Policy Updates

340B Pilot in Limbo After Court Acts – Twice

The future of the Department of Health and Human Services’ 340B Rebate Model Pilot Program is in jeopardy after two setbacks in federal court. A federal court issued a preliminary injunction preventing HHS from implementing the limited model, which was to test replacing the discounts that pharmaceutical companies provide to eligible providers participating in the section 340B prescription drug program when they purchase prescription drugs with post-purchase rebates for products they have already purchased. In issuing its injunction, the court wrote that … the Administrative Procedure Act’s (APA) arbitrary and capricious standard imposes vanishingly minimal requirements that a federal agency [...]

joe2026-01-13T16:50:39-05:00January 15, 2026|340b|

CBO Looks at Opioid Crisis

In light of the growing impact of the opioid crisis on public health, communities, and the economy, the Congressional Budget Office has examined possible approaches to addressing this crisis. In addition to steps such as reducing the supply of illicit opioids, increasing treatment for individuals in the criminal justice system, and enhanced monitoring of drug prescribers, the CBO envisions an important role for health care providers in any attack on the opioid crisis. Specifically, in its new report the CBO explores: expanding Medicaid coverage of treatment expanding use of telehealth for treatment increasing access to overdose reversal medications increasing treatment [...]

joe2026-01-14T12:19:40-05:00January 14, 2026|Medicaid, Telehealth|

Impact of Lost Health Insurance Subsidies Already Seen

The expiration of enhanced tax credits for the purchase of health insurance on Affordable Care Act exchanges is expected to put the cost of such plans beyond the reach of approximately 4.8 million people in 2026 and result in a significant increase in uninsured Americans. Just two weeks into the new year, the number of people who have purchased health exchange policies is reportedly 800,000 fewer than last year at this time. For a closer look at the anticipated impact of the loss of Affordable Care Act premium subsidies, see the following articles: NBC News – “ACA sign-ups fall as [...]

joe2026-01-13T15:17:01-05:00January 14, 2026|Affordable Care Act|

Federal Health Policy Update for January 8

The following is the latest health policy news from the federal government for December 29 to January 8. Some of the language used below is taken directly from government documents. Congress Congress returned from winter recess facing a full policy agenda and health care issues remain prominent. Following the expiration of the Affordable Care Act’s enhanced premium tax credits, the House is expected to vote on a three-year clean extension brought by a discharge petition from Democratic House Leader Hakeem Jefferies (D-NY). The Senate is unlikely to advance the measure but a bipartisan group of senators is developing an alternative: [...]

joe2026-01-08T15:32:32-05:00January 8, 2026|340b, Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for December 29

The following is the latest health policy news from the federal government for December 19–December 29. Some of the language used below is taken directly from government documents. Rural Health Transformation Fund CMS announced that all 50 states will receive awards under the Rural Health Transformation Program, a $50 billion initiative established under the 2025 reconciliation bill, H.R. 1, to strengthen and modernize health care in rural communities. In 2026, states will receive first-year awards averaging $200 million, ranging from $147 million to $281 million. The Rural Health Transformation Program’s $50 billion in funds will be allocated to approved states [...]

sysadmin2026-01-03T11:47:43-05:00December 29, 2025|Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, hospitals, Medicaid, Medicare, Medicare regulations, Medicare reimbursement policy|

Federal Health Policy Update for December 18

The following is the latest health policy news from the federal government for December 12-18. Some of the language used below is taken directly from government documents. Congress In a 216-211 vote yesterday, the House passed the Lower Health Care Premiums for All Americans Act, a Republican package aimed at addressing multiple health care policies. The legislation includes provisions for employee tax-advantaged benefits like HSAs and FSAs, cost-sharing reductions (CSR) subsidies, and increased transparency requirements for pharmacy benefit managers (PBMs). It notably did not include an extension of the enhanced Affordable Care Act premium tax credits that many of the [...]

joe2025-12-18T16:29:43-05:00December 18, 2025|Accountable Care Organization, ACO, Affordable Care Act, Alternative payment models, Center for Medicare and Medicaid Innovation, Centers for Medicare & Medicaid Services, CMMI, Congress, hospitals, Medicaid, Medicaid disproportionate share, Medicaid DSH, Medicaid DSH allotments, Medicare, Medicare regulations, Medicare reimbursement policy, Telehealth|

Controversy Over No Surprises Act Continues

Providers and payers continue to wage war over how the No Surprises Act is being implemented. The law, enacted in 2020, was intended to prevent insured consumers from receiving surprise medical bills, especially for out-of-network care. While it has achieved that objective to a considerable degree, it has left behind providers complaining they are being underpaid for their services and payers – health insurers – insisting that the process of adjudicating such disputes, through what is known as the Independent Dispute Resolution process, is forcing them to pay far too much for providers’ services. At the heart of the debate [...]

joe2025-12-17T12:57:49-05:00December 18, 2025|Uncategorized|

Hospital Bad Debt and Charity Care Rising

Hospital bad debt and charity care are rising, according to a new report. Both are up five percent from October of 2024 to October of 2025 – and 40 percent greater than in 2022. Among the causes are natural demographic changes and post-COVID Medicaid redeterminations, the latter of which is leaving many low-income Americans without health insurance. The impact of rising bad debt and charity care are being felt most in the western U.S. And one bright spot: charity care and bad debt as a percentage of hospital gross revenue fell two percent between October of 2024 and October of [...]

joe2025-12-16T16:30:49-05:00December 17, 2025|hospitals, Medicaid|

Hospitals Shedding Pediatric Services

More and more hospitals are shedding their less profitable pediatric services, a review of 20 years of hospital activity has revealed. Driven by a combination of staffing issues and low Medicaid payments, hospitals are increasingly closing some of their pediatric services, according to a review in the journal Pediatrics, which found that Among more than 3000 US hospitals, 26.7% provided minimal pediatric services in 2003, which increased to 65.0% in 2022… Learn more about the challenges hospitals face in providing care for children and the impact of 20 years of decline in hospitals’ ability to provide such care from the [...]

joe2025-12-11T15:27:48-05:00December 15, 2025|hospitals, Medicaid|

Federal Health Policy Update for December 11

The following is the latest health policy news from the federal government for December 5-11. Some of the language used below is taken directly from government documents. Congress The Senate voted today on competing proposals to address health care affordability: Democrats sought a clean extension of the Affordable Care Act premium tax credits set to expire on December 31 while Republicans tried to consolidate support around an alternative plan. Neither bill gained the 60-vote threshold needed for passage. In the House, Speaker Mike Johnson (R-LA) intends to bring a vote on a health care package next week but at this [...]

joe2025-12-11T15:48:53-05:00December 11, 2025|Affordable Care Act, Alternative payment models, Centers for Medicare & Medicaid Services, CMMI, Congress, hospitals, Medicaid, Medicare, Medicare disproportionate share, Medicare DSH, Medicare post-acute care, Medicare regulations, Medicare reimbursement policy, MedPAC|