Wakely Wire
August 13, 2026
New Insights
Whitepapers, briefs, press releases and more
Week in Washington 08/13/26
No Surprises Litigation – A federal appeals court ruled against HHS regarding the No Surprises Act (NSA). The court ruled that the qualifying payment amount (QPA) which is central to disputes between insurers and providers in out-of-network billing disputes. HHS can appeal but in the interim dispute resolution may temporarily halt. Shift in PBM Usage ... Continue reading
ACA Marketplace Insurer Exits Are Reshaping the Market. Here’s How Health Plans Should Respond.
Opportunity After Exit: Strategic Responses to ACA Exits Key Takeaways Health insurers participating in the individual Affordable Care Act (ACA) Marketplace are facing one of the most challenging operating environments since the program’s early years. As enhanced subsidies expire, regulatory uncertainty grows, enrollment declines, and claims costs increase, many insurers are reevaluating their participation in ... Continue reading
Potential CMS ACA Marketplace Disenrollments: Implications for Health Insurers
A recent US Department of Health and Human Services (HHS) report indicates that the Centers for Medicare & Medicaid Services (CMS) is taking action to identify and remove potentially unauthorized Affordable Care Act (ACA) Marketplace enrollments. These actions could have significant implications for individual ACA market issuers, including changes in morbidity, risk adjustment transfers, financial ... Continue reading
Newsworthy Findings
Kennedy, Oz Contend Fraud Crackdown, Not Skyrocketing Prices, Led Millions To Leave Obamacare
The Trump administration credits its fraud control efforts for the disappearance of millions of people from Obamacare rolls rather than a sharp rise in premiums, a claim disputed by policy experts that glosses over the reality that many more Americans now find themselves without health insurance.
CMS' Mandatory VBC Programs Brought Substantial Administrative Costs For Hospitals: Study
Participation in mandatory value-based payment programs is tied to higher annual administrative costs for hospitals, according to a comparative study published in JAMA Health Forum.
DentaQuest Breach Exposes Data of 15M People, a Record this Year
A hacker breached the Massachusetts-based dental and vision benefits administrator this spring.
Trump Signs Order Seeking to Upend Childhood Vaccine Schedule
The executive order aims to split the MMR vaccine into three separate shots and revive a court-stalled attempt to narrow the immunization schedule.
CMS ends Medicaid, CHIP Funding for Gender-Affirming Care for Minors
The Trump administration has finalized a rule that would pull funding for gender-affirming care for minors from Medicaid and the Children's Health Insurance Program.
Bonus Article
New Treatment Shows Remarkable Motor Improvements in Boys With Muscular Dystrophy—in Just 12 Weeks
Just for Fun
Math Joke:
I’m odd, but if you take away one letter, I become even. What am I?
Prior Week
Q: Why was the calculus student so optimistic?
A: Because they believed every problem has limits.
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