Below is a sampling of what is going on. Times are changing and things are moving. You can also look at the Notes section of the website where articles of interest are listed.
Your summer reading list with links to the full articles:
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7/9/26. Obamacare premiums likely to surge again next year. “Health insurance premiums are likely to grow more expensive next year for those who buy Marketplace plans, after increases this year.
Affordable Care Act Marketplace insurers are proposing a median premium increase of 14% for 2027, which would be a double-digit hike for the second year in a row, according to a new analysis of preliminary rate filings… ACA Marketplace enrollments have seen a steep drop, with 2.6 million fewer Americans on the rolls in February compared with the same time last year, The Associated Press reported.”
7/7/26. Indiana FSSA shares Medicaid work requirement rules. “Low-income Hoosiers will have to work, volunteer or be in school — or meet an exemption. The Indiana Family and Social Services Administration is preparing to phase in work requirements for able-bodied Hoosiers ages 19-64 who participate in Medicaid’s Healthy Indiana Plan, starting Jan. 1, 2027. The agency released new details this week about early compliance for new applicants and how Hoosiers enrolled in HIP can fulfill their monthly 80-hour work requirements. Anyone who plans to apply in January will need to meet work requirements starting in October.
HIP is Indiana’s version of Medicaid expansion, which extended eligibility for Medicaid under the Affordable Care Act to adults ages 19-64 who earn up to 138% of federal poverty guidelines… Estimates from the Urban Institute and Robert Wood Johnson Foundation suggest anywhere from 102,000 to 116,000 Hoosiers could lose eligibility due to the 80-hour work requirement.”
6/30/26. Report: Indiana leads nation in decline of children insured through Medicaid “Georgetown University report finds nearly 20% drop in child enrollment since Jan. 2025. An estimated 174,000 fewer Hoosier children were insured through Medicaid programs in April compared to January 2025, according to a report from Georgetown University School of Public Policy.
That’s a 20% decline — the highest rate in the nation, the report found.
Indiana reported the highest percentage decline and third-highest absolute decline in the nation in this timeframe, behind California (-382,776, or 8%) and Texas (-190,956, or 6%).
Child health advocates attribute the trend to confusion about Medicaid eligibility and fears that identifying undocumented family members to authorities to qualify for insurance coverage could result in their deportation.”
5.11.26. Stewardship over profit: Why Indiana must rethink the Medicaid middle, by Gabe Bosslet MD. “Indiana’s current structure directs a substantial share of each payment to administrative layers that are not consistently delivering value. Last month, the Indiana Family and Social Services Administration (FSSA) announced it is seeking to recoup nearly $200 million in alleged improper payments from five “high-risk” attendant care agencies. The audit results were not just disappointing; they were deeply concerning.
In a sample of claims, auditors found errors in nearly all claims reviewed, with some providers approaching a 100% error rate. These findings raise a fundamental question: is Indiana’s current Medicaid structure delivering the accountability and value that taxpayers and vulnerable Hoosiers deserve?
Attendant care agencies play a central role in Indiana’s home-based care system. They serve as the “employer of record” for thousands of caregivers , including family members, who assist with daily activities such as bathing, dressing, and mobility. For this administrative role, the state pays a bundled rate of about $34.36 per hour.
Under current policy, at least 70% of that rate must go toward caregiver compensation and related expenses, leaving roughly 30% for administration, supervision, and margins. In principle, those funds support oversight and quality. In practice, the recent audit raises concerns about whether those expectations are being met. Investigators reported missing care plans, incomplete background checks, and improper billing.
Indiana may be adding complexity to an already strained structure. With the rollout of PathWays for Aging — a Medicaid program that shifted long-term care into managed care plans — the state is increasingly relying on insurers such as Elevance, Humana, and UnitedHealthcare to coordinate care delivery. These entities can improve coordination, but they also introduce another administrative layer.
As a result, Indiana risks creating a system in which one set of intermediaries oversees another. Each layer adds complexity and profit expectations, making accountability harder to track. In that context, it becomes more difficult to answer a basic question: how much of each Medicaid dollar ultimately supports direct care?
Indiana’s current structure directs a substantial share of each payment to administrative layers that are not consistently delivering value. Other states have taken a different approach — simplifying these layers and, in some cases, eliminating them entirely.
