Healthcare News Roundup

Top of Mind

At an Impasse on the Enhanced Advanced Premium Tax Credits (EAPTCs)

Two bills failed to pass this week that would address the expiring Affordable Care Act (ACA) subsidies. Neither bill had enough votes to overcome the Senate filibuster. There was never consensus.

Four Republicans voted with the Democrats to advance their plan for a three-year extension of the EAPTCs (Lisa Murkowski and Dan Sullivan of Alaska, Susan Collins of Maine, and Josh Hawley of Missouri). The Republican bill did not extend the enhanced APTCs and instead, would have introduced health savings accounts with federal government support of $1000 or $1500 for certain people buying insurance on the ACA Exchange.

There’s little time for a solution to be in place before the resulting premium hikes. There are a couple of bills in the House that combine a shorter extension of the EAPTCs with other reforms. Regardless, next week is the last week Congress is in session for 2025.

In the second half of this week’s KFF podcast “What the Health?”, they discuss what will likely happen as a result of a changing risk pool as a downstream consequence of the expiration of the EAPTCs. If you want to listen, check that out here.

More here from PBS’ coverage

More here from the Harvard Kennedy School

My Take:

The debate over enhanced advanced premium tax credits is a fierce one, but one could argue these subsidies merely paper over a fundamental problem: healthcare in America is genuinely unaffordable, and subsidies do nothing to address why costs keep rising. Something needs to be done in the short term to address the predictable drop-off in enrollment when some experience an insurmountable rise in insurance premiums as the subsidies expire.

The core issue is that health insurance premiums are driven by the rising underlying cost of healthcare. This is why insurance premiums rise. The Peterson-KFF Health Systems Tracker published an excellent piece on the drivers of higher costs. Here they are:

• Rising “Trend,” or the combination of higher utilizations and higher per-unit costs. Trend is expected to be 8% in 2026.

• Inflation

• Labor costs, contracting, consolidation

• GLP-1s and specialty medications

• Tariffs (potentially)

Definitely check out the piece for more detail.

I also wrote more about this in this post.

Okay, just one more article on this topic I have to share with you since it’s so new. In this article in JAMA Network Open authored by Salpy Kanimian, MA, and Vivian Ho, PhD, published online on December 8, 2025, the authors show that among medical cost components (hospital services, professional services, prescription drugs, insurance), hospital service prices increased the fastest, confirming hospitals are the main force behind premium escalation. Check out this visual from the article 👇️ 

They also note the primary reasons for hospital costs skyrocketing are:

• health system consolidation

• CEO compensation tied to profits

• profit-driven pricing strategies

There’s much more to check out in the article. I remember Vivian Ho’s name from this podcast episode of Relentless Health Value where she also covers this topic.

Medicaid Work Requirements Informational Bulletin

The One Big Beautiful Bill Act (OBBBA) requires states to implement Medicaid work requirements starting January 1, 2027. CMS issued this informational bulletin this week.

Most adults enrolled in Medicaid must demonstrate "community engagement,” which includes working, volunteering, attending school, or completing job training for at least 80 hours monthly. as a condition of eligibility starting January 1, 2027. States must verify compliance at application and at least every six months thereafter, though they're required to first use available data sources like payroll records before requesting additional documentation. They have exemptions in place for caregivers of young children or disabled individuals, those with disabilities or serious medical conditions, pregnant women, veterans with total disability ratings, and individuals already meeting TANF or SNAP work requirements.

My Take:

The Medicaid work requirements will directly impact healthcare providers. Providers are likely to feel uncertain about their documentation responsibilities—particularly when patients claim medical exemptions for conditions like substance use disorders, mental health issues, or complex medical needs that require clinical verification. They could also see substantial revenue losses as some patients lose coverage for a host of reasons, including because of documentation failures rather than actual ineligibility. I imagine this will be an emotional strain for some providers.

