Morning Briefing
Summaries of health policy coverage from major news organizations
ACA Insurers Propose Yet Another Double-Digit Rate Increase For 2027
The Wall Street Journal: Obamacare Insurers Seek Big Rate Hikes, Again
Rates for many Affordable Care Act plans rose by double digits this year. Insurers want to do the same next year. Some of the biggest Obamacare companies are seeking hefty premium increases for 2027, often for the second year in a row. In Washington state, Centene is asking for a 28% hike, after boosting rates by 35% in 2026. Blue Cross & Blue Shield of Illinois wants 15%—on top of a 28% increase this year. (Wilde Mathews, 7/8)
KFF Health News: Affordable Care Act Insurers Want More Premium Increases As Enrollment Sags
For the second year in a row, many Affordable Care Act insurers are proposing double-digit premium increases, driven by rising medical costs as well as policy changes by Congress and the Trump administration. In preliminary filings with state regulators, insurers are seeking a median rate increase of 14% for 2027, according to an analysis of filings in 16 states and the District of Columbia by the Peterson-KFF Health System Tracker. If those rates are ultimately approved, it would be the second-highest increase since 2018. (Spears, 7/8)
More on the high cost of healthcare and prescription drugs —
Fierce Healthcare: Pharmacies Hit Prime Therapeutics With Antitrust Suit
A group representing thousands of pharmacies has filed an antitrust suit against Prime Therapeutics, alleging that the company colluded with rival Express Scripts to fix prices. The lawsuit was filed July 2 in Washington federal court by Protecting Access to Retail Pharmacy, LLC, an organization that operates as TRUST, LLC. The group was formed in 2023 by the National Community Pharmacy Association to support pharmacies in investigations and potential litigation to recover controversial direct and indirect remuneration, or DIR, fees from pharmacy benefit managers. (Minemyer, 7/7)
CIDRAP: The Cost Of HIV Drugs For Medicare Is Projected To Skyrocket By 2035
As more people with HIV reach retirement age, the annual cost of antiretroviral therapy (ART) for Medicare for people 65 or older is projected to nearly triple over the next decade, from $6.4 billion in 2026 to $17.8 billion by 2035. Medicare is the federal health insurance program for older Americans and people with disabilities. The analysis, published today in JAMA Network Open, projects that 63% of the cumulative cost to Medicare for older beneficiaries living with HIV will be to pay for ART, which is the lifelong treatment that suppresses the virus to non-detectable levels. Without these antiviral medications, HIV goes from a chronic to a fatal condition. (Boden, 7/7)
MedPage Today: Private Equity Makes Deals With Healthcare Nonprofits
Private equity firms are expanding their healthcare reach by forming joint ventures with nonprofit health systems, according to a new report from the Private Equity Stakeholder Project (PESP). It's been well reported that private equity has moved to acquire physician groups, specialty practices, nursing homes, and other healthcare entities, but nonprofit joint ventures have gone under the radar, the report suggests. (Clark, 7/7)
Modern Healthcare: Why Hospitals Are Betting On Care Navigators To Protect Margins
Care navigators are helping health systems reduce unnecessary admissions and save money as chronically ill older adults and uninsured patients flood emergency departments. Care navigators are typically nurses embedded in emergency departments who connect patients to less costly outpatient services to avoid hospitalizations. Providers, including St. Louis-based BJC Health System and Chicago-based Northwestern Medicine, have been growing care navigator programs. (Eastabrook, 7/7)
KFF Health News: Patients Face A Thicket Of Red Tape Trying To Maintain Consistent Health Coverage
By the time Derion Blackman collapsed in front of a Dollar General in Kissimmee, Florida, in March, he had been waiting two months to regain access to some of the vital medications he’d been taking since undergoing a heart transplant two years ago. “He was on a nasty, dirty ground in front of a store,” recalled Sonja Smith, who is enraged about the circumstances that led to her husband’s heart failure. “He didn’t deserve to die like that.” (Rayasam, 7/8)
In other healthcare industry developments —
Modern Healthcare: Ascension Plans To Acquire Williamson Health
Ascension plans to buy Williamson Health, which operates a hospital in Franklin, Tennessee. The Williamson Health board voted Monday to sell to Ascension, which beat out bids from Nashville, Tennessee-based HCA Healthcare and UnitedHealth Group’s Optum, among other organizations, Williamson Health officials said Monday night during a meeting of the Williamson County Board of Commissioners. Ascension plans to pay $700 million for the independent hospital, clinics and other assets linked to Franklin, Tennessee-based Williamson Health, and spend $250 million on infrastructure upgrades over the next 10 years. (Kacik, 7/7)
ProPublica: Washington Medical Board Is Slow To Publicize Alleged Doctor Misconduct
Experts on laws protecting patient safety give Washington state high marks for the types of information it is willing to disclose about doctors accused of wrongdoing.Like other states, Washington lets patients look up doctors by name online to read any state allegations against them. But decades ago, Washington lawmakers created a separate pathway that doesn’t leave the homework to patients, mandating that regulators issue a press release whenever an investigation results in formal allegations being filed against a doctor. Washington is alone in legally requiring such proactive outreach to the news media, the Federation of State Medical Boards says. (Hiruko, 7/8)
Becker's Hospital Review: Mass General Brigham Prepares For Nurse, Clinician Strike: 5 Things To Know
Somerville, Mass.-based Mass General Brigham is preparing for a seven-day strike involving thousands of nurses and clinicians represented by the Massachusetts Nurses Association. Five things to know: The strike involves more than 4,000 nurses at Brigham and Women’s Hospital in Boston and about 450 clinicians at MGB Home Care. It would be the largest nurse and healthcare professional strike in Massachusetts history, set to begin July 8, according to the MNA. (Gooch, 7/7)
Modern Healthcare: How Abridge, Hippocratic AI, Ambience Are Building Nursing Tools
Health technology companies are shifting their attention to nurses, after years of developing artificial intelligence tools with physicians in mind. Several companies have recognized the best way to launch AI tools nurses will use is to involve them from the start in the development process. Many companies also have nurses on their staff and serving on their leadership teams.In April, clinical documentation company Ambience rolled out Chart Chat for Nursing. The AI tool integrates into a healthcare organization’s electronic health record and allows nurses to ask it questions about a patient’s current status. The tool gathers all the information on one page. (Famakinwa, 7/7)
