May 10-16 is National Hospital Week. The American Hospital Association is going all out to make its case via events, social media and even a wordle developed in collaboration with the New York Times (Well – The New York Times).
But not coincidentally, the week prior saw hospitals under attack*:
- May 4, 2026: This Is the Biggest Culprit for High Health Care Spending https://www.nytimes.com/2026/05/04/opinion/health-care-hospitals-insurance.html
- May 7, 2026: Big Systems, Bigger Profits: Consumers Are Paying the Price of Corporate Hospital Power https://familiesusa.org/wp-content/uploads/2026/05/National-Hospital-Pricing-AnalysisU
To each, AHA offered a defiant response*, challenging the motives of authors, the validity of their data and inadequacy of their understanding of hospital finances and operational complexity:
- May 6, 2026: Setting the Record Straight: Three Ways the Hospital‑blame Narrative Gets it Wronghttps://www.aha.org/news/blog/2026-05-06-setting-record-straight-three-ways-hospital-blame-narrative-gets-it-wrong
- May 8, 2026: AHA pushes back on Families USA report https://www.aha.org/news/headline/2026-05-08-aha-pushes-back-families-usa-report
It’s a familiar story: hospitals blame insurers for underpayments and oppressive business practices; insurers blame hospital consolidation and unnecessary spending for high costs. Both accuse the other of corporatization, both say they’re focused on affordability and blames the other for their lack of progress.
Here’s the rub:
- The public thinks both contribute to unnecessarily high costs and household affordability pressure.
- The public thinks ‘corporatization’ in both is hurting smaller independent operators to the advantage of bigger, better capitalized plans and systems.
- The public thinks the biggest players in both put their business interests first and enrollee service/patient support second.
The scenario playing out in healthcare is not a surprise. Institutional trust in the U.S. health system has decreased every year since 1973 when Gallup began its surveys. In tandem with annual spending hikes exceeding inflation and wage growth and increased visibility of national brands (UHG, Humana, Cigna et al and HCA, Common Spirit, Advent et al), it’s understandable.
The unintended consequence of the perpetual discord between hospitals and insurers is regrettable:
- The public’s faith and confidence in the system is damaged, especially among working-age adults in lower income cohorts and the 18-milllion in its workforce.
- The sustainability of smaller and independent operators in each sector is uncertain: community and (some) provider sponsored health plans and co-ops, rural and independent community hospitals and medical practices, et al face extinction.
- Private investments will increasingly be controlled by large-cap funds that leverage scale to accelerate adoption of disruptive technologies and accelerate consolidation.
- Among hospitals, systemness, interoperability, AI-deployment, clinical innovation and workforce modernization will be suboptimized. Among insurers, standardization of coverage, denial, prior authorization, network design et al black boxes will be protected. And prices in both will remain inexplicable and non-transparent.
- Competition between corporate monoliths will intensify as players seek advantage; near-term financial results will dominate board strategies and executive performance incentives.
- Costs will increase. Affordability will be a bigger problem for consumers. Employers will lose patience and bail on traditional benefits. And populist’ demand for a better system and transformational changes will be loud.
- And in Congress and state legislatures, transparency about business practices, executive compensation and community benefit will increase with an eye toward new regulations and aggressive enforcement.
For Mike Tuffin, President and CEO of America’s Health Insurance Plans and Rick Pollock, President and CEO of the American Hospital Association, the road forward is akin to the current standoff between the US and Iran. Each is posturing for competitive advantage and each has much at stake.
Both AHIP and AHA have forthcoming annual meetings in early summer. Each faces disgruntled members who think leaders aren’t protecting their interests well-enough and a tsunami of outside critics is mounting.
Leading a national healthcare association is tough even on a good day. I remain hopeful Mike and Rick will seek common ground and, with other organizations, pursue the greater good for the future of the health system. Lacking that effort, the health system will collapse sooner than imagined.
The hospital-insurer war hurts everyone because it excuses lack of progress in health system transformation.
Paul
*See Hospitals section in citations below.
PS Today is Mother’s Day. I lost my mom years ago but she’s with me every day. Lemma aka Mimi was a Red Hatter at the Martin Center in Brentwood, TN. Every year, she invited me to speak to her RH girlfriends about healthcare. Their questions were profound in their simplicity—How does Medicare work? Will it be around for them and their kids? Why is it hard to see doctors? Why are hospital bills so high? Why is Medicare so confusing?
I now find myself asking the same questions. Happy Mother’s Day to the Mom’s among my readers! Keep asking the tough questions!!
Sections in today’s report
- Quotables
- Economy
- Hospitals
- Insurers
- Physicians
- Polling
- Prescription Drugs
- Public Health
Quotables
K Pow on April 2026 Employment Report: “… when you have extremely lopsided job growth as we do now, that in and of itself is a recessionary indicator. The main driver post COVID these past few years in particular is private education and health services which consists of approximately 85% healthcare and social assistance related workers.
