Many of June’s most-clicked SmartBrief health news stories featured insurance challenges and opportunities as their central theme, from proposed cuts in government-sponsored coverage to new plan options for the public. Other readers were interested to hear how health care executives are weathering the storms of budget problems, staffing woes and cybersecurity hurdles.
Coverage challenges
What happened: The US House’s “One Big Beautiful Bill Act” proposed Medicaid cuts that could leave 7.6 million people without health insurance and contribute to 16,600 preventable deaths, researchers reported in the Annals of Internal Medicine. Investigator Dr. Adam Gaffney said that if the Senate were to approve the measure that the House did, hundreds of safety-net health centers and hospitals could be forced to shutter, and “medically preventable deaths will soar.” Researchers noted other potential ripple effects, like reduced access to preventive care and drug affordability issues.
What’s next: The bill passed the Senate and was signed into law by President Donald Trump on July 4. An analysis examined how the health care lobby had been unsuccessful in its efforts to oppose the legislation, even though the measure drew heavy collective opposition from many hospitals, insurers and physicians. The law will require states to verify beneficiaries’ Medicaid eligibility twice yearly, and it introduces Medicaid work requirements that could lead to millions losing coverage in the next 10 years.
The law also could compromise medical students’ ability to pay for their education and enter a field that badly needs them.
Prior authorization priorities
What happened: About 50 insurers of different sizes, including giants like Cigna, Elevance Health, Blue Cross Blue Shield and Humana, pledged to work on reforming their prior authorization processes to streamline patient care. They committed to reducing the number of services that must undergo prior authorization, with progress to be demonstrated by the start of next year. They also said they would provide “common and transparent solutions” for electronic prior authorization submission.
What’s next: The improved practices are expected to affect about 257 million Americans who use commercial, managed care, Medicaid and Medicare Advantage plans. AHIP CEO Mike Tuffin said the changes are intended to “deliver a more seamless patient experience and enable providers to focus on patient care” while also modernizing the delivery of care. AHIP has posted additional information about the process, and the American Medical Association also offers updates.
Potential coverage options
What happened: Proposed legislation would create a public-option “Part E” program under Medicare that aims to expand coverage and allow people to opt in. Part E, proposed under the Choose Medicare Act, would compete with private insurance, support itself via premiums, let employers offer the coverage to their workers and allow enrollment through state and federal insurance marketplaces.“Our bill would give all Americans access to Medicare, one of the most popular and successful health care delivery programs in history,” said Rep. Don Beyer, D-Va., in a statement.
What’s next: If the legislation passes, Medicare Part E will include traditional Medicare services and essential health benefits, allow subsidies to be applied to health premiums, prohibit discrimination based on existing health conditions, and offer features like negotiated drug prices and out-of-pocket cost caps.
Health system strategies revised
What happened: A PwC survey found that many US health care executives are revamping their strategies to weather changing regulatory and economic headwinds. Sixty-one percent of health care leaders in the survey said US economic policy is a main driver of these shifts, compared with less than half of executives in other fields. Ninety percent said they were focusing their attention on cyberattack prevention, and 80% said they were dealing with skilled labor challenges.
What’s next: Meaningful change will involve revising financial forecasting and budgets, putting new cost-control measures in place, evaluating the effects of tariffs, renegotiating supplier agreements and possibly even moving manufacturing operations, researchers said.
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