September 2025 marks a significant shift in U.S. health policy, especially its approach to the public’s health.
- On September 9, the Make America Healthy Again (MAHA) Commission issued its first report pursuant to Executive Order 1421 which included 128 recommendations focused on reducing childhood chronic disease prevalence involving nutrition, chemical exposure, “over-medicalization” in pediatric care and more.
- On September 19, the newly-appointed CDC Advisory Committee on Immunization Practices (ACIP) issued new guidance on MMRV, Hep B and Covid vaccines for the coming season.
- On September 22, the FDA announced label updates for acetaminophen (Tylenol) during pregnancy urging caution. In response, the Blue Cross Blue Shield Association (BCBSA) and America’s Health Insurance Plans (AHIP) said they would not modify their coverage from prior guidance.
- On September 26, HHS and the Food and Drug Administration (FDA) announced enforcement actions against misleading DTC prescription drug advertisements aimed at protecting consumers by increasing transparency and accuracy in drug marketing.
All these as Congress faces a federal government shutdown Tuesday where debate centers on the President’s proposed FY2026 budget that cuts CDC funding by 53% compared to FY2024, eliminates over 100 public health programs and elevates readiness risks for outbreaks (e.g., measles) and more. Neither side wants a shutdown. Both see political advantage in staying their courses:
- Republicans enjoy strong MAGA support for federal spending cuts.
- Democrats enjoy voter majority support for extending ACA subsidies and maintaining health programs like SNAP with eligibility/program improvements.
But neither party is trusted by the majority of voters. The public’s distaste for the political system is palpable. Confidence in Congress is at an all-time low (Gallup), and trust in the Centers for Disease Control has plummeted:
“KFF polls have shown a steady decline in the share of the public saying they trust the CDC to provide reliable information about vaccines and other topics, from a high of 85% at the onset of the COVID-19 pandemic to 57% in our latest poll in July. This drop was largely driven by Republicans, among whom the share trusting the CDC dropped from 90% in March 2020 to 40% in September 2023 before rebounding somewhat following President Trump’s 2024 election victory and Kennedy’s appointment as HHS Secretary. While trust among Democrats remained high throughout Joe Biden’s presidency, it began to decline in President Trump’s second term just as Republicans showed signs of increasing trust. As of July, Democrats remained more trusting of the CDC than Republicans, but it’s unclear how recent events might affect trust among partisans going forward.”
In June 2024, Jonathan Samet, Colorado School of Public Health) and Ross C. Brownson (Washington University) offered this view:
“Public health system” is an optimistic misnomer in the United States, as it is used in reference to a fragmented and loosely connected set of entities. Moreover, the public health system, which is itself not readily delimited, is part of a system of systems that encompasses at least governmental public health; community-based organizations; the health care sector; and the education, training, and research of the academic public health and medical enterprises. The organization, policies, and politics of public health in the United States present opportunities and challenges. In the current decentralized model of public health, governance and are distributed across more than3,300 state and local health departments. “
My take:
Public health is a vital part of the U.S. health system but a stepchild to its major players. In reality, the U.S. operates a dual system: one that serves those with insurance (public and private) and another for those without. Public health programs like SNAP, HeadStart, Federally Qualified Health Centers et. al., serve lower income and under-insured populations and integrate with local delivery systems emergency services and during mass-events like pandemics, mass-casualties and disease outbreaks. Funding for public health programs is 2-5% of total health spending shared between local, state and federal governments.
Studies show food, housing and income insecurity—areas targeted by public health– correlate to chronic disease prevalence and health costs. Unlike most developed systems of the world which operate at a lower cost and produce better population-health outcomes, our system perpetuates a structural divide between healthcare and public health. Integrating the two is a necessary strategy for system transformation, but a difficult task given entrenched animosity toward “the system” held by public health leaders and funding pressures. The bridge between public health and the healthcare delivery systems is a two-lane road with lots of potholes at the federal level, and sometimes better in local communities. But funding seems to be an afterthought unless local communities deem it vital.
