable results. 
Comment: When a trial of non inferiority is done, it compares two drugs to each other. What this study says is the margins that determine how close these drugs are is not adequately reported and could lead to more drugs being considered interchangeable.

US commission says $15B biotech investment is needed to maintain dominance over China: A report issued by a US commission recommended the government make a $15-billion investment to bolster the country's leadership in the biotechnology sector — and to prevent China from taking that lead. The document, submitted to Congress on Tuesday and shared with the public, laid out a series of proposals to "make America innovate faster, and slow China down." 

About the public’s health

Pregnancy-Related Deaths in the US, 2018-2022: In this cross-sectional analysis of pregnancy-related deaths in the US, rates increased during 2018 to 2022, with large variations by state and race and ethnicity. The concerning rates in the US should be an urgent public health priority. 

Eating some food additives together may increase diabetes risk, study suggests: See the list of 5 combinations in this article.

Slashed Federal Funding Cancels Vaccine Clinics Amid Measles Surge: Immunization efforts across the country were upended after the federal Centers for Disease Control and Prevention aabruptly canceled $11.4 billion in covid-related funds for state and local health departments in late March.A federal judge temporarily blocked the cuts last week, but many of the organizations that receive the funds said they must proceed as though they’re gone, raising concerns amid a resurgence of measles, a rise in vaccine hesitancy, and growing distrust of public health agencies.

Access and Quality of Care for Older Adults in 10 Countries:
Highlights:

  • Older adults who needed off-hours care in the Netherlands were significantly more likely to report they could easily get it compared to those in other countries.

  • No more than roughly one of five older adults across countries reported problems with coordination of care between their regular doctor and specialist.

  • U.S. Medicare beneficiaries were among the most likely to report their hospital coordinated care with their regular doctor when discharged; older adults in Sweden and Germany were least likely to do so.

  • While most older adults across all countries were satisfied with the quality of their health care, U.S. Medicare beneficiaries were most likely to report their health care professional reviewed their medications with them over the course of a year.

  • Roughly one of five U.S. Medicare beneficiaries reported they felt they were treated unfairly or their concerns were dismissed while receiving care. 

About health technology

NIH, HHS appeal after judge permanently blocks cap on medical research funding: The relief felt by universities and medical research institutes after a US judge blocked an attempt to cut the amount of funding provided by National Institutes of Health (NIH) grants may be short-lived. The NIH and the broader Department of Health and Human Services (HHS) are appealing the ruling, according to a court notice filed on Tuesday.
In February, the NIH implemented a new policy to limit the amount of funding allocated by its grants for infrastructure purposes — called the indirect cost rate — to 15%. Historically, the indirect cost rate on NIH grants was about 27% to 30%.  

World’s Smallest Pacemaker is Activated by Light: Northwestern University engineers have developed a pacemaker so small that it can fit inside the tip of a syringe — and be non-invasively injected into the body, according to a new study published in Nature.
Although it can work with hearts of all sizes, the pacemaker is particularly well-suited to the tiny, fragile hearts of newborn babies with congenital heart defects. 

Today's News and Commentary

About health insurance

Private Medicare Plans to Get Big Payment Boost From Trump Administration: Health insurer stocks soared on Tuesday because the Trump administration said it would substantially increase payment rates for Medicare insurers next year, generating more than $25 billion in additional revenue for the industry and doubling the boost proposed in January….
The rate increase of 5.06%, compared with 2.23% in the earlier proposal from the Biden administration, overshot even optimistic expectations from many Wall Street analysts.

About hospitals and healthcare systems

National Hospital Flash Report [April 8]:
Key Takeaways
1. Volumes remain strong, including in emergency departments.
Performance in February 2025 remains stable.
2. Outpatient revenue has slowed as inpatient revenue grows.
This indicates that rapid outpatient growth in the last few years may have reached its peak.
3. Expenses continue to rise. Non-labor expenses have been the primary driver thus far in 2025.  

