Read today’s Kaiser Health News
About health insurance/insurers
HHS to probe ‘misleading’ Medicare Advantage marketing practices: “In recent years, concerns about aggressive and deceptive marketing practices in Medicare Advantage have become more pressing,” the HHS OIG wrote in July. “These concerns have focused on agents and brokers used by Medicare Advantage plans who target and mislead seniors, at times enrolling them in plans without their knowledge or directing them to plans that substantially increase their out-of-pocket costs.”
The study will focus on complaints received by CMS from 2020 to 2024, specifically looking at the actions taken by agents and brokers that led to the complaints and the incentive structures that encouraged brokers to change individuals’ enrollments. The final study is expected to be released in 2026.
In 2023, CMS finalized a rule aimed at addressing issues related to misleading MA marketing by prohibiting ads that lack specific plan details or mislead beneficiaries through imagery and language.
Oscar Health is latest insurer to cut earnings guidance: Oscar Health is expecting to operate at a loss in 2025 as costs climb in the individual market.
The company reported preliminary results for the second quarter of 2025 on July 22, expecting a loss from operations of $200 million to $300 million in 2025, according to a company news release.
State Waivers for Continuous Medicaid Eligibility to End Under CMS Guidance: Centers for Medicare and Medicaid Services (CMS) released guidance notifying states that it does not anticipate approving new state proposals or extending existing approvals for section 1115 waivers with continuous eligibility provisions for children and adults in Medicaid.
Continuous eligibility generally allows individuals to remain enrolled for a specific period even if there are fluctuations in income. The Consolidated Appropriations Act, 2023 required all states to implement 12-month continuous eligibility for children beginning on January 1, 2024. States must use Section 1115 waiver authority to extend continuous eligibility to adults (or certain adult subpopulations), as well as to provide multi-year continuous eligibility for children.
An Attack on the Medical Establishment Buried in an 1,800-Page Regulation: The entire article is worth reading, but here is a key portion: Under the new proposal, Medicare would pay 2.5 percent less for every procedure, operation and medical test in 2026, based on data suggesting there have been improvements in “efficiency” over the years. Payments for treatments based only on time, like a consultation with a family physician or neurologist, would not be cut. Such adjustments would be repeated every three years.
The proposal also looks to change the kind of data Medicare should consider instead of the relatively small surveys, noting that new sources of health data from hospitals and electronic billing systems could offer more accurate information.
About pharma
Sanofi to buy respiratory vaccine biotech Vicebio for $1.6B: Sanofi has agreed to acquire Vicebio for up to $1.6 billion, gaining access to the UK biotech's Molecular Clamp technology platform for developing next-generation multivalent vaccines against respiratory pathogens. Under the terms, Sanofi will pay $1.15 billion upfront, with an additional $450 million tied to development and regulatory milestones.