Last week, new cycles paid close attention to the economy with news mixed: The University of Michigan Consumer Sentiment Index hit a five year low of 50.80. But the Consumer Price Index showed a slight decline (2.4% in March) as gas prices continued to drop. And speculation about a recession drew coverage as Goldman, BlackRock, JP Morgan and others raised their estimates of its likelihood.
In tandem, polling showed the public’s mounting concerns about tariffs:
- CBS-YouGov: In results released this morning, a majority of adults think the President’s policies on tariffs might make economic matters worse but most are unsure. And the public’s understanding of tariffs remains low.
- Bain: According to a Bain survey conducted shortly before the tariff announcement on April 2, US consumers believe that inflation (51%), illegal immigration (26%), and affordability of healthcare (24%) are the top three issues facing the US today. Only 23% identified tariffs as a top-three issue. Concern about tariffs was greater among those earning high incomes (26% of whom said it was a top-three issue) than those earning lower and middle incomes (19% and 23% of whom placed it in their top three).
While tariffs and trade policy are not understood by the vast majority of the U.S. population, most of the population feels the complicated issues around trade policy, tariffs and the economy beyond their control. The same can be said for views about U.S. healthcare. Most don’t understand the system and how it operates. They think it’s complicated and expensive and believe corporate interests are playing a larger role. What they do understand is what they spend and how unpredictable those expenses are. Like tariffs, they’re anxious and concerned.
Last week, the Bureau of Labor reported that the CPI increased 2.4% in the last 12 months, but medical care services increased 3.0%–20% higher proportionately. But beneath those numbers is the reality that this spend is not shared equally: those with private insurance coverage pay disproportionately more along with their employers, and others pay less or nothing.
As Congress debates Budget Reconciliation aka ‘One Big Beautiful Bill’ this week and the IRS’ Income Tax deadline hits taxpayers tomorrow, what’s spent on healthcare by the government and by taxpayers will not escape notice. The majority of Americans and lawmakers think the system is underperforming and unnecessarily expensive. And acrimony between insurers, hospitals, physicians and drug companies will deepen old wounds and lend to public confusion.
The Trump administration’s first 3 months is getting mixed reviews largely because tariffs are not understood. The same is true for the health system. Its prices and their underlying costs are largely hidden and the public’s tired of excuses.
Tariffs might be a good thing for the economy or something else. Like healthcare, the public’s anxious about the future of the U.S. economy and unsure about what’s next.
Paul
PS: I’m writing this post from Portugal where polls show the health system is reasonably trusted, outcomes are comparable and costs are half of the U.S. Healthcare in Portugal is provided through three coexisting systems: the National Health Service (Portuguese: Serviço Nacional de Saúde, SNS), special social health insurance schemes for certain professions (health subsystems) and voluntary private health insurance. Portugal spent US$ PPP 4464 per person on healthcare in 2022, 62% of which was funded by public sources. Out-of-pocket (OOP) spending in Portugal accounted for 30% of total health expenditure, double the EU average. Most OOP spending went towards cost-sharing for outpatient services and pharmaceuticals.
Resources in addition to sections below:
Navigating Uncertainty: Tariffs and the US Consumer: Where to Focus amid the Noise Bain April 2025 www.bain.com
How Will Trump’s Tariffs Impact Medicine and Healthcare? | MedPage Today
Society for Health Care Strategy & Market Development (SHSMD) SHSMD Webinar | Tomorrow’s Too Late: Time Is Running Out for Health Systems to Validate Their Value BPD
Quotables
Axios on global economic sentiment shift: “Treasury bonds and other U.S. dollar assets have acted as a global safe haven for generations. This week, global investors woke up to the possibility that they are not particularly safe, and not at all a haven.
The big picture: The last nine days will reverberate through economic history, as the kind of shifts in the global trade order and financial markets that usually play out over years were compressed into each news cycle.
- People will write books about April 2025 the way they have about July 1944, August 1971or September 2008.
- The moves in trade policy have been dramatic, with the world’s two largest economiesnow taxing each other’s imports at over 100%. If sustained, this would essentially shut down commerce between the U.S. and China.