About pharma

Therapeutic Benefit of Top-Selling Oncology Drugs in Medicare: This cohort study found that four-fifths of top-selling US cancer drugs provide high added therapeutic benefits according to HTA agencies in France and Germany, and the most effective cancer treatments also earned a majority of revenues. However, cancer drugs offering low or no added benefits accounted for $6.7 billion in postrebate Medicare spending in 2022 and cost more per beneficiary than high added benefit drugs, suggesting opportunities for better aligning clinical benefits and prices of several top-selling cancer drugs. Factors contributing to the widespread use of low-value medications include incentives for pharmacy benefit managers to steer patients to higher-cost drugs, prescribers’ lack of awareness of drug costs, and direct-to-consumer advertising.

Walgreens posts $5.6B operating loss in Q2 : Walgreens Boots Alliance reported a $5.6 billion operating loss in its fiscal second quarter, an improvement from the $13.2 billion loss in the same period last year as the troubled retailer continues to prepare for a private equity buyout. 
Operating losses included a $3 billion impairment charge tied to its Village MD business, according to an April 8 company news release.  

About the public’s health

RFK Jr. tells CDC to change its guidance on fluoride in drinking water: …Kennedy has assailed the practice of community water fluoridation, alleging that it can harm brain development and bones. In an email on Monday, the Department of Health and Human Services said it “is reconvening the community preventative services task force to study and make a new recommendation on fluoride.” The task force will then issue a new recommendation, the agency added. 
Comment: FACT: High doses of fluoride can harm brain development; but the amount used in municipal water systems prevent cavities.

Unique pain research office eliminated in HHS purge: The reduction in force enacted last week by Health Secretary Robert F. Kennedy Jr. eliminated all but one full-time position, out of roughly a dozen, within the National Institutes of Health Office of Pain Policy and Planning, a unit devoted to coordinating pain-related research across the federal government. 
Comment: And yet, the government wants to fight addiction.

About health technology

New Blood Test Detects Alzheimer’s and Tracks Its Progression With 92% Accuracy: A newly developed blood test for Alzheimer’s disease not only helps confirm the presence of the condition but also provides information about how far the disease has progressed, according to research from Washington University School of Medicine in St. Louis and Lund University in Sweden.

While we dismantle our government:
UK invests over $760M in medical research, will fast-track clinical trials: The UK government, in partnership with the Wellcome Trust, announced a £600 million ($764 million) investment to build a centralised medical data repository to speed up the development of new therapeutics. 
The new Health Data Research Service will create a single access point for scientists to view National Health Service (NHS) datasets, a move that's expected to slash "red tape for researchers."
Prime Minister Keir Starmer also unveiled a measure to fast-track clinical trials in the UK. The policy aims to help researchers get clinical trials set up within 150 days — down from the 250-day lengths recorded in 2022. That time-saving goal is expected to be reached in March 2026 by eliminating bureaucracy and standardising contracts.

Today's News and Commentary

From Kaiser Health News and other sources:

‘Most effective way’ to prevent measles is vaccination, RFK Jr. says, in most direct remarks yet: Health secretary Robert F. Kennedy Jr. said Sunday that “the most effective way to prevent the spread of measles is the MMR vaccine,” his most direct statement yet on the issue, following the death of a second child of the condition in the outbreak in West Texas. 
Kennedy, who has long described the vaccine as dangerous, has largely avoided endorsing its use since the start of the outbreak, and he stopped short of explicitly saying he “recommended” it in his latest remarks, as public health officials have called on him to do.

DOJ launches task force targeting ‘harmful barriers to competition’: The Justice Department has launched an anticompetitive regulations task force, aimed at identifying and eliminating federal and state regulations that hinder market competition — including in healthcare.
The initiative will operate within the DOJ’s antitrust division and expand ongoing efforts to combat policies that limit business dynamism, increase consumer costs and reduce innovation. The move reflects a broader deregulatory push by the Trump administration, anchored in recent executive orders focused on rolling back rules that impose undue burdens on businesses, particularly small enterprises.

Nonradiologists interpret nearly 44% of imaging studies, researchers find: Nonradiologists interpreted 43.6% of office-based imaging studies in 2022, according to a study published April 2 in the American Journal of Roentgenology. 