Those 2 categories are mostly grouped together because they’re tied at the hip- as the name implies, social assistance is closely associated with Medicaid…Ultimately that’s why I keep saying all this healthcare job growth is not as rosy as you might think because these are mostly low paying gigs.”
KPow on April Jobs Report (Not that it Matters):
Gorelick (NYT) on National debt: “Not long ago, the national debt was a scandal. Economists said it would wreck the financial system. Voters stewed. A 1990 poll found that 76% of Americans regarded the deficit as “a very serious problem calling for immediate action.” Presidential candidates ran against it; the 1992 race was a referendum on different belt-tightening proposals. At the time, the debt was around $4 trillion.
Now, it’s over $31 trillion, bigger than our entire economy. Here’s what that means: If the federal government were to demand, for an entire year, that all workers hand over 100% of their wages, that all landlords hand over 100% of their rents, that all investors hand over 100 %of their capital returns and that all corporations hand over 100% of their profits, then at the end of that nightmarish year, the government would still be in debt.
That’s not healthy. The United States hasn’t held this much debt since World War II. And it’s still growing, fast.”
Altman (KFF) on MAHA Influencers: “Make America Health Again (MAHA) is led by influencers and commentators and Secretary Kennedy and through that vanguard, it has influence, but the MAHA movement is not a monolith, and it may not be a movement. MAHA is a collection of Americans with interests in different health issues, felt with varying degrees of intensity, and like all Americans, they care much more about health care costs than the issues typically associated with them or with Secretary Kennedy.
This matters because with so many different issues in the MAHA stew, they are not likely to behave as a block on policy issues or in elections. Nor will Secretary Kennedy likely be able to control or deliver them as a group; just parts of MAHA who support him most strongly, which looks like about a third of MAHA supporters…
Twice as many MAHA voters (42%) say lowering health care costs is their top priority for government than say that about their next highest health priority, which is restricting food additives (21%). Vaccines are down the list, picked by just 10%. One issue, pesticides, was picked by 8% as the top priority. That’s an example of an issue that generates considerable intensity from an influential minority. Raw numbers don’t always equal influence.”
Beyond the Data from Drew Altman: There Are Many MAHAs
Goldman Sachs on 2026 economy: “Since January, Goldman Sachs Research has twice revised down its expectations for 2026 growth in discretionary cash inflow (DCF)—the amount of cash the average consumer has to spend on non-essential items after meeting all financial obligations. They now forecast DCF growth of 3.7% this year, compared with an initial estimate of 5.1%. The revised DCF growth figure would mark a decline from 4% growth last year. ..
Higher energy and food costs, combined with SNAP and Medicaid cuts, are pressuring the bottom-income quintile. We are now expecting pre-savings discretionary cash inflow growth of only 0.8% for that cohort this year, well below the 3.7% aggregate growth rate for US consumers…
But the consumer has been relatively resilient—that’s what this discretionary cash flow model has told us, and what it’s still telling us, and a lot of our companies are talking about a choiceful, resilient consumer.
At the lowest end of that income cohort, though, at $50,000 income per year and below, there’s only so many ways they can stretch their dollar. I think that companies serving a true lower-income consumer, that aren’t necessarily getting a benefit of trade-down from a middle-income consumer, have been tougher stocks to own in this environment.”
The Outlook for the US Consumer Amid Rising Inflation | Goldman Sachs
Barnes on federal AI policy: “… the federal government is mad at both the states and itself over how poorly AI regulation is unfolding. First, state governments are WAY out ahead on this (Maverick tracked 195 active state health AI bills between January 1 and March 31, 2026 – 5x as many during the same period last year, see brief here). Second, despite the Trump administration’s “Dear Congress, please preempt state AI legislation” note two months ago, there has been no movement to actually do so. And then, this week, all the lawyers that are left at the DOJ joined Elon Musk’s x.AI lawsuit challenging Colorado’s AI Act. It is the first publicly reported federal action challenging a state AI law under President Trump’s December 2025 executive order. That order explicitly named Colorado as a state imposing excessive AI regulation. [Note: Colorado lawmakers introduced a bill on May 1, 2026, to narrow the scope of the AI Act.] So, the feds are trying to explain to the states that they really shouldn’t regulate things like AI – this policymaking is too impactful for the national economy…”
Only What Matters on Health Information Policy
Economy
Axios on national debt: “The Commerce Department last week reported $31.9 trillion annualized GDP in Q1. That surpasses the $31.4 trillion in debt held by the public on the last day of the quarter…The ratio is on track to continue rising, with the Congressional Budget Office projecting it will reach 120% in 2036.