- But it’s the curious way bond and currency markets have interacted that gives the most alarm about the trajectory of global confidence in the U.S.-centric financial order that has prevailed since the end of World War II.
State of play: In a week that stocks and other risky assets sold off, so did U.S. Treasury bonds and the U.S. dollar.
- This is not normal. In past episodes of extreme tumult, like September 2008 and the early days of the pandemic in 2020, the dollar rallied as global investors sought safety…
- Trading this week has displayed a “rare, ugly and worrying combination of market moves,” Krishna Guha with Evercore ISI wrote.
By the numbers: The yield on the 10-year U.S. Treasury note was 4.57% as of 11am ET today. That level is not worrying (rates were higher as recently as January) but the speed and direction of travel are.
- The 10-year yield was under 4% one week ago.
- Meanwhile, the dollar index — the dollar’s value versus six other major currencies — is down 3.4% since Tuesday and 9.2% since mid-January. Those are massive swings by the standard of the most liquid global currency markets.
Between the lines: It suggests that erratic leadership, ballooning fiscal deficits, and rapidly eroding diplomatic ties are making global investors wary of being too exposed to the United States…
Of note: It kind of got lost in the news shuffle given the trade and market shifts, but also this week the House passed a budget blueprint that lays the groundwork to extend President Trump’s 2017 tax cuts.
- It allows Congress to raise fiscal deficits by up to $5.8 trillion over the next decade, relative to current law under which those tax cuts expire at year-end.
- The Capitol Hill action wasn’t an apparent catalyst for the bond market moves. Still, it underscores the risks investors are taking by lending to a nation with already high deficits and debt.
Zoom out: In the near term, it implies that investors can’t benefit from the usual shelter-in-the-storm effect. If you have a portfolio of both stocks and bonds, it helps if one zigs while the other zags, but that hasn’t happened this week.
- In the medium term, it could mean structurally higher U.S. interest rates and more market pressure to reduce deficits.
- In the long term, if this really does prove to be the start of a reshuffling of the global economic order, trade, and financial flows, the implications are so sweeping that they’re hard to even predict.
The bottom line: Markets can behave weirdly, and maybe this will turn out to be just a few bumpy trading days. But the world’s most important financial markets — for the dollar and Treasury securities — are signaling that something fundamental is shifting beneath our feet.
1 big thing: Global investors don’t trust the U.S.Axios Macro April 11, 2025
On job cuts in the FDA Office of Investigations that monitor drugs’ side effects, drug shortages, bird flu, and heavy metals, toxins, and additives in the food supply: “How long will it take them to realize the full extent of the mistakes they’ve made…I don’t know how much clearer I can be; these health cuts will kill people. They will make us less safe and less healthy.”
Rep.Suhas Subramanyam (D-TX) House Committee on Oversight and Government Reform hearing April 9, 2025 STAT www.statnews.com
On Medicaid cuts: “I am Medicaid, don’t cut me! I am Medicaid, don’t cut me!” The chants echoed across the grass in front of the Capitol building in Washington yesterday morning as hundreds of disability advocates gathered to protest potential cuts to Medicaid.”
Disability advocates rally against Medicaid cuts April 9, 2025 www.statnews.com
On hospital consolidation and employer costs: “Without government action, employers will be unable to restrain price increases that result from increasing market power of consolidated health systems. We identify policy levers that regulators can use to increase competition, but the oligopolistic nature of many health care markets in the U.S. suggest that even more significant government action may be needed.”
Hospital Consolidation Across Geographic Markets: Insights from Market Participants on Mechanisms for Price Increases April 3, 2025 https://read.dukeupress.edu/jhppl/article/doi/10.1215/03616878-11853756/399274/Hospital-Consolidation-Across-Geographic-Markets
AHA on Community Benefits: Nonprofit hospitals provide a broad array of benefits that vary depending on the unique needs of the communities they serve, as well as federal, state, and local laws and policies that may affect their operations. The data clearly show that it is essential to holistically examine community benefits in the context of the local community needs and policy landscape when assessing how nonprofit hospitals contribute to their communities. Nevertheless, some stakeholders have argued that the value of community benefit should be measured solely by the provision of financial assistance or some other limited combination of benefits.
