Since the murder of UnitedHealth executive Brian Thompson in New York City December 4, 2024, attention to health insurers has heightened. National media coverage has been brutal. Polls have chronicled the public’s disdain for rising premiums and increased denials. Hospitals and physicians have amped-up campaigns against prior authorization and inadequate reimbursement. For many health insurers, no news is a good news day. Here’s ChatGPT’s reply to how insurers are depicted:
“Media coverage of US health insurers focuses heavily on the challenges consumers face due to high costs, coverage denials, and complicated policies, often portraying insurers as profit-driven entities that hinder care access. Investigations reveal insurers using technology to deny claims and push for denials during prior authorization, while other reports highlight market concentration and the increasing influence of large companies like UnitedHealth Group and Centene. Media also covers the marketing efforts of insurers, particularly for Medicare Advantage plans, and public frustration with the industry. “
In some ways, it’s understandable. Insurance, by definition, is a bet, especially in healthcare. Private policyholders—individuals and employers– bet the premiums they pay pooled with others will cover the cost of a condition or accident that requires medical care. In the 1960’s, federal and state government made the same bet on behalf of seniors (Medicare) and lower-income or disabled kids and adults (Medicaid). But they’re bets.
But the rub is this: what healthcare products and services costs and their prices are hard to predict and closely-guarded secrets in an industry that declares itself the world’s best. Claims data—one source of tracking utilization—is nearly impossible to access even for employers who cover the majority of U.S. population (56%).
Spending for U.S. healthcare is forecast to increase 54% through 2033 from $5.6 trillion to $8.6 trillion— the result of higher costs for prescription drugs and hospital stays, medical inflation, technology, increased utilization (demand) and administrative costs (overhead). Insurers negotiate rates for these, add their margin and pass them thru to their customers—individuals, employers and government agencies. It’s all done behind the scenes.
The public’s working knowledge of how the health system operates, how it performs and what key players in the ecosystem do is negligible. For most, personal experience with the system is their context. We understand our personal healthiness if so inclined or fortunate to have a continuous primary care relationship. We understand our medications if they solve a problem or don’t. We understand our hospitals if we or a family member use them or occasionally visit, and we understand our insurance when we enroll choosing from affordable options that include the doctors and hospitals we like and when we’re denied services or billed for what insurance doesn’t cover.
Today, corporate names like UnitedHealth Group, Humana, Cigna, Elevance, CVS Aetna and Centene are the health insurance industry’s big brands, corralling more than 60% of the industry’s private and government enrollment with the rest divided among 1,149 smaller players. Today, the public’s perception of health insurers is negative: most consider insurance a necessary evil with data showing it’s no guarantee against financial ruin. Today, it’s an expensive employee benefit for employers who are looking for alternative options for workforce stability. And only 56% of enrollees trust their health insurer to do what’s best for them.
Ours is a flawed system that’s not sustainable: insurers are part of that problem. It’s premised on dependence: patients depend on providers to define their diagnosis and deliver the treatments/therapeutics and enrollees depend on insurers to handle the logistics of how much they get paid and when. At the point of service, patients pay co-pays and after the fact, get an “explanation of benefits” along with additional out of pocket obligations. Hospitals and physicians fight insurers about what’s reasonable and customary compensation, and patients unable to out-of-pocket obligations are handed off to “revenue cycle specialists” for collection. Wow. Great system! Mark it up, pass it thru and let the chips fall where they may—all under the presumed oversight of state insurance commissioners who are tasked to protect the public’s interests.
Do insurers deserve the animosity they’re facing from employers, hospitals, physicians and their enrollees? Yes, but certainly some more than others. Facts are facts:
- Since 2020, health insurance premium costs have increased 2-4 times faster than household necessities and wages for the average household. Affordability is an issue.
- Denials have increased.
- Enrollee trust and satisfaction with insurers has plummeted.
- And industry profits since 2023 have taken a hit due to post-pandemic pent-up demand, pricey drugs including in-demand GLP-1’s for obesity and increased negotiation leverage by consolidated health systems.
Most Americans think not having health insurance is a bigger risk than going without. But most also think healthcare is fundamental right and the government should guarantee access through universal coverage. Having private insurance is not the issue: having insurance that ensures access to doctors and hospitals when needed reliably and affordably is their unmet need.