Public health is an opportunity for industry leaders to demonstrate pursuit of the greater good. Most public health programs are under-funded and dependent on a patchwork of local, state and federal appropriations (sometimes augmented by philanthropy) to keep their doors open. A particular opportunity exists for not-for-profit hospitals and health systems who enjoy tax exemptions to pursue integration as the core community benefits strategy, offering community leaders a sensible basis for eliminating duplicative services, expanding preventive health services and reducing demand for unnecessary hospitalizations resulted from uncoordinated care.
As the federal shutdown is addressed this week in DC, public health officials will be watching closely. As noted on the American’s Public Health Association website (www.apha.org) “The health care industry treats people who are sick, while public health aims to prevent people from getting sick or injured in the first place. Public health also focuses on entire populations, while health care focuses on individual patients.” Both are necessary but responsibility and fundning for the public’s health seems in limbo.
Paul
Resources
Reimagining Public Health: Mapping A Path Forward
Challenges for Rebuilding Trust in the CDC | KFF Quick Takes
Sections in today’s Report
- Quotables
- Economy
- Employers
- Hospitals
- Insurers
- Physicians
- Polling
- Public Health
Quotables
On Public health transformation: “The COVID-19 pandemic and other ongoing public health challenges have highlighted deficiencies in the US public health system. The United States is in a unique moment that calls for a transformation that builds on Public Health 3.0 and its focus on social determinants of health and partnerships with diverse sectors while also acknowledging how the pandemic altered the landscape for public health… A transformed public health system will depend highly on leadership, funding incentives, and both bottom-up and top-down approaches. A broad effort is needed by public health agencies, governments, and academia to accelerate the transition to a next phase for public health.”
Reimagining Public Health: Mapping A Path Forward
On Consulting Industry cuts: “Ascending the ranks as a consultant, while difficult, is a linear track for many who land in the industry. Big firms head to schools and pluck freshly minted MBAs to join their ranks. After years of mentorship, long hours, and loads of hard work, you might eventually become a partner, one of the most prestigious titles a consultant could aspire to.
That dream might be creeping out of reach for younger people trying to break into the industry, which looks to be on the cusp of a big shift as firms trim their ranks, double down on AI, and tighten performance standards across the career ladder, industry analysts told Business Insider.
No one is exactly sure how it will play out, as much of the future will depend on where the economy goes and how quickly AI is adopted. But the end result could look something like a reshaping of the profession, with fewer entry-level and senior roles—something that could make it more challenging for young people in the field trying to rise through the ranks, analysts said.”
Economy
U of M September 2025 Consumer Sentiment: “Consumer sentiment confirmed its early-month reading and eased about 5% from last month but remains above the low readings seen in April and May of this year. Although September’s decline was relatively modest, it was still seen across a broad swath of the population, across groups by age, income, and education, and all five index components… Nationally, not only did macroeconomic expectations fall, particularly for labor markets and business conditions, but personal expectations did as well, with a softening outlook for their own incomes and personal finances. Consumers continue to express frustration over the persistence of high prices, with 44% spontaneously mentioning that high prices are eroding their personal finances, the highest reading in a year. Interviews this month highlight the fact that consumers feel pressure both from the prospect of higher inflation as well as the risk of weaker labor markets.
Year-ahead inflation expectations receded slightly to 4.7% from 4.8% last month. Long-run inflation expectations moved up for the second straight month to 3.7% in September, but stand much lower than the 4.4% spike seen in April.” Key data:
- Consumer sentiment declined in September, with the University of Michigan’s index falling to 55.1 from 58.2 in August.
- The decline in sentiment was broad, affecting various demographic groups, with concerns about high prices and the labor market.
- While 12-month inflation expectations remained elevated, long-run inflation forecasts ticked higher, despite some easing since spring
Surveys of Consumers September 2025 https://www.sca.isr.umich.edu/
Bloomberg on economic mood: The S&P 500 Index has added $15 trillion in market value since early April and notched 27 records in 2025. Its 34% gain over the past five months is a feat topped in just four other instances since 1950, according to data compiled by Bloomberg.
Middling growth typically has coincided with comparatively weak stock gains, according to Bloomberg Intelligence. And the economy is now in a rare in-between zone that’s well off the expansion of 2021 yet short of a recessionary collapse, according to BI’s model, which measures factors such as consumer sentiment and purchasing managers’ indexes.