Beyond what is reported on the IRS Form 990 Schedule H, nonprofit hospitals engage with their communities in a variety of meaningful ways that advance health and well-being. For example, hospitals partner with a range of local organizations to address community needs, such as housing and health screenings, as well as with local health departments in emergency preparedness and response efforts.
It is important to take a comprehensive view of community benefits and the ways nonprofit hospitals are impacting the health of their communities. Nonprofit hospitals and health systems remain steadfastly committed to addressing the unique challenges of the communities they serve and effectively allocating their finite resources to improve the health of their communities.
Nonprofit Hospital Community Benefits: Addressing Each Community’s Unique Needs | AHA
Economy
Consumer Sentiment: U.S. consumer confidence dropped for the fourth consecutive month in early April, the University of Michigan said last Friday: The University of Michigan Consumer Sentiment Index dropped to 50.8 this month from a final reading of 57.0 in March. Economists polled by Reuters had forecast the index falling to 54.5.
“Consumers report multiple warning signs that raise the risk of recession: expectations for business conditions, personal finances, incomes, inflation, and labor markets all continued to deteriorate this month.” Sentiment is down 30% from December “amid growing worries about trade war developments that have oscillated over the course of the year,” the economists add.
Note: The survey, which is preliminary, ended before Trump announced there would be a 90-day freeze on reciprocal tariffs earlier this week.
- Sentiment plunged 11% from March, with “pervasive and unanimous” declines across political parties, age, income, education and geographic region, according to the release.
- Inflation expectations in the year ahead surged to 6.7% from 5% this month, the highest reading since 1981. All political parties reported higher inflation expectations, the University of Michigan said.
CPI: “The Consumer Price Index released earlier last week showed overall prices fell in March, thanks to plunging gasoline prices — data that captures the period before tariffs ramped up. A gauge that strips out energy and food prices was similarly benign last month.
In March, the Consumer Price Index for All Urban Consumers fell 0.1%, seasonally adjusted, and rose 2.4 % over the last 12 months, not seasonally adjusted. The index for all items less food and energy increased 0.1%in March (SA); up 2.8 percent over the year (NSA).
The index for all items less food and energy rose 0.1 percent in March, following a 0.2-percent increase in February. Indexes that increased over the month include personal care, medical care, education, apparel, and new vehicles. The indexes for airline fares, motor vehicle insurance, used cars and trucks, and recreation were among the major indexes that decreased in March.”
Note: Medical care services were up 0.5% in March and 3.0% for the prior 12 months—above the 2.4% overall CPI increase.
CPI Home : U.S. Bureau of Labor Statistics
Study: health spending growth: “Research has shown that the low growth in health care spending can’t be fully explained by prices or demographic shifts, nor is it limited to a single patient group, geographic region, or type of care. For Medicare specifically, a negligible share of the reduction in growth in per-beneficiary spending can be explained by changes in demographics (i.e., the aging of baby boomers). A larger fraction can be explained by stagnant-to-negative inflation-adjusted growth in payment rates for various services. Together, changes in payment rates and beneficiary characteristics accounted for roughly half the difference in per-beneficiary spending growth between the 2008–2011 and 2012–2018 periods.3 Variable growth in spending on prescription drugs has contributed to slower growth in overall health care spending over the past decade. After observed factors are accounted for, however, a substantial, unexplained downward trend in Medicare spending growth remains.”
The Value Zeitgeist — Considering the Slowdown in Health Care Spending Growth Melinda B. Buntin, Ph.D., Ellen Meara, Ph.D. https://orcid.org/0000-0003-0211-1970, and Carrie H. Colla, Ph.D. https://orcid.org/0000-0002-8414-5084Author Info & Affiliations
Bain: Tariffs and inflation: “Ultimately, tariffs are a tax: Who pays and how much depends on who has leverage. This shock differs from the Covid-19 pandemic, during which supply shortages meant that costs were more easily passed through the full value chain. Now, it’s more likely that at least some of the extra costs will stay upstream of the consumer—with manufacturers, for instance.
