Keeping track of all things healthcare is a formidable task. Last week’s news is no exception:
- White House Directives: President Trump fired the heads of the IRS Billy Long and Bureau of Labor Statistics Erika McEntarfer, citing performance issues and lack of confidence in the most recent jobs report. The President also ordered the Commerce Department to “begin work on a new and highly accurate CENSUS” eliminating migrants from counts and announced a stepwise series of pharmaceutical tariffs that could reach 150% within a year and a half, then rise to 250%. And the President ordered the Office of Personnel Management to purge records of federal employee Covid vaccinations.
- FDA Policies: Thursday, the FDA announced it will soon require prescription opioid manufacturers to include stronger language on the medications’ label warning that higher doses and longer-term use carry risks including overdose and death. The new rules also require warnings about the dangers of rapidly reducing someone’s dose or discontinuing altogether.
- HHS MAHA Policies: HHS Secretary Robert F. Kennedy Jr. announced Tuesday that the Biomedical Advanced Research and Development Authority (BARDA) is terminating 22 grants totaling nearly $500 million supporting the development of mRNA vaccines, in today’s roundup of the news in healthcare politics.
- State Initiatives: The Oregon legislature passed a law restricting the influence of private equity in healthcare and the Illinois Gov. JB Pritzker signed an outright ban on the use of AI systems to provide direct mental health services in the state under threat of a $10,000 fine if violated. Note: Nevada, Utah and New York have also passed laws regulating AI and mental health.
- Insurer finances: 2Q earnings reports from health insurers were mostly negative due to higher-than-expected post-pandemic utilization especially in Medicare Advantage plans.
- Drug discovery: In trial results reported last week, Eli Lilly’s orforglipron, an oral GLP-1 (glucagon-like peptide-1) reduced weight loss of 12.4% but lower than Novo’s Wegovy injections disappointing the company’s investors.
- Congressional investigations: Two Senate Committees (Finance, HELP) announced investigations of UnitedHealth Group’s business practices involving cyberattack protections, hospitalization policies, advance directives and marketing. Also last week, the Department of Justice (DOJ) announced a settlement in the Maryland federal court challenge to UnitedHealth’s $3.3 billion acquisition of home health and hospice company Amedisys, with the deal requiring the companies to sell at least 164 locations across 19 states.
- Insurance coverage: A Peterson-Kaiser Family Foundation study released Wednesday estimates the 2026 marketplace premiums impacting up to 20 million will increase 18% for insurers and up to 75% for enrollees due to discontinued subsidies in the Big Beautiful bill.
- Clinical research: A Harvard Medical School study published in Nature last Wednesday found that lithium, an element found in some foods and drinking water and in trace amounts in our bodies, can confer resistance to brain aging and Alzheimer’s. Their work reveals that lithium was the only trace metal that was significantly depleted in the brains of people in the earliest stages of memory loss during aging.
- New legislation: Republican senator Kevin (R-ND) have introduced1868 – Critical Access for Veterans Care Act that would make it easier for the 9 million veterans who depend on the VHA health benefits to seek care at local hospitals and clinics.
- Government accountability: The Government Accountability Office (GAO) found that the Trump administration, by canceling 1800 National Institutes of Health grants via Executive Orders, had violated a 1974 law blocking presidents from withholding funding Congress has approved. The GAO also found that the NIH’s $8 billion shortfall in new and continuing awards between February and July amounted to an illegal withholding of obligated funds.
- Public health: The CDC released findings from its National Health and Nutrition Examination Survey finding adults and children in the United States are getting 55% of their total calories from ultra-processed foods.
- Healthcare investing: Pitchbook advised its followers that the deal environment in healthcare for the balance of 2025 will be strong but valuations in some sectors disappointing.
- Covid vaccine: in Atlanta, a lone gunman, 30-year-old Joseph White, who believed the Covid vaccine had made him ill, attacked the Clifton Road headquarters of the CDC killing Dekalb County Police Officer David Rose, 33, in an exchange.
These events and actions illustrate the administration’s “flood the zone” strategy and its propensity to dictate news cycles in media coverage. They also reflect the ubiquitous role played by healthcare in our society as an employer and economic engine.
Collectively, they appear to cast the industry in a negative light reinforcing populist’ suspicions about affordability, price transparency, corporatization and cost-containment. And they lend to growing disfavor among lawmakers, employers and critics.
As Campaign 2026 and implementation of the Big Beautiful Bill begin, healthcare boards overseeing organizations in the U.S. ecosystem should keep four considerations in mind:
- The Trump administration’s health policies are premised on antipathy toward the industry: it believes…
- The health system is wasteful but profitable for many. It can absorb DOGE and Medicaid cuts in the Big Beautiful Bill.