In the weeks ahead, employers will update their employee health benefits options for next year while facing 9-15% higher costs for their coverage. States will decide how they’ll implement work requirements in their Medicaid programs and assess the extent of lost coverage for millions. Insurers who sponsor market place plans suspended by the Big Beautiful Bill will raise their individual premiums hikes 20-70% for the 16 million who are losing their subsidies. Medicare Advantage (Medicare Part C) insurers will skinny-down the supplements in their offerings and raise premiums alongside Part D increases, And, every insurer will inventory markets served and product portfolio profitability to determine investment opportunities or exit strategies. That’s the calculus every insurer applies every year, adjusting as conditions dictate.
Most private insurers pay little attention to the 8% of Americans who have no coverage; those inclined tend to be smaller community-based plans often associated with hospitals or provider organizations.
Most are concerned about continuity of care for their enrollees: they know 12% had a lapse in their coverage last year, 23% are under-insured and 43% missed a scheduled appointment or treatment due to out-of-pocket costs involved.
And all are concerned about the long-term financial viability of the entire health insurance sector: margins have plummeted since 2020 from 3.1% to 0.8%%, medical loss ratio’s have increased from 98.2% in 2023 to 100.1% last year, premiums increase grew 5.9% while hospital and medical expenses grew $8.9% and so on. The bigger players have residual capital to diversify and grow; others don’t.
Criticism of the health insurance industry is justified for the most part but the rest of the story is key. The U.S. system is broken and everyone knows it. But health insurers are not alone in bearing responsibility for its failure though their role is significant.
The urgent need is for a roadmap to a system of health where the healthiness and well-being of the entire population is true north to its ambition. It’s a system that’s comprehensive, connected, cost-effective and affordable. Protecting turf between sectors, blame and shame rhetoric and perpetuation of public ignorance are non-starters.
Paul
PS: Two important events last week weigh heavily on U.S. healthcare’s future:
In Verona, WI, the Epic User Group Meeting showcased the company’s plans for AI featuring 3 new generative AI tools — Emmie for patients, Art for clinicians and Penny for revenue cycle management. Per KLAS, the private company grew its market share to 42% of acute care hospitals and 55% of acute care beds at the end of 2024.
In Jakson Hole, WY, the Federal Reserve Bank of Kansas City’s annual economic symposium where Fed Chair Jay Powell signaled a likely interest rate cut in its September 16-17 meeting and changes to how the central bank will assess employment status going forward.
Healthcare is labor intense, capital intense and 26% of federal spending in the FY 2026 proposed budget. The Fed through its monetary policies has the power and obligation to foster economic stability. Epic is one of a handful of companies that has the potential to transform the U.S. health system. Transformation of the health system is essential to its sustainability and necessary to the U.S. economic stability since healthcare is 18% of the country’s GDP and its biggest private employer.
Resources: National Association of Insurance Commissioners (NAIC), Kaiser Family Foundation (KFF), Commonwealth Fund, US Bureau of the Census Community Surveys, HHS, Trilliant, Gallup, Business Group on Health, JD Power, Forrester
Sections in today’s report
- Quotables
- Economy
- Employers
- Hospitals
- Insurers
- Physicians
- Public Health
Quotables
Rosenthal on health insurance costs: “Wary of inflation, Americans have been watching the prices of everyday items such as eggs and gasoline. A less-noticed expense should cause greater alarm: rising premiums for health insurance. They have been trending upward for years and are now rising faster than ever.
Consider that, from 2000 to 2020, egg prices fluctuated between just under $1 and about $3 a dozen; they reached $6.23 in March but then fell to $3.78 in June. Average gas prices, after seesawing between $2 and $4 a gallon for more than a decade starting in 2005, peaked at $4.93 in 2022 and recently fell back to just over $3.
Meanwhile, since 1999, health insurance premiums for people with employer-provided coverage have more than quadrupled. From 2023 to 2024 alone, they rose more than 6% for both individuals and family coverage — a steeper increase than that of wages and overall inflation…
If voters paid as much attention to the price of health insurance as they do to the cost of gas and eggs, maybe elected officials would respond with more action.”
