As the nation pivoted to its Back-to-School routines last week while the Senate and House were recessed, the new cycle paid attention to familiar stories:
On page one…
- US involvement in Iran and Ukraine wars.
- Inflation, prices, jobs and costs of living for food, gas and housing.
- Mid-term election primary results and surprises.
- Weather-related disruptions in Hawaii, Iowa and the persistent heat wave.
On page two…
- Courtroom proceedings around Lindsay Clancy (mother of 3 who killed her children), Glen Murdoch (SC lawyer alleged to have killed his wife and son) and Luigi Mangione (alleged killer of UnitedHealth executive Brian Thompson).
- Ongoing fallout from proposed vaccine policy changes by HHS.
- Data center pushback and everything else.
I am a news junkie. I depend on real-time news feeds across the spectrum from conservative to progressive thru traditional and unconventional sources.
I am a healthcare guy: I study the health system to monitor trends, emergent themes and credible studies that influence its policies, performance and winners and losers.
And I am a consumer: I live a relatively normal life hoping to take care of my family and spend time on matters that matter. Increasingly, that involves the health and wellbeing of those I love.
Last week was inconsequential in the big scheme of healthcare: media attention was limited. The 3 court proceedings carried underlying themes of mental health. Reporting about the economy centered on costs of living sans household health costs chronically overlooked in business reporting. And posturing for the November 3 general election sparked commentary about Democratic socialism and Republican intent to make political points on healthcare.
This week will be no different. Healthcare news will largely be subordinate to Page One headlines unless a pandemic at home is declared or a celebrity’s personal health challenge is disclosed on a slow news day.
National media with few exceptions cover healthcare incompletely and inconsistently. In-depth coverage is rare. Investigative reporting is pre-wired toward misdeeds and corporate greed. Local media is equally inclined but budget limitations limit local coverage.
And social media are all over the place: misinformation, inadequate verification/validation of primary sources, and bias are systemic
I believe the U.S. health system’s loss of trust and confidence is a direct result of its inadequacy in communicating. That’s not to say it hasn’t tried but it’s strategies and tactics have failed for obvious reasons:
- The business of U.S. Healthcare prefers a low profile. Most healthcare companies prefer to promote their successes and hide their failures. Transparency has never been welcome.
- The business models that dominate U.S. healthcare are driven by consolidation and corporatization. Access to capital is the gatekeeper. Consolidators are winning and independents aren’t. The industry’s become Big Business to most. It espouses concern for affordability without making it reality.
- The public’s at a loss to pursue alternatives. Polls show dissatisfaction with hospitals, drug companies, insurers, et al is at all-time highs. Polls show the majority think the system is fundamentally flawed and a change necessary. But fear of alternatives is even higher, especially a system engineered by the federal government.
- Regulation of the industry at the state and federal levels has protected its incumbents and sustained its profitability. Its B2B (business to business) model reinforces value creation for investors and limits B2C (business to consumer) intrusion. Insiders with their trade associations and lobbyists seek incremental changes that protect the status quo and keep others out.
The future of the U.S. health system is uncertain. It faces huge barriers to sustaining its “too big to fail” big brands. Its biggest hurdle will be public support.
- The public wants a seamless system that’s easy to navigate and comprehensive, not a patchwork of clinics, specialties, facilities and programs accessible to some but not all.
- The public wants a system that’s transparent: clinical evidence, outcomes, errors, business practices, executive compensation, costs and prices easily accessible when needed.
- The public wants a system that’s personalized: impersonal service thru automated telephony and AI-generated prompts in the name of efficiency are suspect.
- The public wants a system that’s cheaper. It believes there’s a Costco solution in healthcare and they’re not afraid to try it.
The entire industry is now on the defensive. Old playbooks used to tell its stories no longer work. It’s a challenge for most.