Blockbuster Deal Will Wipe Out $30 Billion in Medical Debt. Even Backers Say It’s Not Enough:
Undue Medical Debt
, which buys patient debt, is retiring $30 billion worth of unpaid bills in a single transaction with Pendrick Capital Partners, a Virginia-based debt trading company. The average patient debt being retired is $1,100, according to the nonprofit, with some reaching the hundreds of thousands of dollars.

Key Safety Hotlines Disrupted By HHS Cuts: Teams manning government hotlines for reporting adverse events from foods, supplements and cosmetics, and call centers that provide other essential safety information were among the thousands of Health and Human Services Department employees laid off last week. The Food and Cosmetic Information Center fields tens of thousands of calls annually from consumers and industry representatives about recalls, nutritional information and food business requirements, along with unintended health consequences from using FDA-approved products. 

ICYMI:
35% of Americans cannot afford or access healthcare: Gallup: Reaching the highest level since 2021, 11% of U.S. adults are considered “cost desperate,” a group Gallup defines as those who recently could not afford needed care and medicine. Overall, more than one-third of U.S. adults report they cannot access quality, affordable healthcare.
Gallup and West Health surveyed 6,296 adults in late 2024 for their annual Healthcare Indices Study. Since 2021, the share of cost desperate Americans has increased most significantly among Hispanic adults (18%), Black adults (14%) and households earning less than $24,000 annually (25%), according to survey results released April 2. 
The survey found no meaningful change among white adults or middle- to high-income households. Disparities in healthcare access across race, ethnicity and income are at their highest point since this annual survey began in 2021. 

About health insurance/insurers

Medicare gets a big (unofficial) surprise: a 17-year extension on when it’ll run dry: The Congressional Budget Office recently published its long-term predictions of the federal budget and buried a big surprise for people who follow the Medicare program. The government’s primary piggy bank that pays for Medicare benefits won’t be depleted until 2052 — 17 years later than what CBO analysts predicted last year.  

Inside HCSC's plan to go national after Cigna deal FYI

About hospitals and healthcare systems

25 health systems ranked by long-term debt FYI

Court strikes down FDA rule to regulate hospital lab tests: A federal judge in Texas has ruled that the FDA does not have the authority to regulate laboratory developed tests as medical devices, striking down the agency’s recently finalized rule. 
The decision, issued in the U.S. District Court for the Eastern District of Texas, sided with the American Clinical Laboratory Association and other plaintiffs who argued that the FDA overstepped its authority, according to documents reviewed by Becker’s.

About pharma

Ousted FDA Vaccine Director Calls Kennedy's Start 'Very Scary' : Peter Marks, the Food and Drug Administration (FDA) official pressured to resign over his disagreements with Health and Human Services (HHS) Secretary Robert F. Kennedy Jr., warned in an interview published Friday that Kennedy’s tenure at the HHS has been “very scary” so far. ... In his resignation letter, Marks said he had been “willing” to work to address Kennedy’s “concerns” about vaccine transparency and safety but determined Kennedy only wanted “subservient confirmation of his misinformation and lies.” 

Trump admin nixes Biden-era obesity drug coverage plan: The US Centers for Medicare and Medicaid Services (CMS) announced Friday that it will not finalise a proposal to expand Medicare and Medicaid coverage of weight-loss drugs, reversing course on a plan floated during the final months of the Biden presidency that would have helped millions of Americans pay for the pricy medications.
A CMS spokesperson said the agency doesn't believe expansion is "appropriate at this time," but added that it may revisit the idea after a closer look at the drugs' potential benefits and financial impact, including to state Medicaid agencies

.J&J hit with $1.64B penalty for illegal drug marketing practices: A federal judge has ordered Johnson & Johnson’s Janssen unit to pay $1.64 billion for illegally promoting HIV drugs Prezista and Intelence. 
U.S. District Judge Zahid Quraishi imposed a $360 million penalty and $1.28 billion in civil fines, to be paid to the federal government, for 159,574 false claims submitted to federal healthcare programs, according to court documents reviewed by Beckers.  

FDA tells drugmakers to redo studies run by a contract research firm due to data integrity issues: n a rare move, the U.S. Food and Drug Administration told an unspecified number of drug companies that studies used to support therapeutic equivalence of some of their medicines have been rejected due to false data generated by a contract research organization.
The agency identified “significant” problems with data integrity and the way studies were conducted by Raptim Research, which had been hired by the drugmakers to test their medicines. The FDA expressed concern, specifically, about in-vitro studies, which are run to test biological processes.