Opinion | Health insurance premiums are making Americans poorer – The Washington Post
Andrew Witty, CEO of UnitedHealth Group on Trust in insurers: “Health care is both intensely personal and very complicated, and the reasons behind coverage decisions are not well understood… Resentment toward insurance companies is not inevitable—it’s a symptom of an opaque, broken system. A commitment to honesty, clarity and demonstrating value is the first step toward eliminating hostility and creating a healthier future.”
How Insurance Companies Can Rebuild Trust Forbes
Barnes on Epic’s AI strategy: “For sure, the health AI race is on, and it is all happening so fast. I am reminded of the line by little Charlie Bucket, whom Willy Wonka entrusts to take over the Chocolate Factory, when he nervously asks his Grandpa Joe about the Wonka Mobile: Is this going to go fast, Grandpa? And Grandpa Joe responds: It should, Charlie; it’s got more gas in it than a politician.”
Only What Matters on Health Information Policy Julie Barnes
HHS, NIH, CDC staffers letter to Kennedy, Congress on August 8 CDC shooting: “We, the undersigned, write to you with grave concern for America’s health and security. The violent August 8th attack on CDC’s headquarters in Atlanta was not random. The attacker fired hundreds of rounds into buildings as the CDC workforce inside carried out its mission of serving the American people. The attack came amid growing mistrust in public institutions, driven by politicized rhetoric that has turned public health professionals from trusted experts into targets of villainization—and now, violence. “
Save HHS www.savehhs.org August 20, 2025
Board culture merits attention: “Much has been written about the importance of a company’s culture as a key factor in its performance. The “most brilliant” corporate strategy may fail if it is not aligned with and supported by the company’s culture, which is defined by the National Association of Corporate Directors as “the sum of the shared assumptions, values and beliefs that create the unique character of an organization…
It is far less recognized or discussed in business literature that boards have their own culture, and it can have a huge impact upon the board’s performance. Yet, board culture is often overlooked and is seldom mentioned in board assessments and evaluations, especially when they are performed by the board itself or its nom/gov committee…
So, what is board culture? Similar to company culture, it is a “sum of the assumptions, values and beliefs,” but, in this case, those that underpin the board and its activities, including how it is organized and composed, how it plans and conducts meetings as well as how it makes decisions and follows up on them…”
Board Culture’s Role in Assessment and Evaluation – Directors & Boards
On Trump administration de-regulation efforts: “President Trump has long prioritized deregulation and directed his administration to swiftly eliminate federal rules and unnecessary regulatory burdens…Based on an ongoing review of publicly available changes in the Federal Register, we identified more than 100 agency actions to revoke, withdraw, or repeal existing rules, guidance, or notices across 20 federal agencies…
To date, there has been far less deregulatory action to rescind or withdraw health care-related regulations at the Department of Health and Human Services (HHS). Although HHS has taken fewer actions to rescind policies relative to other agencies, we expect HHS deregulatory action to increase over time, bringing with it the potential for significant disruption for patients, health care providers, health insurers, drug manufacturers, state officials, and other stakeholders. The resulting chaos and confusion will be even more severe if changes are made without advance notice and an opportunity for interested parties to provide input or comment…”
The Trump Administration’s Deregulatory Agenda: A Six-Month Review | Health Affairs
Frist on rural health: “The Rural Health Transformation Program is limited in size and will not solve for the array of challenges our rural health care systems face – including new difficulties arising from the One Big Beautiful Bill’s Medicaid cuts. But it signals a shift: rural health care matters, and technology can help make it more accessible, equitable, and sustainable.
The future of rural health will rely less on large inpatient facilities and more on connected networks—care delivered in homes, local clinics, and mobile units, supported by secure digital infrastructure and AI-driven efficiency.
Rural America’s tradition of resilience and resourcefulness positions it to lead this transformation. Just as mobile technology leapfrogged landlines in parts of the world, rural health can bypass outdated models and move directly into a connected, patient-centered era.
With the right policies, partnerships, and technology, rural communities can shape a health care system that is smarter, earlier, and more personal—delivering care without distance.”
Bill Frist Second Opinion August 18, 2025 (10) Bill Frist | Substack
On leader self-awareness: “The workplace admiration that corrupts leaders starts with a simple lie about their own importance—and ends with devastated families and damaged companies… That lie centers around the importance and “specialness” of being a leader. I know it sounds like a cliché, but the reality is that people laugh harder at a CEO’s jokes, speak to him (or her) with greater respect and admiration, and lavish him with more praise than he deserves. Cliché or not, it’s a reality that can corrupt the humblest of leaders who don’t get the same treatment from their spouses or children, and actually come to resent them.
