Health Insurance Policy Changes

The Centers for Medicare & Medicaid Services has proposed that Medicare Advantage plan revenues will remain flat going into 2027 at a moment when underlying medical costs, labor expenses, and pharmaceuticals continue to rise materially. What does this mean in practice? For beneficiaries: Over time, beneficiaries should expect less generous benefits, tighter utilization management, and narrower provider networks. Access may become more constrained—not necessarily through explicit benefit cuts, but through fewer participating provider groups and more selective contracting. The tradeoff between affordability and choice will become more acute. For brokers and distribution partners: Distribution costs in Medicare Advantage are largely fixed, particularly commissions and marketing infrastructure. As margins compress, plans will continue to reassess how (and how much) they pay for growth. This may include lower upfront commissions, greater reliance on retention-based compensation, or shifts toward more direct-to-consumer enrollment strategies. For provider groups: Provider organizations seeking rate increases will face a much tougher negotiating environment. With plan revenues constrained, upward pressure on provider rates becomes difficult to absorb. As a result, some provider groups may choose to exit Medicare Advantage entirely, while others will narrow participation to fewer plans. The result may be increased network fragmentation and heightened tension between plans and providers over risk, quality expectations, and total cost of care. For managed care company employees: Cost discipline will extend inward. Plans will be slower to hire, more selective about new investments, and may pursue workforce reductions. Expectations will shift toward higher productivity, flatter organizational structures, and doing more with fewer resources. For Investor-backed Medicare Advantage plans: The economics of growth will change. Longer payback periods, lower internal rates of return, and greater regulatory uncertainty will make Medicare Advantage investments less immediately attractive. Capital will still flow to the sector, but it will be more discriminating, favoring scale, operational excellence, and differentiated capabilities rather than growth at any cost. For small and regional health plans: Scale matters more than ever. Smaller plans will struggle to compete. Many may exit the market or seek partnerships, mergers, or acquisitions. Consolidation pressures are likely to intensify as fixed administrative and compliance costs consume a greater share of revenue. Time will tell whether the rate decisions outlined in the Advance Notice hold through the Final Rule. Regardless of the ultimate number, one thing is clear: Medicare Advantage is entering a period of transition. The era of easy growth is ending, and the next phase will be defined by tradeoffs—between generosity and sustainability, growth and discipline, innovation and affordability.

For most Americans, work equals freedom. For millions of Disabled people, it can mean losing the very care that keeps them alive. Across the U.S., outdated benefits laws trap Disabled people in poverty, forcing an impossible choice, Earn an income and lose essential care, or stay poor to survive. $2,000 - the maximum in personal assets an SSI recipient can hold (unchanged since 1989). <3% of SSI and SSDI recipients successfully exit the system due to work. 25% - the reduction in benefits when two Disabled people marry. This is the “benefits cliff”, a policy failure that punishes ambition, marriage, and independence. California has shown what’s possible by eliminating asset limits under Medi-Cal. Now it’s time for national reform. "No one should have to choose between love, work, and survival.” Tyler Lima-Roope Read the full article: https://lnkd.in/epsjMpd6 #DisabilityRights image description: Tyler, using a power wheelchair, is reflected in a mirror, wearing a light-colored hoodie and red cap. He sits in a warmly lit room, gazing thoughtfully ahead.

It started with good intentions. The finance team at a logistics firm in Jebel Ali, we were speaking to recently, were under pressure to cut costs. The HR director found a cheaper health insurance policy that promised “similar coverage” and saved AED 190,000. On paper, it looked like a smart move. But three months later, things started to unravel. Employees were calling HR daily, frustrated that routine claims were being rejected. One warehouse supervisor was told his diabetes treatment wasn’t covered anymore. Their marketing manager waited two weeks for a simple pre-approval. Then came the breaking point. A senior operations manager rushed his daughter to hospital after a sudden illness—only to discover their policy didn’t include that facility. The claim got denied. He resigned a few days later, furious. Replacing him cost the business over AED 500,000. By the end of the year, staff turnover was up 18%. Productivity had dropped. HR was firefighting every week. The company had “saved” AED 190,000 but lost over AED 1.2 million in hidden costs. Cheap insurance didn’t save them—it almlst broke them. So next time you renew your policy, ask yourself: are you protecting your people, or maybe just trying to protect your bottom line?

