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Healthcare Workforce Modernization Needed

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Healthcare Workforce Modernization Needed

Last week, the war in Iran intensified and Kristi Noem’s tenure as DHS Secretary came to an unceremonious close. Perhaps lost in the noise was the February jobs report issued Friday by the U.S. Bureau of Labor Statistics. It showed a surprising decline in job growth prompting speculation the economy might have taken a downward turn. Some headlines….

  • Payrolls unexpectedly fell by 92,000 in February; unemployment rate rises to 4.4% (CNBC)
  • Employers Cut Jobs in Sign of a Shakier Economy (New York Times)
  • Paychecks keep rising for American workers, providing boost to household budgets (Fox Business):
  • The U.S. economy lost 92,000 jobs in February, stoking labor market worries (NBC News)
  • The US economy lost 92,000 jobs in February and the unemployment rate rose to 4.4% (CNN)

Anticipation that the jobs report portends bad news for the economy followed the news cycle all day and through the weekend. And a few, like Axios, went further: “The surprise to many was where the biggest since job growth especially in healthcare and social assistance had buoyed the labor market for 3 years.” Others attributed the decline to hangovers from recent nursing strikes (USC Keck, Kaiser Permanente, MarinHealth) and layoffs by many health systems.

To industry insiders, the BLS jobs report’s capture of declines in healthcare hiring was no surprise. Operating cost reduction has been a strategic imperative in every hospital, long-term care, ancillary and medical group since the pandemic (2020). In tandem, investments in workforce productivity enhancements via technology-enabled workforce redesign and performance-based compensation have elevated human resource management to C-suite status in most organizations. It’s understandable:

Healthcare is capital intense: it needs appropriations from government and in-flows from employers and individual taxpayers to pay its bills. Most of that pays for its labor costs. Today, most Board agenda include updates on labor relations, human resource management issues and workforce adequacy—it’s standard fare. And all weigh options to outsource and devour progress reports from HR management on AI-enabled investments anticipated to reduce labor costs.

Healthcare is highly regulated, especially in workforce activities, and labor-management relationships impact organizational performance and reputation. Every sector in healthcare is regulated by combinations of federal, state and local rules, laws and agency directives that define roles, responsibilities, decision-rights and constraints of its workforce. It’s complicated by the politics of healthcare which avoids policy changes that threaten protections sought by each labor cohort in healthcare. Protecting funding and restricting infringement on scope of responsibility by unwanted outsiders is the primary rationale for professional society’ advocacy efforts. In hospital and long-term care settings, the healthcare workforce is a cast-system that keeps doctors at the top of the pyramid, licensed mid-levels in the middle and everyone else below. In other healthcare settings, executive-level designations dominate hierarchies, and in some Boards play roles in workforce structure and compensation schemes. Workforce modernization in most healthcare settings is acknowledged as a critical need but most default to layoffs and fail to enact a comprehensive strategy.

Looking ahead, technology will alter the status quo for workforce modernization efforts in healthcare:

1-Less dependence on physician recommendations. Might patients access customized clinical decision support tools more widely in the future and make more choices themselves (especially if incentives support self-care)? Might other sources of clinical counsel be more accurate, more accessible and less costly in the future, prompting acceptance (trust and confidence) by patients? Physicians and other caregivers will play key roles, but in concert with tools and processes that enable consumer engagement.

2-More access to verifiable cost, price and value information. The underlying costs and prices for healthcare services are unknown to their caregivers at the points of care so the majority of transactions require pre-authorization by a third-party adjudicator with payments that follow. Physicians bear no responsibility for advising patients about costs and prices: theirs is exclusively the domain of clinical counsel. Thus, labor costs in healthcare presume third party payments, middlemen, incapable self-care and work rules that reinforce old ways and torpedo better ways of work. Might the role and scope of insurer activity be integrated with delivery so that “costs and quality” are directly accountable to providers? Might primary and preventive health hubs (physical + behavioral + nutrition + prophylactic dentistry + self-care enablement + insurance) become the centerpieces of community health replacing traditional insurers and hospitals? Where will the workforce choose to work?

Per the Healthcare Workforce Coalition (www.healthcareworkforce.org), healthcare workforce shortages are a near and present danger to the U.S. health system: shortages of physicians, nurses and allied health professionals are significant, especially in rural areas. The 18-million who constitute the healthcare workforce today are being told to work harder with less. It’s no secret.

In the Affordable Care Act (2010), Title 5 (Section 5101), healthcare workforce modernization was authorized: “The purpose of this title is to improve access to and the delivery of health care services for all individuals…” Subtitle B authorized creation of a 15-member National Health Care Workforce Commission to recommend modernization policies. It would have coordinated workforce initiatives across federal agencies (HRSA, CMS, MedPAC, MACPAC, GAO, et al) along with states and private sector operators to address long-term issues and short-term execution challenges. The Commission never met because its funding was not authorized by Congress.

