In 1970 before there was ESPN Sports Center, there was ABC’s “Wide World of Sports” and its iconic montage opening featuring a disastrous ski jump attempt by Yugoslavia’s Vinko Bogataj and Jim Kay’s voice-over “the thrill of victory and agony of defeat.” It’s an apt framework for consideration of current affairs in the U.S. today and an appropriate juxtaposition for consideration the winners and losers in the White House Office of Management and Budget FY2027 released Friday.
- Last week’s “Thrill of Victory” includes the recovery of Dude 14, the F-15E Strike Eagle pilot shot down over Iran Friday, the college basketball men’s and women’s’ Final 4 contests, the successful launch of Artemis II by NASA and, for some, the additional funding ($441 billion/+44% vs. FY 2026) for the Department of War in the President’s proposed budget.
- And last week’s “Agony of Defeat” includes continued anxiety about the economy, especially fuel prices, growing concern the war in Iran begun February 28 might extend at a heavy cost in lives and money, and for health industry supporters, a $15 billion (-12% vs. FY 2026) cut to HHS and the 10-year, $911 billion Medicaid reduction in federal funding for Medicaid enacted in 2025 (HR1 The Big Beautiful Bill).
In its current form, this budget is unlikely to be enacted October 1, 2026: it’s best viewed as a signal from the White House about priorities it deems most important to the MAGA faithful in Congress, 28 state legislatures and 26 Governors’ offices controlled by Republicans. Though its explosive growth in of War Department funding to $1.5 trillion is eye-popping, cuts to healthcare are equally notable. Both are calculated bets as the mid-term election draws near (6 months) and clearly OMB is betting healthcare cuts will be acceptable to its base. Its view is based on three assumptions:
1- Healthcare cost cutting is necessary to fund other priorities important to its base. And there’s plenty of room for cuts in Medicaid, prescription drugs and hospitals because waste, fraud and abuse are rampant in all.
- Medicaid: Medicaid is a state-controlled insurance program that covers 76 million U.S. women, children and low-income seniors primarily through private managed care plans that contract with states. In HR1, a mandatory work requirement was applied to able-bodied adult enrollees with the expectation enrollment will drop and state spending for Medicaid services will be less. But its enrollees are less inclined to vote than seniors in Medicare and its funding burden can be shifted to states.
- Prescription Drugs: The White House asserts its “favored nation” pricing program will bring down drug costs but the combination of voluntary participation by drug companies and impenetrable patent protections in U.S. law neutralize hoped-for cost reductions. The administration wants to lower drug spending using its blunt instruments it already has: accelerated approvals, price transparency, pharmacy benefits manager restrictions et al. while encouraging states to go further through price controls, restrictive formularies and, in some, importation. In tandem, the administration sees CMMI modifications of alternative payment models (i.e. LEAD) as a means of introducing medication management and patient adherence in new chronic care pilots. Recognizing prescription drug prices are a concern to its base and all voters, the administration will use its arsenal of regulatory and political tools to amp-up support for increased state and federal pricing constraints without imposing price controls—a red line for conservatives.
- Hospitals: Hospital consolidation is associated with higher prices and increased spending with offsetting community benefits debatable. Hospitals represent 43% of total U.S. health spending (31% inpatient and outpatient services, 12% employed physician services). In 4 of 5 U.S. markets, 2 hospital systems control hospital services. And hospital cost increases have kept pace with others in healthcare (+8.9% in 2024 vs. +8.1% for physician services and 7.9% for prescription drugs) but other household costs, wage increases and inflation. Lobbyists for hospitals have historically favored hospital-friendly legislation like the Affordable Care Act preferred by Democrats. The Trump administration sees site neutral payments, 340B reductions, expanded price transparency, limits on NFP system tax exemptions et al. and Medicaid cuts necessary curtailment of wasteful spending by hospitals. They believe voters agree.
Backdrop: Per the National Health Care Fraud Association, 10% of health spending ($560 billion) was spent fraudulently in 2024: the majority in the areas above.
2- The public is dissatisfied by the status quo and supports overhaul of the U.S. healthcare system to increase its affordability and improve its accessibility.
- Consolidation: Through its Federal Trade Commission and Department of Justice, the White House has served notice it believes healthcare affordability and unreasonable costs are the result of hyper consolidation among hospitals, insurers, and key suppliers in the healthcare supply chain. It has appointed special commissions, task forces, and filed lawsuits to flex its muscle believing the industry has pursued vertical and horizontal consolidation for the purpose of reducing competition and creating monopolies. It shares this view with the majority of voters.
- Corporatization: In tandem with consolidation, the White House asserts that Big Pharma, Big Insurer, and Big Hospital have taken advantage of the healthcare economy at the expense of local operators and mom and pop services. It presumes they’re run as corporate strongarms that access capital and leverage aggressive M&A muscle to drive out competitors and bolster their margins and executive bonuses. The administration treads lightly on corporate healthcare, seeking financial and political support while voicing populist concerns about Corporate Healthcare. Photo ops with CEOs is valued by the White House; corporatization is recognized as a necessary plus with a few exceptions. By contrast, most voters see more harm than good. Thus, the administration courts corporate healthcare purposely and carefully.
