Week in Washington

CMS Proposes Changes to MA and Part D: CMS released part of the proposed 2028 policy and technical rule last week. In the rule CMS proposes implementing many of the provisions in the reconciliation bill including: Part D compensation changes, MA provider directory changes (for example if beneficiaries rely on inaccurate network information and receive covered services from an out-of-network provider, their cost sharing would generally be limited to the applicable in-network amount) and changes in Part D low-income cost-sharing (Generic-drug copayments would fall from $1 to $0 for qualifying full-benefit dual-eligible beneficiaries with incomes at or below 100% of the federal poverty level). A second proposed rule will be forthcoming later this fall on other MA/Part D policy and technical changes.

CMS Defers Medicaid Payments to California: CMS announced it would be withholding an additional $1.2 billion in Medicaid payments to California. CMS Administrator Mehmet Oz cited growth in California’s in-health Supportive Services program as the reason for the deferral. The new deferral follows earlier federal actions involving approximately $1.3 billion in May and $867.5 million in July.

Employer Coverage: KFF released its annual Employer Health Benefits Survey, providing an important benchmark for commercial health insurance pricing. The survey, covering approximately 1,900 public and private employers, found that average annual family premiums reached $28,303 in 2026, increasing 5% from 2025. Workers’ average contributions toward family premiums increased substantially faster, rising 9% to $7,471 annually. Approximately 18% of large employers cover GLP-1 medications for weight loss.

Coverage Losses: Commonwealth Fund’s health insurance survey found that the uninsured rate dramatically increased in 2026. The uninsured rate for working age American increased to 11.2% from 8.9%. The uninsured rate of young adults (19-34) increased from 11% to 16% over the past two years. Decreases in Medicaid and individual market were the primary drivers of the increase. About one in three respondents reported having outstanding medical bills our debt.