- The public is dissatisfied with the system’s performance. Lack of price transparency and attention to affordability are concerns to which the industry pays lip service and justification for aggressive counter-actions by the administration.
- The locus of regulatory changes in healthcare will be states: The SCOTUS Dobbs decision (2022) outlawing Roe v. Wade is a template for federal healthcare lawmaking. Major issues like price controls, Medicaid coverage, public health funding, tax exemptions for not-for-profit health services organizations, staffing requirements et al will be addressed first by Governors through executive actions, state legislature lawmaking and voters thru referenda. Congress or the White House will engage as necessary or opportunistically.
- The 2026 mid-term election will be a referendum on direction (style), not results (substance). Capital market stability, monetary policies around interest rates and inflation, global conflicts in the Ukraine, Gaza and others, the impact of tariffs on prices and the public’s mood about the future will weigh heavily as primary voters go to the polls as early as March 2026. The least popular elements of the Big Beautiful Bill take effect after the mid-term but three near-term indicators may be influential to the vote: how work requirements for Medicaid coverage are implemented by states, how and how much marketplace insurance premiums increase, and how insurers, especially Medicare Advantage plans, address utilization and prior authorizations.
- Healthcare costs and affordability will be the focus of primary attention. Healthcare spending is widely viewed as out of control by regulators and employers and inexplicably high and harmful by consumers. Blame is rightfully shared by insurers, the drug industry (PBMs, distributors and manufacturers), hospitals, private equity investors and consumers who make unwise choices. A solution is not achievable thru partisan lawmaking nor neatly fitted into election cycles. It likely requires a Manhattan project welcomed by outsiders but threatening to most (not all) insiders.
Every company, collective and consumer is directly impacted by the healthcare industry. News like last week’s is closely attended by individuals seeking a remedy, investors seeking an opportunity and lawmakers seeking a policy change.
And it’s a complex industry caught in the crosshairs of political brinksmanship between partisans, a widening gap in household financial security and corporate focus on short-term sustainability vs. long-term growth.
Redistricting, Epstein, Gaza and the CDC shooting garnered page one coverage last week. This week, Russia and the Ukraine will headline unless a mass casualty event occurs or other. But page two will feature healthcare—the good, the bad and the ugly. Notoriety is a two-edged sword.
Paul
PS: I am addicted to sources that provide insightful analysis to valid and reliable data. I am increasingly studying household finances; housing is the biggest component (36%) well above food (14%), healthcare (8%), transportation (7%) and energy (4%). Here’s a source I’m finding useful: A Predictably Bad July Jobs Report – by K. Pow
Resources
How much and why ACA Marketplace premiums are going up in 2026 Peterson KFF Health System Tracker August 6, 2025 https://www.healthsystemtracker.org/brief/how-much-and-why-aca-marketplace-premiums-are-going-up-in-2026
Electricity costs rise amid data center boom
Axios Vitals 1 big thing: Obamacare sticker shock could jolt GOP August 8, 2025
How much and why ACA Marketplace premiums are going up in 2026
Eli Lilly Earnings: Stock Slides as Weight-Loss Pill Results Dent Enthusiasm – WSJ
HHS Winds Down mRNA Vaccine Development Under BARDAhttps://www.hhs.gov/press-room/hhs-winds-down-mrna-development-under-barda
Trump’s Biggest Economic Threat Is Inflation – WSJ
Insurers feeling the pressure – POLITICO
Trump NIH cuts violated federal law, GAO watchdog office says | STAT
Sections in today’s Report:
- Economy
- Hospitals
- Insurers
- Physicians
- Polling
- Prescription Drugs
- Public Health
Quotables
Atlantic on GOP health strategy: “In Donald Trump’s second term, Republicans haven’t given up their opposition to universal coverage—far from it—but they have mostly stopped singing the praises of American health-care innovation. Indeed, they are taking a meat axe to it, slashing medical-research funding while elevating quacks and charlatans to positions of real power. The resulting synthesis is the worst of all worlds: a system that will lose its ability to develop new cures, while withholding its benefits from even more of the poor and sick.”
So Much for the ‘Best Health-Care System in the World’ The Atlantic August 8, 2025 https://www.theatlantic.com/politics/archive/2025/08/trump-republicans-health-innovation
Bob Herman (STAT) on drug price transparency: “Drugmakers are hardly raising prices and giving much of their hard-earned money to greedy middlemen. That, at least, is the takeaway from the drug price transparency reports that pharma releases.
But there’s a lot missing from those reports, including pricing information about specific drugs and how much Americans spend on them…. They serve to advance pharma’s political talking points by blaming others for high prices and masking the industry’s opposition to full, mandated price transparency.”