Backdrop: Intellectually, the majority of voters understand healthcare is a business that requires capital to operate and margins to be sustainable. But many think most healthcare organizations put too much emphasis on short-term profit and inadequate attention on their mission and long-term performance.
3-The U.S. healthcare industry will be an engine for economic growth domestically and globally if regulated less and consumers play a more direct role.
- The administration is resetting its trade policies in response to suspension of at-will tariff policies that dominated its first year. At home, it seeks improved market access for U.S. producers of healthcare goods and services. It will associate this effort with US GDP growth and expanded privatization in healthcare. And it will assert that expansion of global demand for U.S. healthcare products and services is the result of the administration’s monetary policy geared to innovation and growth. And it will play a more direct role in oversight of foreign-owned/controlled health products and services and impose limits of their use of U.S. data.
- The administration also seeks to protect intellectual property owned by U.S. inventors and companies by increasing its policing at home and abroad. In this regard, the administration will play a more direct role in the application of AI-enabled solution providers and expedite technology-enabled interoperability.
Backdrop: U.S. healthcare is the world’s most expensive system, so protections against IP theft are important, but the administration’s legacy in healthcare will be technology-enabled platforms that enable scale, democratize science and shift the system’s decision-making (and financial risk) consumer self-care.
Final thought:
The U.S. healthcare system does not enjoy the confidence of the White House: its proposed FY27 budget illustrates its predisposition to say no to healthcare and yes to other pursuits. It bases its position on three assumptions geared to support from its conservative base.
This budget proposal clearly illustrates why state legislators and Governors will play a bigger role in its future at home and abroad. And it means consumer (voter) awareness and understanding on key issues will be key to the system’s future, lest it is remembered for the agony of its defeat than the thrill of its victory.
Paul
Sections in Today’s Report
- Quotables
- Economy
- Hospitals
- Insurers
- Physicians
- Polling
- Population Health
- Prescription Drugs
Quotables
Vought (OMB) on FY27 Budget: “In just one year, the Trump Administration has made historic progress on righting our fiscal ship—the speed and scope of which have not been seen in Washington for many years. The President drove enactment of the Working Families Tax Cut Act—once-in-a-generation legislation to bring our fiscal house in order, invest in critical priorities, and cut taxes for working Americans. This bill bent the cost curve for Federal spending, achieving nearly $2 trillion in savings while securing historic investments in our Nation’s defense, securing the border, and enforcing our immigration laws. It put the Medicaid program on a more sustainable path, reined in student loan borrowing and forgiveness, returned accountability to the Supplemental Nutrition Assistance Program, and ended the Green New Scam.”
Budget of the U.S. Government FY 26 https://www.whitehouse.gov/wp-content/uploads/2026/04/budget_fy2027.pdf
Andrews (Trilliant) on price transparency: “Even if every U.S. hospital complied fully and accurately with CMS regulations, hospital price transparency would still be largely useless for consumers. Annual hospital admissions represented only 11% of all healthcare encounters in the U.S. in 2024, and ~50% of all hospital admissions originate in the emergency department. An emergency department visit is certainly what von Mises would define as “an occasional act of barter in which men who ordinarily do not resort to trading with other people exchange goods ordinarily not negotiated,” the situation for which the No Surprises Act was expressly designed (though based on wildly inaccurate data). But whether an emergent patient can be billed out-of-network charges is completely different from whether that patient will check a price transparency application while strapped to a stretcher in the back of an ambulance.”
Reflections on Federally Mandated Healthcare Price Transparency
MedPage: Depiction of orthopedists in the Pitt: “Clinicians are buzzing about “The Pitt’s” recent portrayal of an orthopedic surgeon and how the specialty is perceived.
In season 2, episode 10, Dr. Brendon Park — referred to as “Park the Shark” by his ER colleagues — bursts into a trauma room, circling his prey with his curt, confident, and aggressive personality.
The tall and muscular Park — played by Lou Ferrigno Jr., whose father played “The Hulk” in the 1970s — examined an x-ray and announced his plans to reattach a patient’s severed limb while hushed colleagues looked on, seemingly stunned or intimidated by his demeanor.
He snapped at his colleagues that he wasn’t blind when they briefed him on the situation unfolding in the ER, and sarcastically called one of them “genius.”
PK Note: I have watched every episode of Seasons 1 and 2: it’s far and away the most realistic depiction of hospital emergency services ever produced for TV. Arguments between clinicians who differ on a patient’s diagnosis, uninvited interventions with hospital business office staff seeking information about a patient’s insurance and resources, anxious medical residents sometimes dressed down by attending clinicians, a recovering addict physician seeking redemption but sometimes facing rejection instead. If ‘Marcus Welby MD’ showed us m-deity, the Pitt shows us “Real Medicine” at least in the context of emergency rooms services in a safety net hospital in Pittsburgh. That why the show’s producers don’t use background music to set the mood of the moment: it’s the action on the screen is quite enough.
