Last Thursday, the Make America Healthy Again Commission released its 68-page report “Making America’s Children Healthy Again Assessment” featuring familiar themes—the inadequacy of attention to chronic disease by the health system, the “over-medicalization” of patient care vis a vis prescription medicines et al, the contamination of the food-supply by harmful ingredients, and more. HHS Secretary Kennedy, EPA Administrator Zeldin and Agriculture Secretary Rollins pledged war on the corporate healthcare system ‘that has failed the public’ and an all-of-government approach to remedies for burgeoning chronic care needs.
Also Thursday, the House of Representatives passed its budget reconciliation bill by a vote of 215-214. The 1000-page bill cuts federal spending by $1.6 trillion (including $698 billion from Medicaid) and adds $2.3 trillion (CBO estimate/$3.4 to $5 trillion per Yale Budget Lab) to the national deficit over the next decade. It now goes to the Senate where changes to reduce federal spending to pre-pandemic level will be the focus. With a 53-37 advantage and 22 of the 36 Senate seats facing mid-term election races in November, 2026, the Senate Republican version of the “Big Beautiful Bill” will include more spending cuts while pushing more responsibility to states for funding and additional cuts. The gap between the House and Senate versions will be wider than currently anticipated by House Republicans potentially derailing the White House promise of a final Big Beautiful Bill by July 4.
And, over the last week and holiday weekend, the President announced a new 25% tariff on Apple devices manufactured in India and new tariffs targeting the EU; threatened cuts to federal grants to Harvard and cessation of its non-citizen student enrollment, a ‘get-tougher’ policy on Russia to pressure an end of its Ukraine conflict, and a pledge to Americans on Memorial that it will double down on ‘peace thru strength’ in its Make America Great Again campaign.
These have 2 things in common:
1-They’re incomplete. None is a finished product. The MAHA Commission, working with the Departments of Health & Human Services, Interior and Agriculture, is tasked to produce another report within 90 days to provide more details about a plan. The FY26 budgeting process is wrought with potholes—how to satisfy GOP deficit hawks vs. centrist lawmakers facing mid-term election, how to structure a bill that triggers sequestration cuts to Medicare (projected $490 billion/10 yrs. per CBO), how to quickly implement Medicaid work requirements and marketplace enrollment cuts that could leave insurance coverage for up to 14 million in limbo, and much more. And the President’s propensity to “flood the zone” with headline-grabbing Truth Social tweets, Executive Orders and provocative rhetoric on matters at home and abroad will keep media occupied and healthcare spending in the spotlight.
2-They play to the MAGA core. The MAGA core is primarily composed of older, white, Christian men driven by a belief that the United States has lost its exceptionalism through WOKE policies i.e. DEI in workplaces and government, open borders, globalization and excessive government spending and control. In the 2024 Presidential election, the MAGA core expanded incrementally among Black, Hispanic, and younger voters whose concerns about food, energy and housing prices prompted higher-than expected turnout. The MAGA core believes in meritocracy, nationalism, smaller government, lower taxes, local control and free-market policies that encourage private investment in the economy. The core is price sensitive. The health system per se is not a concern but it’s the affordability and lack of price transparency are. They respect doctors and frontline caregivers but think executives are overpaid and prone to self-promotion. And the MAGA core think lawmakers have been complicit in the system’s lack of financial accountability largely beneficial to elites.
Looking ahead to the summer, a “Big Beautiful Bill” will pass with optics that allow supporters to claim fiscal constraint and lower national debt and opponents to decry insensitive spending cuts and class warfare against low-and-middle-class households. Federal cuts to Medicaid and SNAP (Supplemental Nutrition Assistance Program) will be prominent targets in both groups—one a portrayal of waste, fraud and abuse and the other tangible evidence of societal inequity and lack of moral purpose. Each thinks the other void of a balanced perspective. Each thinks the health system is underperforming and in need of transformational change but agreement about how to get there unclear.