The CBO projects federal revenue in the next few years will be 17% to 18% of GDP, while expenditures will be north of 23% of GDP. That gap, of around 6% of GDP, is higher than the CBO’s GDP growth projection, which would imply an ever-rising debt-to-GDP ratio. In those projections, the federal government’s interest expenses soar to new heights as a share of the economy — surpassing $1.5 trillion and 4% of GDP in 2031. That assumes interest rates remain broadly in their current zone, with a 10-year Treasury note yielding about 4.4% — and that bond investors prove willing to continue financing an ever-growing debt at those levels…
The national debt hitting 100% of GDP isn’t a worry in and of itself, and it isn’t some magical threshold. What is worrying are the details of how it got there, and what comes next.”
Axios Macro 1 big thing: What is, and isn’t, worrying about 100% debt to GDP May 4, 2026
Healthcare company earnings: “Healthcare companies delivered strong earnings this week, with 18 out of 20 companies beating EPS estimates and 15 topping revenue expectations, as resilient demand across pharmaceuticals, healthcare services, medical devices, and life sciences helped offset pockets of margin and reimbursement pressure.
Compared to the prior year, 16 companies posted higher EPS, while 4 saw declines. Revenue increased year over year for 17 companies, while 3 reported declines.”
Bloomberg on infrastructure: “The amount of power consumed by US data centers alone is likely to more than double to 106 gigawatts through 2035, according to Bloomberg NEF, where a gigawatt can feed around 750,000 homes.
This massive demand is already worrying governments desperate not to fall behind in the AI race, but just as anxious to keep voters onside.”
AI Power Use Risks Blowing Up for Governments – Bloomberg
Pitchbook on investment climate: “Looking ahead, we forecast that global private market AUM managed by GPs will reach roughly $26.7 trillion by the end of 2030, up from about $20 trillion today. This trajectory implies a 5.7% annualized growth rate, which is slower than the historical growth rate and consistent with our view of the maturation of private markets. Even as returns moderate and competition intensifies, we expect private capital strategies to remain central in both institutional and individual portfolios.”
2030-private-market-horizons.pdf
Gibbons: Healthcare bankruptcies in 1Q: The sector recorded 12 bankruptcy filings in the first quarter, up 33% from the fourth quarter of 2025, according to the analysis by Gibbins Advisors. Senior care firms and physician practices drove bankruptcies in the first quarter, with four filings each.
Healthcare Dive: Healthcare Bankruptcies Rise In Q1: Report
BLS Jobs Report for April: Labor Department data shows the share of men participating in the workforce has fallen to a record low: one in three American men was out of the workforce in April, as male-dominated industries continued to shed jobs, baby boomers retired, and younger men increasingly stepped away from work to study or because of illness or disability.
The U.S. economy added 115,000 jobs in April, vastly outperforming economists’ expectations. The unemployment rate remained steady at 4.3%… Economists had anticipated that the economy would only add 55,000 jobs last month. It comes amid great economic uncertainty as the war in Iran has sent energy prices soaring, and many Americans have greatly soured on Donald Trump’s handling of the economy… Hourly average wages were lower than expected, increasing just 0.2% last month, or 3.6% annually, compared to the expected 0.3% for April and 3.8% on an annual basis. Inflation expectations for April are around 4%.
Employment Situation Summary May 8, 2026 https://www.bls.gov/news.release/empsit.nr0.htm
Hospitals
NYT: Cooper (Yale Health Care Affordability Lab) on hospital power (May 4, 2026): “There is boiling rage at health insurers among the public — for instance, over the fact that premiums for a family health plan can exceed $27,000 a year, even as patients routinely get their care denied. Such is the rage that when an insurance executive was murdered in 2024, one poll found that 41% of American voters under 30 perversely thought the killing was acceptable…
Responding to the wrongdoing of insurers is imperative, but it won’t do much to address the unsustainable cost of health care. We are directing our anger at the part of the system that is most visible and frustrating (insurers’ restrictions on care) while ignoring the part of the health system that is most responsible for high costs and economic pain: hospital prices. At a time when two-thirds of the public is worried about the price of health care — a greater share than is worried about affording groceries, gas or housing — we need to have an honest conversation about what is driving high premiums and how to lower them…
Hospital prices are the leading driver of the 320% increase in insurance premiums that Americans have experienced over the past 25 years. Since 2000, prices at hospitals have grown faster than prices in virtually any other sector of the economy. They have grown three times as fast as inflation and twice as fast as prescription drugs and doctor visits…
The reason hospital prices are so high: hospitals’ accumulation of market power, which brings them more bargaining heft when they negotiate prices with insurers…
The physician and scholar Jay Katz spent his career writing about how vulnerability, fear and gratitude make it difficult to hold doctors and hospitals to the kind of scrutiny that we apply to other powerful institutions. We lean on hospitals when our children are born, when our parents get sick and when we approach life’s end. That kind of reliance requires trust.
