In 2009, I facilitated discussions with key health industry trade associations and the White House Office of Health Reform focused on reforms to reduce costs, increase insurance coverage and improve quality by 2019. It was the Obama administration’s aim to use the health system’s bulk as a lever to stimulate recovery from the 2008-2009 recession and simultaneously increase coverage through Medicaid expansion and marketplace subsidies that for lower-income households.
On March 23, 2010, the Patient Protection and Affordable Care Act (PPACA) was signed into law. In June 2012, in a 5-4 decision (National Federation of Business v. Sebelius), the U.S. Supreme Court upheld the law save its Medicaid expansion mandate to states. It’s been in the courts since i.e. in July, 2025, its preventive health requirements for insurers were upheld by SCOTUS (Kennedy v. Braidwood Management).
In 2021, as recovery from the pandemic took center stage, the Biden administration passed the American Rescue Plan Act expanding subsidies above the Affordable Care Act’s 400% of FPL eligibility threshold through 2023 for households where premiums exceeded 8% of their adjusted income. Then, it extended the subsidies through 2025 in the Inflation Reduction Act of 2022 pushing ‘Obamacare’ coverage to 24 million this year. That’s how we got where we are today.
Per the nonpartisan Congressional Budget Office (CBO), more than 4 million people who would otherwise have insurance won’t by 2034 if the subsidies aren’t extended. Per the Kaiser Family Foundation, net premiums after subsidies will increase 114% to $1,904 next year. And for 164 million working-age American’s covered by employer-sponsored insurance, premiums will increase up to 20% (though 24% of these will have no claims this year). Complicated? Frustrating?
The current federal government shutdown is a tipping point for healthcare in the U.S. It’s about more than extended subsidies per Dem’s and holding the line on spending per Republicans. It’s about a growing sense of helplessness among the majority and resentment among many that institutions like the federal government, higher education, big business and healthcare are no longer motivated to serve interests beyond themselves.
And the shutdown brings fresh attention to the PPACA–arguably the regulatory foundation for the U.S. health system and the most contentious legislative package since the Medicare Act in 1965. Its proponents argued coverage was necessary because healthcare is a fundamental right; critics said it cost too much and market forces (competition), not government, was the key to lower costs and better results. The debate divided the country and resulted in Republicans gaining control of the House of Representatives. It was demonized as socialized medicine and bashed for “death panels” but after 50+ failed repeal attempts, it is still the law.
Revisiting the PPACA
The Affordable Care Act produced mixed results The PPACA has been modified in the 15 years since passage. Some parts—like Title V “Workforce Modernization” haven’t been implemented. Some areas—like alternative payment models and comparative effectiveness research—have morphed with mixed results. Some appear to have worked–insurance coverage has increased to 92% of the population but private insurer’ premium increases are increasingly problematic for consumers, employers and government agencies that pay for services. The ACA brought attention to new concepts—value-based purchasing, alternative payment models—but failed to address technology and clinical innovations, the significance of private investment, shifting demand and regulatory paralysis. The result: annual unit cost increases for hospital care, specialty drugs and insurance premiums are hardwired into the system’s finances where consolidation-induced leverage reinforces its spending spiral.
The U.S. healthcare marketplace is fundamentally changed since the ACA passed. The ACA was shortsighted.
What’s next?
The shutdown will end but pressure on the health system will intensify. It’s not working. Affordability is its Achilles—each sector vows concern, then blames others sectors for neglect.
The reality is this:
The public’s fed up. While elected officials opine to their concerns about inflation and prices for groceries, gas and housing, they cower in response to health cost containment policy changes. It’s easier to blame high drug prices, fraud and consolidation but more complicated to address unnecessary demand, administrative overhead, workforce productivity, patient compliance and social determinants. Social media echo chambers exacerbate misinformation about how the system actually operates and stoke public resentment that’s palpable.
The major trade groups in the industry put their members’ interests above what’s best for the entire health system. Understandably, all say they care about the bigger picture but their members expect their leaders to protect their interests first and foremost. Lack of candor on Issues like affordability, scope of practice, workforce productivity, executive compensation, tax exemptions, pricing and others has forced healthcare trade groups into a defensive posture where protecting the status quo is NOT ACCEPTABLE.