As MAHA promotes its agenda, Congress passes a budget and MAGA advances its anti-establishment agenda vis a vis DOGE et al, healthcare operators will be in limbo. The dust will settle somewhat this summer, but longer-term bets will be modified for most organizations as compliance risks change, state responsibilities expand, capital markets react and Campaign 2026 unfolds.
And in most households, concern about the affordability of medical care will elevate as federal and state funding cuts force higher out of pocket costs on consumers and demand for lower prices.
The summer will be busy for everyone in healthcare.
Paul
PS: Changes in the housing market are significant for healthcare: 36% of the CPI is based on shelter vs. 8% for medical services & products, 14% for food and 6% for energy/transportation. While the overall CPI increased 2.3% in the last 12 months, medical services prices increased 3.1%. contributing to heightened price sensitivity and delayed payments. It has not escaped lawmaker attention: revenue cycle management business practices (debt collection) are being scrutinized in hospitals and community benefit declarations by not-for-profit hospitals re-evaluated. The economics of healthcare are not immune to broader market trends nor is spending for healthcare in households protected from day-to-day fluctuations in prices for other goods and services. Check out www.kennycapphd@substack.com
And a shout-out to my alma mater, The Ohio State University. Friday, I visited the new Wexner Medical Center slated for opening in 2026 and met with leaders in health policy, economics and administration. Totally impressed!
Sections in this Report
- Quotables
- Corporate News of Note
- Economy
- Hospitals
- Insurers
- Physicians
- Polling
- Population Health
- Prescription Drugs
- Regulators/Lawmakers
Quotables
MAHA Commission Report: “This report—Make Our Children Healthy Again: Assessment—is a call to action. It presents the stark reality of American children’s declining health, backed by compelling data and long-term trends. More importantly, it seeks to unpack the potential dietary, behavioral, medical, and environmental drivers behind this crisis. By examining the root causes of deteriorating child
health, this assessment establishes a clear, evidence-based foundation for the policy interventions, institutional reforms, and societal shifts needed to reverse course Today’s children are the sickest generation in American history in terms of chronic disease and these preventable trends continue to worsen each year, posing a threat to our nation’s health, economy, and military readiness…By some estimates, up to 40% of American children have at least one chronic condition, and kids with one illness are more likely to have others.“
MAHA Commission Report May 22, 2025
Financial Impact of Budget Reconciliation on Healthcare: “Preliminary CBO analysis shows that the One Big Beautiful Bill Act would severely erode social safety net programs by cutting nearly $1 trillion over ten years in Medicaid and SNAP alone. This includes at least $698 billion in cuts to the Medicaid program and at least $267 billion in cuts to the SNAP program. These changes would shift costs to states to the tune of at least $78 billion in new costs. Even with these cuts, the bill would increase the federal deficit by $3.8 trillion. Note that these are conservative estimates because the CBO’s analysis here does not reflect major policy changes like those to the Affordable Care Act, the distributional effects of the Ways and Means Committee proposal, interactions between various titles, or the changes made in the manager’s amendment on May 21. Household resources for those in the lowest decile (i.e., the lowest tenth) of income would decrease by about 2% in 2027 while household resources for those in the highest decile (i.e., the highest tenth) of income would increase by about 4% in 2027 and by 2%in 2033.”
Health Populi’s on what health consumers value in healthcare: “… kindness as a trait of a health care experience ranks highest by far (on an unaided basis) in the mind’s eye and heart of patients – as – health consumers.
Next comes efficiency and timeliness — a sign of respect from the health care provider, pharmacy, or other touchpoint — in not wasting the time of the patient-consumer-caregiver. Then, it’s listening and individualizing care — again, signs of respect as well as efficiency and innovation.
With growing attention to AI in use cases more patients are coming to value and embrace, continuing to channel kindness and respect must be embedded into… “the living system of experiences.” This is how trust gets re-built, engagement gets inspired, and health outcomes get maximized.”
In Health Care, Consumers Are Seeking Kindness Coupled with Efficiency – HealthPopuli.com
Makary on Covid boosters: “By the way, America doesn’t want COVID boosters.”