Since 1969, the S&P 500 has posted a median return of just 4% over the six months after BI’s indicator shows a reading of 0.5, as it did in August. That compares with a 13% median advance in the same span after the model falls into recession territory, and a nearly 6% gain when it signals a healthy economy,
Slow-Growth Economy Threatens Stocks Priced for Perfection – Bloomberg
Employer
WTW Survey of Employer Benefits strategies: From from Willis Towers Watson survey of 417 employers with 100+ employees (81% were self-insured and 19% were fully-insured).
- Employers their healthcare costs to increase by 9.1% in 2026 (before making plan changes), compared to 8.1% in 2025 and 7% in 2024. After making plan changes, these numbers are 8%, 7% and 6%, respectively. The top drivers of these costs are pharmacy costs (specifically specialty drugs and GLP-1s), high-cost claimants and chronic conditions.
- When asked how they plan to manage costs in the next three years, 59% of employers said they are looking to implement “broader cost-saving actions,” 47% will increase cost shifting onto employees, and 32% will absorb costs. When looking at the last three years, the percentage of employers that adopted these strategies was 46%, 44% and 50%, respectively.
- Employers also plan to hold their vendors more accountable, with 46% of companies evaluating vendor performance. In addition, 36% are taking medical plans out to bid, and another 50% are planning or considering doing this.
- 41% of businesses are also adopting alternative plan designs, and 46% are planning or considering doing so in the future. These include using networks that limit access to certain providers, offering more transparency, and providing more care navigation.
- Additionally, employers are increasingly dissatisfied with their pharmacy benefit manager: 75% have or will take their PBM out to bid. About 49% are using transparent contract structures and 58% have conducted audits on their pharmacy benefits.
WTW: Half of Employers Exceeded Their Healthcare Budgets in 2024 – MedCity News
Hospitals
FY26 Hospital readmission penalties: Per the CMS Hospital Readmissions Reduction Program report released last week:
- The number of hospitals faced with readmissions penalties of at least 1% come Oct. 1 is set to rise to the highest number since fiscal 2022 reserving a 5-year decreased trend.
- The number of hospitals set to pay penalties of 1% or more under the will increase to 8.1%, or 240 hospitals, in fiscal 2026 compared to 7%, or 208 hospitals, in fiscal 2025
- The number of hospitals facing no readmissions penalties next fiscal year remained relatively flat compared to fiscal 2025, rising to 21.8%, or 641, from 21.4%, or 638.
- For the upcoming year, 70.1% of hospitals will be charged penalties of less than 1%, compared to 71.6% in fiscal 2025.
CMS release hospital readmission penalties for fiscal 2026 – Modern Healthcare
CMS modifies, extends AHEAD model: Last week, CMS announced changes to the Achieving Healthcare Efficiency through Accountable Design (AHEAD) model unveiled in 2023 adding new geography-based elements to alter how fee-for-service Medicare enrollees receive care.
- “AHEAD is a voluntary, state-based demonstration project focused on hospitals and primary care.
- AHEAD is a “total cost of care” model, meaning states take responsibility for the health and expenses for all residents across all payers, including Medicare, Medicaid and private insurance. CMS provides states with assistance and up to $12 million in funding.
- Connecticut, Hawaii, Maryland, Rhode Island, Vermont and the downstate region of New York will participate when the model begins operating in January.”
CMS https://www.cms.gov/priorities/innovation/innovation-models/ahead
Insurers
AHIP, BCBSA to follow pre-Kennedy vaccine recommendations: “Two major health insurance associations have decided to stick with the pre-RFK ACIP’s recommendations to guide what they cover. One is America’s Health Insurance Plans, whose members cover 200 million Americans and include over a dozen Blues plans, Centene, Elevance, and Humana. The other is the Blue Cross Blue Shield Association, a group of over 50 Blues plans that cover almost 117 million people (some of them are also AHIP members). Both groups confirmed their member plans will continue to cover all vaccines that were recommended by ACIP prior to the changes made last week with no out-of-pocket costs through 2026. Not everyone is making that pledge. UnitedHealthcare, the country’s largest health insurer, said it will continue to cover Covid-19 vaccines — insurers still have to anyway — and “typical school vaccines” with no cost share, but didn’t go further. “
Health insurers’ associations say member plans will still cover vaccines
Humana suspends MA broker commissions: Humana will not pay third-party marketers for enrolling new members in many of its wider-network Medicare Advantage products for 288 plans across 46 states and the District of Columbia. The insurer will also stop paying agents and brokers to enroll new members in several of its stand-alone Part D prescription drug plans nationwide, according to the notice.