This is a landmark moment. Last week Centers for Medicare & Medicaid Services announced two new structural measures that will help make care safer and better for millions of people. The measures were directly informed by IHI’s work and represent an exciting shift in the policy landscape of aging and patient safety.   #Aging: CMS’ #Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (#IPPS) rule includes an “Age Friendly Structural Measure” that aims to “…ensure that hospitals are reliably implementing the “4Ms” (What Matters, Medication, Mentation, Mobility), and thus providing evidence-based elements of high-quality care for all older adults.” The rule specifically notes that, “The elements in the Age Friendly Hospital measure align with IHI’s and The Hartford Foundation’s national initiative for Age Friendly Systems in which many hospitals already participate.” With the rule set to take effect in 2025, IHI invites hospitals to join the Age-Friendly movement and take action now to earn Age-Friendly Health Systems recognition. There are many ways to do so, including Age-Friendly Action Communities that enable hospitals to accelerate reliable practice of the 4Ms in an active community of learners and testers. More on the movement and how to join can be found here: https://bit.ly/3WN0TQ5.   #PatientSafety: The Patient Safety Structural Measure is the other new measure, which CMS states, “is informed by Safer Together: The National Action Plan to Advance Patient Safety, developed by the National Steering Committee for Patient Safety convened by the Institute for Healthcare Improvement (IHI), as well as scientific evidence from existing patient safety literature, and detailed input from patient safety experts, advocates, and patients.” This measure marks a pivotal shift toward potential payment for systems-level improvement across patient safety infrastructure, culture, leadership, governance, and engagement. For hospital leaders looking to prepare for the measure, this online Self-Assessment is a great place to start to get aligned on the recommendations and tactics in the Safer Together National Action Plan: https://bit.ly/3WOrIU7.   Combined, these measures will help ensure that all older adults and all patients get the best possible care in the US.   At IHI, we are incredibly proud to know that our work has led to these changes. We look forward to continuing to partner with hospitals that are working to make care safe, equitable, and reliable for all!

Since every day in healthcare seems like something new, it can take time to keep up as a startup. I wanted to address some things I think startups should be thinking about if you are operating in healthcare following the Chevron ruling because it could have some significant impacts on your business. Here are a few areas that I think we should all be looking at: Regulatory Uncertainty: Startups should prepare to adapt to a changing regulatory landscape. Agencies like the FDA and CMS, which used to have the final say on ambiguous laws, will now face more challenges in court. This means startups might have to deal with a patchwork of rules that vary by region, making it harder to know exactly what’s required to stay compliant. If your business is taking advantage of a space where there was a regulatory shift in your favor, you need to be really careful that you are safeguarding the business for potential changes. Slower Approvals: Expect things to slow down. With agencies being more cautious to avoid lawsuits, the approval process for new products and services might take longer. This could slow your sales cycle for startups (which seems impossible but is likely). It is easier for a health plan or provider to not act until they have certainty than to take on risk. Make sure you are considering this when you go to market. Higher Legal Costs and Compliance Costs: Legal bills are likely to go up. Startups will need to invest more in legal support to keep up with regulatory changes and defend against potential court cases. Most importantly, just making sure your product stays compliant with changing rules. As an aside, in the post-Change Healthcare world, there is also going to be no wiggle room around security certifications. Advocacy Opportunities: Here’s a silver lining: the new legal landscape could give startups more chances to influence how laws are interpreted. By getting involved in legal advocacy, startups might be able to shape regulations in ways that benefit them and the broader industry. It is obviously easier for startups that are further along to do this, but even in our earliest stages we were adding our voice. Important: you can respond when CMS asks for comments on a proposed rule. Add your voice! Strategic Planning: It’s going to be important to plan strategically. Startups might need to adjust their operations to fit different legal interpretations in various regions. This approach can help mitigate risks and even take advantage of regulatory differences, making startups feel prepared for the changes ahead. Room for Competition: Less red tape could mean more room for competition and potentially innovation, depending on what you are doing. Again, depending on what changes are made, startups might find it easier to introduce disruptive technologies and practices, leveling the playing field against established companies. #healthcare #startups #regulations #chevron #themoreyouknow