PPACA 2.0 will be the result of outside demands, not insider influence. The Patient Protection and Affordable Care Act sparked debate about the system of health (or lack thereof) in the U.S. As health costs escalate and affordability is questioned, the impetus for change will come from employers and consumers who demand something better. They see through the blame and shame games believing healthcare’s corporatization is more about profit than purpose. Where in 2009, the trade groups led deliberation about system transformation, the Patient Protection and Affordable Care Act Version 2.0 will be led by outsiders believing insiders have squandered the opportunity.
This week, we’ll hear about HHS workforce layoffs and continued fallout from Big Beautiful Bill cuts to Medicaid. And we’ll hear about the shutdown and calls for the subsidies to continue.
Some will harken back to the Affordable Care Act in 2010 when coverage was also the issue. We’re there again. But the bigger issue is this: extending subsidies and maintaining coverage will not lower spending or transform U.S. healthcare to an affordable, accessible, appropriately structured system of health.
The moral high ground for healthcare is in jeopardy and its direction unclear. Perhaps PPACA 2.0 is an answer. Doing nothing isn’t.
Paul
PS There are some unusually salient citations in the sections below beginning with Quotables that capture the salience of healthcare at the shutdown debate.
Sections in today’s report
- Quotables on the shutdown
- Quotables on industry
- Economy
- Employers
- Hospitals
- Insurers
- Physicians
- Polling
- Prescription Drugs
- Public Health
Quotables on shutdown
WSJ on shutdown: “Between 2013 and 2019, three government shutdowns were caused by Sen. Ted Cruz’s stand against the Affordable Care Act, Sen. Chuck Schumer’s push on children of immigrants and President Trump’s demand for border wall money.
The 2025 shutdown is about something deeper: a complete breakdown in trust.
Democrats don’t trust that the White House will take any spending agreement and adhere to it. The White House has for months routinely ignored congressional appropriations, keeping government funds from flowing as directed by Congress… Washington’s current dysfunction is a reflection of a broader, nationwide revulsion against America’s political system. Nearly two-thirds of voters believe the nation is too divided to address its problems, a recent New York Times poll found. Nearly 80% in a Quinnipiac University survey agreed with the statement that the nation is in a political crisis…
The crisis of faith in democracy isn’t limited to Congress and the president. Only 27% of Americans this year said they had “a great deal” or “quite a lot” of confidence in the Supreme Court, compared with 40% in 2020, Gallup polling found. Only 17% said they had high levels of confidence in the criminal justice system, about 10 points lower than in 2012 and 2013.
Faith has collapsed in other mechanisms of democracy. Only 11% said they had high confidence in television news, Gallup found this year, tying a record low in surveys that date back more than two decades. Only 17% had high confidence in newspapers, close to a record low.”
Shutdown Lays Bare America’s Latest Crisis: A Total Breakdown in Trust – WSJ
KFF on premium tax credits: “Affordable Care Act (ACA) enhanced premium tax credits are set to expire at the end of this year. Enhanced premium tax credits were introduced in 2021 and later extended through the end of 2025 by the Inflation Reduction Act. The enhanced tax credits both increased the amount of financial assistance already eligible ACA Marketplace enrollees received as well as made middle-income enrollees with income above 400% of federal poverty guidelines newly eligible for premium tax credits.
Since the introduction of the enhanced premium tax credits, enrollment in the Marketplace has more than doubled from about 11 to over 24 million people, the vast majority of whom receive an enhanced premium tax credit. If enhanced tax credits expire, many Marketplace enrollees will continue to qualify for a smaller tax credit, while others will lose eligibility altogether and be hit by a “double whammy” of losing their entire tax credit and being on the hook for rising premiums.
Since 2014, the ACA has capped how much subsidized enrollees pay for their health insurance premiums at a certain percent of their income, on a sliding scale, with the federal government covering the remainder in the form of a tax credit….”
Quotables on industry trends and issues
Jarrard on First Amendment: “Trust in healthcare is fragile. So, what can one leader do to fortify it?
Start here. Trust grows in the exercise of the 1A muscle. Yes, it’s a hard workout. Dialogue is “inefficient.” Disagreement is exhausting. Correcting misinformation feels endless. But trust is built in precisely those uncomfortable moments and your visible leadership in them.
Sometimes you’ll need to offend. Sometimes you’ll need to be disagreeable. Sometimes your organization will be the minority voice — speaking for patients or communities who have no voice at all.
But the First Amendment is the source of good trouble, and the founders knew it. It’s why it must be defended at its extreme, offensive edges. It’s our heavy, virtuous burden.
