40 minutes into the 108-minute State of the Union address Tuesday night, the President laid out his healthcare policy priorities for 2026 and after:
- Increased focus on price transparency (building on 2021 and 2022 Executive Orders that targeted hospitals and insurers).
- Increased use of Most Favored Nation pricing agreements to lower prescription drug costs.
- Increased adoption of Health Savings Accounts by individuals who lost premium tax credits (aka ‘ill-conceived elements of “Obamacare).
These are the backbone of the President’s “Great Healthcare Plan” (January 15, 2026) that is premised on his view that the healthcare system is fundamentally flawed because consumer interests are not served. His plan reckons consolidation and corporatization in the $5.3 trillion U.S. healthcare enterprise as business strategies to profit operators (hospitals, medical practitioners, insurers, long-term care providers), suppliers (drugs, supplies, technologies, facilities), regulators and advisors at the expense of consumers. It posits that increased competition, less regulation, more transparency and a more direct role for consumers are necessary changes.
The administration’s negative predisposition toward the entire health system is well-documented. It has populist appeal, especially in traditional Republican voter cohorts who were the targeted audience for his SOTU. But notably, the President elevated a fourth priority sparking unusually-high tension in the chamber: Medicaid fraud.
The President called out Minnesota for systemic fraud in its Medicaid program blaming state officials for allowing Somali immigrants to mishandle the programs and while pocketing millions through corrupt means. The President then used the spotlight to announce the formation of an Anti-Fraud Task Force focused on Medicaid to be led by VP Vance, HHS Secretary Kennedy and CMS Director Oz.
The next day, Dr. Oz announced initial Task Force actions including “deferral” of $259.5 million in quarterly Medicaid payments to the MN until it “acts to get its fraud under control” and a 6-month nationwide moratorium on Medicare enrollment for new Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers. Game On.
SOTU ‘26 is now in the books, dominating the media cycle the rest of last week while deflecting attention away from the Epstein files at least temporarily. That ended abruptly at 2:30 a.m. Saturday morning when U.S. and Israeli forces bombed Iran and set in motion a conflict of unknown consequence. For now, and perhaps the next few weeks or longer, media attention will set aside healthcare issues though health costs will factor into primary elections in Texas tomorrow.
Lest overlooked, the President’s SOTU did not include topics of high interest in health industry watchers–rural health, food safety, vaccines, workforce shortages, FDA drug review procedures, Veteran’s Health, agency funding (FDA, CDC, NIH, HRSA et al) and many more. But criticism of Medicaid fraud drew POTUS’ commentary because it’s a galvanizing issue for MAGA voters and it resonates with the majority of Americans who think government spending is wasteful. Consider:
- Fraud in healthcare is significant and growing. The FBI estimates up to 10% of healthcare spending is fraudulent—that’s more than $500 billion annually. It’s perpetrated in every sector of the system by known actors, criminal networks and business interests that cut corners illegally. Billing for services not provided, upcoding, unbundling, kickbacks, medically unnecessary services, misrepresentation of clinical benefit, and many more are widespread and even SOP in some sectors and organizations.
- Medicaid is a soft target for anti-fraud efforts in healthcare. It’s a huge program covering 76.8 million low-income adults and children at a cost of $971.billion last year. Medicaid and social services programs are primarily overseen by states. Eligibility, enrollment, coverage, utilization, funding and payments vary widely by state and change constantly. Funding is shared between states and federal appropriations. Federal oversight is modest, federal funding is restricted and the public’s appetite to pay higher federal or state taxes is low. Not coincidentally, the Affordable Care Act (March 2010) under President Obama prioritized Medicaid expansion as a means to increased coverage. The Big Beautiful Bill (July 2025) under President Trump reversed expansion by ending premium subsidies and imposing work requirements for adult enrollees. What makes Medicaid a soft target is (1) states have primary responsibility for their programs allowing members of Congress to deflect accountability to state lawmakers and (2) it serves a low-income population that’s historically under-represented in health policy-setting. And, spending has increased at least 7% annually in recent years, lending to suspicions of waste and fraud.
- Reliable, verifiable information about healthcare fraud is becoming more accessible. News outlets rely on government reports and studies sponsored by private think tanks and trade groups. Healthcare organizations and academics use AI-enabled search tools to probe large datasets to identify anomalies and unexpected patterns. Social media offer bona fide “tips” leading to deeper/broader investigations. Each sector in the industry is producing exponentially more data about transactions, relationships, costs and outcomes: sophisticated analysts are anxious to explore these data and regulators relish their use in the fraud detection activities.