Leadership Lessons From The Coldplay KissCam
STAT analysis: Executive Compensation vs. company performance in healthcare: “The top executives running the health care industry’s blue-chip companies amassed generational wealth in 2024, even as many businesses slipped in the eyes of their investors. Health care remains a highly profitable industry. But the biggest companies didn’t meet the lofty expectations of shareholders, dragging down their stocks. A few CEOs lost their jobs as a result… But many who stayed were rewarded even more…
A STAT analysis of corporate filings found the people leading 275 of the most prominent health care companies made a combined $3.6 billion in 2024 — surpassing the $3.5 billion that a bigger group of CEOs made in 2023. In all, the average health care CEO made more than $13 million, and the median took home $5.5 million. Those were the highest figures since 2021.
Ninety-one CEOs earned at least $10 million in 2024, the highest number of executives making at least eight figures since 2021.
However, health care continued to disappoint its investors. The S&P 500 health care index, which includes 60 of the largest publicly traded health care companies, increased less than 1% in 2024 and Nasdaq’s biotechnology index fell 1%. Meanwhile, the broader S&P 500 soared 24%. But the people leading health care’s biggest firms still reaped big rewards.”
Health care CEO pay 2024: BioNTech’s Uğur Şahin tops list | STAT
Economy
CBO: Impact of Big Beautiful Bill, Medicare cuts: “The Congressional Budget Office and the staff of the Joint Committee on Taxation estimate that under the act deficits will increase by $2.1 trillion over the 2025–2029 period and by $3.4 trillion over the 2025–2034 period relative to CBO’s January 2025 baseline, excluding any macroeconomic or debt-service effects… By CBO’s estimate, average increases in the deficits stemming from the act will total $415 billion over the 5-year period and $339 billion over the 10‑year period…The 4% maximum reduction in Medicare spending would continue to apply to sequestration orders for years after 2026. If OMB ordered a sequestration of $415 billion for each year through 2029 and $339 billion each year from 2030 through 2034, the ordered reductions in Medicare spending would increase to $76 billion in 2034 and would total $491 billion over the 2027–2034 period…”
CBO’s Estimates of the Statutory Pay-As-You-Go Effects of Public Law 119-21 August 15, 2025
Job market for new grads: “New graduates are having an especially tough time landing a job right now: The share of unemployed Americans who are new to the workforce is at a 37-year high…
13.4% of unemployed Americans in July were “new labor force entrants,” those looking for jobs with no prior work experience, including new high school and college graduates. It’s the highest number since 1988, according to the Federal Reserve Bank of Richmond.
The frozen hiring market is a “double-whammy” for Gen Z: Many of these job hunters entered college at the height of pandemic lockdowns and…. the $920 billion in annual savings from AI adoption represents over 40% of what S&P 500 companies spend on compensation, signaling job cuts could be coming. This could show up as companies not replacing workers lost to attrition, rather than doing sweeping layoffs.”
Bureau of Labor Statistics via Federal Reserve Bank of Richmond.
WSJ on housing market slowdown, shift to rentals: “Housing construction in the U.S. jumped much more than expected last month, reflecting a recovery in the multifamily market as developers respond to demand for rental housing.
Housing starts, a measurement of home construction, were 12.9% higher in July compared with a year earlier, according to Census Bureau data on Tuesday. Economists surveyed by The Wall Street Journal had expected a 2.8% increase.
Rental housing drove the big increase. Construction of projects with five units or more was 27.4% higher in July compared with last year, while starts of single-unit projects were 7.8% higher.
Some of that growth is merely a return-to-normalcy after an abnormal pause in construction last summer, when many builders were waiting for a potential interest-rate cut in the fall.
But the July spike also represents a more fundamental divergence in the housing market: Apartment construction is recovering steadily while single-family construction is declining. Construction of projects with five units or more is 18.1% higher from the start of the year.”
Home-Building Climbed Unexpectedly in July – WSJ
Credit card use and consumer spending: “Americans are starting to pull back from a pandemic-era credit-card binge. After a surge in credit-card spending that pushed Americans’ card balances above $1 trillion, growth is now moderating. Credit-card spending has been growing more slowly than debit-card spending since late last year, the first such stretch in nearly four years, according to the latest spending data from Visa and Mastercard.