We are not constitutional scholars, but we well recognize that First Amendment rights live in tension with other vital rights, limitations and duties you carry as caregivers and organizational stewards. Keeping all in proper balance is one of the great charges leaders choose to accept.
But what a great charge it is. “
Healthcare’s First Freedoms – Jarrard Inc
White on ineffective quality measurement in healthcare: “Over the past several decades, an appealing idea rapidly gained popularity: The government could advance a health care system that rewarded the quality of care rather than the volume of care. Medicare began leveraging its economic might to require physicians and hospitals to measure and improve quality….
These well-intentioned efforts to improve quality have failed. Instead, we have seen the emergence of a quality industrial complex—a bureaucratic amalgamation of health care providers, regulators, and the private companies that service the health care sector. This has inflated costs, punished disadvantaged populations and their providers, and driven up physician burnout, all without meaningfully improving patient outcomes. A complex web of interests drives the system to accept more complexity, more burden, and worse results ultimately reducing health care “value…
Quality measures should be refocused toward meaningful health outcomes and patient improvement rather than an excessive box-checking exercise…
These reforms, a departure from the past two decades of top-down, centralized thinking and practice, would build—through appropriate incentives—a virtuous, continuous quality improvement paradigm that is patient-centered, clinically focused, and clinician-engaged. Enormous resistance is expected, as the status quo has long enriched the quality and medical industrial complex. However, the potential benefits to patients and clinicians will serve as a critical counterforce”
Reforming Medicare Quality Measurement | Health Affairs
PharmedOut on drug ads: “Before 1997, direct-to-consumer (DTC) advertising was legal but full safety information was required, so lengthy broadcast ads were not feasible. After FDA changed the regulations so that only a few major risks need be mentioned, as long as a viewer was referred to a site with full information, broadcast ads became ubiquitous. The recent executive order aims to return to the pre-1997 era of full safety disclosure.
However, pharmaceutical ads already contain some risk information; it’s doubtful that additional warnings, especially when happy images are being displayed while risks are being described, will dim the enthusiasm of consumers. And it’s unreasonable to expect accurate health information from advertising. The entire purpose of ads is to increase demand for a product and — cost aside — pharmaceutical ads are brilliant examples of creativity in advertising.
So, curbing DTC drug advertising is unlikely to achieve the goal of curbing excessive prescriptions or rising drug spending. Instead, regulatory actions should focus on banning disease awareness campaigns aimed at consumers.”
Will Cracking Down on Drug Ads Help Patients? | MedPage Today
Steven Lipstein, M.H.A., retired CEO, BJC, St. Louis on executive compensation in healthcare: “In a public company proxy statement, there is a section that describes how executive compensation is determined, including the performance measures used in calculating it. Private health care systems can embrace the same level of transparency and welcome an opportunity to showcase their corporate motivation, values, and aspirations.”
Shackelford on Gen Z and social change: “Around the world, Gen Z is leading a wave of anti-government protests. It is the most significant spike in global dissent since the Arab Spring 15 years ago, with a geographic reach already to four continents. Though the proximate cause of protests in each country differs, all are driven by young people who are angry at rising government corruption, poor government services and mismanaged economies that leave them with bleak futures…
The grievances driving these movements are real. Each of these countries faces significant government corruption and high youth unemployment. Young people want better governance and are fed up with suffering from poor services and economies while their leaders get rich around them and inequality grows…
These movements also share methods, particularly the role of social media, which has fueled and facilitated them all…
The protests are all loosely coordinated, happening almost organically online rather than organized and promoted by traditional activist groups or political institutions. Social media platforms not only make it possible to instantaneously connect and alert people across cities, nations and the world, but they also provide a level of anonymity and fluidity that has made it harder for governments to interrupt or crush them.
The milestones some of these movements have already accomplished is inspiring: toppling bad governments, securing policy changes, and forcing dialogue and inclusion. “
Elizabeth Shackelford is a program director with the Institute for Global Affairs and a foreign affairs columnist for the Chicago Tribune. She also is a distinguished lecturer with the Dickey Center at Dartmouth College. She was previously a U.S. diplomat and is the author of “The Dissent Channel: American Diplomacy in a Dishonest Age.”
