The Hertel Report

CBO Report: MA Will Reach 57% Penetration & Claim 61% of Spending by 2036

Top of The Day

CMS Rules

CMS Finalizes 2.4% Medicare Payment Increase for Skilled Nursing Facilities

Skilled nursing facilities will receive an estimated $882.7 million increase in Medicare payments under the fiscal year 2027 payment rule finalized by the Centers for Medicare and Medicaid Services. CMS approved a 2.4% increase in Skilled Nursing Facility Prospective Payment System rates, reflecting a 3.3% increase in the cost of...

News

Molina Profits Plunge as Membership Falls Across Major Business Lines - Net Income Falls 76%

Like Centene, Molina Healthcare lost members across its major insurance businesses during the second quarter. Unlike Centene, which returned to profitability, Molina reported steep declines in earnings and revenue as medical costs consumed a larger share of premiums. As of June 30, 2026, Centene reported approximately 4.9 million...

News

Centene Turnaround, Predicts $193.5B to $197.5B in Annual Profits in 2027 - Offers Buyouts to Workforce

The improved financial results came despite broad declines in membership. According to Centene, Medicaid enrollment fell 5.5% year over year to 12.1 million, Marketplace enrollment dropped 40% to 3.5 million and Medicare membership declined about 5% to 980,000. Growth in stand-alone Medicare drug plans, up 12% to 8.8 million members,...

National News

Part D Prescription Drug Demo Ends in 2027, Most Enrollees Will Pay More in 2027

More than 510,000 Arizona Medicare beneficiaries enrolled in stand-alone Part D prescription drug plans could face higher premiums next year after the Centers for Medicare and Medicaid Services (CMS) ends a temporary premium stabilization program. According to 24/7 Wall St., an estimated 75% of stand-alone Part D enrollees nationally...

Arizona News

Pima County & Cities Win Injunction Against 2027 ACA Marketplace Rules

Last Thursday, a U.S. District Court sided with a coalition of cities, interest groups and Pima County to issue an injunction against rules finalized by the Centers for Medicare and Medicaid Services (CMS) that would disrupt Affordable Care Act (ACA) healthcare marketplaces and lower the quality of available plans. Pima County joined...

National News

UnitedHealth Raises 2026 Outlook, Pivots to Artificial Intelligence as Net Income Up 61%

UnitedHealth Group has raised its expectations for the year in response to strong improvements in its second-quarter earnings report. The high returns are attributable to strong showings from UnitedHealthcare and Optum. The report showed that net income jumped 61% year-over-year (YOY) to $5.48 billion, and quarterly revenue modestly...

Arizona News

Senate Bid to End WISeR Fails, Arizona Medicare Pilot Continues

The Wasteful and Inappropriate Service Reduction (WISeR) Model will continue operating in six states, including Arizona, after Senate Democrats failed late last week to end the widely criticized pilot, which uses artificial intelligence to support prior authorization decisions for traditional Medicare claims. The program uses AI to...

Arizona News

Maricopa County Measles Update - New Public Exposures Identified

Maricopa County has confirmed 25 measles cases among residents in 2026, far exceeding the county’s annual average of one case over the past 30 years, as health officials warn of continued local transmission and new public exposures across the Valley. The latest exposure alert involves an infected nonresident who visited several...

Arizona News

Arizona Now Leads Nation in Drug Death Rate as Fentanyl Goes From Pill to Powder

Arizona overtook West Virginia in 2025 to record the highest drug death rate even as overdose deaths continued to decline across much of the country. Arizona recorded 43.5 drug deaths per 100,000 residents, nearly twice the national rate of 22.1, according to a New York Times analysis of provisional federal mortality data. Arizona and...

Arizona News

Arizona Monitoring Cyclospora as Multistate Lettuce Outbreak Sickens 1,644

Arizona health officials are monitoring a nationwide rise in cyclosporiasis as federal investigators examine a multistate outbreak linked to shredded iceberg lettuce sourced from central Mexico. Arizona is also not among the states where distribution of recalled lettuce has been confirmed. Cyclospora is a microscopic intestinal...

National News

FQHC Claims 'Food is Medicine' OIG Responds it Won't Enforce Violated Statutes

A federally qualified health clinic (FQHC) reached out to the Department of Health and Human Services (HHS) Office of Inspector General (OIG), seeking approval for a Food Is Medicine-inspired experiment, to test a proposal to either give boxes of food valued at $30 to patients or $20 in food vouchers to buy produce from participating...

News

Congress, Drugmakers and Trump Administration Target $100 Billion 340B Program

As sales from the 340B Drug Pricing Program reach $100 billion, the Trump administration, Congress and pharmaceutical companies are moving quickly to modify the program and reduce flexibilities. Total costs of prescription drugs purchased under the 340B discount drug program increased 22.8% year-over-year, according to new data from...

Arizona News

ACA Enrollment Falls to 19.2 Million - Arizona Sees Nearly 30% Decline - 2027 Rate Increases

Affordable Care Act enrollment numbers are out for the first time since the expiration of tax credit subsidies spiked premiums at the beginning of the year. Arizona ranked as one of the top states in coverage losses. A new report from the Department of Health and Human Services (HHS) found that enrollment has fallen from 22.1 million...

Arizona News

From Repeal to Regulation: Trump Administration & Arizona Reshapes ACA Coverage Options

After a decade of failed attempts to destroy the Affordable Care Act (ACA) through legal challenges, the Trump administration is changing its approach to applying heavy modifications that favor employers and boosting plans that aren't required to meet ACA criteria. This time, the administration is reaching out to states like Arizona for...

National News

HHS Targets Fraud While Medicare Advantage Insurers Battle Over Billions

This week, the Department of Health and Human Services (HHS) announced that it will target fraud in the Medicaid and Medicare Advantage programs, and more MA insurers filed suit seeking to increase their star ratings bonuses. The HHS Office of Inspector General announced it had generated $5.6 billion  in "monetary impact" from...

KaufmanHall: National Hospital Flash Report, May 2026

In May, America's hospitals saw higher net operating revenue and outpatient revenue compared with a year earlier, while inpatient volumes remained comparatively flat. Labor costs continued to rise, although workforce levels have largely stabilized. Drug, supply and purchased service expenses also remained above prior-year...

Select Medical to Close Tucson LTAC Hospital, Lay Off 99 Employees

Select Medical Corp. plans to close its 28-bed Select Specialty Hospital–Tucson East in September, eliminating 99 positions, according to a Worker Adjustment and Retraining Notification (WARN) filed with the state on July 9. The long-term acute care hospital, located on the Tucson Medical Center campus, specializes in the treatment...

National News

CMS Proposes Sweeping Medicare Physician Payment Reforms to Expand Accountable Care

The Centers for Medicare & Medicaid Services (CMS) has proposed sweeping updates to the Medicare Physician Fee Schedule (PFS) that would expand accountable care organizations (ACOs), sunset traditional Merit-based Incentive Payment System (MIPS) in 2029 and further shift physician reimbursement toward value-based care. The CMS...

National News

CDC Vaccine Study Published in JAMA After Being Blocked by NIH Director

Late last month, JAMA Network Open published a report on the effectiveness of the 2025-2026 COVID-19 vaccine after the paper was rejected for publication by the Center for Disease Control and Prevention's (CDC) Morbidity and Mortality Weekly Report (MMWR) by acting CDC Director and National Institutes of Health (NIH) Director Jay...