More recently, household budgets have been under pressure on several fronts, from the resumption of student-loan payments to high credit-card interest rates. In that environment, some card companies are becoming pickier about whom they offer cards to, focusing on well-heeled customers. Consumers are growing more cautious about taking on new debt.
Spending on both credit and debit cards is still rising. But in the first six months of this year, U.S. debit-card spending—which typically accounts for a little more than half of all card payments—rose 6.57% from a year earlier. Credit-card spending, by comparison, rose 5.65%, the Visa and Mastercard data shows…
Many of those borrowers are looking for breathing room as rising rates make revolving debt harder to manage. But relief can be temporary. A separate TransUnion study found that while borrowers who consolidate card debt into personal loans initially reduce their card balances by an average of 57%, many refill those cards within 18 months.”
Americans Pull Back from an Epic Credit-Card Binge – WSJ
Gottlieb on U.S. drug research competitiveness: ”Reconstituting the robust scientific infrastructure that once fueled US biotechnological breakthroughs could become exceedingly difficult. We ought to strengthen the foundations of the US’s biomedical enterprise by implementing measures that reduce the cost and complexity of initial drug development.
This strategy could help keep our entire discovery engine more cost-competitive with Chinese biotechnology firms, which are increasingly gaining the advantage. Their edge lies in a nimble ability to shuttle promising compounds more quickly through early preclinical and phase 1 clinical trials, by testing what works, discarding what does not, and sharpening their focus through real-time data. If the US can lower the regulatory barriers to preclinical and phase 1 clinical testing, we can also expand more of these experiments into the hands of nimble academic laboratories, thereby broadening, rather than narrowing, the scope and productivity of US biomedical research.”
Securing America’s Pharmaceutical Innovation Edge | JAMA Forum | JAMA Health Forum | JAMA Network August 21, 2025
PE slowdown: “The private-equity industry globally had an “inventory” of over 30,000 companies through the first quarter of this year… At last year’s pace of exits, it would take about eight years to clear that inventory….
Dragging out the period from investment to payback reduces investment returns by some measures. It also could extend a recent industrywide slowdown of new fundraising and fee growth. Investors who don’t get their money back from an old fund can be less inclined to sign up for new ones.”
Private Equity Firms’ Stocks Are Struggling, Despite Getting Into 401(k)s – WSJ
Pew: Immigrant population decline: The total number of immigrants in the U.S. has declined for the first time in decades, according to new analysis from the Pew Research Center. The foreign-born population fell from 53.3 million in January to 51.9 million in June, a drop of 1.4 million people that coincides with Donald Trump’s major deportation push and ICE raids. The workforce shrinkage comes from a combination of forced removals and people leaving in fear, according to Axios. Immigrants made up 19% of the U.S. workforce in June, a drop of 1% compared to the same time last year. The study raises questions about the harm the outflux could have on the economy. January’s 53.3 million was a record high for foreign-born workers. Pew’s analysis was conducted using data from the Census Current Population Survey.”
Record 14 Million Unauthorized Immigrants Lived in the US in 2023 | Pew Research Center
Consumer Sentiment: The University of Michigan preliminary August consumer sentiment index dropped to 58.6 from a final reading of 61.7 in July. U.S. consumer sentiment unexpectedly fell for the first time since April, and inflation expectations rose on lingering anxiety about the impact of tariffs. Both the sentiment index and the inflation gauges were worse than economists had anticipated.
Surveys of Consumers August 2025
Employers
Business Group on Health 2026 Employer survey: A total of 121 employers across varied industries who cover 11.6 million people completed the survey between June and July 2025. Highlights:
- Employers predict that health care cost trend increases for 2026 will come in at a median of 9%, offset to 7.6% with plan design changes. On a compounded basis, costs in 2026 are likely to be 62% higher than 2017 levels.
- 41% are either changing PBMs or conducting a request for proposal (RFP), while 51% are either changing or conducting an RFP for other health and well-being vendor relationships.
- In 2024, nearly a quarter of all employer health care spend (24%) went to pharmacy expenses. Further, employers see no relief on the horizon, with a forecast of an 11% to 12% increase in pharmacy costs heading into 2026.