‘Ortho Bro’ on ‘The Pitt’: ‘Most of Us Are Not Like This Guy’ | MedPage Today
KFF on healthcare in Campaign 2026: Key Takeaways
- Historically, health care has often been among the most important issues to voters: In most presidential and midterm election year polling since 1992, health care ranked among voters’ top concerns, with “the economy” taking the top spot in most elections… In almost all recent elections, Democratic voters have consistently been more likely than Republican voters to say that health care is a top electoral issue.
- Partisan advantages on health care and the economy: Historically, Democrats have held an advantage over Republicans on who voters trust to handle health care issues, while Republicans have usually been seen as stronger on the economy…
- Implications for the 2026 Midterms: …As of March 2026, Democrats maintain an advantage over Republicans in voter trust to address the cost of health care and prescription drugs, and majorities say health care costs are important to their vote. Who voters will ultimately trust to handle the affordability of health care, and whether the issue will be enough to translate into turnout and votes,
A Preview of the Role Health Care May Play in the 2026 Election | KFF
NYT on AI adoption: “Technological advancement alone will not reshape the economy. For that to happen, companies need to adopt the tools and figure out how to use them productively.
History shows that the process almost always takes longer than the inventors expect. Legal and regulatory hurdles slow things down. Companies have to retrain workers or hire new ones. Corporate leaders have to develop new processes and overcome resistance from reluctant managers and cautious information technology departments.
Many hospitals kept patients’ health records on paper for decades after the technology existed to digitize them…
There are signs that A.I. could flow through the economy more quickly than past innovations. Already, nearly one in five companies’ reports having used A.I. in the last two weeks, according to data from the Census Bureau, and in some industries the rate is twice as high. Worker’s report using A.I. at even higher rates, suggesting many may be experimenting with the tools on their own initiative.
And while A.I. has not yet had a big impact on aggregate statistics, some economists argue its effects are visible beneath the surface. In a paper published last year, researchers at Stanford University found that employment was declining for entry-level workers in jobs that were highly exposed to A.I.”
Economists Are Drawing Stronger Connections Between A.I. and Jobs – The New York Times
Beckers: FTC action on consolidation: “The Federal Trade Commission is ramping up scrutiny of healthcare markets, and physicians are likely to feel the effects. FTC Chair Andrew Ferguson directed multiple agencies to establish the task force, coordinating efforts across the Bureau of Competition, Bureau of Consumer Protection, Bureau of Economics, the Office of Policy Planning and the Office of Technology, according to a March 20 memo. It will reach beyond the FTC. The task force will collaborate with other federal agencies and law enforcement partners, including HHS and the Department of Justice, broadening the scope of oversight across healthcare, the FTC said.
The FTC sees consolidation as a direct threat to patients and physicians. Mr. Ferguson cited consolidation and anticompetitive practices as key drivers of higher prices, reduced care quality and stifled innovation. Healthcare accounts for roughly 18% of the U.S. economy, yet many patients continue to face high costs and limited access, which the FTC attributes largely to concentrated markets, per the March 20 memo.”
Economy
State Health Cost containment efforts: To help limit health care costs, eight states—California, Connecticut, Delaware, Massachusetts, New Jersey, Oregon, Rhode Island, and Washington—have implemented health care cost-growth benchmarks…several other states have signaled interest in enacting cost-growth benchmark legislation.
In February 2026, the state district court agreed with California that CA Hosp Assoc (CHA) did not have standing to sue over the new cost-growth benchmarks.
CMMI announces new alternative payment model: The LEAD model is CMMI’s “the next big step” in value-based care by increasing participation among hesitant providers. Per CMMI:
- LEAD is designed to address such barriers to support both established and newly created ACOs by providing them enhanced, flexible cash flow payments; and greater freedom and tools to support spending time with and meeting patient needs, including those with specialized care needs.
- Outcomes: Through ACOs, health care providers will be empowered to deliver coordinated, accountable care and preventive services — keeping patients healthier and helping to reduce health care costs and unnecessary emergency room visits and hospitalizations.
- Strategy: LEAD advances the Innovation Center’s commitment to 1) building opportunities for independent health care providers and practices to be rewarded for delivering better care, 2) promoting and empowering patient choice in both coverage and sites of care, and 3) making it easier for health care providers and patients to engage in preventive care that supports healthier living
LEAD (Long-term Enhanced ACO Design) Model | CMS
GAO on CMMI effectiveness: “The Center for Medicare and Medicaid Innovation (Innovation Center) was established within the Centers for Medicare & Medicaid Services (CMS) to test new approaches to health care delivery and payment—known as models—for use in Medicare or Medicaid. From 2011 through 2024, the Innovation Center obligated $11.4 billion for its activities. These included the testing of 70 models—24 of which were actively being tested as of January 2025. Total annual obligations peaked at $1.3 billion in fiscal year 2015 and have since decreased by nearly 40 percent to $789 million in fiscal year 2024. According to officials, these trends reflect the number of models the Innovation Center tests, among other factors…
Though initially projected to produce net savings, in September 2023, the Congressional Budget Office (CBO) determined that the Innovation Center had increased federal spending by $5.4 billion from fiscal years 2011 through 2020. Specifically, CBO estimated that the Innovation Center spent $7.9 billion to operate models and those models reduced federal health care spending by $2.6 billion during this period. CBO noted its initial projection involved considerable uncertainty because of the lack of available data. After further reviewing the Innovation Center’s model activities, CBO subsequently projected that the Innovation Center would increase federal spending by $1.3 billion from fiscal years 2021 through 2030.”