FRAUD is the new F bomb in healthcare. It rallies industry critics to a common purpose. Medicaid is only the start.
Paul
PS: Last week, I chronicled my journey since having quadruple by-pass surgery in December. Reactions came from 3 groups: folks who’d survived the same surgery, folks who had struggled with health system navigation challenges I faced, and folks who vented that most hospitals now care more about profits than patients. Ironically, I spent 4 and a half-hour last night in the ED (again), this time for a precautionary ultrasound. I was 8th when eventually added to the waiting list after the attending found I was mistakenly not listed after assessment by the attending. A pattern?
As I sat there, the complexity of the human condition, the fragility of health and the frontline heroism of ED staff were on full display. Ours is a flawed system; it’s not bad people. It’s worth the effort to fix it.
Resources in addition to citations below:
Pauses in grant proposal evaluations,
KFF Health Tracking Poll: Health Care Costs, Expiring ACA Tax Credits, and the 2026 Midterms | KFF January 29, 2026
Fact Sheet: President Donald J. Trump Calls on Congress to Enact the Great Healthcare Plan – The White House January 15, 2026
State-Level Impacts of Key Medicaid Provisions in the One Big Beautiful Bill Act | RAND
Sections on this report:
- Quotables
- Health Economy
- Hospitals
- Insurers
- Physicians
- Polling
- Population Health
- Prescription Drugs
- Workforce
Quotables
Bloomberg on Consumer Confidence: “The great inflation shock of the 2020s, which helped bring President Donald Trump back to power, is in the rearview mirror now. But the hangover is all around.
Shoppers have been forced to get used to a new normal they plainly resent. While inflation has slowed overall, the costs of things Americans often want or need most continue to rise — like groceries, utilities and housing. For those forced to borrow to cover their bills, it’s becoming a struggle: delinquency rates just climbed to the highest in almost a decade.
All of this has put the question of “affordability” at the center of November’s congressional elections. Living standards are always a key battleground, and there’s been some encouraging data lately. Last month saw inflation come in below forecasts – though it’s still high enough to keep the Federal Reserve worried – while jobs beat them. But in the US economy nowadays, even good news can’t always dispel the bad vibes.”
Inflation Is Down, But Americans Still Feel an Affordability Squeeze Bloomberg February 18, 2026 https://www.bloomberg.com/graphics/2026-cost-of-living
Health Affairs Op Ed on Unit Costs in Healthcare: “There are real consequences of erroneously focusing policy attention on the use and intensity of care as the driver of exorbitant expenditure growth. By suggesting the use and intensity of care as the culprit, decisionmakers may perceive coverage reductions and higher co-payments as the solution to reduce demand. This will result in less access to care and worsen health outcomes, when the real cause of high spending growth is that the prices paid for care exceed the value they provide.
Reframing spending growth away from prices may be appealing, but it does little to change the underlying economics of U.S. health care. While utilization is undeniably part of the equation, prices—whether labeled explicitly or embedded in measures of intensity—remain central to understanding why US health spending levels are high and why spending continues to grow.”
“The US Health Spending Problem Is Still About Prices” Health Affairs February 18, 2026 https://www.healthaffairs.org/content/forefront/us-health-spending-problem-still-prices
Politico on RFK: “He’s taken on Big Pharma and stood toe-to-toe with the American Medical Association. Bent Washington’s most entrenched trade associations to his will and successfully crusaded against some of the world’s most powerful food companies.
But there’s one industry Robert F. Kennedy Jr. has been unable to humble so far in his ground-breaking tenure as secretary of Health and Human Services — the big multinational chemical corporations.
His conspicuous failure to rein in pesticide makers unfolded on a global stage recently after President Donald Trump signed an executive order invoking the Defense Production Act to boost production of glyphosate, the active ingredient in the herbicide Roundup. The move prompted an explosive backlash from Kennedy’s allies, and his attempt to smooth things over was viewed as a flip-flop on an issue that’s been central to his reputation as a change agent.”
The 1 industry RFK Jr. couldn’t steamroll – POLITICO
Pearl Meyer: Public Company Director Compensation: “Median public company director pay rose a modest 3% in 2025, according to the 27th annual Director Compensation Report produced by the National Association of Corporate Directors (NACD) and executive compensation advisory firm Pearl Meyer.
Other highlights:
- Compensation committee chair pay rose 29% from 2020 to 2025 — the largest increase among board committees — compared with an 11% increase for other committee chairs.
- Despite the modest pay increase for directors, NACD’s report showed median director tenure declined to 6.1 years, down from 8.7 years in 2015.”