Threat of future tariffs on pharmaceutical imports alarms health care community: Generic medicines make up nine of 10 prescriptions in the U.S., nearly half of which come from India, which exports about $9 billion in generic drugs to the U.S., according to data last year from the IQVIA Institute for Human Data Science. Nearly all of the United States' generic drugs come from overseas. In a last-minute move Wednesday, the Trump administration excluded pharmaceuticals from Wednesday's retaliatory tariffs, giving consumers a break for now. 

About the public’s health

CDC's Office of Smoking and Health Eliminated: The CDC's Office on Smoking and Health (OSH) was eliminated in its entirety April 4. 

About healthcare IT

Critical Condition: Legacy Medical Devices Remain Easy Targets for Ransomware: Analysis found that 99% of healthcare organizations are vulnerable to publicly available exploits. 

About healthcare personnel

RFK Jr. Said HHS Would Rehire Thousands Of Fired Workers. That Wasn't True:
When HHS Secretary Robert F. Kennedy Jr. said Thursday that he planned to rehire 20 percent of the employees he’d just terminated, he insisted such a move was “always the plan.” Turns out, it wasn’t the plan at all. HHS has no intention of reinstating any significant number of the staffers fired as part of a mass reduction-in-force on Tuesday, despite Kennedy’s assertion that some had been mistakenly cut, a person familiar with the department’s plans told POLITICO. 

About health technology

A streaming brain-to-voice neuroprosthesis to restore naturalistic communication This innovation is an incredible scientific advance:
Here we used high-density surface recordings of the speech sensorimotor cortex in a clinical trial participant with severe paralysis and anarthria to drive a continuously streaming naturalistic speech synthesizer. We designed and used deep learning recurrent neural network transducer models to achieve online large-vocabulary intelligible fluent speech synthesis personalized to the participant’s preinjury voice with neural decoding in 80-ms increments. Offline, the models demonstrated implicit speech detection capabilities and could continuously decode speech indefinitely, enabling uninterrupted use of the decoder and further increasing speed. Our framework also successfully generalized to other silent-speech interfaces, including single-unit recordings and electromyography. Our findings introduce a speech-neuroprosthetic paradigm to restore naturalistic spoken communication to people with paralysis.

Today's News and Commentary

HealthcareInsights.MD will be on vacation and resume Monday, April 7.

Read today’s Kaiser Health News

In other news:

About health insurance/insurers

Humana opens first Walmart clinic: The first grand opening of a CenterWell Senior Primary Care clinic located next to a Walmart will take place March 26 in Gladstone, Missouri.
The new clinic officially opened and began accepting new patients in late 2024, according to a March 20 news release. In July 2024, Humana said it would lease 23 former Walmart Health sites from the retail giant for CenterWell clinics. Walmart shuttered its health centers in 2024. 
Comment: I wonder why Humana thinks it will succeed when other healthcare entities have failed miserably when they entered into this sector.

Low Marketplace Premiums Often Reflect High Deductibles Not news except the study quantifies these differences: Silver-plan deductibles typically exceed $5,000, while bronze plans approach $7,500 — representing up to 21 percent of annual income for those at 250 percent of poverty. Out-of-pocket maximums are generally above $9,000 at both metal tiers. While higher-premium options offer lower deductibles, they often include substantial prescription drug deductibles. 

About healthcare IT

The Healthcare Email Security Report: Key insights from 180 email-related healthcare breaches A great overview of this important topic. For example: According to IBM, the true average cost of a data breach in healthcare is $9.8 million. 

About healthcare personnel

Why we’re getting the expensive problem of employee burnout — and how to fix it — all wrong: We hear a lot about worker burnout, but a new study from the American Journal of Preventative Medicine puts an eyebrow-raising price tag on it. It found that a worn-out employee can cost an organization $21,000 per year in lost productivity — meaning that for the average 1,000-person company, workforce disengagement and burnout could ring up to $5 million a year.  