There's a growing force that's impacting the growth of the workforce this year, and it isn't AI or interest rates. It's the cost of small group healthcare premiums, and it's hitting businesses with less than 50 employees extra hard right now. In 2025, the average premium per employee was ~$18,000/year, with employers covering ~$12,000 and employees covering ~$6,000 through payroll deductions. Now it's getting worse. The median proposed premium increase for small group health insurance in 2026 is 11% across 318 insurers in all 50 states and the District of Columbia. But that’s just the median. About 10% of insurers are requesting premium increases of 20% or more. For a 20-person company contributing ~$12,000 per employee annually that's $240,000 spent on providing health insurance. An 11% increase means an additional $26,400 in health insurance costs. A 20% increase? That’s $48,000 more per year, money that could have helped to fund an additional hire. On the employee side, their ~$6,000/year contribution would jump $660-$1,200/year in the same circumstances. Welcome to the 2026 small group health insurance renewal crisis. If you find yourself sweating these costs as a leader, there's a couple of common options to consider if you haven't already. Option 1: Use a PEO (Professional Employer Organizations) PEOs aggregate multiple small businesses into large pools, giving you access to enterprise-level rates and plan options. How PEOs handle renewals differently: PEOs spread risk over a large number of employees among many clients and can offer better health insurance plans at lower costs compared to options available in the open market. They also provide higher levels of predictability and flatten the renewal curve. Option 2: Individual Coverage Health Reimbursement Arrangements (ICHRA) Instead of offering traditional group coverage, you provide employees with a tax-advantaged stipend to purchase individual marketplace plans. Why this is gaining traction in 2026: ACA premiums in some regions now closely mirror employer-sponsored plan costs. While the overall coverage is typically stronger with a PEO, the ICHRA model is useful for businesses who want a fixed costs that won't fluctuate with the market, and for employees who want more flexibility to suit their individual situation. How it works: - The employer sets a monthly allowance per employee (e.g., $500/month) - Employees shop for individual marketplace plans - You reimburse employees tax-free for their premiums - The employee can choose to put any underutilization of the monthly allowance towards other health and wellness costs. Through a bunch of conversations with leaders on this topic lately, I've found that there's a significant disparity in knowledge in this area, and it's not surprising. For a lot of leaders focused on growth, these details have been an afterthought beyond the traditional "we need to offer good benefits" conversation. I think that's starting to change.

We've spent the past few months talking to older Australians, their families, and people working across the health system about the Federal Government's proposal to cut the health insurance rebate for Australians aged 65 and over. The message I've heard has been remarkably consistent: people feel this policy is unfair. Polling conducted by RedBridge found 39% of Australians aged 65+ with health insurance say they’re more likely to drop their cover if the change proceeds. The research also found widespread scepticism about claims the policy improves intergenerational fairness.  This matters because health insurance helps older Australians access timely care, including procedures such as hip and knee replacements and cataract surgery that dramatically improve their quality of life, and it takes pressure off public hospitals. Younger generations are also concerned. Many working Australians are already balancing the costs of supporting ageing parents and raising children, and they’re worried this proposal will force them to help their parents with the cost of health insurance or hit them with additional caring responsibilities. If this policy proceeds, from April 2027, more than 3.2 million Australians, including at least 470,000 age pensioners, will lose part of their current health insurance rebate.  We encourage policymakers to carefully consider the broader impacts on older Australians, their families, private hospitals and state-run public hospitals before proceeding. Read more: https://lnkd.in/gJ-27B4x