Drug companies’ price transparency reports paint murky picture | STAT
Nancy Tomes (NEJM) on health system corporatization: “No market solution has arisen for the most critical determinant of poor health and health care outcomes in the United States: extreme income inequality. Countless studies indicate that poverty is the most important health risk factor that Americans face. Yet a market-driven health care system offers limited incentives to lower that risk; little profit can be made by preventing or treating poverty-induced illnesses.
U.S. health care needs a new business model. Many physicians resist the pressures to pursue economic goals at patients’ expense, spending countless hours convincing pharmacy benefit managers and insurance companies to cover necessary care. But only more collective physician and patient action will help medicine find a more equitable, sustainable model.
Meanwhile, the Trump administration appears intent on blowing up our fragile health care system in the name of an unrestrained “free market” and corporate profiteering. Many people will suffer if the system collapses completely, but perhaps a more sustainable health care system can be built from the rubble.”
Rita Numerof on system reform: “From the passage of the One Big Beautiful Bill to CMS’s newly announced strategic direction, from executive orders on pharmaceutical pricing to ongoing scrutiny of PBMs, Medicaid and the 340B program, there’s no shortage of movement across the healthcare landscape. At first glance, these efforts may seem disconnected. Actually, they reflect a growing recognition of a system-wide problem: the incentives that govern our healthcare system are broken. Fixing them requires more than incremental change.
If we’re serious about delivering better health outcomes at lower cost, we must embrace a new business model, one that aligns incentives, promotes transparency and holds every stakeholder accountable for the value it provides….
In the American healthcare ecosystem, each stakeholder is doing what the current model rewards, to the detriment of patients and taxpayers. Funding patches and other temporary solutions can’t fix it. We need a fundamentally different business model, one grounded in outcomes, transparency and competition.
Each player must change the way they operate and be willing to take responsibility for creating and communicating value. With a better business model, we can have better results for patients, taxpayers and companies. The path forward isn’t easy. But it is clear.”
A System Wide Diagnosis for America’s $5 Trillion Healthcare Problem Forbes August 5, 2025
MSN on executive power: “In dealing with America’s biggest companies, the commander in chief has no qualms about acting as the micromanager in chief.
President Trump took his penchant for telling corporate bosses how to run their companies to another level Thursday by publicly calling on Intel’s chief executive to resign. The move wasn’t out of character: Trump has told Detroit carmakers not to raise prices and demanded Walmart “eat the tariffs.” He’s pressured the Washington Commanders football team to change its name and wants Coca-Cola to use cane sugar instead of corn syrup.”
Trump Is Making CEOs’ Business His Business August 7, 2025
Blake Madden on price transparency: “The American consumer is woefully uninformed and ill equipped when it comes to any sort of pricing mechanism in healthcare. Copays, deductibles, and coinsurance muddy the waters and frustrate all of us. We have no idea what anything costs, and prices were always veiled between individual payors and providers through trillions of line items and CPT codes, each with their negotiated rate behind closed doors. So, in response to this issue, but also as an attempt to re-introduce free market economic principles into healthcare, CMS unveiled new price transparency laws starting in 2020…
But those initial regulations planted a seed, that over time, started to blossom into a little sapling. Over the past few years, CMS has been slowly making improvements to price transparency requirements.”
Hospitalogy August 5, 2025: https://hospitalogy.com/
WSJ on AI impact on consultancies: “Consulting is emerging as an early and high-profile test case for how dramatically an industry must shift to stay relevant in the AI era. McKinsey, like its rivals, grew by hiring professionals from top universities, throwing them at projects for clients—then billing companies based, in part, on the scope and duration of the project.
AI not only speeds up projects, but it means many can be done with far fewer people, said Pat Petitti, CEO of Catalant, a freelance marketplace for consultants. Junior employees will likely be affected most immediately, since fewer of them will be needed to do rote tasks on big projects. Yet slimmer staffing is expected to ripple through the entire consulting food chain, he said…
One immediate change is that fewer clients want to hire consulting firms for strategy advice alone. Instead, big companies are increasingly looking for a consultant to help them put new systems in place, manage change or learn new skills, industry veterans say.
“The age of arrogance of the management consultant is over now,” said Nick Studer, CEO of consulting firm Oliver Wyman.
Companies, Studer added, “don’t want a suit with PowerPoint. They want someone who is willing to get in the trenches and help them align their team and cocreate with their team.”