Humana is the second-largest Medicare Advantage insurer by membership, with nearly 5.8 million enrollees. UnitedHealth Group’s UnitedHealthcare counts 8.35 million Medicare Advantage members.
Humana ending commissions for some Medicare Advantage plans https://www.modernhealthcare.com/insurance/mh-humana-medicare-advantage-commissions-2026/
Healthscape study: Health plan profitability: “Our analysis reveals that most regional health plans are operating at a loss, and half of those have less than 2 years before triggering formal regulatory intervention…
Operating margins have steadily decreased over the last 3 years as health plans reckon with numerous headwinds: pricing pressure from purchasers, regulatory scrutiny around typical revenue enhancement levers (e.g., risk adjustment and Medicare Advantage Star ratings), and rising medical and pharmacy expenses. While many health plans have successfully navigated these challenges, the number of organizations experiencing annual losses is mounting.”
| Nationals | Regional NFPs | Blues | Other FPs | |
| Median Lives | 17.8M | 73.7K | 1.7M | 45K |
| Administrative
Loss Ratio |
11.5 | 12.4 | 12.2 | 13.2 |
| Medical Loss
Ratio |
87.1 | 90.4 | 90.8 | 90.3 |
| Medicaid enrollment % of total | 21.0 | 46.5 | 9.9 | 14.8 |
Physicians
Study: Physician practice affiliation and costs: “We examined the relationship between provider affiliation model, site of care (SOC), and cost of care for certain high-volume procedures in procedure-intensive specialties for both Medicare and commercial insurance.
“We found that hospital-affiliated physicians are least likely—and PE-affiliated physicians are most likely—to provide care in lower-cost settings. For both Medicare and commercial insurance, SOC contributes meaningfully to procedure unit price, which is consistently greater in hospital-based settings. These findings suggest that the physician affiliation model and associated SOC cost differentials contribute materially to healthcare expenditures. As the Medicare cost differentials are set by statute and regulations, strategies such as site-neutral payments are needed to mitigate the monetary impact of historical and future physician practice migration.”
The study analyzed 32 high-volume CPT codes across cardiology, gastroenterology, orthopedics and urology. Highlights:
- As of 2022, 41% to 52% of physicians were hospital-affiliated, 23% corporate-affiliated and fewer than 4% worked in PE-backed management services organizations.
- Hospital-affiliated physicians were least likely to use lower-cost settings, while PE-affiliated physicians were most likely to shift cases to ASCs or office-based sites.
- The facility fee, rather than professional fees, is the largest driver of higher HOPD costs.
- Between 2001 and 2021, facility fees grew 60% (2.4% year-over-year) compared to just 11% growth (0.5% year-over-year) for professional fees.
- ASC payments are about 42% lower than HOPD payments for the same procedure.
- Across specialties, HOPD reimbursement ranged from 124% to 861% of ASC/office rates for Medicare and 111% to 1,346% for commercial payers.
- Commercial insurance consistently paid more than Medicare, and the HOPD vs. ASC/office dollar gap was larger in commercial markets.
- Echocardiogram (CPT 93306):
- Medicare: HOPD $593 vs. office $196 (303% higher)
- Commercial: HOPD $1,100 vs. office $377 (292% higher)
- Colonoscopy with lesion removal (CPT 45385):
- Medicare: HOPD $1,373 vs. ASC $860 (160% higher)
- Commercial: HOPD $3,428 vs. ASC $1,080 (219% higher)
Jackson Survey: Medicine as a calling: “90% saw medicine as a calling when they began, but more than half say the feeling has diminished. Altruism is an inspiration. 73% of respondents said “helping others/serving humanity” was a key motivator for pursuing medicine.
Baby Boomers are more likely to report a strong sense of calling and the highest levels of passion for their work. Gen Z was most likely to say they are motivated to pursue medicine by a desire to serve humanity…
Satisfaction is higher for those who feel a calling. Those who say medicine was a calling are more likely to feel satisfied with their jobs, say they would pursue medicine again and encourage young people to pursue medicine.