Another limiting factor is that imports only represent less than 15% of US GDP, or about 35% of expenditure on goods alone (rather than goods and services).
For these reasons, the overall inflationary impact of price increases from tariffs (even if directly passed through the value chain) could be more muted than the inflation experienced during the post-pandemic period, but the impact on the consumer goods and retail sectors is likely to be more pronounced.
We believe tariffs might make US consumers pull back primarily for impacts they cause on assets these consumers hold, or the wages they collect: an “indirect” impact.”
Tariffs and the US Consumer: Where to Focus Amid the Noise | Bain & Company
New Yorker on tariff pause: “A week after Donald Trump shocked the world by imposing punitive tariffs on America’s trading partners, he shocked it again today when he announced a ninety-day pause on the biggest duties against most countries—notably excepting China, among a handful of others—while leaving in place a ten-per-cent across-the-board levy.
The Administration tried to spin the midday move, which sent stocks rocketing upward, as an example of the President’s dealmaking prowess, claiming that the tariffs had inspired new trade deals with many countries. But the reality seems to be that Trump caved in the face of alarming disruptions in the huge market for U.S. Treasury bonds, which the American government uses to finance itself.
Trump’s announcement of his “reciprocal” tariffs last week, which weren’t reciprocal at all, sent the markets into turmoil. The White House seemed to have steeled itself against an adverse reaction in the stock market, even as, by Wednesday morning, the total market had fallen by about twenty per cent from its high. What really spooked financial commentators—and Trump himself, as he conceded later on Wednesday, speaking outside the White House—was the turbulence in the bond market, where yields spiked on Monday and Tuesday.
A big sudden rise in bond yields equates to a big sudden fall in bond prices—which can be a sign that some financial institutions are in distress and being forced to sell at any price..”
The New Yorker Daily Newsletter Why Trump Backed Down on Tariffs April 9, 2025
Rock Health: Digital Health investing: Investments in digital health are on the rise but deal flow continues to decline… There were 122 funding deals in the first three months of 2025 compared with 137 deals in 2024. Total funding for the sector stood at $3 billion in the first three months of 2025 compared with $2.9 billion in the prior year. Average deal size increased this quarter to $24.4 million, up from $20.9 million in the first three months of 2024. Seed, Series A and Series B rounds comprised 83% of labeled deals in 2025, which was similar in 2024.
Hospitals
Kaufman Hall: Hospital volume changes: % Change in Annual Hospital Volumes, by Admission Type
| Admission Type | 2023 vs 2024 | 2022 vs 2024 |
| Inpatient | 5.0% | 9.3% |
| Observation | 2.6% | 7.8% |
| Emergency | 4.0% | 8.5% |
| Outpatient | 4.9% | 7.2% |
Kaufman Hall, The State of Hospital Volumes, February 2025
Chartis: Hospital leader poll: Key concerns: % of senior health system executives saying the following emerging trends will have a “significant impact” on their organization:
- Federal and state regulations: 51%
- Technological advancements: 46%
- Payment reform: 36%
- Emerging drug therapies: 28%
- Private equity and venture capital investment in healthcare: 25%
- Rise in consumerism: 23%
- M&A/consolidation: 23%
- Fortune 10 investment in healthcare: 8%
Chartis, Pressures and promise: US health system priorities 2025–2030, February 2025
Insurers
Study: Medicare Advantage overpayments: The study by XXX found shows how UnitedHealth uses coding to rake in extra cash from Medicare Advantage Medicare Advantage insurers pocketed more than $33 billion in extra payments in 2021 by using billing codes that portrayed members as unhealthy to generate additional revenue, according to a study published in the Annals of Internal Medicine last Tuesday.