Column: Gen Z-led protests catch fire across the globe
Barnes on Tech collaboration: “This is normal, right? People go through this in the first year of marriage?” Kyle Marvin’s character asks Dakota Johnson’s character in the movie Splitsville. She shakes her head and admits: “No.” And, no – people do not typically go through a government shutdown during the first year of a new administration. It is also disorienting to have an administration tout its “partnership with innovative private sector companies” as it did in July when Big Tech companies gathered during the Make Health Tech Great Again event, but, only two months later, hear the administration say that Big Tech, major health systems, and government officials coming together to establish guardrails for health AI tools is the wrong way to do things.”
Only What Matters on Health Information Policy
Economy
Consumer prices: “Coffee drinkers exemplify a paradox at the heart of the U.S. economy. Consumers feel pessimistic, worried about the job market and inflation. Though they may trade down in some ways—including by making coffee at home—they continue to spend more overall, keeping the economy chugging.
Americans spent $12.7 billion on packaged coffee in the past year, up from $12 billion a year earlier, according to NielsenIQ.”
BLS: Price Changes LTM: Groceries +2.7%, Gas -6.6%, Coffee +21.7%
Hell Hath No Fury Like a Coffee Drinker in 2025 – WSJ
Case Study: Tennessee:
- Tennessee is the 15th largest state by population and employment and 17th largest economy by GDP: from 2025-2024: Population growth 636,000 (+9.7%), Job Growth: 840,500 (+22.4%), GDP growth $223.8 Billion (+68.4%)
- “Costs of essentials—housing, transportation, child care, and food—are increasing faster than wages”. Changes since 2020: wages: +20.6%, child care: +21.4%, vehicle ownership & operation: +28.6%, median home price: +67.6%
- “Manufacturing, health care, government, and retail trade are the state’s largest industries in both GDP and employment. While the biggest source of jobs in our state, these industries are not growing the fastest or providing the highest wages.” Average wage: $64,718 (+17.5%)
Employers
7Wire Ventures: Employers shift to activism: “Employer-sponsored healthcare has long been the backbone of the U.S. system, covering more than 160 million Americans and representing over $1.4 trillion in annual spending. But today, that foundation is under strain. Costs are rising at the fastest pace in more than a decade, employees are often confused or disengaged with their benefits, and many digital health solutions are still nascent in their development and have yet to deliver concrete ROI. Employers are realizing that simply paying premiums is no longer enough. To meet the needs of their workforce and control costs, they must either step into a more active role as architects of health and wellbeing or make plans to exit benefit design.
This inflection point is underscored by the numbers. Over the past decade, employer health benefit costs have risen sharply. In 2024, the average per-employee cost for employer-sponsored health insurance reached $16,501, reflecting about 5 percent growth from the prior year. Looking ahead, costs are expected to continue rising, with projections of a 6.5 percent increase in 2026 even after accounting for cost-management strategies. At the same time, only about a quarter of employees actually use the benefits available to them, and just 10 percent engage with digital health solutions. For employers, this means billions of dollars are being invested without corresponding returns in health outcomes or cost reduction. The pressure is mounting to find new models that bend the cost curve, improve engagement, and deliver measurable value.
In response, employers are beginning to lean on three strategic levers that promise greater control and accountability:
- Alternative plan designs including self-funding and defined-contribution models like ICHRAs, which are seeing adoption grow by more than 30 percent among larger employers.
- Value-based care, where 83% of employers now cite care navigation as the key to improving quality, and where direct contracting with Centers of Excellence and bundled payments are gaining traction.
- Pharmacy value management, with nearly 80% of employers conducting regular contract reviews and turning to transparent PBM models to combat the mounting costs of specialty drugs, particularly GLP-1s.
Together, these approaches are redefining the employer’s role from a passive payer to an active shaper of health outcomes and value.”
