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U.S. not-for-profit (NFP) hospitals with high exposure to patients insured through the ACA Marketplace face heightened financial headwinds with the expiration of enhanced premium tax credits, Fitch Ratings says. Risk is concentrated in Medicaid non-expansion states without coverage backstops, while diversified urban systems and hospitals in states with safety-net programs face less pressure. Hospitals in non-expansion states that entered 2026 with thin margins and limited financial flexibility are particularly vulnerable to payor mix shifts and higher uncompensated care.
Even as the Trump administration works to implement its most-favored-nation pricing system, the U.S. government continues to advance efforts to negotiate Medicare drug prices as enabled by the Inflation Reduction Act (IRA). Tuesday, the Centers for Medicare & Medicaid Services (CMS) unveiled the next 15 high-spend medicines up for price negotiations under the program.
Providers and health insurers submitted almost 1.2 million cases to a federal portal meant to resolve disputes over surprise medical bills in the first half of 2025 — almost 40% more than in the last six months of 2024, according to new data from the CMS. The top 10 initiating parties represented almost 70% of all disputes in the first six months of 2025, according to the latest CMS data file released on Wednesday.
CMS Proposes 2027 Medicare Advantage and Part D Payment Policies to Improve Payment Accuracy and Sustainability
If finalized, the proposed policies are projected to result in a net average year-over-year payment increase of 0.09% in MA payments to plans in CY 2027. In the Advance Notice, CMS is proposing to make updates to the MA risk adjustment model and to exclude diagnosis information from unlinked Chart Review Records from risk score calculation starting in CY 2027. As a result, diagnoses that are not reported or associated with a service would not be considered for risk adjustment.
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