Wakely Wire
July 24, 2025
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
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
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.
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.
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.
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.
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.
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.
Bonus Article
Arizona Governor Empowers Charity To Totally Cancel $429 Million in Private Medical Debt for $10 Million
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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