Today's News and Commentary

Read today’s Kaiser Health News

In other news:

About health insurance/insurers

Ohio payer beats UnitedHealthcare in racketeering lawsuit, awarded $50M: An Ohio jury awarded Medical Mutual of Ohio over $50 million in damages on March 12 after the payer prevailed in its lawsuit against FrontPath Health Coalition and HealthScope Benefits, a subsidiary of UnitedHealthcare. 
FrontPath offers employee benefits solutions, and HealthScope is a third-party administrator. 
The two companies were accused of conspiring to form an enterprise that consisted of their executives and engaging in fraudulent practices that manipulated the bidding process for a health benefits contract with the city of Toledo in 2015 and 2018. Medical Mutual claimed that the two companies gained unauthorized access to its confidential financial data, which they then used to artificially lower bids, according to a March 14 news release from the company.
The defendants were found to have committed federal wire fraud, telecommunications fraud, tampered with records, and obstructed justice by submitting false bid information. The jury found that the conspiracy resulted in significant damages to Medical Mutual and ultimately caused taxpayers to pay higher healthcare costs than necessary.

About pharma

Optum Rx’s new payment model favors brand names over generics: Effective March 20, Optum Rx will increase reimbursements to pharmacies for brand-name drugs and cut them for generics. 
Optum Rx said the new pharmacy payment models are in response to price increases set by brand name drug manufacturers. 
“With this change, Optum Rx is addressing a legacy, industrywide model that was originally designed to help promote the use of affordable generics,” the company said in a news release. “Effective generic adoption is now quite strong, and increasingly, more high-cost branded drugs are entering the market, raising costs for pharmacies.”

Purdue Pharma files new $7.4B bankruptcy reorganization plan to settle opioid claims: The company hopes to emerge from the Chapter 11 bankruptcy process it entered in 2019 with a new reorganization plan, filed Wednesday with the U.S. Bankruptcy Court for the Southern District of New York. The plan lays out more than $7.4 billion in payments to compensate opioid victims and “abate the opioid crisis,” Purdue said in a press release.

Sanofi pays $600M upfront for Dren Bio's bispecific myeloid cell engager: Sanofi agreed to acquire a targeted bispecific myeloid cell engager from Dren Bio for $600 million upfront, boosting the French drugmaker's efforts in resetting the immune system and its goal of becoming the leader in immunology.
The deal for the CD20-directed candidate DR-0201 also includes potential development and launch milestone payments of $1.3 billion.
The companies noted that DR-0201 targets and engages specific tissue-resident and trafficking myeloid cells to induce deep B-cell depletion via targeted phagocytosis. The bispecific has shown robust B-cell depletion in preclinical testing and two ongoing Phase I trials.

Today's News and Commentary

Read today’s Kaiser Health News

In other news:
Deaths of two important people who contributed to the healthcare field:
Dr. Sheldon Greenfield, Who Exposed Gaps in Health Care, Dies at 86: Dr. Sheldon Greenfield, whose pioneering research found that older patients with breast and pancreatic cancer got subpar treatment and that patients who grill their doctors during consultations receive better care, died on Feb. 26 at his home in Newport Beach, Calif. He was 86…
Dr. Greenfield was a founder and director of the Center for Health Policy Research at the University of California, Irvine, and a leader of the Medical Outcomes Study, involving more than 22,000 patients and 500 physicians. It determined in 1986 that doctors often ordered exorbitant and unnecessary tests and referred patients to a specialist when a primary care doctor or a nurse practitioner could have delivered equally good care. 

James Reason, Who Used Swiss Cheese to Explain Human Error, Dies at 86: By analyzing hundreds of accidents in aviation, railway travel, medicine and nuclear power, Professor Reason concluded that human errors were usually the byproduct of circumstances… rather than being caused by careless or malicious behavior.
That was how he arrived at his Swiss cheese model of failure, a metaphor for analyzing and preventing accidents that envisions situations in which multiple vulnerabilities in safety measures — the holes in the cheese — align to create a recipe for tragedy.

