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News from the week of december 15, 2025

Deloitte 2026 Outlook: Why Traditional Health Strategies Will Fail in the Face of Regulatory Uncertainty (HIT Consultant) – Deloitte’s 2026 outlook highlights digital experiences and technology, scaling of AI and collaboration across industries as key strategies for health care organization success.
PwC 2026 Outlook: Health Services M&A Poised for Rebound as AI Becomes “Core Driver” of Value (HIT Consultant) – PWC predicts growth in health services deal value and volume in 2026 in their year-end report.
Medicare Advantage 2026 Spotlight: A First Look at Plan Premiums and Benefits (KFF) – A KFF brief provides an overview of premiums and benefits in Medicare Advantage plans available for 2026 and key trends over time.
AMA: A look at concentration in commercial insurance, MA markets (Fierce Healthcare) – The AMA calculates insurer market shares by locality, state and national reach for commercial, ACA and Medicare Advantage plans. It also looks at how concentration of payers is changing in these different markets.
More than 100 provider groups tell HHS to pull proposed HIPAA update (Fierce Healthcare) – Provider groups are joining industry representatives in opposition to a proposed HIPAA update designed to improve cybersecurity and other safeguards. The groups say the implementation timeline is rushed and does not allow for innovation.

News from the week of december 8, 2025

Dental Care in Medicaid Programs (ADA HPI) – The ADA’s Health Policy Institute’s new report on dental care in Medicaid finds that while benefits have expanded in most states, dentist participation in Medicaid and dental care utilization among beneficiaries have remained stagnant.
How Do Americans Experience Healthcare in Their State? (Gallup) – Polls from Gallup and KFF detail anxiety about health care costs with Gallup reporting that a record 47% of adults are worried about affording healthcare in the coming year.
The 2025 State of America’s Oral Health and Wellness Report (Delta Dental) –Delta Dental’s annual report on oral health finds that 67% of adults with dental benefits are likely to access preventive care while only 23% of those without coverage say they will seek out care.
Broker Fees and Direct Sales by Health Insurance Market (KFF) – KFF has updated their interactive dashboard with 2023 data illustrating average broker fees across different markets and states.
Medicare Advantage 2026 Spotlight: A First Look at Plan Offerings (KFF) – KFF provides an update on the Medicare Advantage landscape which shows slight declines in available plans across the states. The update also highlights the increase in the number of Special Needs Plans (SNPs).
Recent trends in commercial health insurance market concentration (Petersen-KFF) – The Petersen-KFF Health System Tracker finds competition in the individual market remains high while employer group coverage has become increasingly concentrated and more employers are shifting to self-funded plans, while another article questions the affordability of high deductible plans for workers.

News from the week of december 1, 2025

“Classic” Employer Benefits Are A Strong Draw For US Job Seekers Across Ages (Hiring Lab) – A recent survey from Indeed found workers across all ages value health insurance and paid time off. Vision and dental insurance had a strong showing in the top ten across all age groups. In a related report, The Business Group on Health highlights key issues in health benefits for employers.
States Reporting At Least One Medicaid Benefit Expansion, SFYs 2003-2025 (KFF) – New reports from KFF detail Medicaid benefit expansion efforts over the past 12 years and highlight how regulatory changes may impact Medicaid funding and decrease enrollment by suppressing usage by immigrants and other groups.
CMS proposes significant overhauls to Medicare Advantage star ratings metrics (Fierce Healthcare) – CMS is taking an active approach to Medicare Advantage programs by proposing an overhaul to the star ratings system and introducing the ACCESS Model to improve management of chronic diseases.
Poll: 1 in 3 ACA Marketplace Enrollees Say They Would “Very Likely” Shop for a Cheaper Plan If Their Premium Payments Doubled; 1 in 4 Say They “Very Likely” Would Go Without Insurance (KFF) – New polling highlights how ACA marketplace enrollees are reacting to large premium jumps, creating a good deal of uncertainty in the market.
IDOC Teams Up With Eyes On Eyecare to Release 2025 Optometrist Report (Vision Monday) – A new survey of optometrists provides insights into their practices, preferences, engagement with technology and long term goals.