FDA commissioner Marty Makary at a Senate Appropriations Committee hearing May 22, 2025
HHS Secretary on Chronic disease: “It’s abundantly clear that chronic diseases are causing an enormous amount of death and disability among Americans, and increasingly so during the prime of their lives.
The leading overall causes of death in the U.S. have remained relatively consistent over time: heart disease, cancer, unintentional injuries (including drug overdose), strokes, and chronic respiratory illnesses.
But what kills people varies across the life span. In younger years, and even into early midlife, injuries and suicide — many involving firearms — are the leading causes of death. Later, cancers and conditions like heart disease and liver disease begin creeping in. “
Kennedy’s MAHA movement on chronic disease: battle over priorities
Secretary HHS’ RFK on WHO (World Health Organization): “Like many legacy institutions, the WHO has become mired in bureaucratic bloat, entrenched paradigms, conflicts of interest, and international power politics. While the United States has provided the lion’s share of the organization’s funding historically, other countries such as China have exerted undue influence over its operations in ways that serve their own interests and not particularly the interests of the global public.”
Note: On January 20, 2025, President Trump signed Executive Order 14155 Withdrawing the United States from the World Health Organization which instructs the Federal Government to “pause the future transfer of any United States Government funds, support, or resources to the WHO.”
HHS www.hhs.gov May 20, 2025
Kendrick on Medicaid cuts and rural hospitals: “Hospitals are also looking at sharing administrative burdens across 10 or more similarly situated organizations, as opposed to one large system. There’s a lot of private equity and venture capital, but those firms may view any investment as a math equation and not about care for the community. All these things are being explored.
Having care there when you need it is a need. It’s not a want. It’s not a financial equation. It’s the delivery of care that sustains and prolongs lives.”
Community Hospital Corp.’s Jim Kendrick dishes on DC lobbying | Modern Healthcare
Commerce Secretary Howard Lutnick on Tariffs: “Over the last few days, the single most important question about the tariffs has been what they’ll do to the American consumer.
Lutnick recently decried “silly arguments” that tariffs raise prices. A few days later, Walmart said they’d do exactly that, and a number of other companies have hinted at the same since.
“The president has to stand strong, and you can’t fix things in a day, and that’s still going, but I would expect that prices in America will be unaffected.”
Axios AM May 22, 2025
Corporate Healthcare News of Notes
Major Health Insurers’ Q1 2025 Profit / Revenue:
| Plan | Profit | Revenue |
| Centene | $1.31B | $46.6B |
| Cigna Group | $1.32B | $65.5B |
| CVS Health | $1.78B | $94.6B |
| Elevance Health | $2.2B | $48.9B |
| Humana | $1.2B | $32.1B |
| UnitedHealth Group | $6.3B | $109.6B |
Fierce Healthcare, Elevated medical costs continued to drag insurers in Q1 2025, May 6, 2025
United Health: Last week, UnitedHealth suspended its guidance for the year and named a new CEO. UnitedHealth faces a Justice Department lawsuit alleging it bilked the federal government out of $2 billion through Medicare Advantage upcoding. On Thursday, 28 House Democrats filed an amicus brief in the case, urging the federal judge to take UnitedHealth to trial.
Optum Health struggles with CMS’ V28 change to Medicare Advantage | Modern Healthcare
Regeneron-23and Me: Drugmaker Regeneron Pharmaceuticals will buy genetic testing firm 23andMe for $256 million through a bankruptcy auction, the companies said Monday. 23andMe last month agreed to allow a court-appointed overseer for the company’s handling of customers’ genetic information and its security policies during the bankruptcy. The company has collected genetic data from 15 million customers who ordered its DNA testing kits online and provided saliva samples. 23andMe went public in 2021 at a $3.5 billion valuation, and briefly was valued at around $6 billion. It previously had raised over $800 million in venture capital funding.