AI Is Coming for the Consultants. Inside McKinsey, ‘This Is Existential.’ – WSJ August 2, 2025
WSJ on consumer spending anxiety: “After spending lavishly through the post pandemic years on everything from home improvement to travel, U.S. consumers find themselves in a summer of economic uncertainty. Beef prices are the highest on record. Daily latte habits now face as much as an additional 50% tariff on coffee. Ford Motor, which makes the most popular vehicle in the U.S.—the F-150 truck—said the Trump administration’s flurry of trade deals have heaped a punishing level of duties on the automaker. It has already raised prices on some cars and trucks to help cover the added costs.
Shoppers, wary about inflation, job expectations and their personal finances, are dialing down their spending to focus on the essentials and forego the extras, executives said. The company behind Invisalign said patients are putting off orthodontic treatment and choosing metal braces over pricier clear alternatives…
Americans now spend nearly four hours a day thinking about money, making it the equivalent of a part-time job, according to a June survey by Empower, the 401(k) giant. More than half of the 2,206 adults surveyed said they are thinking about money more often than they did last year…
A May poll of consumer sentiment conducted by consulting firm McKinsey found most people planned to adjust their spending in response to tariffs. Rising prices was the top concern of those surveyed, far outweighing issues such as immigration, international conflict and political polarization.”
American Consumers Are Getting Thrifty Again – WSJ August 3, 2025
Georgetown Center on Education and Workforce: “The current job market is making a good case for recent college graduates to consider going to graduate school. But is it really worth it?
Uncertainty around the potential impact of higher U.S. tariffs is tamping down hiring. And even before tariff stress hit the job market, new college grads faced headwinds.
The unemployment rate for recent graduates (those ages 22 to 27) was 4.8% in May… That’s up from 4.3% in May 2023. The overall unemployment rate, meanwhile, rose to 4% from 3.5% during the same period. (The overall employment rate stands at 4.2% for July.)…
The Georgetown University Center on Education and the Workforce projects that the number of jobs requiring graduate degrees will be 14% higher in 2031 than it was in 2021.There is an alluring earnings premium that typically comes with a graduate degree—18% on average for someone with a master’s degree compared with someone with just a bachelor’s degree…
The problem is the earnings premium has pretty much stayed around 18% over the past 30 years…”
Is a Graduate Degree Worth It in This Tough Job Market? – WSJ August 3, 2025
Economy
WSJ on BLS Jobs reporting: “Well, that was productive—not. President Trump on Friday fired Bureau of Labor Statistics Commissioner Erika McEntarfer after the July jobs report showed that hiring stalled this spring amid his tariff blitz and deportation crackdown. Shooting the messenger won’t help him or the economy.
The BLS estimates a mere 73,000 jobs were added last month, almost all in healthcare and social assistance. It also revised down gains for May and June by a combined 258,000, to a total of 33,000 new jobs, one of the biggest downward revisions in years…
The truth is that the jobs numbers have become more volatile in recent years because of declining business survey response rates…
It helps to understand how the BLS produces its monthly jobs report. The bureau surveys some 631,000 workplaces by a variety of media, including phone, web and even fax. Many businesses don’t respond every month, but the BLS continues to collect data and revise its findings over the next two months.
The survey’s overall response rate has declined to 43% from 60% before the pandemic, and small businesses are less likely than bigger ones to respond, especially in the first month. The jobs estimate can also be off in either direction by 136,000 in any given month because of statistical chance. Such variations tend to even out over several months…”
Trump Claims the Jobs Report Was Rigged. Was It? – WSJ August 3, 2025
Corporate tax savings from Big Beautiful bill: “AT&T recently said it expected $1.5 billion to $2 billion in cash tax savings this year, due to provisions in the tax-and-spending law dubbed the One Big Beautiful Bill Act. The high end of the range is equivalent to an 11% boost to analyst estimates of 2025 free cash flow before the law was enacted. AT&T estimated annual cash tax savings of $2.5 billion to $3 billion in both 2026 and 2027.
In short, changes like allowing upfront depreciation of assets and immediate expensing of research-and-development expenses will bring swift windfalls to American corporations but also lasting tailwinds. This in turn has provided incremental fuel to stock markets, a counterweight to risks from tariffs and other policy uncertainty.
All told, Zion estimates $148 billion in cash tax savings for a sample that covered 369 of the companies in the S&P 500. That is equivalent to 8.5% of the companies’ combined full-year estimates for free cash flow as of June 30, right before Congress passed the tax law, using estimates compiled by S&P Global Market Intelligence.”