If the overall economy is dependent on healthcare to produce an appropriate share of job growth while reducing overall costs, modernizing its workforce is key. It must include unpaid caregivers, licensed and unlicensed providers and technology-enabled solution providers—not just traditional licensed professional groups and their academic partners. That’s not going to happen in the current political environment where each sector’s primary focus is protecting reimbursement and guarding against scope of practice threats.

The health system needs transformation. Workforce modernization is where to start.

Paul

P.S. My journey as a heart patient continues to teach me just how far we have to go as a “system.” Understanding what I have been billed for, by whom, when and why is like reading Russian. As best I can see, $267,490.30 has been charged by the hospital and 13 different doctors who’ve treated me in some way.  How much I end up spending after rehab et al remains a mystery but it’s not remotely close to the hospital’s “price estimator” tool. Little wonder consumers are frustrated about healthcare costs pushing its affordability to the top of their Campaign 2026 concerns.

HHS takes another swing at drug discount overhaul

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https://www.axios.com/2026/02/23/hhs-340b-drug-discount-overhaul?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

The Trump administration is doubling down on efforts to revamp the federal discount drug program — a major flashpoint between Big Pharma and hospitals.

Why it matters: 

The so-called 340B program has been mired in litigation, most recently over administration efforts to let drugmakers carry out price reductions through rebates instead of cutting prices at the front end.

  • After a court halted the attempt on procedural grounds, federal health officials this month laid the groundwork to reintroduce changes that providers say could cost them hundreds of millions of dollars.

Driving the news: 

The Health Resources and Services Administration last week issued a notice soliciting feedback on whether and how to make hospitals and clinics in the program pay full price up front for the medications.

  • Drugmakers would then rebate the price difference later, after verifying that a facility qualifies for a discount.
  • The agency is asking hospitals for financial data to back up industry claims that such a change would threaten facilities’ cash flows and create administrative hassles as they contend with federal Medicaid cuts.

Context: 

A federal court in Maine ruled late last year that the Department of Health and Human Services, which HRSA is part of, didn’t solicit enough stakeholder feedback before proposing its initial rebate model.

  • HHS “cannot fly the plane before they build it,” Judge Lance Walker wrote in response to a lawsuit from the American Hospital Association and other hospital groups.
  • HHS scrapped the pilot in January and dropped its appeal of the decision.
  • The new notice it sent this month “suggests a sense of urgency in advancing a new rebate model proposal,” lawyers at Quarles & Brady wrote in a blog post.
  • Still, HHS would need to formally propose and gather comment on any future model, and has committed to giving providers at least 90 days’ notice before starting the new system.

Where it stands: 

The drug industry trade group PhRMA sees the rebate model as a way to add needed transparency to federal drug discounts, spokesperson Alex Schriver said in a statement to Axios.

  • “We’re heartened by the administration’s efforts to ensure that the program operates as it’s intended,” CEO Steve Ubl told reporters last week.
  • Pharmaceutical companies have been trying to move in the direction of rebates themselves over the past couple of years, arguing that many providers are gaming the system and getting 340B program discounts as well as Medicaid rebates for drugs.
  • Courts have blocked individual companies like Bristol Myers Squibb and Johnson & Johnson from switching to rebates from up-front discounts.

The other side: 

Hospitals are planning to respond to the information request, but they’re holding out hope that HHS will drop the rebate idea altogether.

  • HHS should “recognize that imposing hundreds of millions of dollars in costs on hospitals serving rural and underserved communities is not a sound policy,” Aimee Kuhlman, AHA vice president of advocacy and grassroots, said in a statement.
  • AHA and other hospital groups last week sent a letter to the administration asking to extend the comment period and potentially laying the groundwork for another legal challenge if that isn’t granted.
  • Community health centers, meanwhile, are urging Congress to pass a bill that exempts them from rebate experiments.

The bottom line: 

The administration isn’t giving up on the rebate idea. That will only add to the controversy over a program that covers more than $81 billion in annual drug purchases.

Assessing the White House Plan to Lower Health Care Costs

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https://www.aei.org/op-eds/assessing-president-trumps-plan-to-lower-health-care-costs/?utm_campaign=22139279-ECON_NLR%20Vital%20Signs&utm_medium=email&_hsenc=p2ANqtz–kzE8ICeIfJPOnbTIcNSWrWYGAGRRI9pUx5esLhZO_Nn9-gEI2TP9Vrewu5hHSEPaxvNNJnod666FNOcqRNR21kjvWDQ&_hsmi=402038515&utm_content=402038515&utm_source=hs_email

Last week, the Trump White House released a plan to reduce health care costs that is consistent with its approach to many differing questions. There was a dominant populist impulse, with several provisions targeting corporate interests for supposedly causing most of the problems consumers experience, alongside a more libertarian orientation that emphasizes patient choice and control, although the proposals tied to this theme lacked sufficient detail to be convincing. What the White House did not provide is an actionable legislative plan to lower the cost of health care for most Americans. Instead, the status quo is almost certain to prevail this year and for the foreseeable future.