Note: While it was projected to produce net savings, CMMI increased federal spending by $5.4 billion from fiscal 2011 through 2020, per the GAO report. The CBO estimated CMMI spent nearly $8 billion over a decade testing health delivery and payment changes that only yielded $2.6 billion in savings.
CMS INNOVATION CENTER: Obligations and Model Testing Progress https://files.gao.gov/reports/GAO-26-107953
PK Note: The concept of CMMI in the Affordable Care Act (Section 3021) is solid: to test innovations that improve the health system’s performance. Given the Trump administration’s predisposition to cut healthcare funding in its FY27 budget proposal, it’s incumbent that CMMI assess its own effectiveness and perhaps chart a new course. Perhaps it should require mandatory provider participation. Perhaps, pilots focused on Medicaid and commercial populations. Perhaps required sharing of savings with individual patients (especially since their collaboration is key to savings). Perhaps bigger upside and downside risk models. Clearly, alternative payment models have stimulated discussions about risk sharing arrangements, but the data show net savings to Medicare have been negligible and the biggest winners have been the consultants, IT solution providers and professional/trade affiliates—not the actual providers and their patients.
Fraud in U.S. system: “Across insurance types, up to 10% of the $5 trillion in healthcare spending is fraudulent, according to the nonprofit National Health Care Anti-Fraud Association…
The largest and most common health insurance schemes committed against employers involve applied behavior analysis treatment for autism, substance abuse treatment, durable medical equipment, laboratory testing and telemedicine, said National Health Care Anti-Fraud Association CEO Louis Saccoccio. The big scams are frequently the same across Medicare, Medicaid and commercial coverage…”
National Health Care Anti-Fraud Association www.nhcaa.org
CMS: LEAD model details released: On March 31st, 2026, CMS released details on a new model called LEAD — the Long-term Enhanced ACO Design. It’s positioned as a replacement for ACO REACH. However, LEAD is not just an evolution of ACO REACH. It’s a fundamentally different proposition: a ten-year model with a fixed benchmark that never rebases, an integrated approach to high-needs populations, a ramp designed to bring in organizations that have never participated in value-based care, and a plan to eventually replace traditional risk adjustment with artificial intelligence.
What To Know About CMS’ 10-Year Bet on Accountable Care with LEAD | VBC ExhibitHall Library
Cedar study: Patient financial experiences: Per the Cedar survey of 4,150 U.S. patients. and analysis of 1.5 billion claims:
- 40% of healthcare collections now come from uninsured patients, up 54% in the past three years.
- Patients who typically pay bills within six months earn above $75,000 and tend to live in urban areas. Patients who typically delay paying bills for six months or more earn less than $75,000, living in both urban and rural areas.
- The 65% increase in high-deductible health plan enrollment over the last decade is a contributing factor.
Note: The report notes 20 million individuals are experiencing premium hikes following the enhanced Affordable Care Act subsidies expiration while 10 million others are expected to lose Medicaid coverage through work requirements established under H.R. 1.
2026 Trends In Patient Payments: Healthcare Financial Experience Study https://www.cedar.com/whitepaper/trends-in-healthcare-payments-report-2026?utm_source=pressrelease&utm_medium=pr&utm_campaign=hfes2026
Dayforce on household financial wellbeing: “Even as more Americans save less and borrow more from their retirement funds, Gen Z shines as the only generation to have bucked that trend over the past three years, according to Dayforce’s second annual State of Retirement Savings report.
The total savings rate for full-time workers — including those who save for retirement and those who don’t — declined to 8.9% in 2025 from 9.2% the prior year and the first annual decrease in three years…
In contrast, Gen Z’s savings rate has risen every year since 2022, most recently jumping to 6.2% in 2025 from 5.9% in 2024.
More than a quarter (26%) of Americans who save for retirement reduced their annual contributions last year… After two straight years of gains, total contributions from both the employer and the employee dropped by 5% last year to $5,554 from $5,860 in 2024. But every age group’s total contributions remain above 2023 levels, the report showed.
More Americans are also dipping into retirement savings to prop up their spending, the report showed. Loans from retirement accounts rose for the third consecutive year and are now 22% higher than in 2022. Last year, 18.6% of Americans took a loan from their retirement accounts, up from 15.2% in 2022 and a four-year high.”
Behind the numbers: How affordability challenges are affecting retirement savings in America March 30, 2026 https://www.dayforce.com/blog/state-of-retirement-savings-2026
White House Office of Management & Budget FY 2027 Proposed Budget released Friday: The Trump administration’s fiscal year 2027 budget proposes a $15.8 billion cut to HHS, while requesting $1.5 trillion for defense, a 44% increase.
Developed by the White House Office of Management and Budget, the 79-page plan assumes…
- GDP annual growth will be 5.9% in 2026 leveling to 5.0% by 2036.
- Annual CPI growth will be 2.7% in 2025 and 2.5% in 2026, then settle at 2.2% thru 2036.