News from the week of November 17, 2025

Employers brace for 6.7% increase in health benefits costs next year: Mercer (Fierce Healthcare) – New reports from Mercer, Families USA and Willis Towers Watson dive into the details of increases in health care costs and premiums and provide some recommendations for employers and payers to address these challenges.
With government reopened, healthcare orgs press lawmakers to act swiftly on ACA subsidies (Fierce Healthcare) – Lawmakers continue to debate ACA subsidies while a wide range of healthcare organizations urge action.
Integrated Care Plans Didn’t Boost Medicaid Enrollment for the Poorest Seniors (University of Pennsylvania) – A recent study found that that the expansion of integrated Medicare-Medicaid Plans (MMPs), created to streamline care for dual eligible individuals, has not increased Medicaid enrollment rates.
CMS issues guidance on Medicaid provider tax overhaul (Healthcare Dive) – CMS has started to outline how it will restrict state usage of Medicaid provider taxes, which will impact state’s ability to fund the program.
2026 Medicare Physician Fee Schedule Shows Increase for Doctors of Optometry (Vision Monday) – CMS recent Medicare final rule included a 2.5% payment increase for providers and other provisions related to telehealth, and MIPS for diabetes eye exams.

News from the week of November 10, 2025

Report: Payers need to do more to demonstrate value to plan sponsors (Fierce Healthcare) – A new report, finds payers should be aware of a growing interest in direct-to-consumer or direct-to-employer relationships as employers seek to cut costs. Payers can combat these trends by demonstrating their value in keeping members healthier.
Healthcare Consumer Experience 2025: Safety, AI, and Social Capital Redefine Trust (HIT Consultant) – A new study dives into the trends driving consumer experience in healthcare as expectations continue to evolve. Key pillars include building trust and eliminating friction points.
Medicaid Enrollment & Spending Growth: FY 2025 & 2026 (KFF) – KFF’s annual report on Medicaid enrollment and spending shows enrollment declined by 7.6% in 2025 and growth is expected to be flat in 2026. At the same time, total Medicaid spending increased by 8.6% in 2025 and state Medicaid spending increased by 12.2%. In addition, a majority of the states that responded to the survey say Medicaid budget shortfalls are likely and some are already implementing Medicaid spending cuts.
Participation in Medicare Advantage Risk-Based Provider Payments Shows Little Impact on Care Delivery (University of Pennsylvania) – As Medicare moves from fee-for-service to risk-based contracts designed to minimize costs and improve member health, a new study find these contracts do not meaningfully change how care is delivered.
Concerns Over Fairness, Access Rise as States Compete for Slice of $50B Rural Health Fund (KFF Health News) – As state leaders recently finalized applications for a piece of the $50B Rural Health Fund, some fear that funds will not be fairly distributed. In addition, while funding for test projects is welcome it won’t replace lost Medicaid funding.

News from the week of November 3, 2025

CMS highlights medical-dental integration in 2026 Medicare Physician Fee Schedule (ADA News) – CMS is getting praise for a new oral health–related quality improvement activity within the merit-based incentive payment system. To qualify, Medicare-participating physicians must complete training, implement a referral process and take at least one step to integrate oral health into their practice.
Managed care plans offer recommendations to CMS on rollout of Medicaid work requirements (Fierce Healthcare) – ACAP and MHPA are urging CMS to adopt recommendations that could help smooth the adoption of Medicaid work requirements by allowing insurers to deploy more modern communication methods, enable critical data sharing and other measures.
Assessing Marketplace Coverage for Parents and Children (Urban Institute) –A recent Urban Institute report underlines the importance of marketplace plans for families with children which now cover nearly 5 percent of parents and more than 3% of children. Another analysis by KFF finds that individual market premiums have become more similar to employer-sponsored premiums over time.
Understanding the Evidence: SNAP and Health (University of Pennsylvania) –The Leonard Davis Institute's recent blog post references six studies that highlight how the loss of SNAP can negatively impact heart-related deaths among adults younger than 65, diabetes prevalence and inpatient admissions.
KFF Health Tracking Poll: Public Weighs in on Health Care Debate and Government Shutdown (KFF) – KFF’s latest Health Tracking Poll and an analysis of recent election results provide insights into public opinion on health care costs and the government shutdown.

