Wakely Wire
August 22, 2025
New Insights
Whitepapers, briefs, press releases and more
2024 Supplemental Claims Impact
ACA risk scores increased by nearly 6% due to supplemental claims in the ACA individual market. This translates to roughly $3,000,000 ($30 PMPM) for a 10,000 member population. The 6% also represents a steady increase in supplemental claims impact and doubles the 2019 impact. Issuers should review and benchmark their data against the industry to ... Continue reading
Week in Washington 08/21/25
PAYGO Sequestration CBO released updated estimates of the effects of Public Law 119-21 (the reconciliation bill). Overall, the CBO found that without Congressional action, the law would trigger the PAYGO (4% sequestration) on Medicare and reduce Medicare spending by up to $491 billion. It’s important to note that the PAYGO sequestration has never been implemented, ... Continue reading
Newsworthy Findings
Elevance Loses Medicare Advantage Star Ratings Suit
The Texas judge’s decision — which picked apart Elevance’s argument on mathematical grounds — is expected to cost Elevance $375 million, though the insurer could still appeal.
CMS Initiative Targets Undocumented Immigrants in Medicaid
CMS will provide states monthly reports of beneficiaries whose citizenship or immigration status cannot be confirmed.
Judge Overturns Rule Limiting Broker Payments in Medicare Advantage
Reed O’Connor’s ruling is a setback for smaller MA plans — and efforts to curb predatory marketing to seniors.
Kennedy’s mRNA Cuts Could Set US Science Back, Experts Warn
Scientists say HHS’ decision to defund mRNA vaccine research will leave the country less prepared for pandemics and give other countries a chance to catch up in developing the technology.
Judge Vacates Medicare Advantage Marketing Rule Provisions
Employers are bracing for a 9% healthcare cost increase in 2026, driven largely by rising use of GLP-1 drugs, cancer care, and mental health services, prompting many to rethink coverage policies and vendor partnerships.
Bonus Article
4-Year-Old Calls 911 to Talk About Swimming. Police Respond With Birthday Surprise
Just for Fun
Math Joke:
Why don’t prime numbers ever get along?
Prior Week
Q: Who’s in charge in a pencil case?
A: The Ruler!
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