For Directors, Pay Is Growing Modestly While Board Duties Get Heavier https://worldatwork.org/publications/workspan-daily/for-directors-pay-is-growing-modestly-while-board-duties-get-heavier
Health Economy
Report: National Health Spending 2024: “Health care spending in the US reached $5.3 trillion and increased 7.2% in 2024, similar to growth of 7.4% in 2023, as increased demand for health care influenced this two-year trend. As in 2023, the use and intensity of health care goods and services continued to grow rapidly in 2024, particularly for hospital care, physician and clinical services, and retail prescription drugs. The insured share of the population remained relatively high in 2024, at 91.8%, after its peak in 2023 of 92.5%. Health care spending growth continued to outpace overall economic growth in 2024, and as a result, the health care share of the economy increased from 17.7% in 2023 to 18.0% in 2024.
Health care spending reached $5.3 trillion, or $15,474 per person, growing 7.2% in 2024 This was the second consecutive year of growth above 7% (growth was 7.4 % 2023), after growth of 4.1% in 2021 and 4.0% in 2022. The strong growth in both 2023 and 2024 was driven by nonprice factors (such as increased demand for care and changes in the composition of the health care goods and services consumed), as evidenced by growth in personal health care spending that averaged 8.9% per year the highest average growth rate for two consecutive years since 1991–92, when it was 9.1% (data not shown for 1991–92). The increased use of health care goods and services in 2024 was somewhat higher than many health insurers anticipated.”
National Health Care Spending Increased 7.2 Percent In 2024 As Utilization Remained Elevated Health Affairs January 14, 2026 https://doi.org/10.1377/hlthaff.2025.01683
KFF on healthcare spending 2022-2024: “National health expenditures increased by $692 billion between 2022 and 2024, from $4.6 trillion to $5.3 trillion. During this period, spending on hospital care alone accounted for $277 billion of spending growth, or 40% of the total increase in national health spending. The large contribution of hospital care to overall health spending growth reflects the fact that hospital spending accounted for nearly a third of national health expenditures in 2022 and grew more quickly than national health expenditures overall in both 2023 and 2024.”
CBO Update: Medicare Part A solvency: The Congressional Budget Office’s new projection for Medicare Part A (hospitals, nursing homes): Part A “will run out of money 12 years earlier than they predicted last year, largely due to the GOP tax-and-spending bill.
“We estimate that the HI trust fund’s balance is exhausted in 2040. The balance generally increases through 2031, but spending begins to outstrip income in the following year…
Total benefits would need to be reduced (in relation to the amounts in our baseline projections) by an amount that rises from 8% in 2040 to 10% in 2056, we estimate. It is unclear what changes the Centers for Medicare & Medicaid Services would make to operate the Part A program under those circumstances.
We estimate that the HI trust fund’s actuarial balance measured over a 25-year period is negative: an actuarial deficit of 0.30% of taxable payroll (or 0.13% of gross domestic product, or GDP).
RAND study: HR1 impact on Medicaid: “On July 4, 2025, President Donald Trump signed into law the One Big Beautiful Bill Act (Public Law 119-21), a massive budget reconciliation package with implications for many sectors of the U.S. economy. The law contains a series of policy changes that aim to reduce federal spending and improve program integrity in Medicaid, the nation’s joint state-funded and federally funded health program for people with low incomes and disabilities. Broadly, these Medicaid changes impose work requirements on non-disabled adults, increase the frequency and stringency of eligibility determinations and redeterminations, limit spending on immigrants, and tighten provisions that have historically enabled states to increase their federal funding. The authors of this report combined publicly available data, published literature, state and federal agency reports, and other sources of information and developed customized approaches to build state-level estimates through 2034 of Medicaid budget impact and enrollment changes associated with several key provisions of the law. Key Findings
- In total, state Medicaid budgets will be reduced by $665 billion over the 2025–2034 period. State general funds will be reduced by $86 billion. Estimated federal savings amount to $714 billion.
- Medicaid expansion states with substantial use of state-directed payments (SDPs) and provider taxes — Arizona, Iowa, and Nevada — stand to see reductions of more than 15 % of their Medicaid budgets (a combined impact of reduced federal and state spending). California and New York similarly have substantial use of SDPs and provider taxes and see the largest dollar-value reductions to Medicaid budgets, on the order of $112 billion and $63 billion, respectively.