Cash Windfall from Trump’s Tax Law Is Starting to Show Up at Big Companies – WSJ
Pitchbook on 2Q deal activity: “Although saying healthcare services dealmaking is rebounding would be premature, sector dealmaking has stabilized, and the most pessimistic scenarios for 2025 appear increasingly unlikely….State regulation dynamics have replaced national-level concerns for PE sponsors, as a wave of state legislation led by Oregon’s recently passed SB 95 signals a growing trend of aggressive state-level oversight, with similar efforts emerging in Massachusetts, Washington, and Pennsylvania. “
Q2_2025_Healthcare_Services_PE_Update_19787.pdf
Pitchbook on PE liquidity: “The ratio of PE investments to exits has reached 3.14x, the highest in a decade… That means PE firms make about three investments for every opportunity they exit….
As PE firms hold on to companies for longer and find alternative ways to generate liquidity, managers have been more active with take-privates and carveouts from large public companies, among other plays, he said.
At the same time, even with dry powder hovering around $1 trillion, it now accounts for the lowest share of AUM in years at 28.2%…a sign that managers are actively putting money to work even as exit options remain constrained.”
PE’s gap between investments and exits reaches a decade high – PitchBook
WSJ on BLS Jobs reporting: “Well, that was productive—not. President Trump on Friday fired Bureau of Labor Statistics Commissioner Erika McEntarfer after the July jobs report showed that hiring stalled this spring amid his tariff blitz and deportation crackdown. Shooting the messenger won’t help him or the economy.
The BLS estimates a mere 73,000 jobs were added last month, almost all in healthcare and social assistance. It also revised down gains for May and June by a combined 258,000, to a total of 33,000 new jobs, one of the biggest downward revisions in years…
The truth is that the jobs numbers have become more volatile in recent years because of declining business survey response rates…
It helps to understand how the BLS produces its monthly jobs report. The bureau surveys some 631,000 workplaces by a variety of media, including phone, web and even fax. Many businesses don’t respond every month, but the BLS continues to collect data and revise its findings over the next two months.
The survey’s overall response rate has declined to 43% from 60% before the pandemic, and small businesses are less likely than bigger ones to respond, especially in the first month. The jobs estimate can also be off in either direction by 136,000 in any given month because of statistical chance. Such variations tend to even out over several months…”
Trump Claims the Jobs Report Was Rigged. Was It? – WSJ August 3, 2025
Hospitals
Strata: Hospital, physician practice finances for 2Q2025: “U.S. hospitals and physician practices wrapped up the second quarter of 2025 with steady financial performance, according to new data from Strata Decision Technology analyzing more than 1,850 hospitals and 152,000 physicians.
- Health system operating margins held at a median 1.2% year-to-date in June, marking the sixth straight month of relative stability. Hospitals also posted year-over-year gains in operating margins, with the median change rising 2.4 percentage points from June 2024. Facilities in the South saw the sharpest increase, while hospitals in the West experienced a decline. Small hospitals with fewer than 25 beds saw the largest drop among size categories.
- Hospital expenses continued to rise, driven mainly by a 9.8% year-over-year jump in drug costs. Overall non-labor expenses climbed 8.2%, outpacing a 3.8% increase in labor expenses. Total expenses were up 5.1% from June 2024, though they eased slightly month over month.
- Hospital revenues grew year over year for the 26th consecutive month. Outpatient revenue rose 12.3% and inpatient revenue increased 7.0% compared to June 2024. Net patient service revenue per adjusted discharge increased 3.3% year over year and 2.2% from the previous month.
- Patient volumes were mixed. Outpatient visits rose 8.2% year over year, while inpatient admissions increased 3.7%. Emergency department visits declined 5.2%, and observation stays fell 1.0%. Month-over-month figures showed declines across all categories.
- Physician practices also saw year-over-year revenue growth, with median net patient service revenue per full-time physician reaching $826,575 in Q2, up 11.4%. However, expenses grew as well, with total cost per physician FTE climbing 11.4% compared to Q2 2024. Physician productivity, measured in work RVUs, rose 8.2% year over year.
- Support staffing levels increased modestly, and the median investment per physician FTE rose to $322,490, a 1.7% year-over-year gain. Practices in the Northeast saw the largest investment increases, while the South reported declines.