About health insurance/insurers

Cigna, Blue Cross Illinois parent close $3.3 billion Medicare deal: Blue Cross & Blue Shield of Illinois parent Health Care Service Corp. has closed its $3.3 billion purchase of Cigna’s Medicare operations, the companies announced Wednesday
The deal, which includes Medicare Advantage, Medicare Part D and Medicare supplement assets along with the CareAllies consulting unit, quadruples Chicago-based Health Care Service Corp.'s Medicare Advantage membership to about 800,000 and closes the book on Cigna's Medicare plan business. 

5 Key Facts about Medicaid Program Integrity – Fraud, Waste, Abuse and Improper Payments You should read the entire article, but here is one key fact: Medicaid Paid an Estimated 94.9% of Total Outlays Properly, and Improper Payments are Mostly Due to Insufficient Information.

About pharma

Optum Rx to drop prior authorization for dozens of prescription drugs Optum Rx, the pharmacy benefit manager under UnitedHealth Group, is set to eliminate prior authorization requirements for approximately 80 prescription drugs in an effort to simplify access to medications for patients with chronic conditions. 
The changes are expected to reduce prior authorizations by 25%, representing more than 10% of all prior authorizations across its pharmacy network, according to a March 19 news release from the company. 

About healthcare IT

Digital Health Adoption Trends by Each Generation: From Gen Z to Boomers: A recent survey reveals that 58% of Americans used virtual care in the past year, although this represents a slight decrease (5 percentage points) compared to 2023. Wearable devices and connected devices are also increasingly common, with 53% of consumers owning at least one, and 54% using them to track health metrics digitally.  
However, the way people engage with digital health varies significantly across age groups. Rock Health utilized from its 2024 Consumer Adoption of Digital Health Survey to gather insights into how different generations, from Gen Z to the Silent Generation, are using digital health tools and services.   
Comment: Look at the chart at the beginning of the article.

Today's News and Commentary

Read today’s Kaiser Health News

About pharma

AstraZeneca buys cell therapy biotech in up to $1bn deal: AstraZeneca has struck a deal to acquire biotechnology company EsoBiotec for up to $1bn, as the London-listed pharmaceutical group expands its investments in cell therapies for treating cancer. 

About the public’s health

US births decline to lowest level in 40+ years: n 2023, there were 3.6 million births in the U.S. — the lowest the birth rate has been since 1979 when 3.5 million were recorded — according to data published March 18. 
The birth rate fell 2% compared to 2022, following a decadeslong decline in U.S. births. The data, compiled by the National Center for Health Statistics, also showed a 3% decrease in the general fertility rate, from 56 births per 1,000 women ages 15 to 44 in 2022 to 54.5 births per 1,000 in 2023.
A record high in 2023 was the mean age of mothers at first birth, at 27.5 years old. 

Today's News and Commentary

Read today’s Kaiser Health News

In other news:

Scientists Say NIH Officials Told Them To Scrub mRNA References on Grants: National Institutes of Health officials have urged scientists to remove all references to mRNA vaccine technology from their grant applications, two researchers said, in a move that signaled the agency might abandon a promising field of medical research.
 The mRNA technology is under study at the NIH for prevention and treatment of infectious diseases, including flu and AIDS, and also cancer. It was deployed in the development of covid-19 vaccines credited with saving 3 million lives in the U.S. alone — an accomplishment President Donald Trump bragged about in his first term.
A scientist at a biomedical research center in Philadelphia wrote to a colleague, in an email reviewed by KFF Health News, that a project officer at NIH had “flagged our pending grant as having an mRNA vaccine component.”
“It’s still unclear whether mRNA vaccine grants will be canceled,” the scientist added.

About healthcare quality and safety

How has the quality of the U.S. healthcare system changed over time? This MUST-read from the KFF is a treasure-trove of information on the many dimensions of US healthcare quality.

About health insurance/insurers

CMS doubles down on Medicare drug price negotiations: CMS will not change the Biden administration's plan to negotiate prices for 15 previously named prescription drugs, and the agency's next potential leader says he will defend the program in court.
In January, CMS selected Ozempic, Rybelsus, Wegovy, Trelegy Ellipta, Xtandi, Pomalyst, Ibrance, Ofev, Linzess, Calquence, Austedo, Breo Ellipta, Tradjenta, Xifaxan, Vraylar, Janumet, and Otezla to be included in the second round of negotiations aimed at reducing drug costs for Medicare beneficiaries. 
On March 14, CMS said it had signed agreements with manufacturers, who will now participate in meetings and roundtables throughout 2025 to negotiate maximum fair prices for the 15 drugs, with final agreements due by Nov. 1.