Paul
Sections in today’s report:
- Quotables
- Economy
- Hospitals
- Insurers
- Polling
- Population Health
Quotables
JAMA on commercial determinants of health: “While the remit of a health policy journal often centers on actions of the public sector and its influence on the systems and structures that generate health, it is increasingly well recognized that private sector actions play an equally important, if often not more important, role in shaping the health of populations. The concept of the “commercial determinants of health” has emerged to describe the ways in which corporate practices, through products sold, environments shaped, and science and policy influenced, drive population-level health. This is particularly the case for noncommunicable disease, which accounts for nearly three-quarters of global deaths. Five commercial products in particular—fossil fuels, tobacco, ultraprocessed foods, chemicals, and alcohol—have been assessed to contribute to nearly a third of all deaths globally. When one recognizes that corporate actions matter to the production of health, it becomes apparent that we should be considering the role, and influence, of such corporate actors within the remit of health policy thinking, and using the scholarly tools of the field to better understand the link between commercial forces and health in a way that points to solutions that can create a healthier population.”
Centering Corporate Activity in the Population Health Research Agenda | Health Policy | JAMA Health Forum | JAMA Network August 14, 2026
Paragon on hospital spending: “Hospital services are the largest driver of spending growth. Hospital expenditures increased 8.9% in 2024 and are projected to rise another 8.2%” in 2025—both well above overall health care spending. As John R. Graham documented in recent Paragon research, hospitals remain the least efficient major sector of American health care, yet they continue to command an ever-larger share of national health spending through market consolidation, government payment policies, and regulatory advantages. These trends reinforce the urgent need for reforms that promote competition, transparency, and more efficient delivery of care.”
Health Care Spending, Government Control, and Medicare for All’s Return
Patient Rights Advocate CEO Fisher on lawsuit against AMA: “The government made CPT codes part of the operating law of our healthcare system, but the AMA keeps it behind a paywall and charges patients, doctors, hospitals, health plans, employers and tech firms for the privilege of understanding it. These egregious charges ultimately are increasing the costs of healthcare for American patients and employers, unnecessarily. We are asking the court to affirm a basic principle: No one can charge the public to access standards that are incorporated into state and federal law.”
PatientRightsAdvocate.org Sues American Medical Association to Make Medical Billing Codes Freely Available to the Public August 13, 2026 https://www.patientrightsadvocate.org/
Johnson on synthetic consolidation: “This is a golden opportunity for nonprofit payers and providers that lack scale to break free from the legal, political and cultural impediments that have stifled their ability to grow, develop and thrive. While these types of platforms focus on clinical advances, emerging intelligence platforms will also bring coherence and efficiencies to administrative and operational functions. Arguably, this is already occurring within novel provider organizations, including Longitude Health, Risant Health and the Mindshare Institute.
Of course, synthetic consolidation through intelligent digital platforms is available to for-profit as well as nonprofit organizations. The race to achieve scale is on and the ground underneath all payer and provider organizations is shifting quickly. Successful organizations will be differentiated from also-rans by their readiness to embrace these opportunities now.
Don’t be left at the starting gate.”
Healthcare nonprofits can use synthetic scaling for national scale | HFMA
Economy
BLS July Jobs report: “Healthcare sector added 22,000 jobs in July vs, 42,000 June and the 35,000 created in May. Ambulatory service roles led gains, adding 18,000 new jobs, while nursing and residential care facilities contributed 4,300 jobs. However, hospital employment flattened, declining by 400 jobs. Dentists and child care services jobs also shrank”
THE EMPLOYMENT SITUATION — JULY 2026 https://www.bls.gov/news.release/pdf/empsit.pdf
CPI for July 2026: % change from July 2025:
- All items: +3.4%
- Hospital services: +5.2%
- Physician services: +2.4%
- Medical care commodities: -2.7%
CONSUMER PRICE INDEX – JULY 2026 https://www.bls.gov/news.release/pdf/cpi.pdf
Study: state health spending data misinterpretation: “Multiple states have established benchmarks for health care spending growth. Since 2021, spending growth has exceeded most states’ benchmarks, prompting concerns about unsustainable growth. However, these benchmarks largely do not adjust when economywide inflation changes. I collected data on states’ benchmark-setting processes, targets, and reported health care spending and identified a set of six states that reported data on per capita spending growth in both 2022 and 2023. Meeting benchmark spending targets for these years would have required real (inflation-adjusted) per capita health care spending to decline by an average of 1.6%per year. The same nominal spending benchmark targets would have allowed real spending growth of 1.9% per year if inflation had stayed at its historical average. Actual real spending growth was only 0.7% per year. Consistent with this, health care as a share of gross domestic product for these states remained stable, at 10.9% in 2021 and 10.7% in 2023. These findings suggest that nominal spending benchmark designs can generate misleading performance signals, which can be reduced by adopting inflation-shock adjustment protocols and routinely reporting both nominal and real spending performance.”