- As a non-expansion state without substantial use of SDPs or provider taxes, Florida sees minimal budgetary impacts of the provisions studied (a <0.5-percent change to its Medicaid budget). Some expansion states, such as North Dakota and Nebraska, that similarly do not rely heavily on SDPs and provider taxes will also see minimal budgetary impacts of the provisions studied because expected gains from a rural health program in the law are likely to offset the majority of the losses from other provisions.
- A few states, such as Wyoming and South Dakota, will see increases in Medicaid budgets; these states have small populations (and therefore smaller Medicaid budgets overall), so they stand to gain substantially in percentage terms from the rural health program and see little to no impact from other provisions.
- Across the provisions examined, the authors estimate a joint impact of 7.6 million fewer Medicaid enrollees in 2034.
State-Level Impacts of Key Medicaid Provisions in the One Big Beautiful Bill Act | RAND February 26, 2026
Hospitals
CBO’s Updated Projections of Hospital Insurance Trust Fund (HI): “The HI trust fund is used to pay for benefits under Medicare Part A, which covers inpatient hospital services, care provided in skilled nursing facilities, home health care, and hospice care. The fund derives its income from several sources. Over the next 30 years, about three-quarters of its annual income comes from the Medicare payroll tax and roughly one-eighth comes from income taxes on Social Security benefits. The rest comes from other sources.
We estimate that the HI trust fund’s balance is exhausted in 2040. The balance generally increases through 2031, but spending begins to outstrip income in the following year.
As required by the Deficit Control Act, our projections reflect the assumption that benefits would be paid as scheduled even after the HI trust fund was exhausted. If the balance of the fund was exhausted and the fund’s spending continued to outstrip its income, total payments to health plans and providers for services covered under Part A would be limited by law to the amount of income credited to the fund. Total benefits would need to be reduced (in relation to the amounts in our baseline projections) by an amount that rises from 8 percent in 2040 to 10 percent in 2056, we estimate. It is unclear what changes the Centers for Medicare & Medicaid Services would make to operate the Part A program under those circumstances.
We estimate that the HI trust fund’s actuarial balance measured over a 25-year period is negative: an actuarial deficit of 0.30 percent of taxable payroll (or 0.13 percent of gross domestic product, or GDP).”
CBO’s Updated Projections of the Hospital Insurance Trust Fund’s Finance February 23, 2026 https://www.cbo.gov/publication/62165
Furst Group report: Health system CFO turnover: “The statistics are jarring. Our analysis reveals that 60% of CFOs at health systems with $15 billion or higher in revenue have been in their roles for 2.5 years or less. When we add data from organizations with around $10 billion in revenue, turnover remains significant at 40%…
These aren’t just numbers on a spreadsheet. They represent a significant breakdown in the continuity of financial leadership across our largest health systems, with only 35% of departing CFOs retiring rather than leaving for other opportunities. This indicates that while baby-boomer generation retirements account for about a third of CFO departures, most leadership changes result from other factors, such as career moves, market opportunities, dissatisfaction, or cultural challenges. This generational shift, combined with the increasing complexity of healthcare finance leadership, signals a systemic disruption that demands new thinking about CFO talent identification, development, succession planning, and leadership transition.”
From Crisis to Continuity: Closing the Leadership Gap in Succession Planning for Healthcare CFOs Furst Group https://www.furstgroup.com/resources/from-crisis-to-continuity-closing-the-leadership-gap-in-succession-planning-for-healthcare-cfo
Study: Nurse staffing and hospital outcomes: “In this cohort study of 77 289 hospital admissions across 82 wards in Japan, patients exposed to nurse understaffing during the day shift or during the 24-hour period had higher in-hospital mortality and increased readmission rates, whereas evening and night shift understaffing was not associated with these outcomes. Understaffing during the 24-hour period, as well as during the day shift and evening and night shift, was associated with longer hospital stays…
These findings suggest that maintaining nurse staffing at or above the ward’s typical level for each shift, particularly during day shifts, is associated with improved patient outcomes.
In this cohort study, nurse understaffing during the 24-hour period (specifically during the day shift) was associated with increased risk of in-hospital mortality, hospital readmission, and longer LOS. These findings suggest that close attention to daily staffing levels and prompt action to address understaffing may help improve patient outcomes. Nurse managers should routinely monitor deviations from this benchmark to address immediate needs and enable rapid adjustments through feasible strategies.”
Hospital Nurse Understaffing and Patient Mortality, Readmission, and Length of Stay JAMA Network February 25, 2026 https://jamanetwork.com/journals/jamanetworkopen
HCA stock hits high: The stock price for HCA Healthcare all-time high ($540.57) last Wednesday before ending the week at $529.70—up 30.6% in the last 5 months and more than 100% in the past three years.