MedPAC Report Calls for Increases in Doc Pay for Medicare Services: Physician and other health professional services should get an annual 1.3% increase in Medicare claims reimbursement, and Congress should set a separate safety-net payment averaging 1.7% more for clinicians serving low-income fee-for-service (FFS) beneficiaries.
Those were two recommendations from the Medicare Payment Advisory Commission's (MedPAC) March report o Congress. The independent agency advises Congress on issues related to payment, quality of care, and access to care for 65 million beneficiaries.

About hospitals and healthcare systems

National Hospital Flash ReportKey Takeaways
1. Hospital performance remains stable at the start of 2025.
This is due to a confluence of greater service volume and rising expenses.
2. Expenses continue to be driven primarily by the cost of drugs. However, the rate of cost growth has slowed considerably.
3. Inpatient revenue grew more quickly than outpatient revenue in January. More patients were treated in the hospital and emergency room. 

Physician Flash Report [Based on Data From More Than 200,000 Employed Physicians and Advanced Practice Providers In More Than 100 Specialties]
• Overall revenue per wRVU continues to fall, highlighting broader reimbursement challenges and an indication that traditional fee-for-service structures aren’t sustainable.
• When examining revenue per wRVU by specialty cohort, primary care revenue is holding steady while other specialties have seen a decline.
• Value-based care and other risk sharing models could be a material driver of these differences, and points to value- based care as having a positive impact on revenue.

About pharma

Lifetime Health Effects and Cost-Effectiveness of Tirzepatide and Semaglutide in US Adults: This economic evaluation found that although tirzepatide and semaglutide offered substantial long-term health benefits, they were not cost-effective at current net prices. 

About the public’s health

FDA chooses flu vaccine strains after interagency meeting: A little over two weeks after cancelling a planned advisory committee meeting to determine the composition of influenza vaccines, the FDA has released recommendations for which viral strains should be included in shots for the 2025-2026 season. According to the agency, the decision followed a meeting of scientific and public health experts from the FDA, Centers for Disease Control and Prevention and the Department of Defense.
The abrupt cancellation of the advisory committee meeting — which had been scheduled for March 13 — raised concerns that manufacturers would not have sufficient time to produce the vaccines ahead of the upcoming flu season.
However, in releasing its new recommendations, the FDA said it "does not anticipate any impact on timing or availability of vaccines for the American public."  

About healthcare personnel

The feminization of medicine, explained: The feminization of medicine has accelerated dramatically in the last four decades.
In the 1980s, women made up about 30% of medical school students, but now they make up 54%. Between 2004 and 2022, the number of women in the active physician workforce jumped 97%, compared to an increase of 13% among men. And for the sixth year in a row, women outnumber men in medical schools. 

Today's news and Commentary

Read today’s Kaiser Health News

In other news:

About health insurance/insurers

MedPAC estimates $84B in Medicare Advantage overpayments in 2025:  The federal government will spend $84 billion more on Medicare Advantage enrollees this year than if they were enrolled in fee-for-service plans, according to new estimates from the Medicare Payment and Advisory Commission. 
MedPAC, which advises Congress on Medicare policy, published its annual report March 13. 
The group estimated that CMS will spend 20% more on Medicare beneficiaries enrolled in MA plans than if those beneficiaries were enrolled in fee-for-service in 2025. 

Highmark Health Plans reports $166M loss, cites GLP-1s as headwind: Highmark Health Plans reported a $166 million operating loss in 2024, driven by rising medical costs. 
Highmark, which operates health plans, health system Allegheny Health Network and several other businesses, reported its 2024 financial results March 13. 
In addition, Highmark reported $29.4 billion in 2024 operating revenue and a $209 million operating loss.

10 payers recently fined by states FYI

Will the Trump Administration Fast Track the Privatization of Medicare? A great analysis fro the KFF.