Regeneron to buy bankrupt DNA testing firm 23andMe for $256 million | CNN Business
Walmart CEO Doug McMillon told investors last week that the retail giant will be forced to jack up prices as soon as this month because of tariffs. “We aren’t able to absorb all the pressure given the reality of narrow retail margins,” McMillon said. That prompted Trump to scold Walmart in a social media post Saturday, saying it should “EAT THE TARIFFS” instead and avoid charging customers more.
Trump and Scott Bessent admit: Americans pay for tariffs
Hinge Health: Digital health startup Hinge Health saw a 17% IPO pop on its first day of trading on the New York Stock Exchange, closing the day at $37.56 a share. Hinge Health and its selling shareholders raised $437 million in the IPO, which priced shares at $32 each for a fully diluted market cap of about $3.5 billion. The debut is a long-awaited windfall for early investors Atomico, 11.2 Capital and Insight Partners, and the first major public listing of a VC-backed healthtech company since 2021.
Hinge Health sparks hope with 17% IPO pop in NYSE debut – PitchBook
OpenAI is acquiring Jony Ive’s AI hardware startup, Io Products. The former Apple exec, whose design credits include the iPhone and iPad, will now lead design at OpenAI as the company pushes deeper into hardware. The move highlights a trend of VC-backed companies buying one another amid a shifting tech landscape.
Everything We Know About OpenAI’s $6.5 Billion Purchase of Jony Ive’s Io
Home Depot: “On the surface, the picture looks bright – but dig a little deeper and you’ll uncover warning signs. On Tuesday, Home Depot posted Q1 sales rising 9% year-over-year to total nearly $40 billion. However, comparable sales – what existing stores actually brought in – fell 0.3% overall, with only a tiny 0.2% bump in the U.S.”
Home Depot shows that the housing market chill is hitting hard
Economy
PEPY for coverage groups: Per-Enrollee Spending by Eligibility Group and Medicaid Expansion Status
KFF, 5 Key Facts About Medicaid Expansion, April 25, 2025 |
Income Distribution: To be in the top 10% of individual earners, a U.S. worker has to earn $2,905 per week, according to the Bureau of Labor Statistics, which is $150,000 per year.
- To be in the top 10% of households in 2024, you had to earn $235,000.
- The middle class tops out at $169,800 for a family of three in 2022 dollars, which is $188,400 in 2025 dollars, according to Pew Research Center.
Axios Markets May 22, 2025
Wealth transfer problematic for Millennials: “US is on the precipice of a colossal wealth transfer, with the oldest baby boomers set to turn 80 next year. As they find spots in nursing homes, move in with younger relatives, or die, members of the once-largest generation will leave behind a staggering heap of real estate…
Baby boomers dominate America’s housing market. They own roughly $19.7 trillion worth of US real estate, or 41% of the country’s total value, despite accounting for only a fifth of the population. Millennials, by comparison, make up a slightly larger share of the population but own just $9.8 trillion of real estate, or 20%…They accounted for 42% of buyers between July 2023 and June 2024, data from the National Association of Realtors found, well outpacing millennials’ measly 29% share
Boomers are a big reason Americans are stuck in place: People are staying in their homes almost twice as long as they used to, a Redfin analysis found, with nearly 40% of boomers having lived in their homes for at least 20 years and another 16% staying put for 10 to 19 years….
While demographers emphasize that this will be more of a glacial shift rather than the well-publicized, instantaneous “silver tsunami,” this changing of the guard will happen. Between 2025 and 2035, boomers’ numbers are projected to decline by 23%, or about 15.6 million people, according to an analysis of Census data by the Harvard Joint Center for Housing Studies. Between 2035 and 2045, their numbers are expected to drop by another 47%, or 23.4 million people.
New Millennial Home Dilemma: What to Do with Baby Boomer Real Estate – Business Insider
India’s economy for start-ups: “Move over, Silicon Valley. The next 1,000 unicorns are grazing in Mumbai. India — with its large, tech-savvy population, a growing domestic investor base, and an AI-fueled startup ecosystem — is emerging as a global startup powerhouse. IPOs are surging: There were 338 in 2024, a 44% increase from the previous year, that raised over $20 billion. Brokerage accounts have come close to quadrupling since 2020. And homegrown companies are solving complex problems at scale, such as logistics that work across wide regions and countless dialects. The country’s not just producing code anymore — it’s producing global companies.”