It then breaks down budget changes in each department’s key programs comparing what was spent in FY25, what is expected to be spent in FY26 which ends September 30, and the FY27 proposed discretionary spending,
| 2025
$ Bil |
2026
$ Bil |
2027
$ Requested |
‘27 vs ‘26 $$
|
‘27 vs.’26
% |
|
| HHS | 125.4 | 125.8 | 110.5 | -15.4 | -12.2% |
| VA | 129.3 | 133.4 | 144.9 | +11.5 | +8.7% |
| War | 850.1 | 1009.1 | 1450.0 | +440.9 | +43.7% |
Notably, proposed spending in FY27 for healthcare (HHS) programs is significantly below FY26 funding while Veteran’s Services, which covers health and social support services for living vets, is slated to increase. By contrast, the Department of Defense (War) expects a significant bump—more than any discretionary category in the federal budget.
Specific changes in the HHS proposed budget are also notable:
- Restructure and consolidation The administration proposes to consolidate a number of federal programs into the Administration for a Healthy America saving $5 billion/yr. In addition, the 340B drug discount program will be moved from HRSA to CMS and the Hospital Preparedness Program, Agency for Healthcare Research and Quality (AHRQ) and CDC will be eliminated.
- opposes to defund WHO and Pan-American Health Organization.
Budget of the U.S. Government https://www.whitehouse.gov/wp-content/uploads/2026/04/budget_fy2027.pdf
Trump budget request seeks HHS cuts, moves 340B program under CMS – Modern Healthcare
BLS Jobs Report: March 2026: Total nonfarm payroll employment increased by 178,000 in March, and the unemployment rate changed little at 4.3%…. Job gains occurred in health care, in construction, and in transportation and warehousing. Federal government employment continued to decline.
Both the unemployment rate, at 4.3%, and the number of unemployed people, at 7.2 million, changed little in March…
Health care added 76,000 jobs in March. Employment in ambulatory health care services rose by 54,000, reflecting an increase of 35,000 in offices of physicians as workers returned from a strike. Employment also increased in hospitals (+15,000). Over the prior 12 months, health care had added an average of 29,000 jobs per month. Employment in ambulatory health care services rose by 54,000, reflecting an increase of 35,000 in offices of physicians as workers returned from a strike. Employment also increased in hospitals (+15,000). Over the prior 12 months, health care had added an average of 29,000 jobs per month.
Employment Situation Summary – 2026 M03 Results
WSJ on healthcare job growth: “Factory work used to be Americans’ most reliable ticket to the middle class. Office jobs offered another dependable route. But as automation, globalized manufacturing, and now artificial intelligence threaten or narrow some of these paths, healthcare jobs have become the surest bet. At a time of uncertainty in the labor market, nursing offers not only stability but, for some, a pathway to real prosperity. The median annual wage for registered nurses in the U.S. is $93,600, compared with $49,500 for all occupations, according to the Labor Department. For nurse practitioners and others with advanced degrees, it is $132,050.
Healthcare has generated some of the most consistent job growth of any U.S. profession since the early 1980s, thanks to soaring healthcare spending and the aging population…
The profession’s future, though, looks bright. The Labor Department projects that employment of advanced-degree nurses will increase by 35% from 2024 to 2034, eclipsing the expected 3% growth across all occupations. Registered-nurse employment is projected to rise 5% over that period.
A recent research paper found that from 1980 through 2022, earnings of healthcare workers rose much faster than for non-healthcare workers—particularly for nurses.”
Nursing Is the Surefire New Path to American Prosperity – WSJ
Stat study: Global healthcare workforce: “The global workforce of the 50 health care giants increased 4% from 2021 to 2025, reaching 3.34 million people. The gains were a lot smaller from 2024 to 2025 — a mere 0.5% uptick in employee count…. Many companies, including medical device makers, drug companies, and equipment manufacturers, employ people around the world, including in low-wage countries.
Roughly half of the companies studied did not specify how many of their workers are in the U.S. For the 26 companies that did, U.S. employee count increased 2.2% from 2024 to 2025, roughly in line with broader health care job growth reported by the Bureau of Labor Statistics. There were 18.3 million U.S. health care workers by the end of 2025, up 2% from the end of 2024, according to BLS data. (The BLS considers pharmaceutical and device jobs to be part of the manufacturing sector, not health care.)
The clearest signal from the analysis was the wide-scale pruning among health insurance conglomerates. The eight largest publicly traded health insurers — many of which also own medical clinics, pharmacies, and other non-insurance businesses — collectively shed 20,000 jobs in 2025. Health insurers have had to pay out more in medical claims than they projected and also are contending with reforms to Medicare Advantage payments, changes that are draining their profitability.”
Health care giants are trimming jobs, not driving employment growth | STAT March 30, 2026
Hospitals
Public Citizen: Impact of OB3 Medicaid cuts: Per Public Citizen’s analysis: “The One Big Beautiful Bill Act…will cut $911 billion in federal spending on Medicaid and CHIP over the next 10 years, according to estimates from the Congressional Budget Office.
446 hospitals are at heightened risk of closing or reducing services due to Medicaid cuts. These hospitals collectively have approximately 69,000 beds and served approximately 6.6 million patients in 2024. They employ approximately 275,000 direct patient care workers.”