Study: Definitions of Safety Net Hospitals (SNH): “The lack of universally accepted definitions for safety net hospitals (SNHs) has made it difficult to effectively design policies to support these hospitals and the populations they serve…
Among 4531 short-term acute care hospitals, between 992 (21.9%) and 1326 (29.3%) were SNHs in 2022, depending on definition. SNHs defined based on the absolute level of inpatient days or absolute level of DLIS populations were often large (51% [242 of 476] or 67% [537 of 801]) and were not often rural (9% [45 of 476] or 2% [17 of 801]). Meanwhile, SNHs defined based on relative level of Medicaid inpatient days or relative level of DLIS patients were more often small (63% [298 of 476] and 82% [660 of 801]) and rural (48% [228 of 476] and 69% [555 of 801]) hospitals. The largest overlap across definitions was between a hospital’s Medicaid inpatient day share and Medicare DSH index (55% overlap [808 of 1466 hospitals]), which tended to represent large, teaching hospitals. Public ownership, teaching status, and Medicare DSH index produced the most stable definitions of SNHs over time from 2014 to 2022, with 83% (862 of 1043), 74% (1000 of 1354), and 60% (809 of 1358) of similar hospitals, respectively, meeting safety net criteria. The least stable definitions were based on low operating margins, high uncompensated care share, and high DLIS day share, with only 15% (263 of 1796), 20% (362 of 1823), and 25% (436 of 1725) of similar hospitals, respectively, meeting safety net criteria in 2014, 2018, and 2022.
In this cohort study of US hospitals, different SNH definitions produced different samples, and candidate measures had variable overlap and stability over time. These findings highlight the trade-offs when considering different options to define SNHs.
Variation, Overlap, and Stability in Defining Safety Net Hospitals JAMA Network Open July 30, 2025 2025;8;(7):e2523923. doi:10.1001/jamanetworkopen.2025.23923
Study: patient repayment of hospital co-payment obligations: “Across the full sample of 217 US hospitals (30.7 million patient episodes), mean (SD) patient liability per person, including those with no liability, was higher for individuals with private insurance ($375.41 [$51.55]) than those with Medicare Advantage ($172.50 [$14.84]). Consistent with high-deductible plan design with annual resetting, mean patient liability was higher for visits in January than December, particularly among the privately insured (eg, mean [SD] patient liability for visits among the privately insured in January: $479.44 [$29.21] vs December: $321.63 [$14.29]).
Prior to the COVID-19 pandemic (January 2018-February 2020), mean repayment rates were 53.9% and 54.0% for patients with private or Medicare Advantage insurance, respectively, and repayment rates declined in more recent years. Across the entire sample, patients with private or Medicare Advantage insurance paid either 0% or 100% of their owed cost sharing in 92.2% and 94.1% of cases, respectively. Repayment rates varied by bill size with lower repayment rates on the largest bills and the smallest bills, and higher repayment rates on midsized bills.”
Patient Repayment of US Hospital Bills From 2018 to 2024 JAMA Health Forum August 8, 2025 2025;6;(8):e252284. doi:10.1001/jamahealthforum.2025.2284
Insurers
Insurers adjust Medicare Advantage strategies: “Shakespeare famously wrote in The Tempest, “What’s past is prologue,” to express how events of the past set the stage for developments in the present.
That sentiment was clear for health insurers in the second quarter, in which companies that slashed Medicare benefits and cut loose unprofitable members last year enjoyed apparent immunity from the tidal wave of medical costs burying their peers.
Humana and CVS were the only insurers to raise their annual profit expectations following the second quarter, bucking a broader downturn. Four other major payers — UnitedHealth, Elevance, Centene and Molina — either lowered their profit expectations or established new floors well below previous targets.
(The other major publicly traded insurer, Cigna, reaffirmed its previous outlook. Cigna does not participate in MA.)
The state of play is a sharp about-face from 2024. Last year, Humana and CVS were hit hardest by utilization and regulatory changes in the privatized Medicare program as Biden administration policies that shrunk reimbursement coincided with increasing medical spending. Their insurance profits plummeted as a result.”
The great Medicare Advantage contraction appears set to continue | Healthcare Dive
Medicaid MCO survey re: prior authorization policies: To improve understanding of state Medicaid managed care prior authorization processes and oversight, the 24th annual Medicaid budget survey, conducted by KFF and Health Management Associates (HMA) in the summer of 2024, asked about specific prior authorization process-related policies in place as of July 1, 2024. Key findings include:
- Prior Authorization Decision Timeframes. Nearly half of responding MCO states (17 of 36) required MCOs to make “standard” prior authorization decisions within 7 calendar days or a shorter timeframe. New federal rules that take effect in January 2026 require standard prior authorization decisions to be made within 7 calendar days.
- Offering of Electronic Denial Notices. Only about one-third of responding MCO states (12 of 38) required MCOs to offer prior authorization denial notices electronically. Delayed receipt of denial notices can leave enrollees without enough time to request an appeal.
- Access to External Medical Review. At least one-third of responding MCO states (15 of 39) provided enrollees with access to an independent external medical review process to review an MCO’s decision to uphold a denial.