Large cap companies recover in 2026 YTD: “As the U.S. healthcare sector extends its advance, both the cap-weighted and equal-weighted S&P 500 healthcare indexes have reached fresh all-time highs. The move points to continued strength across the sector as companies navigate changing demand, healthcare spending trends and evolving industry dynamics.
The latest strength in healthcare has been broad enough to lift both the cap-weighted and equal-weighted S&P 500 healthcare indexes to fresh all-time highs. The cap-weighted index recently reached 1,962.95, while the equal-weighted benchmark climbed to 22,221.73, suggesting that the rally is extending beyond the sector’s largest constituents. That broad advance comes after a strong recovery from the sector’s weakness in 2022 and 2023, with healthcare stocks regaining momentum into 2026…”
Hospitals
Beckers on hospital report cards: Becker’s compiled and compared the 2026 results of U.S. News & World Report‘s Best Hospitals, the CMS Overall Hospital Quality Star Ratings, Forbes‘ Top Hospitals, the Lown Institute Hospitals Index for Social Responsibility and The Leapfrog Group’s spring safety grades to see where they agree, where they diverge and what separates them. Highlights:
- The four major rankings almost never pick the same hospital. Of the 5,432 hospitals assessed, just three were included among S. News ‘Best Regional Hospitals, Forbes and CMS’ five-star hospitals and Lown’s honor roll
- For-profit hospitals are underrepresented. For-profit hospitals represent about 23.6% of U.S. acute care hospitals, but their share among award recipients was less than 11% across every ranking. Among the 1,677 hospitals S. News evaluated, the mean High Performing count was 3.67 for for-profits vs. 6.17 for nonprofits.
Leapfrog’s 11 straight- “A” hospitals, or those that have consecutively received an “A” since 2012, have minimal overlap with other lists:
- 4 of 11 are Forbes five-star
- 0 of 11 are on Lown’s Honor Roll
- CMS stars range from 3 to 5
- 8 of 11 areS. News Best Regional Hospitals
About 100 hospitals are ranked top-notch. Of the 1,838 hospitals ranked by U.S. News, each specialty ranking includes only 186 hospitals, or 10% of the rated field. Three ranks in all 14 specialties: Johns Hopkins in Baltimore, Mayo Clinic Rochester (Minn.) and New York-Presbyterian Columbia and Cornell in New York City.
PK Note: Studies indicate 20-25% of hospitals advertise themselves among the best, top, award winning or nationally recognized based on recognition in one or more lists. And these do not include recognition insources like Health Grades and Vizient that use different methodologies.
9 takeaways from 3,700+ ranked hospitals
Pitts on hospital price transparency effectiveness: “Americans can compare the price of an airline ticket, a mortgage, or a hotel room in seconds. Yet they still frequently enter hospitals without knowing what care will cost or how those prices compare with competing providers. The Trump administration sought to change that when it implemented the Hospital Price Transparency Rule requiring hospitals to disclose negotiated prices that had long remained hidden from patients, employers, and researchers alike. Five years later, the rule has fundamentally changed the availability of pricing information without fully changing the marketplace it was intended to improve. That apparent contradiction defines the next phase of transparency policy…
Despite substantial progress, assessments continue to conclude that complete compliance remains inconsistent across the hospital sector, and meaningful price comparison remains difficult for many patients and purchasers. The problem is no longer whether hospitals possess the information the administration required them to disclose. They do. Nor is it whether federal regulators possess authority to require disclosure. They do. The central policy question has become whether current law and regulation create sufficient incentives for transparency to become routine business practice rather than a continuing compliance exercise.
STAT on FTC investigation of EPIC: “The Federal Trade Commission is examining Epic Systems Corp., the nation’s largest vendor of electronic health records, for potential violations of antitrust law as part of a broad inquiry into the company’s business practices, according to four people who were recently contacted by investigators…
Epic’s main product is electronic health record software that chronicles patients’ medical histories and forms the digital backbone of medical services delivered to millions of Americans. Its clients are the largest and most influential hospitals in the country. In recent years, the Wisconsin-based company has also branched into related businesses serving health insurers and other large health care entities.