That might have been the intention, as the White House probably wants to avoid a protracted debate on health care as the midterm election approaches. The administration’s one-page summary of its ideas, called “The Great Healthcare Plan,” seems to have been put together for defensive reasons. The Republican Party has been scrambling for several months to deflect Democratic attacks over the December expiration of enhanced premium credits for Affordable Care Act (ACA) insurance plans that had been approved through 2025 during President Joe Biden’s term. The Trump White House’s plan was developed to provide the Republican Party, or at least key officials in the administration, with something to talk about when opposing a straight extension of the credits.

The administration’s plan contains nine proposals that purport to boost transparency, lower costs, or give consumers more control over their health care choices. The net effect of the plan will be minimal because the causes of high and rapidly rising health costs have deep roots and cannot be addressed with surface changes that leave untouched the basic architecture of the status quo.

Read More.

Government Reports on Healthcare require a Closer Look

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Government Reports on Healthcare require a Closer Look

Last week, the Federal Government released agency reports that paint a perplexing picture for the health industry entering 2026:

Tuesday, The Bureau of Labor Statistics released the EMPLOYMENT COST INDEX SUMMARY noting “Compensation costs for civilian workers increased 0.7%, seasonally adjusted, for the 3-month period ending in December 2025 and 3.4% for the 12-month period ending December, 2025.” Closer look: it was +3.6% for hospitals and +3.2% for nursing homes.

Employment Cost Index Summary – 2025 Q04 Results

Wednesday, the Bureau of Labor Statistics released THE EMPLOYMENT SITUATION — JANUARY 2026: “Total nonfarm payroll employment rose by 130,000 in January, and the unemployment rate changed little at 4.3%… Job gains occurred in health care, social assistance, and construction, while federal government and financial activities lost jobs…Health care added 82,000 jobs in January, with gains in ambulatory health care services (+50,000), hospitals (+18,000), and nursing and residential care facilities (+13,000). Job growth in health care averaged 33,000 per month in 2025. Employment in social assistance increased by 42,000 in January, primarily in individual and family services (+38,000).” Closer look: the jobs report is based on employer sampling which is revised as subsequent surveys are added to the sample. Thus, data for any single month is at best only directionally accurate. Reliable federal data about the healthcare workforce remains a work in process.

Employment Situation Summary – 2026 M01 Results

Friday, BLS released the CONSUMER PRICE INDEX REPORT FOR JANUARY, 2026: “Consumer prices rose 2.4% in January from a year earlier down from 2.7% in December.” Core prices, which exclude volatile food and energy items, rose 2.5% from a year earlier vs. medical care commodities (+.3%), hospital services (+6.6%) and physician services (+2.1%). Closer look: prices for hospitals and physicians vary widely (by ownership, specialty, size and location) but differ in one respect: Medicare rates are used as a proxy for both, but rate setting for physicians disallows inflationary adjustments.   

Consumer Price Index February 13, 2026 https://www.bls.gov/charts/consumer-price-index/consumer-price-index-by-category.htm#

Taken together, they reflect the obvious: The healthcare economy is a big deal in the scheme of the overall economy and the nation’s monetary policy. The CBO’s revised projection shows it increasing from 18% of the GDP today to 20.3% by 2033.

But a closer look exposes worrisome signals in the reports:

  • Increased housing costs are destabilizing lower-and-middle income household finances resulting in increased medical debt, delayed care and heightened sensitivity to healthcare affordability. It also has direct impact on the availability of the local workforce where home ownership or rental costs are out of reach.
  • Hospital price increases used to offset escalating labor and supply chain costs are well-above other spending categories; some have healthy margins while others are struggling. Public perception about hospital finances is susceptible to misinformation and executive compensation is a lightning rod for detractors. Per a KFF report last week, hospitals accounted for a third of total health spending increases since 2023 but 40% of the total spending increase—higher than any other factor. That puts added pressure on hospitals to justify costs and account for prices.
  • The healthcare workforce has become the backbone of the labor market: the majority of its expanded labor pool are skilled and unskilled hourly workers for whom competitive wages and benefits are key. Healthcare delivery is labor intense. Across all settings in healthcare, efforts to increase productivity via data-driven, technology-dependent process improvements have been made. But reimbursements by payers have punished improvements in productivity requiring more work for less money. The result: disenchantment about the future of the system is a tsunami in the healthcare workforce.