Many patients may be working, volunteering, or attending school but struggle to provide the required monthly proof of 80 hours of activity, even if those patients remain medically eligible and continue seeking care. This creates a dual financial strain as a result of the new law. it means increased uncompensated care from newly uninsured patients who still need treatment, combined with the administrative burden of helping eligible patients document exemptions to maintain coverage. There will likely be churn of patients moving in and out of coverage, and that complicates billing, disrupts care continuity, and strains margins. Those who may be most likely to feel the burdens are safety-net providers serving vulnerable populations who are most likely to struggle meeting the 80-hour monthly requirements.

The MAHA ELEVATE (Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence) Model

Another model to address chronic disease has been announced. This time, it’s a Notice of Funding Opportunity (NOFO) for up to 30 evidence-based proposals for functional or lifestyle medicine interventions (all which must include nutrition and physical activity) that support conventional care and that are most applicable to the population of Americans with Traditional Medicare. There is $100 million dollars to distribute via 3-year cooperative agreements. The awards will be in two rounds for two cohorts. One will begin in 2026 and one will begin in 2027.

CMS notes that proposals will only be considered if they have documented scientific evidence of the intervention’s safety, efficacy, and cost impact for the target population. The services offered cannot be services that are already covered by Traditional Medicare.

Also, this model is focused on testing what will work for Medicare beneficiaries that empowers them to engage with their health and make lifestyle changes. This will require patients to make and sustain behavior change.

Who can apply to participate? This get interesting. Applicants must be experienced in delivering the interventions they propose to offer and prove they are safe and effective and supported by peer-reviewed literature. There are also data collection requirements. There is a wide range of organization types that may apply, including state and local governments, providers, ACOs, practices, and they don’t provide an all-inclusive list. The most interesting they suggest? Senior living communities.

Read more about it on the Model’s landing page.

My Take

Actually, I’ll first share a few quotes by Dr. Ben Schwartz, MD, that I just read in his Substack article. This is a snip from the article and a clever perspective 👇️ 

and this 👇️ 

Highly recommend checking out the full article.

As for me, I like the idea of giving a lot of flexibility and some funding to let the innovators build out proven solutions for the Medicare population that include services not reimbursable through the set of billing codes available. The codes and their values create incentives that have contributed to the worst health outcomes of any industrialized nation at the population level. I imagine you will not see a lot of specialist physicians applying for the funding, but rather providers and organizations with potential to leverage their expertise for the Medicare population in ways they haven’t been able to do at scale.

I try to analyze anything in health policy from an unbiased lens. I admittedly can’t help but see opportunities here for my own profession as a doctor of physical therapy and for other professionals like dieticians, occupational therapists and behavioral health providers. The public and other providers largely don’t know how much impact these professionals’ expertise can have, and this model may be an opportunity to highlight what’s possible and elevate 😄 the professions.

I’m excited to see what kinds of proposals are put forward!

Oh, and if you aren’t familiar with functional medicine, I pulled the below from Dr. Mark Hyman, MD’s website. 👇️ I think of him as the face and father of functional medicine. If you want a deeper dive into functional medicine principles, his book “Food Fix: How to Save Our Health, Our Economy, Our Communities, and Our Planet—One Bite at a Time” is on “pre-order” now.

Resources/Reads

KFF’s 2026 Health Policy Predictions by Drew Altman, December 8, 2025.

MedPAC held it’s December public meeting. Here’s the link for the transcript and the slides used for the topics covered, with screenshots below of some of the topics covered, and here’s the AMA’s letter to MedPAC:

CLEAR (NYSE: YOU) announced on December 9th a contract with CMS. Medicare.gov will use CLEAR1 to address identity verification for Medicare beneficiaries and providers. This is in support of CMS’ nationwide Health Tech Ecosystem initiative and the “kill the clipboard” efforts. What this means practically is Medicare beneficiaries will eventually be able to verify their identify via a selfie (that’s the exact word used on the CLEAR announcement). Clear1 technology is already used by Epic, Ochsner Health, Hackensack Meridian Health, and others.