But we should still push back on a merger in Terre Haute, Ind., that will cost 500 workers their jobs, and scrutinize an industry in which 25 years of price increases have left care unaffordable. Holding that tension between the immense good that hospitals do and the economic harm their market power creates is what it will take to address the rising cost of health care.”
This Is the Biggest Culprit for High Health Care Spending May 4, 2026 https://www.nytimes.com/2026/05/04/opinion/health-care-hospitals-insurance.html
AHA Response (May 6,2026): “A May 4 guest essay published in The New York Times frames hospitals as the leading “culprit” behind rising health care costs. It reduces a complex health care system and a much-needed conversation on affordability to a caricature. At a moment that calls for constructive dialogue, the essay chooses to inflame the debate, urging the public to direct its “anger” at hospitals rather than commercial insurers. That framing is hardly surprising given the author’s close ties to UnitedHealth Group and Arnold Ventures. Here are just three ways the essay misses the mark.
- It Treats “Hospital Prices” as the “Driver” of High Health Care Costs and Ignores That Hospitals Are Price Takers…
- It Excuses Commercial Insurer Behavior
- It Overlooks the Real Cost Pressures Hospitals Face
If we are serious about making health care more affordable, we need solutions that reflect the full picture — not narratives that assign fault to one part of the health care system. Hospitals and health systems are committed to being part of the answer. But providing affordable care for all Americans requires policies grounded in facts and realities, not biases and blame.”
Setting the Record Straight: Three Ways the Hospital‑blame Narrative Gets it Wrong March 6, 2026 https://www.aha.org/news/blog/2026-05-06-setting-record-straight-three-ways-hospital-blame-narrative-gets-it-wrong
Families USA on hospital consolidation (May 7, 2026): “America’s health care affordability crisis is driven by a clear culprit: unchecked health care consolidation, particularly among hospitals, that gives big health care corporations the ability to set high and irrational prices with little to no accountability or improvement in health outcomes or quality. As reaffirmed in this paper, with few truly competitive hospital markets left in the country, most of our nation’s families get their care through large corporate hospital systems that charge nearly three times more for hospital care than what Medicare pays for the same services. These corporate health systems are charging excessive prices and raking in tens of millions of dollars each year, while patients and families struggle to pay their medical bills.
Families USA’s new analysis of financial data and commercial insurance prices from over 2,800 hospitals across 49 states and the District of Columbia from 2018-2023 adds to the extensive academic evidence demonstrating that unchecked hospital consolidation and high hospital prices are a major driver of unaffordable health care across the United States, leading to substantial profits and operating margins for some of the largest corporate health systems in the country. These findings suggest that while corporate hospital chains often plead poverty to avoid accountability for their high and irrational prices, their own self-reported data indicates they are generating millions of dollars in profits. This analysis adds important data for policymakers to use in understanding hospital financial health and strengthens the rationale and urgency for holding corporate health systems accountable for charging excessive prices.
The report finds that a handful of corporate hospital systems in each state now control most of American hospital care. In 42 states and the District of Columbia, just five or fewer health systems in each state controlled at least half of all hospital care in 2023. In nearly half of all states, just three systems controlled the majority of care that year. This level of consolidation gives major hospitals the ability to set prices with no meaningful competition or accountability…
- The 15 largest systems in the country charged on average 2.82 times what Medicare paid for the exact same services.
- Those big systems also raked in an average of more than $22 million in net income per hospital per year.
- No state was spared. Average commercial hospital prices in every state were higher than what Medicare paid for the same services, with average commercial prices in each state ranging from 157% to 365% of the Medicare rate. The most expensive states — Colorado, Florida, Georgia, New Mexico, South Carolina, West Virginia and Wisconsin — had average hospital prices ranging from 320% to 365% of the Medicare rate for the same services.
- The biggest systems earned the most. Individual hospitals owned by a health system generated nearly 10 times more in annual net income ($27.7 million) than independent hospitals not owned by a health system ($3.0 million). Rural independent hospitals generated the lowest average net income ($2.3 million). Particularly large and expensive systems from the study period of note include the following:
- HCA Healthcare, the largest for-profit health system in the United States, operated 158 hospitals in our sample across 20 states, charged an average of 339% of the Medicare rate for hospital services, and generated $70.3 million in annual net income per hospital.
- CommonSpirit Health, a Catholic health system that is currently the largest nonprofit hospital system in the country, operated 140 hospitals in our sample across 17 states, charged an average of 306% of the Medicare rate for hospital services, and generated $17.4 million in annual net income per hospital.