Redefining the Benefits Equation: Innovation in Employer Healthcare – 7wire Ventures
Employer Costs: Health Conditions Driving Employer Health Care Costs, 2025
- Cancer: 88%
- Musculoskeletal: 71%
- Cardiovascular: 35%
- Diabetes: 21%
- Mental health: 18%
- Obesity: 15%
- Maternity: 15%
- Autoimmune: 11%
- Gastroenterology/digestive issues: 7%
- Neurology: 5%
- High-risk maternity: 5%
- HIV/AIDS: 1%
- Other: 5%
Business Group on Health, 2026 Employer Health Care Strategy Survey: Executive Summary, August 2025
Hospitals
AEI on tax exempt hospitals: “On September 16, 2025, the Subcommittee on Oversight of the House Ways and Means Committee held a hearing on the purpose and use of the tax-exempt status widespread in the hospital sector. Several Representatives and panel witnesses expressed concern that tax-exempt hospitals were abusing their significant financial privileges by engaging in excessive advertising, awarding high executive salaries, placing inappropriate emphasis on diversity activities and personnel choices, providing gender-changing treatment to children, and pursuing competition-killing mergers and vertical consolidations. They also cited the omission of sufficient charity care and the failure to provide low-compensated services to poor populations, for example through Medicaid shortfalls…. As long are there are poor populations that remain uninsured and Medicaid continues to pay significantly less than Medicare and commercial insurance, it is reasonable to expect tax-exempt hospitals to expend significant resources in these areas, approaching the value of their tax exemption…”
How Hospitals Should Merit Their Tax-Exempt Status | American Enterprise Institute – AEI
Axios on shutdown impact on hospitals: “Hospitals in rural and underserved areas could lose out on billions of dollars in federal funding if the government shutdown drags on…
Safety-net hospitals face an $8 billion cut to Medicaid add-on payments in the absence of a government funding package. The cuts to so-called disproportionate share hospital payments originate from the Affordable Care Act. Congress has postponed the pay reductions more than a dozen times, but the most recent delay expired on Tuesday and Congress hasn’t signaled if or when it will step in.
The add-on payments are made quarterly, so hospitals may not feel immediate effects, even if Congress doesn’t further delay the cuts, according to the American Hospital Association. But state Medicaid agencies could let the cuts take place if they think lawmakers’ standoff will continue indeterminately, per AHA.
Additionally, two long-running programs that give pay bumps to rural hospitals expired on Wednesday. One program adjusts Medicare payment upward for rural hospitals that discharge relatively few patients. The other gives increased reimbursement rates to rural hospitals that have at least 60% of patients on Medicare. Hospital industry groups have also been urging Congress to extend enhanced Affordable Care Act tax credits, which have become a flashpoint in the shutdown fight. Democrat lawmakers have so far refused to pass GOP-led funding proposals that don’t include a full extension of the subsidies.”
Government shutdown puts hospital funding in peril
Insurers
WSJ on insurance market: “Some 40% of those in fully subsidized plans had zero claims in 2024.” But the presence of enrollees with few or no medical claims is the sign of a healthy market. It is common in all insurance markets to find young adults who use less healthcare and therefore file fewer claims.
The enhanced ObamaCare subsidies have helped increase enrollment among those under 35, strengthening the risk pool and reducing costs. Roughly 25% of those enrolled in a Blue Cross and Blue Shield commercial plan don’t file any claims in a given year…”
The Case for Extending ObamaCare Subsidies – WSJ
Study: Medicare Shared Savings program participation: In this cross-sectional study representing 179,221,355 beneficiary-years, 56.7% of those eligible for the MSPs from 2018 to 2020 were enrolled; take-up varied across states and was higher among Medicare Advantage beneficiaries compared with traditional Medicare enrollees. Enrolled individuals had worse health, lower income, and fewer assets than individuals eligible for the MSPs who did not enroll
“This cross-sectional study of Medicare beneficiaries suggests that MSP take-up remains incomplete and varied across states despite policy efforts. A policy to encourage participation in the MSPs among eligible populations that target less socially and financially vulnerable—although still with low income and eligible for the MSPs—individuals may be more likely to be associated with gains in the MSP take-up.”
On insurer vertical integration: “In the large-group commercial market, the three largest insurers—Kaiser Permanente, UnitedHealthcare, and Elevance—held a combined 39% of the national market share in 2023. In the Medicare Advantage market, the top five plans—UnitedHealthcare, Humana, CVS Health/Aetna, Elevance, and Centene—accounted for 68% of total enrollment in 2023. All of these insurers operate within larger parent companies that own or control a range of health care provider entities….
As states pursue policies to slow cost growth, they must apply greater scrutiny of vertical integration arrangements—especially around internal financial transactions between affiliated entities…
Policy makers should also reassess whether, given these market dynamics, current regulatory tools such as the MLR are adequate. Addressing these issues will be essential for maintaining the integrity of cost containment efforts and ensuring that health care dollars are spent on delivering meaningful care.”