News from the week of October 31, 2025

Insurers most often blamed for medical debt, but providers trusted to protect patient interests: survey (Fierce Healthcare) – A recent survey from the nonprofit, Undue Medical Debt finds a majority of voters blame payers for medical debt. The survey also looks at how debt is impacting respondents ability to access health care.
High volume of surprise billing disputes are ineligible for arbitration, insurers allege (Healthcare Dive) – A recent payer study alleges that PE-backed provider groups are flooding the Surprise Billing dispute system with ineligible claims that are nonetheless getting approved.
ROI from virtual care remains elusive, report shows (Healthcare IT News) – New research finds virtual care and digital health remain priorities for health system leaders, even though they are not seeing significant ROI from virtual care investments. Another study from PWC explores how people in different age groups utilize health technology.
The Vision Council Submits Comments to Department of Commerce About Possible New Tariffs on Optical Products and Equipment (Vision Monday) – Health industry groups are urging the US government to provide tariff exemptions for a wide range of medical products and equipment.
Multi-Sector, Community-Driven Partnerships: An Intentional Strategy to Advance Health Equity (National Academy of Medicine) – The National Academy of Medicine looks at two examples of multi-sector, community-driven partnerships designed to improve health outcomes.
The risks when dentists give pediatrics opioids (Dr. Bicuspid) – A new JADA article tackles the issues tied to prescribing opioids for pediatric dental care. The study shows 1 in 10 pediatric dental visits in which opioids were used were linked to overdose or persistent use with some requiring hospitalization after dental treatment.

News from the week of October 24, 2025

Workers and Employers Face Higher Health Insurance Costs (NY Times) –Rising health care costs, including a sharp rise in 2025 premiums and costs for consumers, are documented by a new KFF report, while a Families USA poll finds lowering healthcare costs is a top concern for voters.
H.R. 1 and Medicaid: What Healthcare Providers Need to Know About Upcoming Changes (HC Innovation Group) – A Foley & Lardner webinar takes a closer look at the impacts of the new federal budget law on providers and warns of the danger of a snowballing effect on state programs and the rest of the health care ecosystem while Kansas continues to expand Medicaid dental benefits in an effort to increase preventative care.
Officials Show Little Proof That New Tech Will Help Medicaid Enrollees Meet Work Rules (KFF Health News) – KFF investigated federal pilot programs in Louisiana and Arizona, which are designed to help Medicaid enrollees verify work requirements. They found very limited program information and little proof of success.
Optometry’s Expanding Scope: Bridging the Eyecare Gap (Vision Monday) – Optometrists are gearing up to expand the scope of their practices in several states which could help fill health care gaps due to shortages of eyecare professionals and increased demand due to an aging population.
Dentistry enters a “golden era” of oral health thanks to innovation and AI (Dental News) – A recent podcast hosted by the ADA’s Marko Vujicik looks at recent breakthroughs in technology, data-analytics, patient-centric care and new business models.

