Wakely Wire

New Insights

Whitepapers, briefs, press releases and more

2025 Individual Market Risk Pool Considerations

This whitepaper provides a preliminary view into how the individual market risk pool is shifting in 2025 following the Medicaid redetermination period in 2023-2024, sizable historical market growth, and other recent enrollment dynamics. Early results point to a notable increase in market risk for 2025, with demographic normalized relative risk rising over 8% when comparing ... Read more

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Week in Washington 07/24/25

Congress: The House of Representatives went on recess early this week.  Without the House in session, it will be difficult for legislation to move. The implication of this is that it is very unlikely that legislation that extends enhanced subsidies (ePTC) in the individual market will be passed in time to affect 2026 rates. It ... Read more

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Events & More

CMS RADV Rules Will Impact Your MA Risk Contracts

Wakely, an HMA Company, supports a range of providers who take risk in Medicare Advantage (MA) and other government and commercial insurance programs. We recently developed a RADV Strategy Guide addressing the critical impacts of CMS’s expanded Risk Adjustment Data Validation (RADV) audit program on provider risk agreements.

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Newsworthy Findings

Hospitals Are Buying More Doctor’s Offices. That’s Tied to Higher Costs, Study Finds

New research from the National Bureau of Economic Research (NBER) links hospital-physician consolidation to lower competition and higher costs down the line. The American Hospital Association slammed the study as flawed.

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Editor's Note
Hospital acquisition of physician practices has doubled over 2 decades and could be linked to higher prices and lower physician income, the National Bureau of Economic Research (NBER) finds.

Judge Dismisses Humana’s Medicare Advantage Star Ratings Suit

A Texas federal judge has dismissed Humana’s lawsuit against the federal government seeking to improve its Medicare Advantage star ratings, in a significant loss for the insurer.

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Editor's Note
Humana’s lawsuit was dismissed against CMS over its star ratings by a federal judge. It was ruled that the company filed prematurely before exhausting the administrative appeals process. This decision could cost the insurer up to $3 billion in 2026 due to reduced reimbursement.

10M People Will Lose Insurance Due to GOP Policy Law: CBO

The final tally from the nonpartisan budget scorekeeper estimates the law will decrease federal healthcare spending by $1.1 trillion over the next decade.

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Editor's Note
Of the $1.1 trillion in projected healthcare spending cuts, $326 billion comes from implementing work requirements, $149 billion from limiting state-directed payments, and $191 billion from freezing provider taxes. These changes along with the large increase in the uninsured population are expected to significantly impact rural hospitals and providers that depend heavily on Medicaid reimbursement.

ACA Health Plan Premiums Could Spike in 2026: Report

Insurers are requesting a median premium increase of 15% for 2026, as payers grapple with policy uncertainty on tariffs and increased financial assistance for plans on the exchanges.

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Editor's Note
An analysis of 105 insurers across 19 states and D.C. shows that most are seeking premium hikes between 10–20%, with over a quarter requesting increases of 20% or more. Unlike previous years, these proposed rate hikes are driven primarily by policy uncertainty—especially the scheduled expiration of enhanced premium tax credits at the end of 2025 and rising costs due to tariffs on drugs, medical equipment, and other healthcare supplies.

CMS Tightens Oversight, Spending in Medicaid, CHIP Programs

The U.S. Centers for Medicare & Medicaid Services (CMS) is strengthening regulatory oversight of certain state-based and pediatric programs in an effort to reduce redundant spending.

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Editor's Note
A 2024 analysis showed that 2.8 million individuals were enrolled in multiple programs and fixing this issue could lead to a potential cost savings of $14 billion a year.

Bonus Article

Just for Fun

Math Joke:

Why won’t Goldilocks drink a glass of water with 8 pieces of ice in it?

Prior Week

Q: Will all of the math jokes and puns on this newsletter be super cheesy?

A: Only sum.

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