UnitedHealth Group subsidiary UnitedHealthcare profited the most from its “coding intensity” strategy, collecting $13.9 billion, or 42%, of the total, followed by Humana with $6.3 billion, Elevance Health with $2.1 billion, CVS Health subsidiary Aetna with $2 billion and Kaiser Permanente subsidiary Kaiser Foundation Health Plan with $500 million, researchers from the University of California, San Diego, and Actuarial Research Corp. found.
The average risk score for Medicare Advantage members was 1.26 in 2021, while the risk score for people with traditional Medicare was 1.07, the study says. The average risk score for UnitedHealthcare Medicare Advantage policyholders was 1.35.
“Differential coding resulted in an estimated increase in revenue of $1,863 per member at UnitedHealth, substantially greater than the industry average of $1,220 per member,” the paper says.
Annals of Internal Medicine April 8, 2025
WSJ: CMS MA Rate hike: “Medicare Advantage plans will get a 5.06% rate increase, well above the 2.23% bump that the Biden administration proposed.
Health insurer stocks soared on Tuesday because the Trump administration said it would substantially increase payment rates for Medicare insurers next year, generating more than $25 billion in additional revenue for the industry and doubling the boost proposed in January.
The news led to a rally in the shares of big Medicare insurers such as UnitedHealth Group, Humana and CVS Health, parent of Aetna. Shares in UnitedHealth rose 8% in morning trading, while Humana was up more than 11% and CVS increased 9.5%.
The rate increase of 5.06%, compared with 2.23% in the earlier proposal from the Biden administration, overshot even optimistic expectations from many Wall Street analysts…
The rate increase, combined with a rule issued last week that withdrew a Biden administration proposal to cover drugs for obesity, provides a turnaround for big insurers after a difficult year when the long-profitable Medicare business became a drag on margins and share prices.
Health Insurer Stocks Soar on Medicare Rate Boost – WSJ
ProPublica Investigation: Blue Cross of La. Loses long-running lawsuit: “Frustration with insurers is at an all-time high. The December fatal shooting of United Healthcare CEO Brian Thompson allegedly by Luigi Mangione serves as an extreme and tragic example. Doctors and insurers are locked into a perpetual conflict over health care costs, with patients caught in the middle. Doctors accuse insurance plans of blocking payments for health care treatments that can save the patients’ lives. Insurance companies insist they shouldn’t pay for procedures that they say are unnecessary or overpriced. It is easy to emerge from an examination of the American health care system with a cynicism that both sides are broken and corrupt. However, interviews with scores of doctors, patients and insurance executives, as well as reviews of internal documents, regulatory filings and academic studies, reveal a fundamental truth: The two sides are not evenly matched. Insurance companies are players in the fight over money, and they are also the referees. Insurers produce their own guidelines to determine whether to pay claims. When a doctor appeals a denial, insurers make all the initial decisions. In legal settings, insurers are often given favorable standing in their ability to set what conditions they are required to cover. Federal and state insurance regulators lack the resources to pursue individual complaints against multibillion-dollar companies. Six major insurers, which include some of the nation’s largest companies, cover half of all Americans. They are pitted against tens of thousands of doctors’ practices and large hospital chains.”
Health Care: Pulling Back the Curtain on the Health Industry and Regulation ProPublica April 12, 2025 Investigative Reporting on Health Care — ProPublica
JP Morgan: Small business and health insurance: “Entrepreneurship is a significant driver of economic growth and dynamism, yet recent trends suggest stagnation in some industries. A critical factor contributing to this stagnation may be the burden of health insurance payments, which disproportionately affects small businesses. This study addresses a critical gap in understanding how health insurance burdens affect small businesses and their survival, particularly within different industries.” Highlights:
“Our findings highlight the substantial financial pressures faced by small businesses in managing health insurance costs, underscoring the need for a deeper understanding of these challenges and for targeted policy measures or strategic initiatives aimed at supporting their resilience and growth.
- Nearly one-third of small businesses dropped health insurance coverage from one year to the next, with rising health insurance burdens as a contributing factor.
- Most small businesses that stopped paying health insurance premiums continued to operate in the following years.