About hospitals and healthcare systems

Hospitals are making gains in safety, leading to better patient and staff experiences Data in this report show that:
—Hospitals are performing at or better than pre-pandemic levels on multiple measures of quality and patient safety, including patient falls and pressure injuries (i.e., bed sores) that reflect work led by nurses to care for patients.
—Millions of patients report that their overall care experience is improving. Press Ganey data from more than 1 million members of the health care workforce show a rebound from pandemic lows in engagement, resilience and safety culture.
—Patient safety, patient experience, workforce experience, and well-being are all tied together by a hospital or health system’s culture of safety. Across clinical settings — the single largest driver of a patient’s reported experience of care is how well their care team members work together. Better teamwork has long been shown to drive better outcomes.  

About pharma

10 drugs poised to be best-sellers in 2026 FYI 

About the public’s health

Cases of whooping cough across N.C. more than double compared to this time last year Measles is not the only childhood disease that is spreading.

About healthcare personnel

Arkansas bans noncompete agreements for physicians: Arkansas has enacted a law prohibiting health care employers from enforcing noncompete agreements that restrict physicians from joining competing organizations. Arkansas Gov. Sarah Huckabee Sanders “signed a bill earlier this month that augments existing state law by voiding noncompete provisions in physician contracts that would prevent them from joining a rival organization. The law will take effect in mid-July.” Arkansas will now join “several other states, including Pennsylvania, Maryland and Illinois, which have outlawed noncompete agreements tied to clinicians. California, Minnesota, North Dakota and Oklahoma have blanket noncompete bans for all employers.” 

Today's News and Commentary

Read today’s Kaiser Health News

In other news:

Trump's health team takes shape as FDA, NIH picks confirmed: The US Senate on Thursday confirmed Marty Makary as Commissioner of the FDA and Jay Bhattacharya as director of the National Institutes of Health (NIH), completing key appointments to President Donald Trump's health leadership team. 

About health insurance/insurers

CMS to end 4 Medicare payment programs early : The CMS Innovation Center will terminate four Medicare payment models early in a move that aims to save nearly $750 million and shift focus to more viable approaches to value-based care.

The models set to end by Dec. 31, 2025, include:

CMS said the decision reflects ongoing evaluations of financial impact, quality outcomes and operational feasibility and ensures that resources are allocated to programs with the highest potential for success. 

About pharma

Trends In FDA FY 2024 Inspection-Based Warning Letters:The U.S. FDA issued a total of 190 warning letters to drug and biologics manufacturers in Fiscal Year 2024 (FY24). Of those, 113 were based on an FDA inspection, including 12 letters issued to clinical investigators or sponsors following inspections conducted as part of the FDA’s Bioresearch Monitoring (BIMO) Program. For the purposes of this article, we have chosen to analyze 111 of those letters, removing two due to their focus on new animal drugs and medical devices, respectively.1
The FY24 warning letter total is higher than the 94 letters issued in FY23 and the 74 letters issued in FY22. While the FDA’s top observations remained generally consistent, the FY24 breakdown for both country of origin and facility type varies greatly from previous years.

Mallinckrodt, Endo set for $6.7B merger: Confirming rumours that surfaced yesterday, Mallinckrodt and Endo announced Thursday that the companies will combine in a cash and stock transaction valued at $6.7 billion. The deal comes as both firms look to recover from financial and legal challenges related to the US opioid epidemic, which saw both declare bankruptcy.
Under terms of the agreement, Endo shareholders will receive a total of $80 million in cash and will own 49.9% of the combined company, with Mallinckrodt shareholders owning the remaining 50.1%. The transaction, which has been approved by both boards, is expected to close in the second half.

About the public’s health

The toll of chronic conditions: Where each state stands: West Virginia has the highest proportion of adults with at least one chronic condition of any state, according to new analysis from KFF.
The report is based on 2023 survey data from the CDC's Behavioral Risk Factor Surveillance System. Figures represent the percentage of adults ages 18 to 64 who reported at least one of the following health conditions: hypertension, diabetes, cancer, arthritis, asthma, chronic obstructive pulmonary disease, depression or kidney disease.