UBS, a multinational investment bank and financial services company, upped its target price for the health care company on Feb. 23 to $635 per share from $598 per share.
HCA Healthcare www.hchealthcare.com
Insurers
Arnold Ventures comment letter on Medicare Advantage overpayment: ”Our work within the health care sector is driven by a recognition that the system costs too much and fails to adequately care for the people it serves… there are substantial overpayments in MA and action is urgent to ensure MA delivers on its promise of robust competition leading to value for beneficiaries and taxpayers, and the sustainability of the Medicare trust fund… Arnold Ventures strongly supports CMS’s efforts and urges CMS to finalize these changes – especially the proposal to remove chart-review-based diagnoses not tied to medical encounters from risk adjustment… MedPAC estimates that Medicare premiums – paid by beneficiaries in both TM and MA – were about $13 billion higher in 2025 because of excess payments to MA plans…”
Re: Comments on the CY 2027 Medicare Advantage Advance Rate Notice February 20, 2026 hbgjioklmpbdmemlmbkfckopochbgjpl/https://assets.arnoldventures.org/uploads/PDFs/AV-Comment-Letter-on-2027-MA-Advance-Notice_022026.pdf
KFF on 2026 Medicare Advantage enrollment growth: “Overall, the data show that total Medicare Advantage enrollment continued to increase, although at a slower rate of growth than in prior years…
These patterns suggest that the Medicare Advantage market remains an attractive choice for Medicare beneficiaries. In 2026, the average Medicare beneficiary can choose from among Medicare Advantage plans with prescription drug coverage, most of which have no premium (other than the standard Part B premium) and the vast majority of which offer dental, vision, and hearing benefits, in addition to reduced cost sharing compared to traditional Medicare without a supplement.
Just over 35 million people are enrolled in Medicare Advantage as of February 1, 2026. That reflects an increase of 1.1 million people since February 2025, which translates into 3% growth year-over-year. Enrollment in Medicare Advantage has increased steadily over the last two decades, rising from 8 million people (19% of eligible beneficiaries) in 2007 to 34 million people (54% of eligible beneficiaries) in 2025, but the pace of enrollment growth has recently slowed. In 2025, enrollment increased 4%…”
Medicare Advantage Enrollment Grew by About 1 Million People, Mainly Due to Special Needs Planshttps://www.kff.org/medicare/medicare-advantage-enrollment-grew-by-about-1-million-people-mainly-due-to-special-needs-plans
KFF: Insurer margin, MLR comparisons in 2024: KFF analyzed insurer data provided to the National Association of Insurance Commissioners (NAIC) at the end of 2024. Highlights:
“In 2024, per enrollee gross margins in dollars were highest in the Medicare Advantage market, and medical loss ratios (measured as percentages) were lowest in the individual insurance market. In 2024, the Medicaid managed care market had both the lowest gross margins per enrollee and highest medical loss ratio…
Gross margins: At the end of 2024, gross margins per enrollee ranged from $608 in the Medicaid managed care market to $1,655 in the Medicare Advantage market. Gross margins per enrollee in the group market was $846, roughly half the level observed among Medicare Advantage plans on average. Per enrollee gross margins in the individual market in 2024 amounted to $987….
In 2024, MLRs were similar between the Medicare Advantage, Medicaid managed care, and group markets. However, individual market loss ratios were lower. Simple loss ratios were around 85% in individual market, 88% in the fully insured (group) market, 90% in the Medicare Advantage market, and 91% in the Medicaid managed care market.”
Health Insurer Financial Performance in 2024 February 23, 2026 https://www.kff.org/medicare/health-insurer-financial-performance
UnitedHealth announces Optum reset: In January, UHG told investors its revenue for 2026 might decrease. Last week, while announcing fourth quarter and full-year 2025 earnings, the nation’s largest insurer said it plans to reduce its delivery division shedding 550 locations, or 20% of its footprint.
Optum Health lost $278 million from operations in 2025, a decline from the $7.8 billion in gains reported a year ago, as revenue fell less than 1% to $25.5 billion. The company attributed the performance to tighter controls over Medicare Advantage spending and higher costs.
Optum CEO Patrick Conway said slowdowns in Optum Health, the pharmacy benefit manager Optum Rx and the technology unit Optum Insight were expected this year as emphasis shifts to valued-based care initiatives. The company’s UnitedHealthcare subsidiary appears set to rebound sooner than other lines of business despite recording just $10 million, or $0.01 per share, in net earnings during the fourth quarter, a 99.8% drop from the year-ago period. Fourth-quarter revenues rose 17.5% to $87.1 billion.
