Below is a roundup of payer-centric news headlines you may have missed during the month of May 2025.

Leading stories

SCAN Group sole owner of PACE organization

The SCAN Group is now the sole owner myPlace Health, a company operating through the Program for All-Inclusive Care for the Elderly (PACE) model.

MyPlace was previously owned by both the SCAN Group and the Commonwealth Care Alliance. Members are dual-eligible adults or adults just eligible for Medicaid.

“By fully bringing myPlace Health into SCAN’s family of companies, we’re asserting our belief that PACE is one of the most effective models for delivering holistic, comprehensive care to older adults with the most complex healthcare needs,” said Sachin Jain, M.D., president and CEO of the SCAN Group, in a statement. “This acquisition allows us to expand our impact and continue delivering on our mission to keep seniors healthy and independent.”

Medicaid studies

The reconciliation bill, which includes seismic Medicaid changes, is making its way through Congress. Everyone has an opinion on how Medicaid has impacted healthcare already and what would happen if cuts take place.

Medicaid expansion under the Affordable Care Act reduced mortality by 2.5% in the low-income adult population, or 21% among new enrollees, a working paper in the National Bureau of Economic Research finds.

A 15% cut in Medicaid is equivalent to $1.8 billion in lost revenue (PDF) for rural hospitals, or the salaries of 21,000 full-time employees, revealed the Chartis Center for Rural Health. Almost half of rural births are partially covered by Medicaid.

The uninsured population is expected to increase the most in Washington, Oregon, New Mexico, Louisiana, Kentucky and New York, an analysis by the KFF found.

And the budget reconciliation bill as passed in the House plus expiring enhanced premium tax credits and other various changes could lead to 15.9 million more uninsured in 2034, the Urban Institute found. Between 2025 and 2034, that would also trim provider revenues by more than $1 trillion, with $400 billion of that shouldered by hospitals. 

Legislation

Virginia lays groundwork for IVF coverage

Virginia will mandate the state’s Health Insurance Reform Commission consider coverage for diagnosis and treatment of in vitro fertilization as an essential health benefit, reported Virginia Mercury.

An amendment from Republican Gov. Glenn Youngkin to deny coverage due to a religious or ethical conscience objection was rejected by the state’s legislature.

Georgia, Indiana PBM bills

The National Community Pharmacists Association (NCPA) and the National Association of Chain Drug Stores (NACDS) recently praised new laws from the states of Georgia and Indiana.

In Georgia, the NACDS saw a new law that will require the state’s health benefit to reimburse pharmacies for certain drugs with a transparent pricing model and fair dispensing fees.

In Indiana, the NCPA and the Indiana Pharmacy Association support a law imposing new floors on reimbursement for the commercial market.

Colorado studying single payer, gender-affirming care

Democratic Gov. Jared Polis signed two bills into law this month.

One bill will evaluate how a single-payer system would run in the state in a report filed to the state’s general assembly by the end of 2026.

The other mandates coverage for gender-affirming care determined to be medically necessary, reported Colorado Newsline.

Industry

Arizona awards long-term care contracts

Four health plans will now offer health insurance to members under the Arizona Long Term Care System-Elderly and/or Physically Disabled program.

Three-year contracts will be awarded to four plans, following settlement agreements. The four plans are UnitedHealthcare, Banner-University Care, Mercy Care and a Centene company.

CareSource acquires Wisconsin provider

Managed care organization CareSource is buying Lakeland Care, a Wisconsin-based managed care provider.

It is the third agreement between CareSource and a Wisconsin health organization, according to a news release.

“In just five years, the need for long-term care will nearly double with almost 25 million Americans requiring this support to live safe and independent lives,” said Erhardt Preitauer, president and CEO of CareSource. “Serving complex populations is our calling, and we are focused on bringing operational excellence, innovation and heart to transform the health care experience and outcomes for the most vulnerable.”

Studies

Cancer drug prices

The launch prices of anticancer therapy drugs increased on average by nearly $1,700 per year, with prices up to 200% higher than if inflation alone increased prices, a new JAMA Network study found.

Under the Inflation Reduction Act (IRA), newly launched drugs are not required to pay rebates to Medicare for large price increases and are not subject to the drug price negotiation program. Anticancer drugs, the authors said, must be covered by Part D formularies.