- 67% of multinational employers said U.S. health costs impact their global strategies. Cancer, musculoskeletal conditions, cardiovascular issues and diabetes were again identified as the top cost drivers of concern worldwide. Domestically, cancer, mental health, obesity and women’s health are primary targets of employer cost concerns.
- Employers see several approaches as having promise to improve quality of care: navigation to higher-quality providers (selected by 82% of employers), greater transparency of quality data (82%) and coordination of integrated care teams (79%).
- 99% see protecting and affirming ERISA as a key policy imperative. When employers were asked to rank their top priorities for the U.S. government, 85% responded with protection of tax-free status as one of their top five, followed closely by protection of ERISA preemption (81%). In addition, more than six in 10 employers (62%) said they would also prioritize pharmacy supply chain reform.
2026 Employer Health Care Strategy Survey: Executive Summary | Business Group on Health August 19, 2025
eHealth survey of small businesses: eHealth surveyed 503 owners/managers of employers with fewer than 500 employees in July 2025. Highlights:
- 89% of those currently sponsoring group health plans worry they won’t be able to afford it within three years.
- 93% say it’s time for a new health benefit solution, because the current model isn’t working anymore.
- 75% say employers should make defined monetary contributions for employees to use toward purchasing their own coverage, rather than sponsoring a traditional employer-based group health plan.
- 66% of those not currently offering group health benefits say they would contribute toward the cost of employee-purchased health insurance premiums if there was a way to do so.
- 92% of respondents say government leaders aren’t paying enough attention to the health benefit challenges of business owners.
- 82% say they would be more likely to adopt ICHRA if tax incentives proposed in the House version of the Big Beautiful Bill became available.
- 54% of respondents remain unfamiliar with or uneducated about ICHRA even after Congress debated an expansion of ICHRA in an early version of the Big Beautiful Bill
The Challenge of Health Benefits for Smaller Businesses
Hospitals
SG2 on Inpatient costs: The average cost of an inpatient stay rose 4.8% from mid-2023 to early 2025… At academic medical centers, per-case cost growth nearly doubled the rate of expense inflation at community hospitals between the first quarters of 2022 and 2025.
www.sg2.com
HHS Study: Medicare discharges Against Medical Advice (AMA): “The rates at which enrollees leave acute care hospitals against medical advice (AMA) have steadily increased since 2006 across most demographics we analyzed and spiked during the COVID-19 public health emergency. Enrollees who left AMA were more likely to have poor health outcomes than enrollees discharged to their homes. The rates at which enrollees have left AMA appear inversely correlated to the quality of-care ratings of the associated hospitals— the lower the rating, the higher the rates. Enrollees eligible for both Medicare and Medicaid (dual enrollees) and enrollees with a mental health diagnosis were more likely to leave AMA than Medicare-only enrollees and enrollees without a mental health diagnosis, respectively. • This data brief may be beneficial in the development of future guidance to address this growth, which could improve enrollee health outcomes and save taxpayer dollars
Nursing shortage due to faculty shortage: In 2024, U.S. nursing schools turned away 80,162 qualified applications. Within that total, 65,398 applications from entry-level baccalaureate were turned away, 1,530 from RN-to-BSN, 7,603 from master’s, 5,366 from DNP and 265 from PhD nursing programs.
To address these issues, health systems are taking up the torch to support education opportunities for nursing students and new nurses…
The American Association of Colleges of Nursing found the number of students enrolling in most nursing undergraduate and graduate programs has increased, reversing a several-year-long downward trend. In 2024, the total number of applications to nursing programs of all levels reached 728,819, an increase of 46,272 applications since 2023. By program, the applications increased by 8.5% for BSN, 4.5% for master’s, 7.2% for PhD, and 18.5% for DNP programs. Only RN-to-BSN programs saw a slight decrease in applications, at -0.7%.”
Study: Not-for-profit CEO compensation: “From 1978 to 2022, CEO compensation grew 1,209.2%, whereas the typical worker’s compensation in the same period grew only 15.3%. In 2022, among the largest 350 public corporations in the US, it was estimated that CEOs were paid 344 times more than the average nonsupervisory worker…The health care industry employs eight of the ten highest-paid nonprofit CEOs in the country. An analysis of hospital wage ratios found that the highest-paid nonprofit hospital CEOs received 60 times the average hourly pay of hospital workers without advanced degrees. Previous research found that from 2005 to 2015, the CEO-pediatrician pay gap increased from 7:1 to 12:1, and the CEO-nurse pay gap increased from 23:1 to 44:1.