The Big Ugly Threat to Safety Net Hospitals BUL_Hospital_Risks_2026 (1).pdf March 2026
CMS on hospital nutrition: Per the CMS memo last Tuesday, “This memorandum reminds hospital providers of their obligations related to patient food and nutrition services. On January 7, 2026, HHS and USDA released the Dietary Guidelines for Americans, 2025–2030 (DGAs), which place heightened emphasis on diet quality — including limiting ultra-processed foods, sugar-sweetened beverages, refined carbohydrates, and added sugars, while prioritizing whole and minimally processed foods… Given the scale of Medicare’s investment in inpatient care, CMS has a responsibility to ensure that hospital food and nutrition services support high-quality, evidence- based care and improved health outcomes.”
Center for Clinical Standards and Quality/QUALITY & SAFETY SPECIAL ALERT March 30, 2026 MEMOhttps://www.cms.gov/files/document/qssam-26-03-hospital-cah-original-release-2026-03-30.pdf
Lown Institute: “Fair share” analysis: Lown used opposes 2021 IRS data from 2,425 nonprofit hospitals to calculate private nonprofit hospitals’ “fair share spending.” Read the full methodology here. Findings:
“More than 1,900 hospitals pay less than their “fair share” — meaning the value of their meaningful community contribution falls short of the value of their tax breaks. The combined fair share deficits totaled $25.7 billion.
Five Catholic health systems were among the 10 systems with the greatest fair share deficits, which accounted for 15% of the fair share deficit: Providence ($1 billion deficit), Common Spirit ($923 million), Trinity ($784 million), Ascension ($614 million) and Bon Secours Mercy ($488 million).
Hospital Fair Share Spending – Lown Institute
Insurers
CMS prior authorization disclosures for insurers: Per the 2024 CMS Interoperability and Prior Authorization Final Rule (45 CFR Part 156)) that requires public disclosures of prior authorization rates by insurers, these 2025 metrics are available (April 1, 2026) for the three largest Medicare Advantage insurers, UnitedHealthcare, Humana, and Aetna. Highlights:
Prior authorization in Medicare Advantage has grown in recent years — from 37 million requests in 2019 to more than 46 million in 2022 — with nearly 53 million determinations by 2024.
Per an AMA study, the average medical practice completed 39 prior authorizations per physician per week in 2024, with physicians and staff spending about 13 hours weekly on paperwork. In MA, insurers fully or partially denied 4.1 million prior auth requests, or 7.7% of the total, in 2024, according to KFF data.
Insurers’ Prior Authorization Data Offers Little Insight Into What Gets Approved or Denied April 2, 2026 https://www.kff.org/quick-take/insurers-prior-authorization-data-offers-little-insight-into-what-gets-approved-or-denied/
Fixing prior auth: Nearly 40 prior authorizations a week is way too many https://www.ama-assn.org/practice-management/prior-authorization/fixing-prior-auth-nearly-40-prior-authorizations-week-way
Medicare Advantage Insurers Made Nearly 53 Million Prior Authorization Determinations in 2024 https://www.kff.org/medicare/medicare-advantage-insurers-made-nearly-53-million-prior-authorization-determinations-in-2024/#6e420acb-2fc1-4707-8689-ac19594e493a
CMS Star Ratings Update: Last Thursday, CMS issued its expected Medicare Advantage Star Rating update: Highlights:
- The final rule does not implement the Excellent Health Outcomes for All reward (previously called the Health Equity Index), which had been finalized under the Biden administration and was set to take effect in the 2027 star ratings. CMS will instead continue the historical reward factor, which incentivizes high performance across all enrollees and all quality measures.
- CMS finalized the removal of 11 star ratings measures it characterized as focused on administrative processes or areas with too little variation to be meaningful to beneficiaries.
- CMS is adding a new MA depression screening and follow-up measure to address behavioral health gaps, beginning with the 2027 measurement year and reflected in 2029 star ratings.
Medicare Program; Contract Year 2027 and Certain Contract Year 2026 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, and Medicare Cost Plan Program 2026-06600.pdf
States Tax Insurers to address Medicaid shortfall: “States are staring down tough budgetary decisions as a result of the Medicaid cuts and policies in the tax law President Donald Trump enacted last year. Part of Iowa’s answer is a new, retroactive tax on health insurance companies.
Iowa Gov. Kim Reynolds (R) signed a bill last Thursday to raise the tax rate on Medicaid managed care contractors from 0.925% to 3.5%, dating back to Jan. 1 and running through Sept. 30, to generate funds to pay for Medicaid. After that, it will drop down to 0.95%.
Iowa faces a $91 million Medicaid shortfall in fiscal 2026, which ends June 30, and a $161 million budget hole in fiscal 2027, according to the state.
States and the federal government split Medicaid expenses, with federal taxpayers covering more than half of the costs. States use taxes on hospitals, nursing homes and insurers to reduce general fund expenditures while maximizing federal matching funds. The federal government sends states $24 billion annually as a result of these, according to CMS.”
