"According to one expert at Pitchbook, two core issues are likely to dominate healthcare reform discussions in 2026: rising costs and flaws in Medicare Advantage. Healthcare affordability remains a major systemic issue preventing millions of Americans from accessing care, and Medicare Advantage's risk-adjustment system is "clearly broken," creating incentives that pull excess money into the program, explained Brian Wright, lead analyst for healthcare research at Pitchbook."
"Medicaid eligibility issues are going to pressure hospital systems - and what do they do? They typically make up for it by billing to the commercial side. The commercial side always is that subsidizer for the rest of the healthcare system. So the thought process is 'Okay, how can you go about making a market on the commercial side work better than it is now?'"
"Under the ACA today, payers can generally charge older adults no more than three times what they charge younger adults. If those limits were to be expanded to allow payers to charge older adults, say, up to five times more, then there would be lower premiums for younger people. 'That way younger, healthier people are incentivized to get into the risk pool,' Wright declared."
Rising costs and problems in Medicare Advantage's risk-adjustment system are expected to dominate healthcare reform in 2026. Healthcare affordability prevents millions of Americans from accessing care. Medicare Advantage's risk-adjustment incentives move excess funds into the program and distort payments. Policymakers will likely pursue Affordable Care Act and commercial-market reforms to improve affordability and strengthen risk pooling. Medicaid eligibility pressures are prompting providers to shift costs onto commercial payers, making the commercial market a de facto subsidizer. Potential reforms include loosening age-rating limits to attract younger enrollees and giving states more flexibility to set minimum coverage standards across metal tiers.
#healthcare-affordability #medicare-advantage #risk-adjustment #medicaid-eligibility #affordable-care-act-reform
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