The inflation-adjusted average annual wage for CEOs increased from $813,657.6 in 2009 (95% confidence interval: 772,578.9, 854,736.4) to $1,037,182.7 in 2023. The top five paid executives saw an increase in their average annual wage from $509,121.7 in 2009 to $626,726.8 in 2023. The average employee wage increased from $76,837.3 in 2009to $84,370.5 in 2023. The average wages of the CEO and top executives grew by 27.5% and 23.1%, respectively, whereas the average wages for all employees (including top executives) increased by 9.8%)..
Our study results establish the existence of major wage inequalities between executive and nonexecutive hospital workers within nonprofit hospitals. We found that these inequalities may be more dramatic than previously reported.”
Pay Gap Between Nonprofit Hospital CEOs And Employees Grew, 2009–23 | Health Affairs August 2025
Insurers
Trilliant report on health plan price variation: “Commercially insured patients across the country pay widely varying amounts for the same procedure, the costs of which are primarily underwritten by employers. Across six inpatient procedures, negotiated rates varied by an average ratio of 9.1 across the country.
- Within the same state, the average ratio for the most to least expensive negotiated rate ranges from 3.2 for small and large bowel procedures (MS-DRG 330 and 331) to 3.4 for coronary bypass without cardiac catheterization without major complications or comorbidities (MS-DRG 236) and hip and knee joint replacement without major complications or comorbidities (MS-DRG 470).
- Different payers negotiate very different amounts for the same procedure at the same hospital. Across six inpatient procedures, the average difference in price between the Aetna and UHC negotiated rate ($15,366) was equivalent to 30.0% of the average median procedure price.
- Within a sample of 10 hospitals that have been featured on various “best hospital” lists, there was no observable correlation between aggregate measures of cost and quality.
- Across the five outpatient surgeries that were examined, the national median surgery center rate was always lower than the median rate for hospital outpatient departments.
…these results reveal a startling spread in pricing for healthcare services that begs for explanation, not rationalization or justification.” coupled with publicly available quality benchmarks, empowers employers and consumers to understand the actual price differences for the same service in the same market and, in turn, to evaluate the value for money offered by the providers in that market.”
2025 Health Plan Price Transparency Report | Trilliant Health.pdf
JD Power: enrollee satisfaction falling: A July 2025 study by J.D. Power found a significant decline in member satisfaction with Medicare Advantage (MA) plans: satisfaction dropped to an average score of 623 out of 1,000, which is down 29 points from the previous year. According to the study, the primary cause for this decline is a 39-point drop in members’ overall trust in their plans. Related findings:
The study found a strong correlation between digital engagement and satisfaction…
First-year members often experience confusion and unmet expectations, with only 38% saying their insurer fulfills their service expectations. This number rises to 45% among established members who have been with the same plan for more than a year. Common challenges for new members include understanding their explanation of benefits, how to find in-network doctors, deductibles, prior authorizations, and the use of their Health Savings Account (HSA) or Health Retirement Account (HRA).
Medicare Advantage Study | J.D. Power
Study: Medicare Part D after IRA: “The Inflation Reduction Act (IRA) included several changes to Medicare Part D prescription drug coverage effective in 2024 and 2025, including a $2000 annual out-of-pocket limit and the shifting of spending from the government to plan sponsors. Federal policies prevented premium increases in 2025, but Part D plans may have responded by increasing deductibles or medication cost sharing.”
Researchers analyzed annual changes in Medicare Part D premiums, deductibles, and cost sharing from 2019 to 2025. Findings:
“For Medicare Advantage plans, mean deductibles decreased from $153 in 2019 to $66 in 2024, then increased to $228 in 2025…For 9 high-spending, non-specialty, brand-name drugs, mean monthly out-of-pocket costs ranged from $46 to $55 from 2019 to 2024 and increased to $73 in 2025. In stand-alone plans, changes were observed before and after implementation of the IRA: mean deductibles increased steadily from $295 in 2019 to $490 in 2025, and the proportion of beneficiaries with coinsurance for preferred brand-name drugs increased from 21.9% to 84.0%. Cost sharing for the 9 drugs increased steadily from $62 in 2019 to $108 in 2025 in stand-alone plans. Premiums for both plan types decreased throughout the study period.