Connecticut, for example, took a direct approach. In 2012, the state eliminated managed care organizations from its Medicaid program and brought administration back under state control. Today, administrative costs run in the range of 3–4% of total spending — far below many managed care models. While not a perfect comparison, it shows that states can reduce costs and improve transparency by removing unnecessary intermediary layers…
The distinction is critical. In Indiana’s current model, agencies both employ caregivers and bill the state, retaining a share of each payment. A fiscal intermediary separates those roles. The patient or family acts as the employer, directing care, while the intermediary performs a limited administrative function without controlling care delivery or retaining a large portion of the funds. In practical terms, this shifts the role of the middleman from managing care to processing its transactions.
Taken together, these examples point in the same direction: states can reduce reliance on layered managed care while redesigning necessary administrative functions to be simpler, more transparent, and lower cost…
Indiana cannot dismantle its current system overnight. Agencies and managed care organizations provide infrastructure that many families rely on. At the same time, the recent audit suggests the balance is not working as intended. The question is not whether administrative functions are necessary — it is whether Indiana should continue relying on an agency-based model that has shown clear weaknesses, or begin transitioning to a more transparent alternative.
A gradual shift toward self-directed care supported by fiscal intermediaries would preserve access while improving transparency and efficiency. Such a transition will require effort: revising contracts, modernizing data systems, and strengthening oversight within FSSA. But maintaining the current approach also carries costs, financial and operational, especially in the context of Medicaid budget pressures.
Indiana does not need to design a new model from scratch. Elements of a more streamlined, accountable approach already exist in other states. Taxpayer dollars should reach the bedside as directly as possible. Every layer of the system should be able to demonstrate the value it adds to patients, caregivers, and the public that funds it.”
[Note: One of the major middlemen involved in Indiana Medicaid administration is Elevance, and we see in the next article below how they have admitted to defrauding the government]
Healthcare Uncovered is edited by our old friend Wendell Potter and is priceless. Here are some recent don’t-misses:
7.1.26. Elevance Had to Give $342 Million Back to Taxpayers. “Elevance Health, one of the nation’s biggest health insurance conglomerates, wired more than $342 million to the Centers for Medicare & Medicaid Services a few weeks ago after the agency threatened to suspend enrollment in the company’s Medicare Advantage plans over what CMS described as years of “substantial and persistent noncompliance” with federal billing requirements.
The payment represents only part of what the company itself has estimated it may ultimately owe the government, which is closer to $1 billion. As I wrote in April, Elevance knew that it was billing Medicare improperly but kept doing it anyway. Inside the company’s Q1 2026 earnings release, Elevance disclosed that it had set aside funds to cover its potential liability after CMS concluded the company failed for years to properly correct unsupported diagnosis codes that directly affect how much Medicare pays private insurers.
According to CMS, Elevance repeatedly declined to use the agency’s required electronic reporting systems, instead submitting corrections through encrypted flash drives despite repeated warnings from regulators.
The company disputes the government’s interpretation of the rules and has denied wrongdoing. But companies don’t voluntarily wire more than $342 million to the federal government for no reason.
7.7.26. Senators Introduce Bill to Cap Traditional Medicare Out-of-Pocket Costs at $5,000. For as long as traditional Medicare has existed, it has had a flaw so obvious and so consequential that it is understandable why many seniors have enrolled in private Medicare Advantage plans despite the many downsides of doing so: There is no limit on what a beneficiary enrolled in traditional Medicare can owe in a single year. Get seriously ill, face a hospitalization, live with a chronic condition that requires intensive care — and the bills pile up with no ceiling. Every other major insurance program in the country — Medicare Advantage, employer-sponsored coverage, plans sold on the Affordable Care Act marketplace — has an annual out-of-pocket cap. Traditional Medicare never has.
Just before the holiday, Senate Democrats introduced legislation to fix that. The Medicare Cost Cap Act, led by Senators Ron Wyden of Oregon, Lisa Blunt Rochester of Delaware and Senate Democratic Leader Chuck Schumer of New York, would establish a $5,000 annual cap on out-of-pocket costs for traditional Medicare beneficiaries starting in 2028. “Nobody should go broke to get the health care they need, especially seniors who have paid into Medicare with each paycheck during their working years,” said Wyden.