How Insurers That Own Providers Can Game the Medical Loss Ratio Rules | Health Affairs
Polling
KFF: Tax credits: More than three-quarters (78%) of the public say they want Congress to extend the enhanced tax credits available to people with low and moderate incomes to make the health coverage purchased through the Affordable Care Act’s Marketplace more affordable, a new KFF Health Tracking Poll finds. That’s more than three times the share (22%) who say they want Congress to let the tax credits expire.
Most Republicans (59%) and “Make American Great Again” supporters (57%) favor extending the enhanced tax credits, which otherwise would expire at the end of the year and require Marketplace customers to pay much more in premiums to retain coverage. Larger majorities of Democrats (92%) and independents (82%) also support extending the enhanced tax credits, as do most people who buy their own health insurance, most of whom purchase through the Marketplace (84%).
KPMG Private Company Director survey 2025: highlights:
- Top Challenges: difficulty in accessing market trends, customer expectations and competitors (49%) and scenario planning and risk analysis (48%).
- Boards can improve the strategic planning process by challenging management assumptions (50%) and providing fresh perspectives (48%).
- The majority of directors think their organization’s scenario planning process is inadequate.
- The majority think AI and technology will change their organization’s strategy significantly.
2025 Private Company Board Survey Insights
CNN: Business confidence: Gallup measured views on 25 industries in August: “For each of the following business sectors in the United States, please say whether your overall view of it is very positive, somewhat positive, neutral, somewhat negative or very negative.
| Industry | % Very/Somewhat
Positive |
%Very/Somewhat
Negative |
| Farming and agriculture | 60 | 16 |
| Healthcare Industry | 36 | 51 |
| Pharmaceutical Industry | 28 | 58 |
| Federal Government | 23 | 61 |
Latest Ratings of U.S. Industries
Gallup: Trust in media: Share of Americans who say they have a great deal or a fair amount of trust in mass media, by party based on survey of 1,000+ U.S. adults 1997 to 2025:
- 28% of Americans say they have a great deal or a fair amount of trust in the mass media, down from 68% in 1972: lowest point ever this year for Republicans (8%), Democrats (51%) and Independents (27%).
- The percentage of U.S. adults 18-29 and 30-49 that say they have a great deal or fair amount of trust in U.S. media has fallen to historic lows of less than 30% for both groups, while those ages 65+ report much higher levels of trust (43%)
Media trust hits new low across the political spectrum
E Health poll: Medicare beneficiaries’ understanding of MA: Highlights of an eHealth survey of beneficiaries:
- 75% of beneficiaries say choosing a plan is confusing.
- 51% plan to review their options this year, down from 63% in 2024.
- 36% of Medicare Advantage and Part D enrollees are unaware of significant cost and benefit shifts expected in 2026, while one-third say they do not fully understand the differences between Medicare Advantage, Medicare Supplement, and Part D plans.
- 33% incorrectly believe Medicare covers glucagon-like peptide-1 (GLP-1) drugs for weight loss and 29% are unaware that recommended vaccines are covered at no cost.
Note: In 2026, Medicare Advantage enrollment is projected to be 34 million–a decrease from 34.9 million in 2025, with MA enrollment representing approximately 48% of all people enrolled in Medicare, compared to 50% in 2025 per CMS.
Survey: 75% of Medicare beneficiaries say selecting a plan is confusing. eHealth. News release. October 1, 2025. Accessed October 1, 2025. https://www.prnewswire.com/news-releases/survey-75-of-medicare-beneficiaries-say-selecting-a-plan-is-confusing-302572267.html
Coombs B. Medicare Advantage enrollment expected to fall in 2026 as insurers cut back on unprofitable plans. CNN. September 29, 2025. Accessed October 1, 2025. https://www.cnbc.com/2025/09/29/cms-sees-medicare-advantage-enrollment-falling-in-2026-.html
CNN: Opinions of political independents: Surveys were obtained August 21 to September 1, 2025, with a representative sample of n=2,077 respondents, n=1,448 from the SSRS Opinion Panel and n=629 from RBS (509 from fresh sample and 120 recontacted among those RBS completed in April 2025). The sample design resulted in 1,006 political independents, including those who consider themselves politically independent, lean toward a party or do not affiliate with either major party.
- What one issue do you feel is the most important issue facing the country today? Economy, jobs, cost of living 37%
- How important are each of the following issues to you personally? Extremely/Very Important: The economy (92%/#1), Healthcare (86%/#2)
cnn-poll-of-political-independents.pdf
Prescription drugs
FDA approval: Last week, the Food and Drug Administration approved a new generic version of the abortion drug mifepristone manufactured by Evita Solutions.