Hospitals
Site neutral payments impact: “Medicare pays hospital outpatient departments higher rates than physician-owned practices, leading to higher spending and incentivizing hospitals to acquire physician practices. The Bipartisan Budget Act of 2015 introduced site-neutral payments for new outpatient departments but excepted existing ones. To evaluate the impact of this law, we analyzed 2013–20 Medicare claims data, comparing spending under site-neutral rates with spending under site-based rates and using difference-in-differences analysis to assess the effect on hospital-physician integration. During the period 2017–20, most Medicare payments were unaffected by the Bipartisan Budget Act: Only 1.5% of outpatient department spending occurred at site-neutral facilities. Counties subject to the Bipartisan Budget Act did not show a statistically significant difference in the percentage of hospital-integrated physicians (2020 estimate: −0.2 percentage points). The act did little to reduce Medicare spending or hospital-physician integration, suggesting that site-neutral legislation could be strengthened by reducing exceptions.
Section 603 of the Bipartisan Budget Act of 2015 was Congress’s first enactment of site-neutral payment reform…In the first four years after enactment, few services were paid at the site-neutral rates authorized by the Bipartisan Budget Act; more than 98% of services continued to be paid at hospital-based rates. Further, although proponents expected that reducing site-based payment for hospital outpatient departments might curtail hospital-physician integration, we found that the act exerted little to no effect on integration. Taken together, these results imply that providers have been mostly immune to the Bipartisan Budget Act’s site-neutrality provisions and that payment-related incentives for hospital-physician integration remain intact.”
Actuarial Research Corporation study: site neutral payments: “With a comprehensive expansion of site neutrality, Medicare beneficiaries would save $80 billion over ten years through lower Part B premiums and cost sharing. Beneficiaries would average savings of $114 per year. Millions of high-utilizing beneficiaries, such as those receiving chemotherapy, would save several hundred dollars annually. Comprehensive site neutrality would reduce federal spending by $148 billion over ten years. Additionally, tax revenue spillover effects from lower employer-sponsored insurance costs would increase federal revenue by $30 billion. A narrower policy focused solely on off-campus HOPDs would reduce spending by $28 billion over the same period.
The Cassidy-Hassan framework proposes expansion of site neutrality while reinvesting in rural and high-needs hospitals. We estimate 29% of facilities (14% of beds) may qualify for reinvestment. For these hospitals, reinvestment can fully offset revenue losses from site neutrality, though results are sensitive to specific details in how the framework is ultimately implemented.”
“Updated Estimates of Site Neutrality and Evaluation of the Cassidy-Hassan Framework” Actuarial Research Corporation May 14, 2025 www.aresearch.com
Study: Private equity ownership of psychiatric hospitals: The number of PE-owned psychiatric hospitals grew rapidly from 2013 to 2021, but the quality of care did not diminish when compared to facilities not owned by private equity:per the study.
Researchers found that the facilities had higher occupancy rates and a lower staff-to-patient ratio compared to non-private equity owned facilities during the eight-year period. However, the facilities’ care quality did not decline, including lower usage of restraints and equal rates of seclusion, though the authors were quick to note that this data is self-reported and prone to tampering.
The authors also noted that the results were somewhat surprising, given private equity’s track record in health care. Private equity firms’ ownership often coincides with poorer health outcomes for many populations, including people with developmental disabilities, psychiatric care, and autism. More data is needed to determine the impact of private equity on psychiatric hospitals’ financials and quality of care.
Insurers
Study: impact of premium increase on re-enrollment: Researchers addressed the question “do lower-income Health Insurance Marketplace enrollees lose or change coverage when they experience turnover and are defaulted from a zero-premium silver plan to a silver plan with a premium?