If enacted, beginning on January 1, 2028, once a beneficiary’s combined cost-sharing under Parts A and B — including hospital deductibles, physician coinsurance, and other out-of-pocket payments — reaches $5,000 in a calendar year, Medicare pays 100% of covered costs for the remainder of that year.’
[This is a significant upgrade to Traditional Medicare. Remember that PNHP calls for of Medicare to be expanded and improved and this is part of that effort, to address the weaknesses in Traditional Medicare.]
Dr Stone’s recent column in the June/July Bloom Magazine Healthcare For All (many of you have seen this before):
“Why not take on the health insurance companies?
We are today closer to a universal healthcare system than America has ever been. I’m serious. Hear me out.
This November 2026 it’s plausible that Democrats will take control of the House of Representatives. In January of 2027 there is a likelihood that a Democratically controlled House will aggressively move to counter President Trump, including impeaching him, while it remains less likely that impeachment would lead to conviction. Either way, in 2028 it is plausible that Democrats will win control of the White House and both houses of Congress, and that in 2029 legislation to implement universal healthcare will pass, and we have universal care starting 2030.
According to the Commonwealth Fund’s health survey, reported in 2023, the United States among “high-income countries” has “the lowest life expectancy at birth, the highest death rates for avoidable or treatable conditions, the highest maternal and infant mortality, and among the highest suicide rates.” We also have the highest rate of people with multiple chronic conditions and an obesity rate nearly twice the average of other high-income countries. And yet, health care spending has remained far higher in the U.S. than in other high-income countries, all of whom have universal health coverage. Their universal plans don’t allow private for-profit insurance companies and private equity takeovers. Economists believe eliminating them would save 30% of our healthcare spending, enough savings to take care of everyone and still haver money left over.
The problem is not that we can’t afford to take care of everyone. We are spending plenty of money. That makes getting to universal care much easier than it would be otherwise. In fact, Dr. Alan Sager at Boston University of Public Health has written a book The Easiest, which begins with, “Affordable high-quality healthcare for all Is the easiest problem to fix in the United States. Not easy, just easier than any of the others—because we already spend enough. And, the most strategic because, unless we fix health care, we won’t be able to find the money to address the others.”
What stands in our way? Even though the arguments are persuasive, people throw up their hands and say, “It will just never happen! Healthcare is impossibly expensive and complicated. The insurance companies are too powerful. Give up hoping for that pie in the sky”.
We haven’t given up that easily on climate change. Climate change is killing us, literally, destroying lives and our economy, but do we give up on working to save our planet because it’s “impossible”? No.
Healthcare is easy compared to the enormity of fixing climate change. We know because every other wealthy democracy has figured out how to do it. Medicare has been taking care of the sickest and most expensive of us since 1965. The problem is that our system is designed to produce profits, not a healthy population. It’s the profiteers, the for-profit insurance companies, pharmacy benefit managers (PBMs), private equity takeovers, all things that none of our peer countries has allowed.
The solution is simple, dis-intermediation. Like Uber or Airbnb or Amazon. Disrupt the market by eliminating the insurance middlemen. That’s how traditional Medicare works now. I see my patient. My office sends a bill to Medicare, and they send me back a check.
That is not how employer-based insurance or Medicare Advantage work or private equity take overs work. Healthcare has become an extractive industry like mining or logging, but here too much of our system extracts money without producing any more health or care.
Too expensive? The Congressional Budget office says a Medicare for All system will actually save money. And we never seem to have trouble finding money to pay for wars. Too radical a change? DOGE wiped out USAID in a week. I’m not saying that was not a disaster, but changes can be made rapid
I’m not saying it is an easy thing to do, but it’s the right thing to do. It means taking on greed, racism, sexism, fraud, all good things to fight against. What are we waiting for?”
Watch this video of Dr Abdul El-Sayed, a PNHP member running for Senate in Michigan as United Auto Workers President Shawn Fein introduces him after the UAW has endorsed his candidacy:
Our goal is to attract people to support a national health program using data and information provided by Physicians for a National Health Program. Go to the PNHP web site PNHP.org for ideas for Letters to the Editor or emails to your legislators in our area. Keep talking to your friends and neighbors. Load up with information to support your position.
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