UnitedHealth sees first annual revenue drop in over 30 years – Modern Healthcare
Physicians
Study: Ghost physicians in Medicaid: “To assess patterns of Medicaid participation among physicians, we linked physician enrollment files to Medicaid administrative claims from the period 2019–21, focusing on five physician specialties: cardiology, dermatology, ophthalmology, primary care, and psychiatry. We examined the proportion of Medicaid-enrolled physicians with any claims activity and the volume of unique Medicaid patients and encounters per physician. We found that although 68–89% of physicians were enrolled in Medicaid, nearly 28% delivered no care to Medicaid beneficiaries in 2021. Participation in Medicaid varied widely by specialty: More than 40% of psychiatrists were “ghost” physicians who saw no Medicaid enrollees in a given year, whereas primary care physicians were most likely to be high-volume “core” participants. Although most physicians maintained stable participation over time, approximately one-fifth of ghost providers and one-third of “peripheral” providers (those seeing 1–10 Medicaid enrollees per year) transitioned to a higher-engagement group between 2020 and 2021. Taken together, our findings demonstrate that given relatively limited and variable Medicaid participation, targeted policy efforts—particularly in specialties such as psychiatry—may help strengthen physician engagement and reduce access gaps.”
‘Ghost’ Physicians: More Than One-Quarter Of Physicians Enrolled In Medicaid Delivered No Care To Beneficiaries In 2021 https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2025.00703
Study: Bundled Payments for Care Improvement Advanced Model (BPCI-A) results: “The design of BPCI-A evolved across four model years; however, previous analyses have not examined its impact on hospital and CMS spending throughout this period. We conducted a synthetic difference-in-differences analysis with a 100% sample of Medicare fee-for-service beneficiary data from the period April 2014 through December 2021 to evaluate spending changes across 883 participating hospitals and 1,772 nonparticipating hospitals. BPCI-A led to an average $324 reduction in hospitals’ ninety-day episode spending, with larger reductions in model years 3 and 4. The largest spending reductions were for orthopedics and neurological care. Yet large incentive payments to hospitals led to net CMS losses of $171 million during the study period, despite net savings in model year 4. BPCI-A reduced payments to skilled nursing facilities during the study period. Thus, BPCI-A had minimal impact on the CMS budget while shifting payments to hospitals and away from skilled nursing facilities. Our results suggest that voluntary bundled payment is unlikely to generate meaningful savings for CMS.”
Bundled Payments For Care Improvement Advanced: Effects On Hospital And CMS Spending, 2018–21 Health Affairs February 2026 https://www.healthaffairs.org/doi/abs/10.1377/
Study: Impact of EHR use in Primary Care: “Primary care physicians face increasing workload pressures. Some are delivering fewer patient visits, potentially in response to these pressures. However, the relationship between reduced visit volume and overall workload is unclear. Using national Epic electronic health record (EHR) metadata from the period 2019–22, we examined changes in EHR usage and patient characteristics among 772 primary care physicians who reduced monthly visits by 10% or more, compared with 16,477 primary care physicians who did not. One year postreduction, reducers’ monthly visits fell by 32.6% relative to those of non-reducers, but EHR time declined by just 21.2%, which increased EHR minutes per visit by 21.3%. Electronic inbox messaging and EHR time outside of scheduled hours per visit also rose, and reducers’ patient panels became more complex. When primary care physicians reduced visit volume, they reduced EHR use by less than the reduction in visit volume. Our findings highlight the persistence of asynchronous EHR work in primary care even when fewer visits occur. Innovative approaches are needed to enable the efficient delivery of asynchronous primary care.”
Changes In Primary Care Physicians’ Electronic Health Record Patterns After They Reduced Clinical Visit Volume February 2026 https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2025.00734
Polling
Recent polling on AI:
- 58% of Americans don’t trust AI much or at all. 63% say AI will decrease the number of jobs in the U.S., according to an Economist/YouGov pollout last week.
- In a December 2026 YouGov survey 77% of Americans were concerned AI could pose a threat to humanity.
- 79% of Americans don’t trust companies to use AI responsibly, a Bentley-Gallup survey
- 50% of Americans felt more concerned than excited about AI’s role in daily life, citing fears of job displacement, reduced human creativity, and ethical issues. While recognized for efficiency, it sparks distrust regarding misinformation and dehumanization. Pew Research Center
Reuters/Ipsos: U.S. Political environment: Reuters/Ipsos survey of 4,638 adults nationwide on February 18-23
- 61% agree “Trump has grown erratic with age” (R:30%, D: 89%, Other: 64%)
- 45% agree “Trump is mentally sharp and able to deal with challenges” (R:81%, D: 19%, Other: 36%)
- 79% agree “elected officials in Washington, D.C., are too old to represent most Americans.” (The average age in the U.S. Senate is about 64, and in the U.S. House of Representatives, it’s 58.)
