Melanie MacEachern, Author at The Hertel Report

Melanie MacEachern

Freelance writer with skills and knowledge in healthcare policy, reproductive justice and art history. Skilled administrative assistant. Graduated from University of Michigan.

Author's Posts

Arizona News

AHCCCS Turns to AI for Fraud Detection

On Monday, Arizona Governor Katie Hobbs announced that a new artificial intelligence tool would be deployed to target offenders in the state's largest fraud scandal. The scheme targeting AHCCCS/Medicaid has defrauded the state of at least $2.5...

Arizona News

CMS: Medicaid Plans Need Fewer Quality Measures

Medicaid quality measure reform is gaining momentum in the Trump administration as Centers for Medicare and Medicaid Services (CMS) leaders are raising questions about the abundance of metrics. Center for Medicaid and CHIP Services Director Daniel Brillman said that the high volume of quality measures is burdensome for states and...

CMS Rules

CMS Opens Up Plan Variety: No Provider Network - No Problem - Highlights of 2027 Marketplace Final Rule

Last Friday, the Centers for Medicare and Medicaid Services (CMS) finalized a rule that will implement new policies next year including eligibility restrictions and expanded access to non-traditional health plans. The rules will allow plans that otherwise would not qualify for the Affordable Care Act's (ACA) insurance exchange,...

News

SCOTUS Ruling Prevents Restrictions on Mifepristone

The Supreme Court has extended access to mifepristone, a widely-used and clinically-determined safe drug that is used to induce abortion. The order, issued by Justice Samuel Alito on Monday, holds back restrictions on the drug imposed by the Fifth Circuit Court of Appeals. The case at hand was originally filed by the State of...

Arizona News

Medicaid Work Requirements Looming

With the Medicaid work requirement guidance deadline looming, the advisory panel that reports to Congress on Medicaid voted to recommend that the Centers for Medicare and Medicaid Services (CMS) should develop a plan for monitoring and evaluating Medicaid work requirements and how these policies affect eligibility, enrollment, spending,...

National News

Medicare Advantage Improvement Act of 2026 Gains Industry Support

Industry leaders and health sector lobbies are lining up to support the Medicare Advantage Improvement Act (MAIA) of 2026, a bipartisan bill that addresses structural issues within Medicare Advantage. The bill focuses on critical issues with billing and coverage like prior authorization, payment timing, and billing transparency. The...

National News

Humana Q1 Report Shows Growth and Earnings Pressure

Humana will move forward on cutting supplemental benefits offered in its Medicare Advantage in response to a lower-than-expected base payment increase in federal reimbursement and a difficult first quarter due to a lower 2026 Medicare Advantage Star Rating. Earlier this month, the Centers for Medicare and Medicaid Services (CMS)...

National Reports & Surveys

Hospital Pricing Scrutiny from Families USA

New analysis from Families USA shows that hospitals are charging commercial plans far more than what Medicare pays for services, highlighting the hospital industry's role in rising medical costs. The four largest hospital systems in the country use their market dominance to overcharge customers relative to the Medicare rate, Families...

National News

ACA Enrollment Down in 2026 Q1

The Affordable Care Act health insurance exchange has taken a major hit in the first quarter of the year, according to earnings reports from large insurers, largely due to the expiration of enhanced premium subsidies that kept plans affordable for many enrollees. In aggregate, health insurers expect enrollment will shrink by at least...

National News

CVS Aetna Releases Q1 Report - Membership Declines, Revenues Increase, MLR Improves

Aetna stabilized in the first quarter (Q1) of the year after a rocky 2025, bolstering parent company CVS Health's report. The improvement was directly related to the company's government-affiliated businesses, including Medicare Advantage (MA), Medicare Supplement plans and Medicaid managed care. In a quarterly report released this...

White Papers, E books, Reports and more

Study: Medicare Advantage Compliance Enforcement is Sporadic & Ineffective

A new study published investigated federal oversight of Medicare Advantage (MA) plans and the scope of enforcement actions taken against insurers that violate federal standards. It found that enforcement actions were limited, raising concerns for regulatory effectiveness. The study, published in JAMA Internal Medicine, was prompted by...

National News

Trump Replaces U.S. Surgeon General Nominee

President Donald Trump has selected a new nominee for Surgeon General after pulling another after backlash to the another MAHA movement candidate. President Trump initially nominated Casey Means, a wellness entrepreneur, physician and published author associated with the Make America Healthy Again (MAHA) movement that believes...

National News

CMS Exposes Healthcare Social Security Data Posted by 102 Providers

The Centers for Medicare and Medicaid Services (CMS) accidentally posted the Social Security data for 100 healthcare providers in the National Provider Directory. The issue was initially noticed by the Washington Post, which reported that the publicly accessible database contained Social Security numbers linked to providers' names....

Available To All

SCOTUS Blocks Restriction on Mifepristone by Mail - Justices Pause Ban for 1 Week to Consider Louisiana Case

Late last week, the Fifth Circuit Court of Appeals reinstated a ban on abortion pills sent by mail in a ruling between the state of Louisiana and the U.S. Food and Drug Administration (FDA) over the safety of mifepristone and the accessibility of medication abortion by mail. The U.S. Supreme Court temporarily reversed the order on...

Arizona News

The New Federal West Coast Healthcare Strike Force Coming to Arizona

A new federal healthcare fraud task force will tackle Medicare and Medicaid fraud on the West Coast, including states like Arizona and Nevada, in addition to California. The Centers for Medicare and Medicaid Services (CMS) has a new data analytics system that will be deployed with the "West Coast Health Care Fraud Strike Force" to...

CMS Rules

CMS & FDA Announces RAPID: A New Pathway to Expedite Access to Innovative Medical Devices for Medicare Beneficiaries

The Regulatory Alignment for Predictable and Immediate Device (RAPID) coverage pathway is designed to streamline communication from the Centers for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA) to manufacturers in the early stages of product development, allowing Medicare beneficiaries to participate in...

National News

Consortium of Health Insurers Create New Prior Authorization Standards

The new standards are expected to be adopted by a group that includes Centene, Cigna, Humana, Aetna and UnitedHealthcare and will apply to orthopedic surgeries and imaging services like CTs and MRIs, in addition to other medical services that usually require prior authorization. Modern Healthcare reports the standards will apply to...

Available To All

Centene & UnitedHealth Group Report Healthy First Quarter Results

Health insurers are holding their first quarterly calls with investors for 2026; UnitedHealthcare appears to be back on track after a rocky 2025, and Centene is reportedly holding steady despite losses from surging ACA premiums. Centene's profits rose 17.5% to $1.5 billion in the first quarter with revenue increasing 7.1% to $49.9...

Arizona News

Measles Case Reported in Pinal County - Arizona/Utah Outbreak Grows to 600+ Cases

As the South Carolina measles outbreak comes to a close, the Arizona outbreak continues with the first confirmed community case of measles in Pinal County recorded this year. Nationally, improved detection methods are signaling that America's measles elimination status is on the rocks, propelled by increasing rates of vaccine...

White Papers, E books, Reports and more

Research: University Studies Reveal Impact of New Hep B Vaccine Policy for Newborns

Last year, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted to end the long-standing, 30-year recommendation for universal hepatitis B vaccination for all newborns within 24 hours of birth. Researchers then launched two studies, both published on Monday, on how ending the universal hepatitis B vaccine would affect...

Page 5 of 92...3 456 7 ...