Region and work type have little impact on beliefs about purpose…”.
Is Medicine Still a Calling? Exploring Physician Attitudes About Purpose in Medicine
Government Accountability Office (GAO) Report: Physician consolidation: The GAO reviewed relevant literature, including peer-reviewed studies and reports published from January 2021 through July 2025 by researchers, stakeholder groups, and others. GAO also interviewed or received written responses from 14 selected stakeholders, as well as four organizations that collect or analyze relevant data on physician employment. Highlights:
“Physicians have become increasingly consolidated as the share of physicians in practices owned by other entities has increased over time. For example, studies show that at least 47% of physicians were employed by or affiliated with hospital systems in 2024, up from less than 30% in 2012. Estimates of the share of physicians consolidated with health insurers and corporate entities vary. Private equity ownership of or investment in physician practices represents a small but growing share of physicians nationally—about 6.5%in 2024.
“Hospital-physician consolidation tends to raise commercial prices: studies find about 17% higher office-visit prices after consolidation (2010–2016), 3%-5% higher inpatient hospital prices (2009-2015), and about 15% higher physician prices for childbirth in OB/GYN, alongside modest increases in hospital prices.”
Polling
Gallup on United Nations September 22, 2025: “Americans don’t believe the United Nations is doing a good job, but mostly continue to support its mission and existence, albeit at slightly lower levels than in the past. While Republicans tend to hold the U.N. in lower regard than Democrats and independents do, most still want the U.S. to remain a U.N. member nation.” Highlights:
- Slightly fewer American (60%) s now than in 2019 (85%) say U.N. is necessary
- 79% think U.S. should remain a U.N. member
- By 63% to 32%, Americans say U.N. doing a poor rather than good job
United Nations Seen as Necessary but Ineffective
Quinnipiac on public sentiment: This RDD telephone survey was conducted from September 18 – 21, 2025 throughout the contiguous United States. Responses are reported for 1,276 self-identified registered voters. Highlights:
- In the wake of the assassination of conservative activist Charlie Kirk, 79% of voters say the United States is in a political crisis, while 18 percent say it is not. Democrats (93 – 6 %), independents (84 – 14%), and Republicans (60 – 35%) say the United States is in a political crisis.
- Voters 53 – 41 percent think that the system of democracy in the United States is not working. Democrats (74 – 21%) and independents (61 – 32%) think the system of democracy in the United States is not working, while Republicans (74 – 22%) think it is working.
- Given a list of four economic issues and asked which one worries voters the most right now, 53 percent say the price of food and consumer goods, 28% say the cost of housing or rent, 8 percent say their job situation, and 7% say the stock market.
- 42% say they have cut spending on non-essential items compared to one year ago, while 14 % say they have increased spending, and 43% say there is no change in their spending on non-essential items compared to one year ago.
Public Health
Study: Affordability among Medicare enrollees: “Out-of-pocket spending increased with increasing income: $1363 for beneficiaries with near low income, $1765 for beneficiaries with low income, $2611 for beneficiaries with middle income, and $3964 for beneficiaries with high income. However, beneficiaries with near low income faced the highest levels of health care affordability challenges compared with the other income groups. After adjusting for age, sex, and health status, 54.0% of beneficiaries with near low income reported experiencing at least 1 affordability problem, compared with 43.0% in the low-income group, 45.2% in the middle-income group, and 25.5% in the high-income group. These patterns remained consistent across all affordability measures. Although few beneficiaries experienced all 3 types of affordability problems, larger proportions of beneficiaries reported financial burden alone, financial barriers to care alone, or both without medical debt….