In this cross-sectional study including 2159 counties representing roughly 10 million HealthCare.gov enrollees annually in 29 states, zero- to positive-premium plan turnover was associated with an approximately 7% decrease in automatic reenrollment; turnover also was associated with a roughly 14% increase in enrollees selecting new plans in lieu of their prior plans.
Findings: “In this cross-sectional study including 2159 counties representing roughly 10 million HealthCare.gov enrollees annually in 29 states, zero- to positive-premium plan turnover was associated with an approximately 7% decrease in automatic reenrollment; turnover also was associated with a roughly 14% increase in enrollees selecting new plans in lieu of their prior plans.”
Study: denials in 2024: In 2024, insurers initially denied 11.8% of dollars associated with hospital-based claims, according a report from consultant Kodiak Solutions. That compares with 11.53% of dollars denied in 2023.
The company examined data from its revenue cycle analytics platform used by more than 2,100 hospitals and 300,000 physicians. It categorized any initial bill that commercial, Medicaid and Medicare insurers initially rejected, or requested more information for, as a denial.
Insights | Healthcare industry reports and events | Kodiak
Medicare Advantage funding: “When private plans were first paid capitated payments by the Medicare program, the federal government paid plans 5% less than traditional Medicare because plans were intended to be more efficient without compromising beneficiaries’ quality of care. It is time for agencies responsible for informing federal policy debates to determine whether Medicare Advantage plans have fulfilled that promise. Those calculations would provide critical context for any specific proposed changes in Medicare Advantage rules and regulations, context that is imperative for informing responsible federal health policy making.”
Policymakers Need Data On The Budgetary Impact Of Medicare Advantage Growth | Health Affairs
Physicians
Survey: Reasons for Not Having a Primary Care Physician, by Generation:
| Reason | General Population | Gen Z | Millennial | Gen X | Baby Boomer |
| Difficult to find a doctor accepting new patients | 20% | 29% | 14% | 17% | 36% |
| Difficult to find a doctor in-network for insurance* | 11% | 15% | 13% | 5% | 14% |
| Difficult to get an appointment | 15% | 14% | 18% | 10% | 11% |
| I am healthy and haven’t needed a PCP | 34% | 32% | 30% | 41% | 33% |
| Prefer to use urgent care | 16% | 18% | 19% | 12% | 11% |
| Prefer to use the ER | 6% | 8% | 6% | 8% | 0% |
| Prefer to use telehealth | 8% | 17% | 7% | 8% | 0% |
Gen Z: 18 to 27 years, Millennial: 28 to 43 years, Gen X: 44 to 59 years, Baby Boomer: 60 to 69 years
Aflac 2025 Wellness Matters Survey, April 2025
Polling
Corporate Board Member-Diligent survey: Director priorities: “As tariffs, inflation and sourcing disruptions grow…Directors’ outlook for the coming months ticked up in Q2… but that doesn’t mean America’s board members are breathing easy. Our latest polling finds the director community remains deeply concerned about the economic impact of the Trump administration’s policies, prompting new approaches to risk oversight in America’s boardrooms.
The extent of the impact from the current administration is extensive. Directors rate the current risk level for U.S. companies at 6.8 out of 10, on a scale where 1 is Negligible and 10 is Significant, with 81 percent of the 126 public company board members polled May 12-14 listing tariffs as the top business risk today.
Second on the list? A tie at 46% between two other Washington-created challenges: “supply chain / sourcing disruptions” and “inflation and currency fluctuations” (the survey asked directors to list their top three challenges). The third and fourth picks were D.C.-driven as well: geopolitics and regulatory changes.“
Poll Finds U.S. Boards Struggling to Navigate Washington ‘Mess’ – Corporate Board Member
Axios-Harris poll: Top 100 Corporate Reputations: Per Harris: “This survey is the result of a partnership between Axios and Harris Poll to gauge the reputation of the most visible brands in America, based on 20 years of Harris Poll research The Axios Harris Poll 100 is a trusted ranking of the reputations of companies most on the minds of Americans, with a framework Harris has used since 1999.”
