Week in Washington

Hospitals

Politico reported that hospitals are increasingly lobbying around potential CMS rules that would reduce hospital spending. While CBO had originally estimated the reconciliation bill would result in hospital losses of $340 billion through 2034, if the proposed CMS rules are implemented hospitals could lose $681 billion through 2034. Hospitals are especially worried about further site-neutral policies as well as changes to 340B reimbursement found in the proposed 340B reimbursement rules.

Elections

With two months to go until the 2026 election, House Democrats introduced legislation to reverse Medicaid cuts in the reconciliation bill as well as permanently extend enhanced premium tax credits for the Marketplace. The expectation is that if Democrats retake control of Congress, there will likely be a fight with the White House over health policy issues.

Budget Bill

President Trump signed a bill into law that would extend current spending until December 11^th. This means that there will almost certainly be no congressional action until after the election.

Medicaid Updates

A new report by Epic research found that self-pay encounters rose between 2022 and 2026 while Medicaid declined. The steepest increase in self-pay was in the emergency department (5.5% to 7.6%). The decline coincides with Medicaid unwinding. The expectation is that self-pay will continue to increase given expected coverage losses.

ACA Updates

The State Marketplace Network released new enrollment data. The report includes enrollment data from 18 SBMs through May 2026. While there is significant variation from state to state, overall enrollment losses were found to have accelerated with enrollment now down 8.5% compared to 2025.

Commercial Trend Increases

A new report of Employer-Sponsored Health Plans found that costs are expected to increase 8.2% on average in 2027, the highest increase since 2003. This accounts for planned cost-reductions matters. Employers estimated that without changes, costs would increase 11% on average. Cost drivers cited in the report included GLP-1 medications, improved physician coding due to AI-enabled software, and the No Surprises Act.

Stars Lawsuit Update

A federal judge gave a mixed ruling on Elevance’s Stars case in which the case was not dismissed but Elevance was not granted an immediate injunction. In other words, Elevance’s rating and quality payments will not be changed before Open Enrollment, but the company could still win the case and therefore receive recompense.