This cross-sectional study demonstrates that as the IRA’s changes to Part D were implemented in 2024 to 2025, there were concurrent changes in plan design that may increase cost sharing, particularly for beneficiaries who do not spend more than the $2000 annual out-of-pocket limit and for those in Medicare Advantage plans. Additional policies may be needed to address cost sharing and ensure the affordability of essential medications covered by Medicare Part D.”
Physicians
Medscape: Factors that Affect Physician Incentive Bonus Calculation: Per Medscape, the average incentive bonus was $48k in 2024 based on these factors
- RVUs (productivity): 60%
- Quality care metrics: 43%
- Patient satisfaction ratings: 26%
- Records completion: 24%
- Number of procedures: 18%
- Patient mix: 11%
- Payer mix: 11%
- Patient throughput time: 10%
- Cost-of-care reduction: 10%
- Other: 14%
Medscape Physician Compensation Report 2025, July 2025
Prescription Drugs
Study: Costs of drug exclusivity protections: “In this retrospective serial cross-sectional analysis of 4 top-selling drugs (imatinib, glatiramer, celecoxib, and bimatoprost) including 5.7 million Medicare beneficiaries, extended market exclusivity beyond key patent expirations ranged from 7 to 13 months. This delay resulted in an estimated $3.5 billion in excess spending over a 2-year period, with $1.9 billion in commercial plans and $1.6 billion in Medicare.
These findings indicate that policies promoting timely generic drug availability by limiting market exclusivity extensions could lead to substantial savings for US patients and payers.”
Public Health
AAP at odds with HHS guidance on Covid vaccinations for children: Last Tuesday, the American Academy of Pediatrics recommended Covid-19 shots for all children ages 6 months through 23 months. Children in that age group are particularly vulnerable to severe Covid-19 infections and the vaccines would protect them from serious illness. The group’s guidance differs from current Covid-19 shot recommendations from the Centers for Disease Control and Prevention under the leadership of Health and Human Services Secretary Robert F. Kennedy Jr., a longtime vaccine skeptic who accused AAP of a conflict of interest due to its relationships with corporate sponsors including Pfizer and Moderna.
HHS (Kennedy reply: “AAP should … be candid with doctors and hospitals that recommendations that diverge from the CDC’s official list are not shielded from liability under the 1986 Vaccine Injury Act,”
Leading Pediatrics Group Recommends Covid-19 Shots for Young Children, Differing From CDC – WSJ
JAMA study: Financial conflicts of interest (COIs) among federal vaccine panel members: “US Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr has expressed concerns about conflicts of interest (COIs) in HHS vaccine advisory committees. He has stated that the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) is “plagued” with COIs and that “97% of the people on [ACIP] had conflicts,”1 citing a 2000 congressional report on a single vaccine.” Analysis:
- The average prevalence rate of reported COIs among members of the CDC Advisory Committee on Immunization Practices (ACIP) dropped from 42.8% in 2000 to 5% in 2024, said Genevieve Kanter, PhD, of the University of Southern California in Los Angeles, and colleagues.
- On the FDA Vaccines and Related Biological Products Advisory Committee (VRBPAC), average annual COI prevalence fell from 11.1% in 2000 to less than 4% between 2010 and 2024…
Conflicts of Interest in Federal Vaccine Advisory Committees | Regulatory Agencies | JAMA | JAMA Network August 18, 2025
Report: transgender population in U.S.: 2.8 million people in the U.S. age 13 and older identify as transgender, according to a new report from the Williams Institute. That comes out to 3.3% of 13- to 17-year-olds and 0.8% of adults. Among trans adults (2.1 million total), there’s a pretty even split between trans men, trans women, and trans nonbinary people.
The Williams Institute, part of UCLA, has been reporting on the size and characteristics of the trans population since 2011, and the report notes that data quality and availability has substantially improved in that time. But that’s changing under the Trump administration. The report uses data from the CDC’s Youth Risk Behavior Survey and the Behavior Risk Factor Surveillance System. But the CDC has said it will no longer process data on transgender identity.
How Many Adults and Youth Identify as Transgender in the United States? – Williams Institute