In this cross-sectional study of Medicare beneficiaries, health care affordability problems were common. Medicare beneficiaries with near low income, who qualified for only partial financial assistance with Medicare costs, faced greater financial hardship compared with beneficiaries in other income groups. These affordability challenges may have restricted access to needed care, highlighting the need for targeted strategies to enhance financial protections and improve health care affordability for these beneficiaries
Study: Food insecurity and chronic illness among children: “The most common conditions were ADHD and asthma. Across the study period, the weighted prevalence of food insecurity among children with and without chronic conditions was 14.8% and 9.0% respectively. This difference was attenuated but persisted after controlling for family and child characteristics…In 2021, the prevalence of food insecurity among children with and without chronic conditions decreased to 9.7% and 6.6% respectively, but then increased to 15.9% and 11.1% respectively, by 2023. In this cross-sectional analysis, children were more likely to have food insecurity if they had chronic conditions than if they did not. This difference was only partially explained by several key demographic characteristics. Findings suggest children with chronic conditions should be prioritized in efforts to screen for food insecurity and efforts to enroll patients in programs designed to mitigate food insecurity.”
Study: Comparisons of Obesity definitions: “The Lancet Diabetes & Endocrinology Commission recently proposed a new evidence-based definition of clinical obesity incorporating direct measures of body fat and emphasizing the presence of organ dysfunction or physiological impairment due to excess adiposity. The present study compared the prevalence of body mass index (BMI)–based obesity and clinical obesity using the National Health and Nutrition Examination Survey (NHANES) to identify populations potentially misclassified by conventional BMI thresholds.
Despite the similar prevalence estimated by the 2 definitions, only 25.76% of the study population was classified as having both BMI-based and clinical obesity. The remaining 18.01% were classified as having obesity only by BMI-based criteria, and 18.87% only by clinical obesity criteria. The prevalence of clinical obesity increased with age, reaching 83.65% among individuals aged 80 years or older. Clinical obesity was more prevalent among adults with lower-income and lower-education as well as among Asian and Hispanic adults. Among adults with excess adiposity, 45.67% were classified as having preclinical obesity, and this proportion declined with age, from 77.27% among adults aged 20 to 29 years to 8.49%at age 80 years or older. Among those with clinical obesity, both organ dysfunction and mobility limitations were higher in older adults, women, and socioeconomically disadvantaged groups.”
Study: Firearms injury costs: “The Monte Carlo analysis included 2400 simulations. Firearm injuries in the US led to an estimated 298, 721 ED visits and 185, 846 inpatient visits, with a total health care cost of $7.7 billion from 2016 to 2021. Inpatient admissions accounted for 93% of the cost, or $7.2 billion. Treatment for children younger than 18 years accounted for 9% of the cost, or $684 million. Annual ED and inpatient visits were both approximately stable from 2016 to 2019, at which point they grew by 42% and 40%, respectively, from 2019 to 2021. Annual total health care cost was also stable at approximately $1.2 billion until 2019, when cost began to grow to a peak of $1.6 billion in 2021. The mean (SE) ED visit cost was $1743 (4.5), and the mean (SE) inpatient admission cost was $38 879 (138.9). These costs remained stable annually over the sample period.”
Census Bureau: Centenarians: Per the “Centenarians: 2020” special report released by the U.S. Census Bureau last week. Though a small proportion of the total population, the centenarian population in the United States increased by 50% from 53,364 in 2010 to 80,139 in 2020… faster than the growth of other age groups among older adults since 2010. Highlights:
- Sex Composition: In 2020, centenarians were overwhelmingly female at 78.8%. This was a slight decline from 2010, when centenarians were 82.8% female. Between 2010 and 2020, the male centenarian population grew by 85.3% versus a 42.9% increase for female centenarians.
- Racial and Ethnic Composition: Centenarians, a largely White alone and female population, became slightly more racially diverse and male in 2020.
- Regional and State: Compared with the national centenarian proportion of 2.42 per 10,000 people in the population, the Northeast had the highest centenarian proportion among regions at 3.19 centenarians per 10,000 people.
- Living Arrangements: In 2020, female centenarians lived alone without familiar household members to a much greater extent than male centenarians. About half (49.7%) of male centenarians lived with others in a household, while only about a third (33.8%) of female centenarians lived with others in a household.
The U.S. Centenarian Population Grew by 50% Between 2010 and 2020
Study: OTC sales of naloxone: “OTC sales peaked during the first month of availability after the FDA approved them in September 2023, then declined rapidly before stabilizing, according to the study. The amount of naloxone distributed by pharmacies or free programs was much larger than OTC sales. The average cost for a two-pack of naloxone nasal spray was nearly $45.”
