Payer
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Cities sue to block ACA rule for increasing uninsured rate
City leaders said the regulation risks undermining the Affordable Care Act exchanges and adding new costs for local governments. Now, they’re suing to overturn the rule.
By Sydney Halleman • June 8, 2026 -
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Over half of Medicaid enrollees say they’re unaware of upcoming work requirements
Many enrollees don’t know they’ll need to report work, education or volunteer hours starting in less than six months in order to stay covered, according to a recent survey from the Health Management Academy.
By Emily Olsen • June 8, 2026 -
Explore the Trendline➔
Yujin Kim/Healthcare Dive
TrendlinePayer/provider relationships
As M&A intensifies and companies embrace more holistic and value-based care models, partnerships have become more closely intertwined.
By Healthcare Dive staff -
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Sponsored by ParadigmWhy health plans are leaving surgical cost savings on the table
Surgery avoidance isn’t enough. Outcomes optimization is critical to your cost of care efforts.
By Nicola Merryman, Senior Vice President, Healthcare Solutions, Paradigm • June 8, 2026 -
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1 in 5 U.S. adults denied doctor-recommended care: Commonwealth Fund
Americans are increasingly frustrated about being blocked off from care, which results in worse health outcomes and financial stress, per the new study. Still, insurers generally defend their claims review processes.
By Rebecca Pifer Parduhn • June 5, 2026 -
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Consumers are less satisfied with their health plans: JD Power
Rising costs are eroding Americans’ trust in their commercial plans despite an industry-wide push to increase consumer satisfaction, the analytics firm found.
By Rebecca Pifer Parduhn • June 3, 2026 -
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CMS releases Medicaid work requirements guidance for states
The highly anticipated interim final rule weighs in on key issues for states hustling to operationalize work requirements before the 2027 deadline. But there’s still some gray area — and lots of critics.
By Rebecca Pifer Parduhn • Updated June 2, 2026 -
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Massachusetts sues UnitedHealthcare for alleged Medicaid fraud
The state claims UnitedHealthcare inflated the sickness of seniors enrolled in MassHealth managed care plans to reap at least $100 million in improper payments.
By Emily Olsen • June 1, 2026 -
Permission granted by Elevance Health
Elevance again avoids Medicare Advantage sanctions, but threat remains
The CMS pushed back sanctions until July 1 after Elevance made progress on fixing faulty data submissions for its privatized Medicare plans. But the company still has more to do, regulators said.
By Rebecca Pifer Parduhn • June 1, 2026 -
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‘A missed opportunity’: Payers lash out against surprise billing final rule
A highly anticipated rule finalized Thursday meaningfully improves how insurers and providers settle disputes over out-of-network bills. But payers say it doesn’t go far enough to curb alleged provider abuse.
By Rebecca Pifer Parduhn • May 29, 2026 -
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Uninsurance rate holds flat in 2025: CDC
The percentage of Americans without insurance last year remained relatively stable compared to 2024. However, more people are likely to lose coverage in the years to come due to healthcare spending cuts from the “Big Beautiful Bill.”
By Emily Olsen • May 29, 2026 -
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There are no ‘perfect decisions’ with healthcare: Virta Health CFO
As CFOs confront rising healthcare costs, thinking hard about worker retention and where costs can be made more efficient is essential, Virta’s Manu Diwakar said.
By Grace Noto • May 28, 2026 -
Courtesy of Eli Lilly
CVS obesity drug deal puts Lilly on equal footing with Novo
The agreement includes Lilly’s new pill Foundayo and restores coverage for Zepbound, erasing what had been a commercial edge for rival Novo Nordisk.
By Kristin Jensen • May 28, 2026 -
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Judge dismisses BCBS Texas’ surprise billing lawsuit against HaloMD
It’s the fourth federal court in six weeks to reject insurer attempts to relitigate No Surprises determinations, HaloMD said. The dismissals have thrown cold water on insurers’ efforts to contest alleged profiteering.
By Rebecca Pifer Parduhn • May 28, 2026 -
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Surprise BillingTrump administration reforms surprise billing dispute resolution
The industry has been waiting for regulators to finalize the rule amid snowballing concerns about how insurers and providers settle out-of-network claims. The regulation is aimed at making that process more efficient.
By Rebecca Pifer Parduhn • May 28, 2026 -
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CVS sues to challenge new Tennessee PBM-pharmacy breakup law
The law, which would prohibit PBM conglomerates from owning or operating pharmacies, illegally boots out-of-state companies from Tennessee’s pharmacy market, CVS argued in a suit filed Friday.
By Rebecca Pifer Parduhn • May 27, 2026 -
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PacificSource exits ACA exchanges, Montana amid financial strain
High costs and other stressors have made it difficult for the regional nonprofit to continue offering coverage, the company said. About 42,000 members will be affected by PacificSource’s exits.
By Rebecca Pifer Parduhn • May 26, 2026 -
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HHS launches AI-backed health fraud crackdown
The department will use AI to examine audits from states and other federal grant recipients, and potentially withhold funds if they aren’t able to fix errors.
By Emily Olsen • May 22, 2026 -
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Hospitals sue CVS for allegedly siphoning $250M in 340B funds
Hospitals affiliated with Mount Sinai, the University of Michigan and the University of Kansas allege that CVS artificially deflated reimbursement for 340B drugs for years, causing them to lose out on savings.
By Sydney Halleman • May 22, 2026 -
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Vertical integration doesn’t appear to lead to higher drug costs in Medicare, HHS OIG finds
However, data was limited, so it’s too early to make firm conclusions, the watchdog clarified. That didn’t stop the largest PBM lobby from jumping on the report as concrete proof that consolidation doesn’t drive up prices.
By Rebecca Pifer Parduhn • May 21, 2026 -
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Trump administration proposes crackdown on Medicaid state-directed payments
The proposed rule codifies cuts outlined in the GOP’s “One Big Beautiful Bill,” but also takes other steps to restrict supplemental Medicaid payments. The CMS said it would save the federal government over $500 billion if finalized.
By Sydney Halleman • May 21, 2026 -
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Lawmakers mull Medicare physician pay reform to tamp down consolidation
Physician pay hasn’t kept up with the costs of providing care, pushing independent practices to sell to health systems and likely increasing costs, witnesses said during a House subcommittee hearing.
By Emily Olsen • May 21, 2026 -
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Providence shuts down most insurance businesses for 2027
The nonprofit giant has offered health insurance for decades. But recent challenges, including higher costs and regulatory changes, have placed Providence in an untenable position, according to the integrated system’s CEO.
By Rebecca Pifer Parduhn • May 21, 2026 -
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ACA deductibles reach record high as membership losses slated to continue: KFF
A fuller picture is emerging of how the expiration of enhanced subsidies is affecting the Affordable Care Act exchanges and the millions of Americans who rely on them for coverage.
By Rebecca Pifer Parduhn • May 20, 2026 -
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Senate Democrats move to roll back Medicare AI prior authorization pilot
Lawmakers introduced a resolution to end the WISeR model, which Democrats say is delaying and denying care to seniors.
By Emily Olsen • May 20, 2026 -
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Q&AAetna’s chief digital and technology officer on how the insurer is using AI for patient engagement
Nathan Frank discusses how the insurer is using AI to engage members, how the company thinks about risks, and the importance of monitoring the tools and soliciting feedback.
By Emily Olsen • May 19, 2026