| Overall | Healthcare | ||
| Rank: 2025
Score |
Change in Rank
‘19-‘25 |
Rank: 2025
Score |
Change in Rank
’19-25 |
| 1-Trader Joe (82.1)
2-Patagonia (82.0) 3-Microsoft (80.7) 4-Toyota (80.6%) 5-Costco (80.6)
|
+12
+6 +8 +6 +6 |
57-CVS (73.4)
61-Pfizer (72.8) 62-Johnson & Johnson (72.8) 65-Walgreens (71.9) |
-21
+4 +11 -14 |
Note: The Axios-Harris 3-stage methodology is solid. Understandably, the study focus lends itself to national brands of organizations that advertise/market directly to consumers.
The 2025 Axios Harris Poll 100 reputation rankings
Population Health
Study: homeless population use of health system: In 2023, more than 650 000 people experienced homelessness on any given night in the US; 28% of the homeless population of the US and 49% of its unsheltered population reside in California. UCSF researchers analyzed use of the health system surveying 3200 homeless adult last year. Findings:
In this cross-sectional study of 3200 adults experiencing homelessness in California, there was low ambulatory care use, high unmet needs for health care and medication, and high short-term care use, but most participants had insurance. Being unsheltered, having impairment with activities of daily living, and illicit substance use were associated with poor health care access; being insured was associated with having access.
Meaning: The study results suggest that people experiencing homelessness have limited access to health care and high short-term care use despite high rates of insurance.”
Health Care Access and Use Among Adults Experiencing Homelessness | JAMA Health Forum | JAMA Network
Avalere: Opioid abuse cost: “Opioid abuse is as much an economic problem as a public health one, according to a comprehensive analysis provided first to Axios that concludes it costs an average of nearly $700,000 to treat each affected person. The cost burden falls unevenly, with states in a belt stretching through Appalachia to New England typically having bigger caseloads and a higher cost per case.
- Opioid use disorder cost the U.S. an estimated $4 trillion in 2024, ranging from $419,527 per case in Idaho to more than $2.4 million in D.C. That covers lost productivity, health insurance costs, property lost to crime and other variables. The cost per case totaled more than $1 million in West Virginia, Rhode Island, Ohio and Maryland.
- The cumulative economic burden on patients, including years of life lost and reduced quality of life, exceeded $3 trillion in 2024, Avalere estimated. Behavioral therapy alongside long-acting injectable buprenorphine —a treatment that reduces the risk of future overdoses — generate an estimated $295,000 savings per case, the biggest cost-saver of the options Avalere analyzed.
Avalere www.avalere.com
Prescription Drugs
Study: Part D network design: “Medicare Part D plans incentivize the use of specific pharmacies through preferred networks. We found that independent pharmacies and pharmacies in low-income, Black, and Latinx neighborhoods were less likely to be preferred by most Part D plans than chains and pharmacies in other neighborhoods. Pharmacies that were not preferred by most plans were 70–350% more likely to close than other pharmacies.”
Regulators/Lawmakers
CMS: ACO REACH changes expected: “The Centers for Medicare and Medicaid Services will revise a popular Medicare accountable care organization as new evidence indicates the program is saving more money. CMS is updating financial benchmarks and risk-adjustment formulas for ACO Realizing Equity, Access and Community Health, or ACO REACH to improve the model’s sustainability.
Background: In 2023, standard ACOs reduced gross spending by $197.5 million, or 0.9%; new ACOs achieved $36.8 million, or 6.2%, in gross savings; and high-needs ACOs produced $2.3 million in gross savings, or 0.3%. CMS also found that all types of ACO REACH participants substantially reduced emergency department visits without losing ground on quality. However, after Medicare paid out shared savings and losses and quality bonuses, ACO REACH still operated at a net cost to the government, which CMS aims to change by modifying the model.