- Tenet Healthcare, a publicly traded for-profit system, operated 70 hospitals in our sample across 10 states, charged an average of 312% of the Medicare rate for hospital services, and generated $24.2 million in annual net income per hospital.
- AdventHealth, a nonprofit faith-based system, operated 38 hospitals in our sample across eight states, charged an average of 410% of the Medicare rate for hospital services, and generated $38.4 million in annual net income per hospital.
To be clear: nonprofit hospitals can charge exorbitant prices too. Despite their tax-exempt status granted on the premise that they provide community benefit, nonprofit hospitals charged nearly as much as for-profit hospitals (276% of the Medicare rate versus 297% of the Medicare rate, respectively) and brought in nearly as much in annual net income ($24 million versus $26.8 million, respectively), offering consumers no better protection from price gouging.
The biggest differentiator is whether a hospital is independent. Independent hospitals–hospitals not owned or affiliated with a health system — charged a much lower average commercial price of 221% of the Medicare rate and generated an average of $3 million in annual net income per hospital, a fraction of what system-owned hospitals collected. Rural independent hospitals charged the least of all, with an average commercial price of 216% of the Medicare rate, and generated an average of $2.3 million in annual net income. At the same time, rural hospitals owned by a system charged an average of 270% of the Medicare rate and brought in an average of $7.5 million in annual net income.
The data is clear, but one question remains: What will lawmakers do to hold big corporate hospital systems accountable for high health care costs?
Big Systems, Bigger Profits: Consumers Are Paying the Price of Corporate Hospital Power https://familiesusa.org/wp-content/uploads/2026/05/National-Hospital-Pricing-AnalysisU
AHA Response May 8, 2026: “This report is long on rhetoric and short on reality. Hospitals and health systems are the backbone of care in every community, open 24/7 for every patient, regardless of ability to pay. Hospitals are largely price takers, not price setters, navigating rates set by government programs and negotiated by insurers.
The report relies entirely on inappropriate benchmarks, like chronically low Medicare rates, and completely lets commercial insurers and other critical stakeholders off the hook for driving up premiums and costs. It leans on flawed data while ignoring the real pressures hospitals face: chronic Medicare and Medicaid underpayments, skyrocketing drug costs, and commercial insurer tactics that delay, deny and disrupt care while adding unnecessary costs and clinician burden. At the same time, hospitals are managing workforce shortages and rising expenses as they continue to deliver cutting-edge care close to home.
America’s hospitals and health systems are deeply committed to high-quality, accessible and affordable care, but driving affordability requires every stakeholder to be part of the solution. If we’re serious about lowering costs, we should focus on strengthening care delivery and access — not recycling tired narratives that miss how the health care system actually works.”
AHA https://www.aha.org/news/headline/2026-05-08-aha-pushes-back-families-usa-report
Tennessee removes CON: On May 5, Tennessee Gov. Bill Lee signed into law the second bill in three years removing restrictions for health systems looking to expand their footprint. Beginning July 2028, companies will no longer need to obtain a certificate of need from the Tennessee Health Facilities Commission to build new acute care hospitals.
Tennessee eliminates certificate of need for acute care hospitals – Nashville Business Journal
Study: NFP hospital use of consultants: Nonprofit hospitals in the US (n = 2343) collectively spent more than $7.8 billion on management consulting services from 2009 to 2023. A stacked difference-in-differences design comparing 306 US nonprofit hospitals that used a management consulting firm for the first time with 513 matched hospitals that did not use a management consulting firm…
“These findings raise questions about the net value that nonprofit hospitals receive from management consulting services and call for careful examination of these contracts. More than 20% of nonprofit hospitals hired management consultants during the study period. Nonprofit hospitals that hired management consultants paid an average of $15.7 million for their services, and nonprofit hospitals collectively spent more than $7.8 billion on these services from 2009 to 2023. Despite this substantial investment, analyses of hospitals’ financial performance, operational decisions, and claims-based patient outcomes revealed little evidence of substantial, statistically significant, or systematic improvements attributable to consulting engagements. Relative changes were estimated for financial measures, such as net patient revenue, operating expenses, fixed assets, bad debt, days’ cash on hand, total margin, and operating margin…
Nonprofit hospitals expend substantial resources on management consultants, but there was no evidence of meaningful changes in hospital finances, operations, or quality of care. These findings raise questions about the net value that nonprofit hospitals receive from management consulting services and suggest the need to carefully examine the widespread use of management consultants by hospitals and other organizations across the health care industry.”
PK Note: Hospitals—for profit, public and private NFP—use consultants considerably more than this study concludes. And results vary widely. I have worked with hospital consultants for 50 years—big, small, specialized, generalists et al. I have serious questions about this study based on personal experience.