FDA OKs New Generic Abortion Pill, Drawing Conservative Ire
WSJ on Pfizer deal: “What was revealed that day in the Oval Office, as Bourla stood near Trump, Kennedy and others while giving each other smiling glances, was a win for both parties. Trump got to announce a deal cutting drug prices and a start on a new direct-to-consumer platform dubbed TrumpRx. And Pfizer avoided tariffs with a strategy that would be a minimal hit to its bottom line… The deal has lifted beleaguered drug stocks by pointing a way for companies to remove the threat of tariffs and deal with U.S. pricing pressures…
The deal might not put the industry completely in the clear. But for now, the price cuts don’t apply to patients with Medicare and commercial insurance, which makes up most of Pfizer’s U.S. business. Medicaid is less than 5% of Pfizer’s U.S. revenue, said Leerink Partners analyst David Risinger. And the most-favored-nation prices that will be applied to Medicaid might not be much lower than discounts Pfizer and other drugmakers already provide to Medicaid.”
Exclusive | Inside Pfizer’s Drug-Pricing Deal with the Trump White House – WSJ
46Brooklyn on 2Q 2025 drug price changes: There were a net of 56 brand list price changes in April (60 increases offset by 4 decreases), 24 in May (26 increases; 2 decreases), 21 in June (23 increases; 2 decreases), and 159 in July (162 increases; 2 decreases). With so many price changes, you would probably not be surprised to learn that the degree of list price changes were all over the map…if you happen to need that medication outside of government programs like Medicaid and 340B, expect to pay for it to cross-subsidize the losses the manufacturer incurs on the drug for those programs…”
A quarterly-ish review of U.S. drug price changes — 46brooklyn Research
Public Health
Study: Impact of Medicaid work requirements: Researchers examined health insurance coverage and employment changed among working age adults with low incomes in Georgia, the first state to implement Medicaid expansion with work requirements under the Pathways to Coverage program. Findings:
“After the implementation of Pathways to Coverage, Medicaid coverage did not change in Georgia (35.5% to 32.4%) or in neighboring control states (39.6% to 39.3%), resulting in no differential change in Medicaid coverage between these states. These patterns were similar for the uninsured rate (−2.3 percentage points, −6.9 to 2.3). Additionally, employment did not increase in Georgia compared with control states (−1.6 percentage points, −8.7 to 5.4). In a secondary analysis that aimed to isolate the effects of work requirements, Medicaid coverage did not change in Georgia (35.5% to 32.4%) but increased in South Dakota (36.6% to 44.6%)—a state that expanded Medicaid without work requirements—resulting in a differential decrease in coverage in Georgia relative to South Dakota (−11.7 percentage points, −19.5 to −3.9). There was no differential change in employment (−0.1 percentage points, −9.8 to 9.6) between these states.
The implementation of work requirements with Medicaid expansion in Georgia did not increase health insurance coverage or employment during the first 15 months of the program. These findings have important implications as US policy makers recently enacted legislation that will mandate work requirements in Medicaid programs across all US states beginning in 2026.”
STAT on autism research: “Last week, the National Institutes of Health made a $50 million bet: Understanding environmental factors, agency officials believe, will help researchers better understand why some people have autism.
The agency is doling that pot of money out to researchers behind 13 proposals, most of them aimed at understanding the condition’s etiology, or cause…
The NIH’s Autism Data Science Initiative is part of a larger government effort to tackle what federal officials see as an “epidemic” of rising autism rates in the United States, including a highly controversial decision to recommend acetaminophen be avoided during pregnancy because of research, still inconclusive, showing possible links to autism. Many autism researchers are enthusiastic about the science being funded by the NIH — but not thrilled about the acetaminophen warning…
Health secretary Robert F. Kennedy Jr. has long insisted that there is a single cause of autism and that a specific environmental exposure is responsible for it — a view that has received significant pushback from autistic people and that is at odds with the beliefs of most autism researchers…
Understanding the environment’s role in determining a person’s health — a field called exposomics — is the final piece of a puzzle that’s been decades in the making, says Kristen Lyall, associate professor at the A.J. Drexel Autism Institute who was awarded a grant.”
NIH autism research project launches under cloud of Tylenol episode
