Wakely Wire

New Insights

Whitepapers, briefs, press releases and more

ACA Non-Network Plans: How Big of a Disruption?

On February 9, 2026, the US Department of Health and Human Services (HHS) released the proposed Notice of Benefit and Payment Parameters (NBPP) for 2027. Under the proposed rule, non-network plans would be allowed to be certified as Qualified Health Plans (QHPs) and be able to offer Affordable Care Act (ACA) products on the Exchange ... Continue reading

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Potential Swings in County-Level Benchmarks: Understanding the Nuanced Impacts of CMS’s Proposed Changes for 2027

CMS’s Calendar Year 2027 Advance Notice, released on January 26, 2026, proposed changes to fee-for-service (FFS) expenditures and introduced a new risk adjustment model. Together, these updates could result in material changes in the average geographic adjustment (AGA) factors, which drive the county-level Part C benchmark rates. In this whitepaper, we describe three key proposed ... Continue reading

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Week in Washington – 3/19/26

Vaccine Change Injunction A federal judge issued an injunction against changes on vaccine policy. The injunction blocks recent changes to the vaccine schedule and likely halts further potential changes in the near term.  Vaccine take-up has rapidly eroded since Secretary Kennedy took office. Researchers have estimated that further reductions in vaccine take-up in measles vaccination ... Continue reading

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Newsworthy Findings

Federal Court Blocks RFK Jr.’s Moves to Upend US Vaccine Policy

The ruling, related to a lawsuit from several major medical organizations, stated that HHS ignored established protocols in altering the childhood immunization schedule and overhauling a CDC panel.

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Editor's Note
Last summer, RFK Jr. dismissed all 17 members of the Advisory Committee on Immunization Practices (ACIP) and subsequently reconstituted the panel. Since then, the committee has revisited several vaccine recommendations related to childhood diseases and respiratory infections, including COVID-19. The court’s ruling reflects concerns about whether established scientific and procedural standards were followed.

CMS Wants Seniors to Use AI for Care Navigation

The agency plans to introduce AI agents to help Medicare beneficiaries find doctors and health plans, a challenge given many enrollees don’t yet trust the tools, CMS Administrator Dr. Mehmet Oz said.

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Editor's Note
CMS is exploring the use of AI tools to help Medicare beneficiaries navigate care, including selecting providers and health plans, with the broader goal of improving access and managing healthcare spending. However, adoption may be limited by low levels of trust among seniors - only 31% of Medicare enrollees aged 65 and older report trusting AI for healthcare-related tasks, according to a recent KFF survey.

Allina Health To Join Sutter Health In $26B Proposed Transaction

Sacramento-based Sutter Health and Minneapolis-based Allina Health unveiled plans to join and form a 39-hospital, $26 billion nonprofit health system.

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Editor's Note
Sutter Health and Allina Health plan to combine into a $26 billion, 39-hospital nonprofit system, with Allina operating as a regional division while keeping its brand. The deal aims to expand access, invest in care and technology, and improve recruitment, with a targeted close by the end of 2026 pending approvals. The combined system would serve over 5 million patients annually and leverage strengths in AI, digital health, and clinical expertise to enhance patient care and operational efficiency.

Moody's: Insurers' 2026 Outlook Is Negative as Cost Pressures Continue to Batter Industry

The health insurance industry's credit outlook for the year remains negative as medical costs continue to rise, according to a new report from Moody's Ratings. The Moody's analysts said that in the current environment, payers will have "limited prospects for profitable growth" this year.

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Editor's Note
Moody's Investors Service says the health insurance industry’s 2026 outlook is negative due to rising medical costs and limited opportunities for profitable growth. Insurers are expected to focus on improving margins through actions like benefit cuts, plan redesigns, and scaling back in weaker markets, while facing added pressure from regulation and lagging reimbursement rates.

Payers, Hospitals Pan CMS' Plan to Bring Non-Network Plans to ACA Exchanges

Insurers and hospitals have come together to rebuke a Trump administration proposal to roll back limits of plan designs that may be listed on the Affordable Care Act’s (ACA’s) exchanges.

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Editor's Note
While CMS issued this proposed policy with the aim of reducing overall health care costs, the opposing groups believe that non-network plans cannot offer comprehensive coverage that is required for a Qualified Health Plan.

Bonus Article

Just for Fun

Math Joke:

Why did the statistician bring a ladder to the bar?

Prior Week

Q: Why did the function stop dating the constant?

A: There was no change in the relationship.

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