The FTC is not alone in pursuing the inquiry. Attorneys general in states across the country have also joined calls with interview subjects or reached out to their private lawyers to ask for information, according to all three people who spoke with STAT.”
Antitrust questions circling Epic Systems, nation’s largest EHR vendor | STAT August 14, 2026
Related: “In the United States today, one private company holds the digital keys to the nation’s health. Epic Systems provides the electronic health record for 42.3% of acute care hospitals and controls over half (54.9%) of all acute care hospital beds, a concentration of market power unprecedented in modern healthcare IT,
Confronting Epic’s monopoly is critical to restoring competition, fostering innovation, and ensuring that digital health serves patients and the public good.”
A problem of Epic proportion | PLOS Digital Health March 13, 2026
KFF study: Medicaid State Directed Payments for Hospital Services: An estimated $60 billion in federal Medicaid spending in 37 states (including the District of Columbia) would likely exceed new federal limits on state directed payments for hospital services once fully implemented.
The 2025 reconciliation law made major changes to Medicaid eligibility and financing, including new limits on how much states can direct Medicaid managed-care organizations to pay for certain services, including hospital care.
The eight states with the biggest potential reductions in Medicaid payments to hospitals account for half of the total: California ($7.4 billion), Illinois ($4.0 billion), Kentucky ($3.9 billion), Texas ($3.5 billion), North Carolina ($3.4 billion), Louisiana ($3.3 billion), Arizona ($3.0 billion) and Michigan ($2.6 billion).
Insurers
Insurer Premiums in 2027: Per the Peterson-KFF Health System Tracker analysis:. Insurers are proposing a median premium increase of about 14% for small group plans in 2027, driven by rising medical costs, specialty drug spending and a deteriorating risk pool. Highlights:
- Most small group insurers (59%) are proposing rate increases between 10% and 20% for 2027 coverage.
- The median insurer estimate of underlying medical cost growth next year is 10.8%, reflecting rising prices for hospitalizations, physician care and prescription drugs, alongside increased utilization.
- Enrollment in the fully insured small group market has declined roughly 41% since 2013, from about 17 million people to about 10 million in 2024.
- High-cost specialty drugs were a frequently cited cost driver in insurers’ filings. Excellus BCBS noted that specialty medications are used by roughly 2% of its members but account for more than 50% of total drug spending. insurers reported rising GLP-1 costs even after discontinuing coverage for weight loss indications, as utilization for diabetes and other conditions continues to climb.
How much and why premiums are going up for small businesses in 2027 https://www.healthsystemtracker.org/brief/how-much-and-why-premiums-are-going-up-for-small-businesses-in-2027
Insurers propose 14% small group premium bump for 2027: 7 notes – Becker’s Payer Issues | Payer News
KFF study on Insurer Prior Auth: Insurers were required to post the first year of data, for the 2025 calendar year, by March 31, 2026. KFF collected and analyzed these metrics from the largest insurers in most market segments for which reporting is required, including Medicare Advantage, Medicaid managed care, and the Affordable Care Act (ACA) federally facilitated Marketplace.
- Medicare Advantage insurers denied 12% of standard prior authorization requests, Medicaid managed care insurers denied 14%, and ACA Marketplace insurers denied 18%.
- 67% of prior authorization denials were overturned upon appeal in Medicare Advantage, 47% were overturned upon appeal in Medicaid managed care, and 43% were overturned in the ACA federally facilitated Marketplace.
- Median response times in all markets were about 1 day for standard prior authorization requests, and about half a day for expedited prior authorization requests for Medicare Advantage, and approximately 1 day for Medicaid managed care and the ACA Marketplace. Insurers are not required to report response time ranges or differences by service category.
Prior Authorization Metrics Provide New Insights into Insurer Practices, but Gaps Remain | KFF August 13, 2026
Insurance market financial performance: 73% of health plans recorded an operating loss in 2025, up from 70% in 2024 and 54% in 2023. Losses were most common among Blues and regional plans, but the rate among national carriers also surged to 43%, up from 14% in 2023 and 2024. More than two-thirds of plans logged at least three consecutive years of operating losses during the 2023-2025 period, up from 12% during 2020-2022.
In parallel, the broader insurance industry has been losing jobs at more than four times last year’s pace, according to new Bureau of Labor Statistics data, as insurers exit markets, automate operations and face budget constraints.