- Trump’s approval rating is 40%, down from 47% (January 21, 2025)
Most Americans say Trump is growing erratic with age, Reuters/Ipsos poll finds February 24, 2026 https://www.reuters.com/world/us/most-americans-say-trump-is-growing-erratic-with-age-reutersipsos-poll-finds-2026-02-24/
Pew: Opinions about Product Safety: Per the Pew survey of 5,357 U.S. adults conducted Oct. 10-17, 2025:
- 84% said that the government “needs to do more to identify and regulate harmful chemicals found in everyday products.”
- 83% said that “companies that make chemicals found in everyday products cannot be trusted to ensure product safety without government oversight.”
- 83% want companies to tell them more about the chemicals in their products.
- 77% said polluters should be primarily responsible for paying to clean up contamination from harmful chemicals; 23% said the government should bear the main responsibility.
2025 EBRI/Greenwald Research Consumer Engagement in Health Care Survey (CEHCS): Highlights from survey conducted Oct. 13–Nov. 8, 2025 of adults ages 21–64 with coverage through an employer, purchased directly from a carrier, or obtained through a government exchange:
Health Plan Basics: Employment-based health coverage remained the dominant source of health insurance for privately insured adults, with six in 10 receiving coverage through their own job. Coverage patterns have been largely stable, with about one-third enrolled in individual-only
coverage and most others covering a spouse or partner. Deductibles remained a common feature of health coverage. More than three-quarters of enrollees had a deductible for medical care, including 70% of traditional plan enrollees. The share of traditional plan enrollees with deductibles increased in 2025, reinforcing the idea that exposure to upfront costs is not limited to high-deductible plans. Enrollment in high-deductible health plans declined slightly in 2025, and enrollment in consumer-directed health plans and health savings accounts (HSAs) appeared to be relatively stable. Non–HSA- eligible high-deductible plans continued to represent a small share of coverage.
Plan Choice: Provider networks were the most important factor when choosing a health plan, outranking premiums and other plan features. Cost- related considerations continued to play a central role in plan- choice decisions across plan types. Traditional plan enrollees placed greater importance on lower out-of-pocket costs when receiving care, while high-deductible plan enrollees placed greater importance on lower premiums. Prescription drug coverage increased in importance compared with prior years. Despite widespread familiarity with consumer-directed health plans, concerns about out-of-pocket costs continued to be the most common reason traditional plan enrollees do not select these options…”
2025 Consumer Engagement in Health Care Survey, EBRI, February 26, 2026https://www.ebri.org/content/2025-consumer-engagement-in-health-care-survey
Population Health
American Heart Association Scientific Statement: Heart disease prevalence among women: Per the AHA statement released last Wednesday: “Using historical trends from the 2015 to 2020 National Health and Nutrition Examination Survey, 2015 to 2019 Medical Expenditure Panel Survey, and census estimates for population growth, we estimated trends in prevalence through 2050 for cardiovascular risk factors based on suboptimal levels of Life’s Essential 8 and clinical cardiovascular disease and stroke, overall and by age and race and ethnicity. Results:
“Among adult women overall, the prevalence of hypertension is estimated to increase from 48.6% in 2020 to 59.1% in 2050. Diabetes (14.9% to 25.3%) and obesity (43.9% to 61.2%) will increase, whereas hypercholesterolemia will decline (42.1% to 22.3%). Prevalences of suboptimal diet, inadequate physical activity, and smoking will decline over time, and inadequate sleep will increase. Prevalences of coronary disease (6.85% to 8.21%), heart failure (2.45% to 3.60%), stroke (4.14% to 6.74%), atrial fibrillation (1.58% to 2.31%), and total cardiovascular disease and stroke (10.7% to 14.4%) will rise. Similar trends are projected in girls 2 to 19 years of age, with an increase from 19.6% to 32.0% projected in obesity. Most adverse trends are projected to be more pronounced among women and girls identifying as American Indian/Alaska Native or multiracial, Black, or Hispanic.”
Prescription Drugs
Stat on pharma lobbying: “Health secretary Robert F. Kennedy Jr. has repeatedly promised to root out industry influence from the Food and Drug Administration.