Medicaid cuts push Iowa to increase health insurance taxes – Modern Healthcare
Physicians
Commentary on physician altruism: Despite this ideal and similar assertions by medical societies, there is probably substantial variation in the extent to which physicians prioritize patients’ interests, although little evidence is available on this question. Prioritizing patients’ interests could be considered a form of altruism — a key component of professionalism. My colleagues and I recently used a well-established type of economic experiment to measure altruism, assessing the extent to which people shared money available in the experiment with an unidentified person. We found that although only one third of physicians acted highly altruistically, the average physician acted more altruistically than members of the general population and much more altruistically than the average highly educated, high-income person. We also found evidence that patients of physicians categorized as altruistic had fewer potentially preventable emergency department visits and fewer potentially preventable hospital admissions than patients of other physicians.”
Physicians, Corporatization, and the Unmeasured Quality of Care | New England Journal of Medicine
CMS increases ACO attractiveness: “For the 2025 performance year, CMS will not factor a set of durable medical equipment codes, including for certain orthotics and urinary catheters, into its cost calculations for both ACO REACH and the Shared Savings Program.
CMS will also exclude 90% of billing for skin substitutes in its ACO REACH calculations but will not adjust for these costs in the Shared Savings Program, according to the memo.
Prior regulations sought to mitigate improper spending for some of these services for the 2026 performance year and beyond.
CMS said the billing codes it is limiting are flagged for “significant, anomalous, and highly suspect” activity, meaning the change in volume isn’t easily explained by policy changes or increased demand. This type of deviation from historical patterns often signifies fraudulent, wasteful or abusive spending.
The growth of such practices is significant: Medicare spending for skin substitute services rose from $256 million in 2019 to over $10 billion in 2024, CMS said in its 2026 physician pay rule.”
CMS holds ACOs harmless from suspect Medicare billing practices – Modern Healthcare
Study: Industry inducements to cardiologists: Researchers used publicly available data on industry payments to providers (Open Payments) and professional fees per provider for traditional Medicare beneficiaries for 2022. Findings:
“Results: Our sample included 26,805 cardiologists, and of these, 82.3% received at least 1 payment. The mean (SD) industry payment to cardiologists was $3958 ($17,471). In the main model, a $10,000 increase in industry payments was associated with greater mean spending per Medicare beneficiary by $14.1 (95% CI, $11.9-$16.3).
Conclusions: Industry payments were positively correlated with spending per traditional Medicare beneficiary attributed to a given cardiologist. Although our analysis does not establish causation, the relationship between industry payments and attributed spending is potentially significant, even if industry payments directly influence only a fraction of the overall expenditure. Future studies should better characterize the relationship between payments from device and pharmaceutical companies and spending for those specific devices and drugs and use causal methods to measure the extent to which these payments may influence health care utilization.”
Industry Payments to Cardiologists Are Associated with Higher Medicare Spending | AJMC
Study: Industry incentives to surgeons for robotics:” In this cohort study of 20 313 US surgeons, receipt of an industry payment was associated with a significant increase in the proportional use of robotic-assisted surgery compared with surgeons who never received payment, with a significant dose-dependent response to higher payment amounts.
Among 20 313 surgeons (mean [SD] age, 50.7 [10.2] years; 86.2% male) performing 886 385 surgeries, 5933 (29.2%) received at least 1 industry payment… There was a significant dose-dependent response. For example, surgeons receiving less than $500 increased use of robotic-assisted surgery after payment from a mean of 1.5% to 3.7% compared with 0.4 to 17.0% among surgeons receiving more than $10 000.”
Study: Teamwork and physician burnout: “In this cross-sectional study of 14 051 physicians across 85 health care organizations, 60% of physicians experienced a strong sense of belonging and 80% felt their teammates have their back. Endorsing a sense of belonging and teammate support are associated with lower odds of burnout, intent to reduce hours, and intent to leave.”
Polling
Politico Poll: Opinions about Healthcare: Based on an online sample of 3841 US adults conducted March 13-18, 2026:
- 41% across party lines support reducing how many vaccines Americans receive, with Republicans significantly more likely to hold that view. 58% of Trump 2024 voters support reducing how many vaccines Americans receive, compared to 29% of Harris 2024 voters.
- 47% say they support the MAHA movement, including roughly a third of voters who backed former Vice President Kamala Harris in 2024 and about a third of Americans who plan to vote for Democrats this November. By comparison, 70 percent of Trump 2024 voters say they support the MAHA movement
- 41% of people who voted for Trump in 2024 said he hasn’t done enough for Americans’ health — nearly the same proportion of this group (40%) said he has done enough.
Poll: The battle for MAHA that could sway the midterms – POLITICO
Population Health
Study: state gun laws and firearm suicide rates: “In this cross-sectional study of 2450 observations collected from 1976 to 2024, the mean overall rate of suicide was 13.7 deaths per 100 000, with 7.9 deaths per 100 000 for firearm-related suicide and 5.8 deaths per 100 000 for non–firearm-related suicide across the study period. Handgun permit requirements, waiting periods, and requiring a license for concealed carry were significantly associated with a reduction in firearm suicide rates.
These findings suggest that laws restricting access to guns may be effective in reducing rates of firearm suicide.”
