September 18, 2025

The enhanced ACA subsidies — which removed the income cap for tax credit eligibility (400% of the FPL) and limited premiums to 8.5% of household income — are set to expire at the end of this year. If they lapse, CBO projects that 4 million people will leave the ACA exchanges, and KFF estimates that out-of-pocket costs could rise by an average of 75%

Doctors in select states will be required to obtain AI powered prior authorization for some services in traditional Medicare as part of a new CMS pilot program called the Wasteful and Inappropriate Service Reduction (WISeR) model. It aims to reduce healthcare spending by curbing medically unnecessary care, which CMS says it cost up to $5.8 billion in 2022, but many providers fear the program will create administrative burdens and delay needed treatment.

Lawmakers are divided over nonprofit hospitals’ tax-exempt status, with critics citing $37B in tax breaks, weak reporting, and “mission creep,” while supporters stress nonprofits’ essential services and financial strain; the AHA (American Hospital Association) counters with $149B in reported community benefits and warns against rigid federal definitions.

Optum Rx’s move signals a broader industry recognition that outdated generic-focused payment models no longer align with today’s high-cost branded drug landscape; whether these adjustments will meaningfully shore up struggling independents, or simply ease pressure without addressing deeper PBM criticisms, remains an open question.

Shifts in vaccine attitudes are reflected in recent state level policy changes, with state lawmakers introducing more than 2,500 vaccine-related bills since 2021, with almost half targeting vaccine requirements.