Insurers are under siege heading into 2027 – Becker’s Payer Issues | Payer News
Insurer profitability: “Health insurers are growing more confident in their long-term earnings potential, so much so they expect to stick with their current strategies into next year.
Nearly three-quarters of insurers reported operating losses last year as medical costs outpaced premium revenue, according to a report published this month by HealthScape Advisors, a Chartis company. That dynamic was more pronounced for Blue Cross and Blue Shield companies and regional nonprofit insurers than for national carriers, the report said.
Insurance behemoths such as UnitedHealth Group, CVS Health and Cigna Group scaled back their insurance offerings last year by exiting product lines, eliminating unprofitable plans, slashing supplemental benefits and raising premiums to prioritize margin over enrollment.
Cutting benefits and raising premiums has benefited companies…Cost-cutting is the core priority going into 2027….”
UnitedHealth, Humana, CVS focus on margins – Modern Healthcare
Polling
Commonwealth Poll May 2026: “The affordability of health care was the dominant concern among U.S. adults, with about three-quarters identifying either the cost of premiums or high out-of-pocket costs as the most important problem in the U.S. health care system. 42% identified high insurance premium costs as the top problem and 36%said high out-of-pocket-costs — or the costs people pay when they get medical care or fill prescriptions, including deductibles and copayments — was the most-pressing problem.
Premiums were the top concern for people who pay them (i.e., those with employer coverage, individual or marketplace coverage, and those age 65 and older with Medicare coverage) as well as for people without insurance.
There is no political divide over top concerns, with similar rates of Republicans, Democrats, and Independents saying insurance premiums and out-of-pocket costs are the top problems, by a wide margin…”
What Americans Want Fixed in Health Care and Who Should Do It | Commonwealth Fund
A recent poll conducted by Tavern Research on behalf of the Searchlight Institute tested the idea of automatically enrolling every American in a government-run health insurance plan like Medicare. The idea garnered net total support of 33 percentage points, though support fell to 11 points when respondents were told the plan would replace private and employer-sponsored coverage and be funded through higher taxes. Seventy percent of respondents said they would prefer to keep their current insurance if given the option.
As healthcare affordability issues mount, a Century Foundation survey from late May found two out of three registered voters want either new public insurance options or a complete system overhaul. And heading into the midterms this fall, voters on both sides of the aisle say the cost of insurance is the biggest problem facing the healthcare system, according to a new survey of 25,000 people from the Commonwealth Fund.
Population Health
Commonwealth study: care coordination in developed health systems: Highlights
- Frequent care coordination between primary care physicians (PCPs) and other types of providers was not universally reported in any of the 10 surveyed countries.
- Most PCPs across the surveyed countries do not receive a report from the specialists to whom they’ve referred patients within a week.
- The majority of physicians across all 10 countries reported they were able to electronically coordinate with providers outside of their practice.
- Around half of PCPs in Canada, New Zealand, and the U.K. said the amount of time they spend coordinating referrals with specialists was a major problem for their practice, while about one in four did so in the U.S.
How Care Coordination Varies in 10 Countries | Commonwealth Fund
HHS introduces treatment first toolkit targeting addiction among homeless: “Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr., White House Office of National Drug Control Policy (ONDCP) Director Sara Carter, and Housing and Urban Development Secretary Scott Turner today announced the Best Practices Toolkit: Addressing Homelessness and Addiction Through Treatment First [PDF, 2.14 MB]. This first-of-its kind resource provides communities with practical and proven strategies to help Americans transition from homelessness and addiction to recovery and self-sufficiency.
This toolkit advances a “Treatment First” model that prioritizes coordinated and accountability-driven engagement in evidence-based treatment and recovery support services to ensure access to effective, comprehensive, and evidence-based care necessary for homeless individuals.
Data shows 75% of homeless Americans are addicted to drugs, while 78% suffer from mental illness…
This announcement was made at the San Diego Rescue Mission, which has been providing meals, shelter, clothing, education and job-skills training for homeless men, women, and single parents with children since 1955.”
HHS, ONDCP, and HUD Launch First-Ever ‘Treatment First’ Toolkit to Combat Homelessness and Addiction August 12, 2026 https://www.hhs.gov/press-room/hhs-ondcp-hud-launch-treatment-first-toolkit-homelessness-addiction.html