Study: Hospital community needs assessments and climate change: “Nonprofit hospitals conduct a community health needs assessment every three years to maintain federal tax-exempt status. Federal rules do not require these assessments to consider climate-related health risks, despite evidence that climate change affects health and health care delivery. This study examined the extent to which hospitals address climate-related health in community health needs assessments. We reviewed a nationally representative sample of 566 community health needs assessments (2021–24) from 3,468 US hospitals. Climate-related content was scored on an eighteen-point rubric including climate hazards and health risks (for example, extreme heat and flooding). The assessments’ climate-related content was limited (mean score, 2.51 of 18). Hospitals serving more climate-vulnerable communities, especially those with greater socioeconomic disadvantage, were less likely to identify climate-related health risks. Scores in the Northeast and West were nearly twice those in the South and Midwest, although they were still low. Federal requirements should better align community health needs assessments with emerging public health risks, including climate change, to improve health system resilience.”
McKinsey Nursing Survey: The 2026 McKinsey Nursing AI Insights Survey included 521 frontline registered nurses across the United States and was in the field from February 17 to March 17, 2026. Highlights:
- 65% report using more AI tools today than a year ago, signaling strong momentum. Yet adoption remains uneven: 23% of nurses report no use, and only about 2 % say AI is embedded in everything they do.
- A higher proportion of nurse respondents from physician practices are superusers (21%) compared with those in acute care hospitals (5%).
- 80% say AI can help improve patient care at least somewhat, including 16% who believe it can do so significantly.
How AI in nursing transforms frontline care | McKinsey
Insurers
Marketplace enrollment in 2026: “Sign-ups were down 5% to 23.1 million at the end of the open enrollment period, the Centers for Medicare and Medicaid Services reported in March. That total has been dwindling since the beginning of the year as enrollees elect not to effectuate their coverage by paying premiums.
Wakely Consulting Group projects that enrollment on the Affordable Care Act of 2010 marketplaces will drop by as much as 26% this year. The actuarial firm estimates that those who remain will be up to 6.5% less healthy and therefore costlier to cover. The company also reports that Bronze enrollment increased nearly 11% while Silver dropped 17% during the sign-up season.”
ACA enrollment losses reshape Centene, Molina Healthcare outlooks – Modern Healthcare
WSJ on Marketplace enrollment: “ACA enrollment reached 23.1 million in 2026, a 5% decrease from 2025, according to a CMS report released March 27. While that represents a drop of about 1.2 million consumers from the prior open enrollment period, 2026 enrollment remains 8% higher than 2024 and 41% higher than 2023.
The composition of remaining enrollees has shifted toward lower-cost, higher-deductible plans. Bronze plan enrollment grew 26% nationally, from 7.3 million to 9.2 million, even as total enrollment fell. The share of ACA enrollees in bronze plans increased from 30% in 2025 to 40% in 2026, according to CMS data. Texas saw the largest increase in bronze enrollment from 2025 to 2026, while West Virginia saw the largest decrease.
The average out-of-pocket premium after advanced premium tax credits is $178 in 2026, up from $113 in 2025. Nationally, about 14% of ACA policyholders in 2026 failed to pay their first monthly premium bill.. according to the Wall Street Journal. In a typical year, the rate is in the mid-single-digit range.”
ACA payment failures rise sharply as subsidies expire: WSJ https://www.beckerspayer.com/payer/aca/aca-payment-failures-rise-sharply-as-subsidies-expire/
Milbank: Analysis of coverage contractions: “We reviewed studies of four prior large scale coverage contractions: Reagan-era Medicaid cuts, the 2005 Tenncare Disenrollment, the 2019 implementation of work requirements in Arkansas, and the postpandemic “Unwinding” of Medicaid.
- The One Big Beautiful Bill Act (OBBBA) may impose the largest coverage losses in US history, causing the number uninsured to rise by 55% in the coming decade.
- We examined four prior coverage contractions—Reagan-era Medicaid cuts, the 2005 TennCare disenrollment, 2019 Arkansas work requirements, and the Medicaid Unwinding—to shed light on the OBBBA’s impacts. These suggest that most who lose Medicaid do not find alternative coverage, and that states are unlikely to compensate for federal cuts, findings that run counter to some assumptions adopted by the Congressional Budget Office in predicting the impacts of Medicaid cuts.
- Studies of coverage contractions complement data from coverage expansions in predicting worse health care access, household finances, and health for needy individuals due to the OBBBA. Studies also suggest that the magnitude of harms from contractions may exceed that suggested by expansions.”
