Wakely Wire

July 3, 2025

New Insights

Events & More

Newsworthy Findings

Bonus Article

Just for Fun

New Insights

Whitepapers, briefs, press releases and more

New Wakely white paper explores potential impacts of House Reconciliation Bill on ACA Individual Market Coverage

Future market will look fundamentally different as enrollment declines A new white paper released today by Wakely Consulting Group, an HMA Company, (Wakely) examinesthe potential enrollment and premium impacts of the House budget reconciliation bill, H.R. 1, and the expiring subsidies for the ACA Individual Market. “Future of the Individual Market: Impact of the House ... Read more

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Events & More

Adapting for Success in a Changing Healthcare Landscape

Join senior professionals from across the healthcare landscape in New Orleans

This year’s HMA National Conference is packed with insights you can’t afford to miss. With major developments underway in Medicare, Medicaid, and the ACA Marketplace, you’ll hear directly from the experts driving change—federal and state leaders, health system and payer executives, and healthcare innovators. Whether your focus is closing gaps in behavioral healthcare, navigating new federal Medicaid priorities, thriving in risk-based payment models, or integrating digital health innovations, this is where you’ll get the strategies, connections, and momentum to move your work forward.

Learn more and register

Newsworthy Findings

Senate Passes Trump’s Spending Bill With Massive Medicaid Cuts

After a marathon “vote-a-rama,” the Senate narrowly passed the legislation 51-50, with Vice President JD Vance casting the tiebreaking vote.

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Editor's Note

The bill includes sweeping health care provisions. Most notably, it imposes new work, volunteer, or education requirements—at least 80 hours per month—for adult Medicaid recipients, and mandates more frequent eligibility checks by states. One of the most contentious provisions is a freeze on provider taxes, which are a critical source of Medicaid funding for hospitals. Rural hospitals are expected to face the greatest strain. In response to mounting opposition, lawmakers included a $25 billion fund aimed at supporting these vulnerable facilities.

Optum Rx Slashes Reauthorization Requirements for More Drugs

The pharmacy benefit manager has removed reauthorization requirements for more than 140 drugs so far this year amid what Optum Rx says is a push to improve patient access to critical medications.

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Editor's Note

Prior authorization has long been criticized for delaying patient care and increasing administrative burdens on providers. Optum Rx’s decision to reduce reauthorization requirements—based on guidance from an independent panel of pharmacists and physicians—could ease those challenges and improve timely access to essential medications.

Centene Corporation Withdraws 2025 Guidance

Centene Corporation is withdrawing its previous 2025 GAAP and adjusted diluted earnings per share (EPS) guidance, including the underlying guidance elements.

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Editor's Note

Centene Corporation has withdrawn its 2025 earnings guidance due to preliminary data indicating significantly higher market morbidity and lower risk adjustment revenue than expected in the Health Insurance Marketplace. The company anticipates a negative impact of approximately $2.75 per share and is taking corrective pricing actions for 2026, while also noting higher Medicaid cost trends and better-than-expected Medicare performance.

DOJ charges more than 300 in $14.6B healthcare fraud bust

Matthew Galeotti, head of the Justice Department’s criminal division, called the operation “the beginning of a new era of aggressive prosecution and data-driven prevention” of healthcare fraud.

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Editor's Note

The Justice Department charged 324 individuals, including nearly 100 healthcare professionals, in its largest-ever healthcare fraud takedown, uncovering $14.6 billion in false claims. To combat increasingly sophisticated schemes, the government launched a new healthcare data fusion center and is intensifying enforcement and cybersecurity efforts across agencies.

CMMI to Add Prior Authorization for Some Medicare Services

Beginning next year, the CMS will launch an AI-powered prior authorization process for some services as it seeks to cut funding for what it deems medically unnecessary care.

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Editor's Note

The government hopes the technologists’ solutions streamline medical review of services, reduce inappropriate utilization, lower Medicare spending and ease provider administrative burden.

Bonus Article

Wisdom Teeth Contain Unique Stem Cell That Can Form Cartilage, Neurons, and Heart Tissue

If they don’t grow in right, most people will treat their wisdom teeth as bio-baggage, useful only for preventing money from burning a hole in one’s pocket due to the surgical costs of removing them. But an astounding new discovery has found that this third set of molars contain a unique form of human stem cell that can be harvested and used to regrow bone, heart tissue, and even neurons.

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Just for Fun

Math Joke:

Why did the algorithm go to therapy?

Prior Week

Q: Why did the p-value break up with the null hypothesis?

A: It found someone more significant.

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