But the Trump administration’s injection of political priorities into the agency, which has long been shielded from such meddling, has opened new avenues for lobbying. The pharmaceutical industry is working to capitalize…
Companies pressuring the FDA to make favorable decisions is not new. Biogen, for example, famously lobbied senior FDA officials to approve its controversial Alzheimer’s drug. But the approach is becoming more common and more blatant. It’s reaching beyond the FDA as companies work to sell the White House or senior health department leaders on how a decision — or company’s success — can be spun as a win for the Trump administration, according to four people involved in the strategies.”
Note: Drug industry spending also is up in general. The sector had its largest single-year increase in lobbying spend on record — $61 million — according to OpenSecrets. The Pharmaceutical Research and Manufacturers of America, which represents brand-name drugmakers, spent nearly $38 million on lobbying last year, it’s highest on record. The American Chemistry Council, meanwhile, spent almost $19 million last year.
The Consumer Brands Association and the American Beverage Association, representing food conglomerates and soft drink producers, respectively, spent less than $11 million combined.
Pharma lobbyists focus on a surprising new target: the FDA StatNews February 23, 2026 https://www.statnews.com/2026/02/23/fda-lobbying-efforts-grow-under-trump-administration
Workforce
Study: Nursing school debt burden: “After enactment of HR 1 (119th Congress), the Department of Education established new annual and aggregate loan limits for professional degree programs. On November 7, 2025, the Department of Education concluded degree programs eligible for the highest level of unsubsidized loans: annual caps of $50 000 and lifetime aggregate caps of $200 000. Graduate nursing programs, including post-baccalaureate Master’s and Doctorate of Nurse Practice Degrees, were excluded and instead would be subject to a lifetime aggregate cap of $100 000. Final rulemaking is expected in early 2026…
Among respondents who answered the loan status question (n = 9570), 2086 RNs and 692 APNs reported active loans, representing 28% and 33% of the respective subgroups. In 2025 dollars, the median (interquartile range) loan balance was $33 210 ($15 498–$55 350) for RNs and $66 420 ($33 210–$110 700) for APNs.” Other findings:
- Among those with loans, 116 (5.6%) of RNs and 200 (28.9%) of APNs reported nursing student loan balances that exceeded $100 000.
- RNs and APNs with student debt cited family finances more frequently as a top concern, compared with those without student debt (73.5% vs 38.8%, respectively).
- Among nurses who had recently changed positions or anticipated changing positions within 1 year, those with student debt cited pay and benefits more frequently as the key factor, compared with those without student debt (51.0% vs 10.1%).”
Nurses carry substantial student loans: health care workforce implicationshttps://academic.oup.com/healthaffairsscholar/article/4/2/qxag019/8436264
Mehlman Consulting Committee Report: House Ways and Means Hearing on Healthcare Workforce February 25, 2026: Key Takeaway:
“There was bipartisan agreement on the need to address the nation’s physician shortage and improve health care access in rural and underserved areas. Republicans emphasized reforming Graduate Medical Education (GME) to address geographic disparities and physician shortages in rural areas; expressed concern that current GME funding mechanisms are outdated and benefit large urban hospitals over rural communities; and highlighted the need to integrate chronic disease prevention, nutrition, and technology into physician training. Democrats focused on the negative impacts of recent Medicaid cuts on rural hospital stability and health care access; and raised concerns that new caps on student loans would exacerbate physician shortages.”
2.24.26 House W&M Health Sub Hearing on Advancing Health Care Workforce – Adobe cloud storage
Workforce compensation: Payscale Compensation Survey:: “The 2026 Compensation Best Practices Survey gathered 3,413 responses from October–December 2025 with a completion rate of 50%. Highlights:
“40% of organizations report faster and more efficient compensation decision-making through AI, confidence depends heavily on governance. This highlights a clear executive concern: speed and insight must be balanced with fairness, explainability, and risk management….
In 2026, compensation management is shaped by a slow-moving labor market and tighter financial discipline, requiring organizations to be deliberate in how they invest in pay. Voluntary turnover has dropped to 8%, and positions take a median of 30 days to fill, signaling reduced churn and less urgency to compete aggressively for talent. As a result, organizations are planning measured base pay increases of 3.5%, balancing market movements and employee expectations around inflation concerns with constrained budgets. Notably, 51% of organizations cite balancing pay expectations with financial limits as their top challenge, underscoring the central tension.”
2026 Compensation Best Practices Report chrome-extension://hbgjioklmpbdmemlmbkfckopochbgjpl/https://www.payscale.com/content/report/2026-compensation-best-practice-report.pdf