Physicians
Rep. Comer letter to CMS Administrator Mehmet Oz (April 30, 2026): “The Committee on Oversight and Government Reform is continuing to investigate the drivers of rising healthcare costs in federal programs, including systemic issues that may enable waste, fraud, and abuse. The Current Procedural Terminology (CPT) code system, which is mandated by the federal government as the standard for billing Medicare and Medicaid plays a central role in determining how billions of taxpayer dollars are spent each year. The complexity of this system may be contributing to improper billing and higher costs for patients and taxpayers. Because the Centers for Medicare and Medicaid Services (CMS) is responsible for administering these programs and enforcing billing standards, the Committee requests a staff level briefing on CMS’s oversight of CPT coding and its impact on program integrity and federal spending…
The billing system has grown to include over 7,800 highly granular codes, updated annually through a process largely driven by external stakeholders. This complexity creates an environment where billing inaccuracies can flourish. The U.S. Department of Health and Human Service (HHS) Office of Inspector General (OIG) found from fiscal year 2014 through fiscal year 2019, hospital stays billed at the highest severity level increased almost 20% with hospitals billing at the top severity level for 40% of all 8.7 million Medicare inpatient cases in FY2019. At the end of fiscal year 2022, the Department of Justice (DOJ) had reached $2.2 billion in settlements for civil cases involving fraud and false claims, the vast majority of which occurred in the Medicare and Medicaid programs.”
Study: PE ownership of PC practices and hospitalization rates: In this economic evaluation with a difference-in-differences analysis, private equity (PE) acquisition of primary care practices was not associated with clinically meaningful changes to all-cause or preventable hospitalizations. PE acquisitions were associated with a modest reduction in emergency department visits. There were no observed changes in patient composition in terms of demographics and patient risk.
“The analysis included 24,397 beneficiaries with PE-acquired primary care physicians, matched to 121,939 control patients. The mean (SD) age was 74 (10) years, and 56% of patients were female. After PE acquisition, the number of all-cause ED visits decreased by 1.36% (95% CI, −2.72% to −0.14%) per patient-quarter relative to baseline. Considering various sensitivity tests, there were no significant changes to the probability of or number of potentially preventable hospitalizations or all-cause hospitalizations. Patient composition remained unchanged.”
Polling
Gallup on healthcare affordability: “In a nationally and state-representative survey of nearly 20,000 U.S. adults conducted from June 9 through August 25, 2025, roughly one-third of respondents — the equivalent of more than 82 million Americans — said they have made at least one trade-off with daily living expenses to afford healthcare. These financial trade-offs are far more common among Americans who do not have health insurance, with 62% saying they have made at least one sacrifice to pay for healthcare, including 32% who have borrowed money and 24% who have prolonged medication. But even among those with insurance, close to three in 10 have made at least one sacrifice.”
One-Third of Americans Cut Back to Cover Healthcare Expenses March 12,2026 https://news.gallup.com/poll/702596/one-third-americans-cut-back-cover-healthcare-expenses.aspx
Prescription Drugs
WSJ on global weight loss drug market: “As the weight-loss category grows more competitive, obesity-leader Eli Lilly LLY -1.22%decrease; red down pointing triangle has started to look a bit richly valued to some investors.
Prices for weight-loss drugs have been falling, and early scripts for Lilly’s new pill, Foundayo, didn’t suggest it was off to a rousing start in the U.S. That is why, leading up to last week’s earnings, the stock fell sharply—a rare moment of investor doubt for a company that hit a $1 trillion market capitalization just last fall.
But the skeptics were focusing on the wrong thing. The fastest-growing part of the weight-loss market—and perhaps the most underappreciated driver for both Novo Nordisk NOVO.B -2.10%decrease; red down pointing triangle and Lilly—is outside the U.S. After all, there are more than one billion people in the world with obesity. And right now, the two companies together are treating less than 2% of them.
Roughly 75% of Lilly’s international weight-loss revenue is cash pay, meaning patients are reaching into their own pockets rather than waiting for health systems to catch up. The overall international GLP-1 market has grown 77% over the past year, according to Iqvia data cited by Lilly, and the company has been gaining ground within it. Both companies have now launched across more than 50 countries, with Lilly pointing to particularly strong momentum in Brazil, the U.K., Korea and China.
America’s Weight-Loss Drug Boom Is Going Global – WSJ
NYT on mifepristone access by mail: On Friday, May 1, the Fifth Circuit Court of Appeals temporarily restricted mail-order access to targeting a 2023 FDA policy that allowed mifepristone to be prescribed via telehealth and delivered by mail or retail pharmacy, and instead reinstating an in-person dispensing requirement. More than a quarter of U.S. abortions in H1 2025 were prescribed via telehealth, so this ruling effectively limited a growing pathway for medication abortion nationwide—even in states where abortion is available—and reinforced the uncertainty of the post-Dobbs era over who defines access. By Monday morning, the Supreme Court had provisionally blocked Friday’s ruling, allowing time for emergency appeal reviews.