- Non-employer firms with the highest health insurance burdens experienced the largest premium increases, even though the typical firm across industries saw mixed growth rates.
- For employer firms across all industries, payroll expense increases explained the decrease in health insurance payroll burden over time.”
The consistency of health insurance coverage in small businesses: industry challenges and insights
Study: Coding accuracy by MA plans: Researchers analyzed coding for 697 MA contracts offered by 193 insurers in 2021. Results:
Coding differences that year helped push the average MA enrollee’s risk score 18.5% higher than the enrollee average for traditional Medicare. That differential coding and resulting greater average risk score led to an estimated extra $33 billion paid to MA plans that year, according to Richard Kronick, PhD, of the University of California San Diego, and colleagues.
“In 2021, the average MA risk score was 1.26; the average for a comparable group in TM was 1.07. The average MA risk score was 0.19 (95% CI, 0.17 to 0.21) higher than it would have been if MA coding patterns had been identical to coding in TM. The average risk score at UnitedHealth Group was 0.28 (CI, 0.26 to 0.31) higher than it would have been if its plans had coded identically to TM. In contrast, Kaiser Permanente coded only slightly more intensely than TM. As a result of differential coding, MA plans received an estimated $33 billion (CI, $28 billion to $38.5 billion) in additional payment in 2021, $13.9 billion (CI, $12.4 billion to $15.5 billion) (42%) of which went to UnitedHealth.”
JD Power: Insurer digital experience: According to the J.D. Power 2025 U.S. Healthcare Digital Experience Study’s released last week:
- Health insurance mobile app experience lags other service industries:On average, customer satisfaction with apps is 653 (on a 1,000-point scale) among commercial member health plans and 597 among Medicare Advantage plans. Comparatively, customer satisfaction with apps is significantly higher in three other industries in which J.D. Power conducts studies: full-service wealth management companies (794);1 property and casualty insurers (700);2 and automotive finance companies (672).3
- Digital experience affects satisfaction and intent to renew: Among commercial member health plan digital experiences in which overall satisfaction scores are 801 or higher, 58% of members are likely to have a much more positive impression of their employer. Among Medicare Advantage plan digital experiences in which overall satisfaction scores are 801 or higher, 85% of members say they “definitely will” renew with their current plan, which is more than double the intended loyalty rate for those digital experiences with scores of 500 or less.
- Missing basics of ease of use and navigation: The most important factor driving satisfaction with both commercial health plans and Medicare Advantage plans is ease of finding information needed. When that basic criterion is met, overall member satisfaction rises 83 points. Yet, health plans are failing to deliver that level of digital experience 39% of the time.
- The percentage of commercial health plan members who have used their insurer’s mobile app within the past year rises to 37% in 2025, up from 31% in 2024, and overall satisfaction is highest (636) among those who use the mobile app when compared with a website (607) or phone (607). However, when members have a poor digital experience, their likelihood of reusing that channel again in the future falls to just 27%.
2025 U.S. Healthcare Digital Experience Study | J.D. Power
Physicians
Physician survey: Medicine as a calling: “Most respondents felt “called” to medicine. 90% of respondents 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. Work gives them purpose. Half of respondents rated their ability to live their purpose at work as a 4 or 5 on a 5-point scale. Generations have different drivers. 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. APPs feel called to their work. Advanced practice providers (APPs) are more likely than physicians to say medicine was definitely a calling. 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. When looking at locum tenens vs. permanent clinicians, there were no statistically significant differences in beliefs about passion and purpose. The same was true when looking at urban, suburban and rural clinicians, and by practice “
Is Medicine Still a Calling?
