June 25, 2026

U.S. healthcare spending rose 7.3% to $5.7 trillion in 2025, driven primarily by increased use of healthcare services and expensive prescription drugs, especially GLP-1 weight loss and diabetes medications, rather than higher prices. CMS projects healthcare spending will continue to outpace economic growth, reaching $9 trillion (20.6% of GDP) by 2034, with Medicare seeing the fastest spending growth due to an aging population, while Medicaid growth slows because of recent policy changes and coverage reductions.

Anthem’s Ohio exit highlights that insurer participation in ACA markets depends heavily on regulatory and funding stability. When subsidies, taxes, and rules are uncertain, carriers may reduce their footprint or leave markets entirely.

This article provides an overview of the DOJ's latest nationwide healthcare fraud enforcement effort, emphasizing the scale of alleged fraudulent activity, Medicaid program integrity initiatives, and interagency collaboration to combat healthcare fraud.

The Clover ruling could force meaningful changes to how CMS calculates MA Star Ratings, creating new upside for some plans but broader volatility and litigation risk across the program.

The rural health fund is intended to transform care, but because of Medicaid cuts, funding limits, and clawback risk, it may function more like a managed downsizing program for rural hospitals.