India’s New Labour Codes: A Big Step Forward for Workers — Especially Women & Gig Workers The latest labour reforms are more than policy updates — they’re a long-overdue upgrade to how India protects, values, and empowers its workforce. Here are the biggest wins: 1️⃣ Stronger Protection for Women Workers ➡️Equal pay for equal work is now guaranteed (finally, a no-debate clause). ➡️Women can choose to work night shifts, mining, and heavy-machinery roles — sectors that were previously off-limits. ➡️Mandatory safeguards: women must be represented in grievance committees, employers must ensure safe transport, CCTV coverage, security staff, and written consent for night duty. • Double wages for overtime. • Parents-in-law are now legally recognised as “family,” expanding caregiving leave for female employees — a quiet but powerful win. 2️⃣ Social Security for Gig Workers For the first time, India’s 21st-century workforce — cab drivers, delivery partners, freelancers, app-based service providers — gets access to: • Provident Fund (PF) • ESIC • Insurance Platforms and aggregators will now contribute 1–2% of their annual turnover to a national social-security fund. A baseline safety net for people who keep our cities running. 3️⃣ Minimum Wages for All ➡️Minimum wage norms are now standardised nationwide — no more sector-wise patchwork. ➡️Beedi & cigar workers: 8–12 hour shifts with a hard 48-hour weekly cap. ➡️Digital and audiovisual professionals — journalists, dubbing artists, stunt performers — finally receive full employee benefits. These changes may read like bullet points, but they’ll transform daily life for millions — especially women and gig workers who’ve traditionally fallen through the cracks. Upgrading our workforce protections isn’t just a labour reform. It’s nation-building. #labourreforms #nationbuilding

My favorite account type - HSAs - might be getting sweeter 🍧 In the proposed tax bill, there are expansions to HSA access: → HSAs could be used for some fitness/gym memberships moving forward. → An additional 20 million Americans are predicted to gain access to HSAs, including those on Medicare Part A and those on ACA Bronze and Catastrophic plans. → Catch-up contributions will be simplified for spouses sharing one HSA. Currently, those over age 55 need to save their $1,000 catch-up into their own separate HSA accounts. The new tax bill will allow spouses to add to the same HSA account. The bill is pending approval by the Senate. Stay tuned.

The most disruptive healthcare reform in a decade isn’t getting headlines. Buried in the “Big, Beautiful Bill” is a tiny tax credit with massive implications: 💥 $1,200 per employee for small businesses to offer healthcare via CHOICE Arrangements (aka the next-gen ICHRA). What’s the catch? 👉 No catch. Just a shift that could finally break the employer-sponsored insurance status quo. Let me explain: Most small businesses (<50 employees) can’t afford traditional group plans anymore. The math is broken: - Group plan prices are climbing fast. - Employees can often get better coverage, cheaper, on the ACA marketplace. - Level-funded plans are cherry-picking healthy groups, driving up premiums for everyone else. Enter CHOICE. With a $1,200 tax credit, businesses can give tax-free dollars to employees to buy their own individual plans — and come out ahead. This is not a niche subsidy. It’s the beginning of the 401(k)-ification of health insurance — a shift from employer-owned plans to portable, personalized benefits. If this passes, here’s what happens: ✅ Small group plans start to die off ✅ CHOICE / ACA pools swell from 25M → 35M+ ✅ Larger employers take notice: bigger, healthier risk pool = better individual plan options ✅ Even giants like Amazon and Walmart can’t beat the scale of a 35M-person individual market ✅ Traditional group plans start to look… retro The ripple effect? This bill doesn’t just change how small businesses offer healthcare. It rewires the whole system. Let’s hope Congress sees it for what it is — a chance to modernize American healthcare, starting at the roots. 🌱