Polling
CBS News-YouGov: Tariffs and the economy: Based on its survey of 2410 Americans conducted April 8-11 released today:
Impact of tariffs:
- Short term: make it worse 65%, no impact/not sure 27%, make it better 8%
- Long term: make it worse 42%, no impact/not sure 23%, make it better 34%
New tariffs on imported goods: favor 42%, oppose 58%
Trump’s policies are making you feel better:
- March 2025: worse 42%, the same 35%, better off 23%
- April 2025: worse 49%, the same 30%, better off 21%
BPD: Opinions about the health system:
Sources of stress in everyday life: 2024 vs. 2012:
- Inflationary impact of prices: 74% vs. 64%
- Future of the nation: 55% vs. 36%
- The cost of healthcare: 47% vs. 40%
- Personal health concerns: 47% vs. 45%
Levels of trust in institutions: Aug 2024 vs. Dec. 22
- Hospitals: 66% vs. 57%
- Health insurance company: 44% vs. 44%
- Government: 27% vs. 38%
- Pharmaceutical company: 35% vs. 38%
- News Media: 36% vs. 36%
- Social media: 24% vs. 30%
- Non-profit organizations: 54% (Aug 24)
Strongly Agree/agree (Aug 24 vs. Dec 22): Overall trust in healthcare has eroded in the last 2 years: 69% vs. 64%
West Health-Gallup: Medical debt: Per the survey of 3583 adults conducted via web Nov. 11-18, 2024:
- More than 31 million Americans (12%) report needing to borrow about $74 billion last year to pay for healthcare despite most having some form of health insurance
- Nearly one-third (28%) report being “very concerned” that a major health event could throw them into debt.
- “Almost 20% of Americans aged 49 and under needed to borrow money to cover medical costs compared with just 9% of those 50 to 64. Women between the ages of 50 and 64 were twice as likely as men in the same age group to say they had to borrow (12% vs. 6%). Two percent of Medicare-eligible adults (those over the age of 65) reported having to borrow.”
Americans Borrowed $74 Billion Last Year to Cover Healthcare Costs | West Health
Population Health
Robert F. Kennedy Jr. on measles outbreak: “I am also here to support Texas health officials and to learn how our HHS agencies can better partner with them to control the measles outbreak, which as of today, there are 642 confirmed cases of measles across 22 states, 499 of those in Texas. In early March, I deployed a CDC team to bolster local and state capacity for response across multiple Texas regions, supply pharmacies and Texas run clinics with needed MMR vaccines and other medicines and medical supplies, work with local schools and healthcare facilities to support contact investigations, and to reach out to communities, including faith leaders, to answer any questions or respond to locations seeking healthcare. Since that time, the growth rates for new cases and hospitalizations have flattened. The most effective way to prevent the spread of measles is the MMR vaccine.”
Secretary Kennedy on X April 6, 2025 3:39 PM
Study: Medically-tailored meals and health status: “Medically tailored meals (MTMs) can reduce health care use among high-risk patients with diet-related conditions. However, the potential impact of providing coverage for MTMs across fifty US states remains unknown. Using a population-based, open-cohort simulation model, we estimated state-specific one-year and five-year changes in annual hospitalizations, health care spending, and cost-effectiveness of MTMs for patients with diet-related diseases and limitations in activities of daily living, covered by Medicaid, Medicare, or private insurance. Assuming full uptake among eligible people, MTMs were net cost saving in the first year in forty-nine states, with the largest savings seen in Connecticut ($6,299 per patient). The exception was Alabama, where MTMs were cost-neutral. The number of treated patients needed to avert one hospitalization ranged from 2.3 (Maryland) to 6.9 (Colorado). These findings can inform state-level policy makers and health plans considering MTM coverage through state-specific strategies.”
Prescription drugs
ICER: Policy options for obesity medication access: The Institute for Clinical and Economic Review (ICER), in collaboration with researchers from Brown University, examined several potential solutions, including enhanced evidence-based coverage criteria, formulary and provider network management, carve-out programs for obesity management services, and a reduction of costs at the federal level through aggressive drug price negotiation in the Medicare program.
Regulators
CMS Medicare Advantage Rate Notice for 2026: Medicare Advantage plans will receive a 5.06% ($25 billion) payment increase next year, the Centers for Medicare and Medicaid Services announced Monday “largely attributable to an increase in the effective growth rate,” The agency previously projected a 5.93% effective growth rate but now expects it to be 9.04%.