CMS www.cms.gov
HHS on MAHA commission report: “Coming just 98 days after President Trump signed an Executive Order, links to an external website establishing the MAHA Commission and tasking it with delivering a “Make Our Children Healthy Again Assessment, links to an external website,” the report exposes a range of contributing factors—including poor diet, accumulation of environmental toxins, insufficient physical activity, chronic stress, and overmedicalization.”
MAHA Commission Unveils Landmark Report Exposing Root Causes of Childhood Chronic Disease Crisis | HHS.gov May 22, 2025
CMS seeks input on hospital price transparency rule effectiveness: “Regulations, Proposed Rules To meet the President’s Executive Order to ensure compliance with the transparent reporting of complete, accurate, and meaningful data, CMS seeks public input (by July 21, 2025) on whether and how CMS can improve hospital price transparency (HPT) compliance and enforcement processes to ensure that the pricing information in the machine-readable file (MRF) is accurate and complete. To improve our understanding of this issue, CMS encourages input from a broad range of stakeholders including hospitals that are subject to the HPT requirements; innovators who utilize and analyze the HPT data; payers, such as employers who may use the data for contract negotiations; researchers; consumers who may use the information to find out how much a hospital will charge for items and services; and other interested parties.
Background: Section 2718(e) of the Public Health Service Act (the PHS Act) requires each hospital operating within the United States (U.S.) for each year to establish, update, and make public a list of the hospital’s standard charges for items and services provided by the hospital, including for diagnosis-related groups (DRGs) established under section 1886(d)(4) of the Social Security Act (the Act). Section 2718(b)(3) of the PHS Act requires the Secretary of HHS (Secretary) to promulgate regulations to enforce the provisions of section 2718 of the PHS Act, and, in so doing, the Secretary may provide for appropriate penalties.
CMS Hospital Price Transparency Accuracy and Completeness Request for Information | CMS
CMS’ Most Favored Nation Drug Pricing mandate: “HHS expects each manufacturer to commit to aligning US pricing for all brand products across all markets that do not currently have generic or biosimilar competition with the lowest price of a set of economic peer countries. The MFN target price is the lowest price in an OECD country with a GDP per capita of at least 60% of the U.S. GDP per capita. These targets will drastically bring down U.S. drug prices, which are often three to five times higher than prices abroad, while preserving innovation by simply ensuring that Americans bear no greater burden than patients receiving the same drugs in other countries.”
HHS, CMS Set Most-Favored-Nation Pricing Targets to End Global Freeloading on American Patients May 20,2025 www.hhs.gov
FDA announces vaccine policy change: Last Tuesday, the FDA announced it will require drug manufacturers to conduct more scientific studies before approving updated COVID-19 vaccines for healthy adults under age 65. FDA officials said the new framework will likely shift away from approving updated COVID-19 vaccines each year, especially since the virus is now mutating at a slower rate.
Regulators will require more data showing the shots are safe and effective for healthy adults and children; by requiring randomized, controlled trials to show benefits outweigh risks, FDA commissioner Marty Makary and Prasad wrote in a commentary in the New England Journal of Medicine. The FDA also announced yesterday that it will limit access to Covid-19 vaccines going forward to people 65 and older and others who are at high risk of becoming seriously ill if they are infected, and will require manufacturers to conduct clinical trials to show whether the vaccines benefit healthy younger adults and children.
FDA www.fda.gov
Reproductive freedom ballot initiative: On Nov. 3, 2026, Missouri voters will decide on a constitutional amendment that would repeal Amendment 3, which added a fundamental right to reproductive freedom to the Missouri Constitution. This move will make Missouri the first state where voters will decide whether to repeal an existing right-to-abortion constitutional amendment.
Note: Missouri is one of 14 states that have decided on a state right-to-abortion constitutional amendment. The first three states to pass these amendments were California, Michigan, and Vermont in 2022, the same year the U.S. Supreme Court overturned Roe v. Wade in the Dobbs v. Jackson Women’s Health Organization decision. Out of the 14 states, voters passed amendments in 11 and rejected amendments in Florida, Nebraska, and South Dakota.
Ballotpedia May 20, 2025