State Gun Laws and Firearm Suicide Rates | Public Health | JAMA Network Open | JAMA Network
Pitchbook on gut health market: “People’s growing interest in their gut health is colliding with the boom of harnessing AI for health and wellness, spawning startups like Throne, whose testing device attaches to toilets, and Zoe, which sells at-home testing kits and personalized dietary plans.
Last year alone saw $500 million in venture capital invested in gut health startups, but there’s still a lot the scientific community doesn’t know. And by extension, neither do the AI models trained on scientific literature…
The microbiome craze has emerged out of a few sweeping changes in consumer behavior. More Americans are taking GLP-1 drugs, and some are finding that they can cause gastrointestinal distress as a side effect. There’s simultaneously more awareness about the health impacts of ultra-processed foods. As a result, a whole community of nutritionists and clinicians is hopping on social media channels and tapping into users’ insatiable desire to be gut-healthy…”
AI gut health startups are selling answers that science can’t back up – PitchBook
The Atlantic on education: “The past decade may rank as one of the worst in the history of American education. It marks a stark reversal from what was once a hopeful story…
We are now seeing what the lost decade in American education has wrought. By some measures, American students have regressed to a level not seen in 25 years or more. Test scores from NAEP, short for the National Assessment of Educational Progress, released this year show that 33% of eighth graders are reading at a level that is “below basic”—meaning that they struggle to follow the order of events in a passage or to even summarize its main idea. That is the highest share of students unable to meaningfully read since 1992. Among fourth graders, 40% are below basic in reading, the highest share since 2000. In 2024, the average score on the ACT, a popular college-admissions standardized test that is graded on a scale of 1 to 36, was 19.4—the worst average performance since the test was redesigned in 1990.
American schoolchildren have given up almost all of the gains they achieved at the start of the century. These learning losses are not distributed equally… In 49 out of the 50 states (all except Mississippi), the gap between the top tenth and the bottom tenth grew. 13-year-olds, according to NAEP’s long-term-trend data, are hitting lows in reading and math scores not seen since these tests began in 1971 and 1978, respectively.
A seemingly plausible culprit, and a familiar boogeyman for progressives, is insufficient spending. The problem with this tidy explanation is that it’s not tethered to reality. School spending did not decline from 2012 to 2022. In fact, it increased significantly, even after adjusting for inflation, from $14,000 a student to more than $16,000.”
America Is Sliding Toward Illiteracy – The Atlantic
NYT: Blood test for dementia? “Could a simple blood test predict your risk of getting dementia years, or even decades, before you experience memory loss?
That’s the potential promise of a new class of biomarker tests. Two were approved last year by the Food and Drug Administration to help diagnose people with Alzheimer’s disease if they have symptoms of dementia. Scientists are now studying whether these types of tests can also identify who is at risk for Alzheimer’s long before symptoms appear: One recent paper found they might be able to predict the onset of dementia symptoms as many as 20 years ahead of time.
The push to diagnose Alzheimer’s at the earliest possible stage, even before symptoms occur, coincides with a push to develop treatments to prevent or delay cognitive decline. Clinical trials on a few drugs are currently underway, with results expected in 2027.”
The New Alzheimer’s Blood Tests: What to Know – The New York Times
Prescription drugs
FDA approves second GLP-1 pill: Using its fast-track approval process, the FDA approved Eli Lilly’s Foundayo which, will compete directly with Novo Nordisk’s Wegovy pill.
FDA approves Lilly’s Foundayo™ (orforglipron), the only GLP-1 pill for weight loss that can be taken any time of day without food or water restrictions April 1, 2026 https://investor.lilly.com/news-releases/news-release-details/fda-approves-lillys-foundayotm-orforglipron-only-glp-1-pill
Novo Nordisk: Wegovy subscription: Last Tuesday, Novo Nordisk announced its GLP 1 subscription program. Patients can enroll in 3, 6, or 12-month plans thru telehealth providers (WeightWatchers, LifeMD, Hims & Hers et al).
A 12-month subscription costs $249 per month. Cash-paying patients who do not enroll in a subscription can still access the lower-dose Wegovy pill — 1.5 mg and 4 mg — for $149 per month. Starting in September, the 4 mg dose will rise to $199 per month. The recently approved 7.2 mg injection dose will be added to the subscription program at a later date.
Novo Nordisk launches Wegovy subscription program
Study: Prescription drug pricing: “With an average cost of $508.48 per medication, the U.S. ranks highest in medicine expenses. Our data shows this figure is 758.69% higher than the global median, placing America in a category of its own.
The gap becomes clearer in direct comparisons with other countries. Prices in the U.S. are nearly twice as high as in Canada, where the average cost is $263.53.
Compared to the United Arab Emirates, where medications average $140.33, Americans pay more than 3.6 times as much for the same types of drugs.
Across all (34) countries studied, the spread between the highest- and lowest-priced markets reaches roughly 155 times. After the U.S. and Canada, prices fall sharply. The third-ranked country, which is the UAE, records an average cost that is more than 72 percent lower than the U.S., highlighting the scale of global pricing disparities.
33 of 43 benchmarked medications show savings of 50% or more compared to publicly listed U.S. retail cash prices. Over one in five (23%) exceed 80% savings.”
America’s Prescription Drug Price Gap & Push For Transparency
