Monday, April 6, 2026

Summary: CMS began enforcing updated hospital price transparency requirements on April 1. Hospitals must now publish median allowed amounts (replacing estimated allowed amounts) plus 10th and 90th percentile allowed amounts in machine-readable files. Penalties: $10/bed/day, minimum $300/day, maximum $5,500/day ($2M/year). No 35% penalty reduction available for core violations (failing to publish MRF or shoppable services). Under old rules, 46% of hospitals were non-compliant.

Summary: The first public prior authorization data is one week old. KFF published a critique: data is aggregated across all services with no breakdown by service type, no denial reasons, no prescription drug data. Insurer websites vary in format — some aggregate by line of business, others require navigating multiple pages. Key numbers hold: Centene MA — 93.6% appeal overturn rate (2023), 95.5% (2024). Oscar ACA — 25.3% denial rate. UHC — dropped from 33% to 20% the year Congress started asking questions. 53M PA requests in 2024, 4.1M denied in MA alone.

Summary: Spartanburg Regional Healthcare System goes out-of-network with Aetna on April 16. Root cause: Aetna imposed a new inpatient severity policy in January that lets Aetna pay "substantially lower" amounts after patients already received care. Spartanburg asked Aetna to remove the policy. Aetna refused. Medicare Advantage patients had until March 31 to switch plans. This is happening against the backdrop of Aetna pulling out of 100 counties and dropping 90 MA plans nationwide.

Summary: Enhanced ACA premium subsidies expired December 31, 2025. 22 million people received those subsidies. Average annual premium payments for subsidy recipients more than doubled — from $888/year to $1,904/year (114% increase per KFF). Insurers raised gross premiums 26% on average for 2026. 9% of ACA enrollees are now uninsured. Urban Institute projects 5 million will lose coverage total. 55% of people who reenrolled are cutting spending on food and clothing to afford premiums.

Summary: Federal judge ordered UnitedHealth to produce tens of thousands of documents on its nH Predict AI denial algorithm by April 29. Court filings allege 90% error rate — 9 of 10 appealed denials reversed. Algorithm overrides physician determinations for elderly rehab patients. UnitedHealth says nH Predict is a "guide," not a decision-making tool. CEO received $60M equity award. 23 days until document production.