“This limits pharmacy benefits managers’ negotiating leverage,” the paper reads. “Second, the IRA limits out-of-pocket spending ($2,000/y) and price increases aftermarket entry.”

Although the price of anticancer drugs on launch did not increase disproportionately, the prices follow a similar trend as before the IRA.

“This suggests that companies were already engaging in price maximization for anticancer therapies and continued to do so after implementation of the IRA,” they added.

IRA and insurer exits

In 2024, nearly 3 million people lost their Part D insurance coverage.

A study in JAMA Network found 7.5% of beneficiaries lost their Part D insurer, versus just 0.1% to 2.3% of beneficiaries from 2018 to 2023. The authors suggested this could be due to changes to the Part D prescription benefit and a $2,000 out-of-pocket spending limit under the IRA.

“Because these changes increase risk and constrain plan design for Part D plan sponsors, there have been concerns that some beneficiaries will have interrupted coverage from plans exiting the market," the paper says.

A critique of Medicare Advantage

Taxpayer dollars are too often spent on nonmedical perks, argues Chris Pope, a senior fellow for conservative think tank Manhattan Institute for City Journal.

He highlights Clever Care paying for golf fees, Select Health in Utah covering ski fees, Humana boasting coverage of pet food or Medicare plans paying for beauty services (PDF). The problem, he said, is an increase in special supplemental benefits for the chronically ill utilization. These perks are attractive to more active Medicare Advantage enrollees.

“Purchasing new golf clubs for Medicare beneficiaries with diabetes won’t reduce their risk of costly hospitalizations, while paying for their ski passes may actually increase it,” he wrote. “But doing so will encourage the relatively healthy among them to enroll in plans.”

Low-income subsidy in Medicare

Medicare beneficiaries that receive a low-income subsidy were associated with a higher risk of mortality after Medicaid disenrollment, a study in The New England Journal of Medicine shows.

After evaluating data over an eight-year period ending in 2023, dual-eligible beneficiaries saw higher levels of cumulative mortality after 17 months of disenrollment, particularly for people who unenrolled earlier. The pattern was especially clear for people taking cardiovascular disease, chronic lung disease or HIV infection medication.

Premiums and plan turnover

When beneficiaries go from a zero-premium health plan to a plan with a premium, plan turnover was associated with a 7% decrease in automatic reenrollment, research in JAMA Health Forum revealed.

The study evaluated more than 2,000 counties across 29 states and found nearly 94% of counties saw plan turnover increase from 2021 until 2024.

“Turnover affects coverage losses by decreasing automatic, passive reenrollment among lower-income enrollees that may not realize they need to start paying premiums to retain coverage that previously did not have a premium,” the authors wrote. “Turnover also nudges returning enrollees to select new plans rather than selecting their previous plans. This likely increases insurer price competition but also may create hassles for enrollees.

“These findings suggest that coverage losses from turnover in 2026 among lower-income marketplace enrollees may be particularly large if enhanced subsidies from the IRA expire,” the researchers wrote.

Quick hits

• To try to balance the state budget, California Gov. Gavin Newsom is no longer supporting healthcare coverage for undocumented immigrants, reported NBC. Provider groups in the state have pushed back on the plan.
• Blue Cross Blue Shield of Vermont and MVP Health Care are looking to dramatically increase premiums on their members, reported VT Digger.
• Aon says GLP-1 drugs represent an “once-in-a-generation” opportunity to bend the healthcare cost curve, finding a 7% improvement in medical spend for GLP-1 users in the second year. Users also had a 44% reduction in risk of hospitalizations from cardiovascular events.
• Carmen Heredia, director of the Arizona Health Care Cost Containment System, was forced to resign, an investigative report from ProPublica explained.
• Minnesota-based HealthPartners has exited a state Medicaid program for people with disabilities after reporting almost $200 million in operating losses, reported the Minnesota Star Tribune.
• A Clover Health report finds patients with congestive heart failure (PDF) have better health outcomes when using Counterpart Assistant.
• Alabama will allow the state’s farmers federation to offer a healthcare plan to members, which are not subject to standard regulations, despite opposition from Blue Cross and Blues Shield of Alabama, reported AL.com.