News from the week of October 17, 2025

Survey from Aflac shows more burnout, anxiety over health insurance (Aflac) – A recent Aflac survey finds employees are navigating burn-out and anxieties about the rising cost of health care and the KFF health tracker illustrates how employers are juggling cost sharing of health benefits. Employees are facing health care costs that are growing faster than wages and inflation.
ADA launches toolkit to support dentists in Medicaid participation (ADA) – The ADA has a new Medicaid toolkit and updated Medicaid fee schedules available for dentists to maximize efficiencies in their practices.
37 dental insurance reform laws passed in 2025 (ADA News) – The ADA reports that thirty-seven new dental insurance laws have been enacted across 18 states this year. Most of the activity was centered around dental loss ratios, virtual credit cards, assignment of benefits and provider credentialing process improvements.
How Medicaid cuts in the “Big Beautiful Bill” will impact dental practices (Dental Economics) – Dental Economics takes a closer look at how impending Medicaid cuts will impact dental practices including patient’s experiencing loss of coverage and confusion increased administrative burdens for office staff. These changes will make strong insurance workflows even more critical.
Medicaid-Covered Dental Visits during and after Pregnancy (RWJF) – A new study from the Robert Wood Johnson Foundation finds a marked increase in dental visits during and after pregnancy in states that extended Medicaid coverage at least one year postpartum while a KFF report looks at how children’s health access may be impacted by the recent changes to Medicaid.
Commonwealth Fund: Medicare member experience varies by state (Techtarget) – The Commonwealth Fund has published a study comparing Medicare Advantage member experience across the states and finds disparities in access to care, costs and red tape. Differing state healthcare policies are a key predictor of member experience. A closer look at Kentucky reveals where gaps lie.
No Real Choices: How Medicare Advantage Fails Seniors of Color (PNHP) – A study from Physicians for a National Health Program provides a critical look at how Medicare Advantage is serving communities of color while a STAT piece advocates for streamlining plan choices to help seniors better evaluate plan options.

News from the week of October 10, 2025

KFF Health Tracking Poll: Public Weighs Political Consequences of Health Policy Legislation (KFF) – A recent KFF Health Tracking Poll shows nearly 80% of adults support extending the enhanced tax credits for plans purchased through the ACA Marketplace. In addition, a strong majority say higher premiums would significantly impact their finances, with 4 in ten saying they would go without health coverage if premiums doubled.
Medicaid enrollees at risk of disenrollment report multiple chronic conditions: study (Healthcare Dive) – A recent JAMA study found that a large number of Medicaid beneficiaries likely to be impacted by new work requirements, suffer from three or more chronic conditions. For Medicaid recipients between 50 and 64 years old, more than 66% were impacted by multiple chronic conditions.
A Look at Variation in Medicaid Spending Per Enrollee by Group and Across States (KFF) – KFF breaks down total Medicaid (state and federal shares) spending per enrollee for full-benefit Medicaid enrollees by eligibility group and state. As expected, the highest spending rates were among seniors and people with disabilities.
ADA pushes back against payer downcoding on multisurface restorations (ADA News) – The ADA and state of California are warning payers to work with providers on any network fees or downcoding of procedures.
Why one DSO incorporated virtual dental care (Dr. Bicuspid) – One DSO is integrating after hours virtual-first emergency dental care to help relieve stress on staff and improve patient care.

News from the week of October 3, 2025

How an ACA Premium Spike Will Affect Family Budgets, and Voters (KFF) – The ongoing federal government shutdown highlights potential impacts of the expiration of tax credits on ACA premiums, the uninsured rate, healthcare spending and employer-based benefits.
Government Shutdown Watch: Impacts on the Industry, Vision Care and More (Vision Monday) – The vision industry is closely watching developments in Washington as the shutdown could not only hit those practices that serve Medicaid and ACA patients, but could also be impacted by staffing reductions at the FDA and customs.
CMS: Average MA premiums are set to decline for 2026 plan year (Fierce Healthcare) – Medicare Advantage enrollment and premiums are set to decline in 2026 and as some insurers reduce their footprint people in some areas will have to revert to traditional Medicare. At the same time special needs plans are seeing strong growth.
The State of the U.S. Dental Economy (ADA HPI) – The ADA’s Health Policy Institute’s Q3 report on The State of the U.S. Dental Economy shows dental practices continue to be impacted by decreases in demand and higher prices.
2025 State of America’s Oral Health and Wellness Report (Delta Dental) –
Delta Dental is out with their 2025 State of America’s Oral Health and Wellness Report. Only 36% of adults surveyed rated their oral health as good or excellent.
Participation in Medicaid child dental care continues to decline in Georgia, audit finds (Georgia Recorder) – A new report sharply criticizes Georgia’s Department of Community Health for failing to follow through on recommendations from a 2021 state audit detailing declines in Medicaid child fee for service dental care utilization in Georgia. This new report showed that this trend continues to worsen with only a 28% participation rate in 2024. Reimbursement rates for providers in this program is below rates offered in the managed care program.

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