Physicians
Study: Unsolicited Patient Complaints and Industry Payments for US Physicians: In a cross-sectional study of 71 944 physicians, higher Patient Advocacy Reporting System Index scores, reflecting a greater number and severity of unsolicited patient complaints, were significantly associated with an increased likelihood of accepting general payments, particularly in higher amounts.
“In this cross-sectional study of nearly 72 000 physicians across the US, physicians with higher PARS Index scores, indicative of a higher risk of medical malpractice claims, worse patient outcomes, and well-being concerns, were more likely to accept industry payments, particularly in higher amounts. These findings underscore the importance of conflict-of-interest review and management to support medical professionalism and patient trust.
Unsolicited Patient Complaints and Industry Payments for US Physicians
Doxemity: 2025 physician compensation: Highlights:
- “Average physician compensation in the U.S. increased 3.7% from 2023 to 2024, a slightly lower increase than the 5.9% reported in the prior year.
- The 3.7% increase in compensation has done little to close existing pay gaps across the profession. In 2024, average compensation for men rose 5.7%, compared with just 1.7% for women—widening the gender pay gap to 26%, compared with 23% in 2023. Significant disparities also persist between physicians who care for adult versus pediatric patients. In some specialties, the pay gap between pediatric and adult specialists exceeded 80%, despite similar levels of training and clinical complexity.”
Doximity Physician Compensation Report 2025 https://www.doximity.com/reports/physician-compensation-report/2025
Polling
KFF on Trusted Information sources: The KFF survey was conducted July 8-14, 2025 among a nationally representative sample of 1,283 U.S. adults in English (n=1,212) and in Spanish (n=71). Highlights:
- 55%of adults, including larger shares of young adults and Black and Hispanic adults, say they use social media to find health information and advice at least occasionally and most adults report seeing health-related content in the past month on social media, with the largest shares saying they’ve seen content about weight loss, diet, or nutrition (72%) and mental health (58%). Overall, fewer adults report seeing content related to vaccines (38%), abortion (30%), and birth control (22%). Even people who say they never use social media for health information and advice report being exposed to health information in the past month – with weight loss, nutrition, and diet information being the most common.
- Most adults are skeptical of the health information and advice they see across social media platforms. When asked to assess the health information and advice on various social media platforms, fewer than half say they find “most” or “some” of the information they see on each platform trustworthy, and less than one in ten say “most” of the information is trustworthy.
- About one in six (15%) social media users (14% of the public overall) say they regularly get health information and advice from social media influencers. Among those who report regularly getting health information and advice from influencers on social media, six in ten (61%) say health influencers are mostly motivated by their own financial interests, while about four in ten (39%) say health influencers are mostly motivated by serving the public interest.
KFF Health Information and Trust Tracking Poll: Health Information and Advice on Social Media August 7, 2025 https://www.kff.org/health-information-trust/poll-finding/kff-health-information-and-trust-tracking-poll-health-information-and-advice-on-social-media
Poll: Insurer drug coverage: Per the poll sponsored by the PAN Foundation’s Center for Patient Research by Harris from July 15-17, 2025, among 2,080 adults ages 18 and older:
- 54% of insured adults with commercial insurance have been told by their health insurance plan that medications for their chronic or rare disease are no longer covered.
- 48% report that their health insurance plan referred them to work with an external company to obtain their medications, causing delays and negative impacts on their health and life.
- 39% opted to work with the external company they were referred to by their insurance plan. Among those patients, they reported the most common methods these external companies used to obtain the medication included:
- Importing the medication from an international pharmacy (44%)
- Securing the medication through a manufacturer’s patient assistance program (43 %)
- Securing the medication through a charitable patient assistance foundation (40%)
- Among those who opted to work with an external company, 39% experienced a delay of one month or more from the time their medication was prescribed to when they began their treatment. In some cases, the delays were longer.
National poll reveals half of patients denied coverage for medications
Bank of America survey on spending habits: This survey of 1069 U. S. adults was conducted online from April 4 – 25, 2025, by Ipsos. Key findings:
- Over the last 12 months, 72% took steps to improve their financial health, such as putting money toward savings (51%) or paying down debt (24%).
- Nearly two-thirds (64%) focused on reducing expenses – 41% cut back on dining out and 23% shopped at more affordable grocery stores.
- And more are going it alone. While 39% receive financial support from parents and other family members, this is down from 46% a year ago. And they are getting less money – 22% receive $1,000 or more per month compared to 32% a year ago, and 54% receive less than $500 per month compared to 44% a year ago.
- When it comes to their romantic lives, many Gen Z aren’t spending money on dates – with roughly half of men (53%) and women (54%) spending $0 a month, and 25% of men and 30% of women spending less than $100 per month.