In a brief order, Justice Samuel A. Alito Jr. paused a lower-court ruling from Friday that had prevented abortion providers from prescribing the pills by telemedicine and shipping them to patients, causing confusion for providers and patients. The one-sentence order imposes a pause until at least May 11. He requested that the parties file briefs by Thursday, and then the full court will determine how to proceed.”
Supreme Court Temporarily Restores Access to Abortion Pill by Mail – The New York Times
Public Health
Status : hantavirus outbreak: Per the World Health Organization’s report Thursday: the MV Hondius is moving to the Canary Islands. The disease has been linked to three deaths on a cruise ship in the Atlantic. Human-to-human spread is uncommon.
“Given the number of people who were on the ship for part or all of its journey, the fact that the ship stopped in several ports, and that people aboard came from at least 28 countries ranging from St. Kitts and Nevis to Denmark, New Zealand, and Ukraine, many people may have had some contact or will have some contact with people who were on the MV Hondius. Potential contacts will be instructed to be on the alert for symptoms for weeks — symptoms that in the early stages of infection can seem like those associated with a number of other respiratory diseases. Some cases, like that of the Swiss man, may turn out to be confirmed. Some, maybe many, will not.”
Key takeaways from WHO briefing on hantavirus cruise ship outbreak May 7, 2026 https://www.statnews.com/2026/05/07/hantavirus-outbreak-key-takeaways-who-cruise-ship-briefing
JAMA: Opiod use disorder update: “The prevalence of opioid use disorder (OUD) in the US climbed rapidly for more than 2 decades, affecting 5.7 million people and causing almost 80 000 deaths in 2023. US Food and Drug Administration (FDA)–approved medications for opioid use disorder (MOUD), which include buprenorphine, methadone, and extended-release naltrexone, can substantially reduce cravings, overdoses, and/or mortality. However, MOUD is markedly underused, with only 18% of people receiving it.
People with OUD are hospitalized frequently for acute medical conditions, both related to and unrelated to substance use, with an average rate of about 24% per year. From 2005 to 2020, opioid-related hospitalizations rose from 137 to 250 per 100 000 population,7 accounting for 3.4% of all hospitalizations in metropolitan areas. Yet, few inpatients receive MOUD, even after overdose, resulting in high posthospitalization mortality rates and profound costs at the patient, clinician, health system, and societal levels. “
Study: Comparison of excess deaths across high income countries: “In this cross-sectional study of more than 63.5 million deaths in the US, circulatory diseases accounted for the largest number of excess US deaths, increasing after 2001 for ages 45 to 64 years and after 2009 for ages 65 years or older. Drug poisonings, alcohol, and suicide accounted for 24% of the increase in excess US deaths overall and most of the increase for ages 0 to 44 years.
The findings suggest that the rise in excess mortality is due largely to increases in circulatory and metabolic diseases, drug poisonings, alcohol-related deaths, and suicide.
In this repeated cross-sectional study of cross-national mortality, the US had substantially higher death rates than other HICs between 1999 and 2022, despite having similar access to advanced medical technology. Many of these excess US deaths could likely be avoided by adopting health and social policies that have benefited other HICs. These descriptive findings should be interpreted in light of uncertainty arising from differences in death coding, data completeness, and other aspects of data comparability across countries.”
WSJ on wellness and health coaches: “A new study of health and wellness influencers found that nearly as many say they are coaches or entrepreneurs as say they are health professionals.
The new data, by the Pew Research Center, found that 41% of health and wellness influencers described themselves as some sort of healthcare professional in their profiles, while 31% said they were coaches and 28% said they were entrepreneurs. (Many put themselves in more than one category.) Another 16% reported no credentials in their bios. The healthcare professional category was a broad one: It included doctors, nurses, dietitians, social workers, chiropractors and massage therapists, among other jobs…
Trust in the information people get from influencers is mixed, Pew research found. About 65% of those who get health and wellness information from influencers say they trust some of the information, while 10% said they trust all or most of it. Around a quarter of people said they trust not much or none.”
Who Exactly Is That Wellness Influencer? Not Likely a Doctor or Nurse – WSJ
Wellness device market growth: WSJ: “Chunky bands and rings are all the rage, stylish enough that they don’t look like tech—until you spot the glow from their skin-facing sensors. While the Apple Watch remains the most popular wearable overall, sales of these screenless health and fitness trackers are exploding. Smart-ring maker Oura raised over $900 million while performance-band maker Whoop raised $575 million in March. Both are valued at over $10 billion. U.S. purchases of fitness trackers grew 88% between 2024 and 2025, according to market-research firm Circana. Smart-ring purchases alone grew 195%.”
The New Google Fitbit Air and Other Fitness Bands Are Losing Screens—and Gaining Fans – WSJ