HHS: GLP-1 coverage by Medicare, Medicaid: The government said it “may consider future policy options” for anti-obesity medications, after declining to finalize a Biden-era proposal that would have expanded coverage to millions of Medicare patients. Medicare when prescribed for another eligible condition, such as diabetes or reducing a patient’s cardiovascular risk.”
HHS says it may revisit policy for anti-obesity drugs
CMS’ Nursing home staffing rule: Last week, a Texas federal judge struck down new staffing standards for nursing homes participating in Medicare or Medicaid, ruling that federal health officials overstepped their authority by establishing a one-size-fits-all requirement.
Opinion attached
FDA: The Trump administration is formally taking on fluoride in drinking water, with Health and Human Services Secretary Robert F. Kennedy telling the CDC to end its longtime recommendation for the practice. PA head Lee Zeldin also said his agency is “ready to act. “Kennedy last November called fluoride “an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.”
Robert F. Kennedy Jr, EPA head Zeldin promise action against fluoride – Axios Salt Lake City
CMS to end Medicaid health, social needs programs: The Centers for Medicare and Medicaid Services is cutting off funding for initiatives designed to address health-related social needs for Medicaid enrollees, the agency notified states in a letter Thursday. So-called designated state health programs and designated state investment programs currently in operation under 1115 waivers may continue, but CMS will not extend them nor approve new applications, Center for Medicaid Director Drew Snyder wrote in a letter to state officials. States have employed this funding for a variety of non-medical purposes, such as housing, nutrition and transportation assistance, that aren’t covered under Medicaid but may promote health and save money.
CDC: Cuts to alcohol-related death unit: “A small office that produced data on alcohol-related deaths and harms, and worked on policies to reduce them, has been shuttered by the Trump administration…
At least 11 states directly relied on the Alcohol Program in the Centers for Disease Control and Prevention for funding, data assistance and other guidance. The three-person, 24-year-old program was cut by the large reduction-in-force that began April 1 at Health and Human Services..
The alcohol program was part of the CDC’s Division of Population Health, which government officials gutted last week…
Recent estimates suggest excessive alcohol use causes 178,000 deaths each year, or nearly 500 deaths per day, in the U.S. Myriad chronic diseases and at least half a dozen cancers have also been linked to alcohol use. As of 2010, excessive drinking cost the U.S. $249 billion. These very statistics are products of the CDC alcohol team.
Trump cuts CDC program on alcohol-related harms, prevention | STAT
NIH: A federal district judge in Boston ordered a permanent injunction on Friday in the case against the National Institutes of Health over indirect costs, blocking the Trump administration from slashing funding for grantees’ administrative and facilities expenses and handing a win to universities that rely on the money. In February, the NIH attempted to cut overhead costs it pays to universities and grantees to 15 percent, a decision that critics said would result in a $4 billion shortfall to universities and decimate the U.S. research enterprise. Groups representing universities sued and Judge Angel Kelley issued a preliminary injunction, temporarily blocking the cuts.
On Friday, prior to Kelley’s decision, the Trump administration filed a motion asking Kelley to issue a permanent injunction in an effort to speed its appeal.
Trump’s New Tariffs Could Drive Up Health Care Costs, Experts Warn
CMS Proposed Rule on (released April 11) for FY 2026 for the Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System:
- 4% increase in inpatient hospital payment rates for FY 2026 — reflecting a 3.2% projected market basket increase offset by a 0.8% productivity adjustment. Net effect: increased hospital payments by $4 billion including $1.5 billion in additional Medicare disproportionate share hospital payments and $234 million in new technology add-on payments.
- Long-term care hospitals are slated to receive a 2.6% payment rate update, resulting in a net 2.2% payment increase, or about $52 million in total additional payments.
- Alternative payment models: January 2026 launch of Transforming Episode Accountability Model focused on 5 surgical procedures and care coordination through 30 days post-discharge.
- Modifications of measures (8) used in the Hospital Inpatient Quality Reporting program
- Modifications to Hospital Readmissions Reduction Programand Hospital Value-Based Purchasing Program.