- …51% of Gen Z surveyed say the high cost of living is a barrier to financial success. Total monthly spending is higher than they thought it would be for 35%, especially for everyday expenses including groceries (63%), rent and utilities (47%) and dining out (42%).”
Prescription Drugs
STAT on drug price transparency: “Over the past decade, pharmaceutical companies have released carefully curated “price transparency” reports that make it appear the prices of their medicines are barely increasing — or even going down.
But the reports disclose no pricing information about specific drugs, manipulating the reality of how much Americans spend on prescription drugs…
By 2019, the world’s largest drugmakers were putting out annual reports that detailed average changes in the list prices and net prices across all of their medicines. Similar to the hospital industry, list prices are the artificially inflated amounts drug companies charge, and net prices are what they actually get after negotiations with PBMs.
But the pricing data within the reports have several flaws. The data are rarely weighted, meaning drugs that bring in more revenue and potentially offer minimal discounts are compared equally to drugs that bring in less revenue and offer bigger discounts. Companies also don’t break down price swings for each drug, in effect keeping the most pertinent data on net prices and rebates behind their proprietary walls.”
Drug companies’ price transparency reports paint murky picture | STAT August 4, 2025
WSJ on drug pricing negotiations: ”Thousands of Medicare recipients will have to wait longer to get some price relief on the expensive cancer drugs they depend on for treatment, while others might not get any reprieve at all.
Two little-known provisions in the One Big Beautiful Bill Act signed by President Trump in July will delay Medicare price negotiations for some of the biggest-selling drugs in the world, including Merck’s Keytruda, which is used to treat cancer and had $17.9 billion in U.S. sales in 2024. Other drugs, such as Johnson & Johnson’s Darzalex, will be excluded entirely.
Medicare gained the power to negotiate prices on a handful of prescription drugs each year under the Inflation Reduction Act in 2022. The Big Beautiful Bill now puts new restrictions on when and which types of drugs can be negotiated. “
How Trump’s ‘Big Beautiful Bill’ Will Keep Drug Prices Higher Longer and Cost Medicare Billions – WSJ August 4, 2025
Report: GLP-1 eligibility among adolescents and youth: “An estimated 17 million U.S. adolescents and young adults were eligible for GLP-1 receptor agonists, but many lacked insurance or a routine place for healthcare. Adolescents and young adults were eligible for GLP-1 receptor agonists due to type 2 diabetes, obesity, or BMI of 27 or higher with a weight-related condition (the latter indication was included only for young adults). One in five young adults eligible for GLP-1 receptor agonists were uninsured, and one-third denied having a routine place for care.
Though an estimated 17 million U.S. adolescents and young adults were eligible for GLP-1 receptor agonists for conditions like obesity and type 2 diabetes, many lacked insurance or a routine place for healthcare.”
In a sample of adolescents eligible for GLP-1 receptor agonists, 40.3% were insured by Medicaid, 40.5% were privately insured, and 7.2% were uninsured. Among eligible young adults, 20.8% were insured by Medicaid, 49% were privately insured, and 19.4% were uninsured.
While 92.2% of eligible adolescents reported having a routine place for healthcare, only 68.1% of eligible young adults reported the same.
Study: Prescription drug access by ethnicity: “In this cross-sectional study of 143 health conditions among persons in 50 states and Washington, DC, per capita pharmaceutical use was highest among White populations and lowest among Asian or Pacific Islander and Hispanic populations. However, after standardizing for age and disease prevalence (for 52 conditions with available data), prescription fills were substantially lower for Black populations relative to the all-population mean. Disparities in medication use relative to disease burden persist—especially underutilization among Black populations—highlighting the need for targeted efforts to advance pharmacoequity.”
Prescription Drug Utilization and Spending by Race, Ethnicity, Payer, Health Condition, and US State JAMA Health Forum August 8, 2025 2025;6;(8):e252329. doi:10.1001/jamahealthforum.2025.2329
Public Health
Study: Cost-Effectiveness of 2023-2024 COVID-19 Vaccination in US Adults: “This decision analytic modeling study in a simulated cohort projected that cost-effectiveness for a 2023-2024 COVID-19 mRNA vaccine using base case assumptions was cost saving for individuals older than 65 years, $25,787 per quality-adjusted life-year gained for those aged 50 to 64 years, and $115,588 per quality-adjusted life-year gained for those aged 18 to 49 years. Results were robust to changes in parameter inputs for the older age groups but sensitive to inputs for the younger age group.”
Cost-Effectiveness of 2023-2024 COVID-19 Vaccination in US Adults JAMA Network Open August 7, 2025 2025;8;(8):e2523688. doi:10.1001/jamanetworkopen.2025.23688
