CMS Unveils New Model To Bring Most-Favored Nation Pricing To Medicaid

The Trump administration is rolling out a new model that aims to bring most-favored nation pricing to the Medicaid space. The Centers for Medicare & Medicaid Services announced late Thursday the launch of the GENErating cost Reductions for U.S. Medicaid (GENEROUS) model, under which participating state Medicaid programs will be able to purchase certain drugs at ...

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Shutdown Has Highlighted Washington’s Retreat From Big Ideas on Health Care

In the run-up to the 2020 election, all 20 Democratic presidential candidates promised voters they’d pursue bold changes to health care, such as a government-run insurance plan or expanding Medicare to cover every American. Fast-forward to the congressional stalemate that has closed the federal government for more than a month. Democrats, entrenched on one side of the ...

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Estimated 400K Californians Could Be ‘Priced Out’ Of Covered CA If Congress Doesn’t Extend Funding

This year’s open enrollment for Covered California comes at a pivotal time. If Congress does not extend the tax credits as part of the government shutdown deal, hundreds of thousands of Californians who have the state’s health insurance could see a 97% increase in monthly premiums. “We do estimate as many as 400,000 of our current enrollees could be ...

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Trump Administration Reaches Drug Price Agreements With Eli Lilly, Novo Nordisk

The Trump administration on Thursday announced agreements with two leading drugmakers to reduce the prices many Americans pay for several of their most popular drugs. “Today, I’m thrilled to announce that the two world’s largest pharmaceutical manufacturers, Eli Lilly and Novo Nordisk, have agreed to offer their most popular GLP-1 weight loss drug — I ...

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Small Business Health Premiums Soar 23% Since 2022

The median health insurance premium for small businesses has risen by 23% since 2022, far outpacing inflation over the same period. Even after adjusting for inflation, health insurance costs still exceeded inflation by more than 13% in that period, leaving many small business owners struggling to keep up with cost increases. “Health insurance costs are ...

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Trump Proposes Sending ACA Subsidies Direct To Consumers, Rattling Health Insurance Stocks

President Donald Trump spooked health insurance investors Saturday by proposing in a Truth Social post — in response to the current fight in Congress over federal health insurance premium subsidies — that the government should send health insurance subsidies straight to consumers, rather than to health insurers. Trump posted the following: “I am recommending to Senate ...

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Insurers Slammed By Medical Costs, Regulatory Pressures Yet Again In Q3

Health insurers felt the sting of elevated medical costs yet again in the third quarter, with the congressional debate over the Affordable Care Act (ACA) subsidies looming large for investors. UnitedHealth Group was the most profitable company in the third quarter, bringing in $2.3 billion in earnings. The Cigna Group was the next-highest earner with ...

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Dems Accept Shutdown Deal Without ACA Guarantee

Enough Senate Democrats are poised to accept a deal to reopen the government without a concrete agreement to extend Affordable Care Act subsidies — but with the promise of a showdown vote on the assistance next month. Why it matters: If a bill to temporarily fund the government passes this week, it would be a relief ...

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CMS Grants Temporary Flexibility For Telehealth Coverage In Medicare Advantage During The Government Shutdown

The Centers for Medicare & Medicaid Services (CMS) has issued new guidance allowing Medicare Advantage plans to maintain coverage of certain telehealth services that technically expired when federal telehealth authorities lapsed on October 1, 2025. Under the announcement, CMS will temporarily waive the prohibition on mid-year benefit changes to permit plans to continue offering these ...

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Fixing The Unintended Consequences Of High-Deductible Health Plans

High-deductible health plans were introduced to curb rising health care premiums and costs with the aim of giving employees more control over spending and driving a consumer-driven approach to care. Yet over time, HDHPs have shifted from being a strategic choice to a default option for millions of Americans: today, 58% of privately insured individuals are enrolled, ...

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