In every hospital, medical group nursing home and home care organization, pressure to attract and keep a viable workforce is mission critical. In some, the Human Resource function is effectively aligned with regulatory, clinical and technology changes, in some, compensation plans from executive to support are strategically designed to optimize short and long-term performance and ROI. In some, the Board Compensation committee is well-prepared to adjust policies as talent requirements change. In some, leaders and frontline teams show mutual respect and sincere appreciation. But many fall short.

These reports are public record. But their headline stats don’t tell a complete story. Every healthcare organization is obligated to do the rest.

Trump administration pressed on details of drug price deals

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https://www.axios.com/2026/02/03/trump-drug-price-deals-pfizer-eli-lilly

The Trump administration is facing new pressure to disclose details about its confidential pricing agreements with big drug companies and whether they meaningfully lower costs for patients.

Why it matters: 

President Trump has touted the “most favored nation” drug pricing deals as one of his signature accomplishments, but most of the details have been kept under wraps, including how the new prices are calculated.

Driving the news: 

The advocacy group Public Citizen filed a Freedom of Information Act suit last week, seeking the text of the deals the administration struck with Eli Lilly and Pfizer.

  • Those and other agreements were touted in high-profile Oval Office ceremonies as a step toward lowering U.S. drug prices and aligning them with what’s paid in other developed countries.
  • The deals have been described in broad terms, but questions remain about basic matters like what exactly the companies agreed to.
  • The administration is “shaking hands with pharma CEOs and telling us they fixed drug pricing and then not disclosing any text,” said Peter Maybarduk, access to medicines director at Public Citizen. “It makes it hard to believe, makes it hard to understand, makes it hard to assess.”

Congressional Democrats also wrote to Pfizer, Eli Lilly, AstraZeneca and Novo Nordisk in December asking for details of their respective agreements.

  • The letter to Pfizer said the company and the administration seem to be “attempting to shield themselves from oversight, accountability, and specifics that could inform consumers about whether this agreement will save money.”
  • An administration official said: “Because the drug pricing agreements contain confidential, proprietary and commercially sensitive information, they will not be released publicly.”
  • None of the four companies provided more details when asked about the agreements. A Novo Nordisk spokesperson said “this agreement will bring semaglutide medicines to more American patients at a lower cost,” referring to the active ingredient in its blockbuster weight-loss drugs.

Between the lines: 

The deals would for the most part not lower existing drug prices for a huge segment of the public that gets coverage through Medicare or workplace insurance.

  • Instead, the most-favored nation prices would apply to Medicaid. One unanswered question is how much lower would those prices be, since drugmakers already are required to have low prices for Medicaid.
  • The deals also anticipate most-favored nation prices for newly launched drugs in future years. But it’s not fully clear how that would work, since drugs are usually launched in the United States first and there wouldn’t yet be prices abroad to use as a comparison.
  • There would also be discounted drugs sold through the government’s direct-to-consumer website TrumpRx. But the portal is built around cash purchases, which many cannot afford.

The big picture: 

Trump has railed against what he calls “global freeloading” and ending the way the U.S. pays more for drugs than other developed countries. But policy experts have questioned whether manufacturers will only meet him halfway, raising prices abroad without cutting them in the U.S.

  • “You can kind of see why the pharmaceutical industry wouldn’t be so opposed if what they end up getting is maybe a slightly lower price in the U.S. and higher prices in other countries,” said Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF.
  • The Trump administration has also proposed new payment models to incorporate most-favored nation pricing into Medicare, which would lead to savings.
  • But the changes are tests that would only apply in certain geographic areas, and analysts say they would not have a drastic impact on Medicare spending.

The bottom line: 

Maybarduk, of Public Citizen, acknowledged that the goals of the drug pricing efforts are laudable, even if the practical effects remain unclear.

  • “The thing that we agree with here, of course, is that Americans pay too much for drugs, and we pay more than other countries for drugs.”

What is “Medically Necessary”?

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https://healthcareuncovered.substack.com/p/what-is-medically-necessary?utm_source=post-email-title&publication_id=255152&post_id=185846351&utm_campaign=email-post-title&isFreemail=true&r=59t65&triedRedirect=true&utm_medium=email

How Big Health Insurers hijacked a medical term and built a denial machine around it.

We hear the term “medically necessary” used every day by insurance companies as a reason to deny or delay health care. While doctors were hard at work treating patients, insurers quietly co-opted the term, and that’s causing serious problems now.

If you ask most doctors to define ‘medically necessary,’ you’ll get some version of: “The test, therapy, drug or procedure that will do the best job of treating my patient.” It’s that simple: whatever is best for my patient.

If you ask an insurer, you may get some legal definition about care “provided for the cure or relief of a health condition, illness, injury or disease (looks good so far, but wait there’s more!), and is not for experimental, investigational or cosmetic purposes and is necessary for and appropriate to the….” The problem begins with the meaning of “necessary and appropriate.”

The terms ‘necessary’ and ‘appropriate’ are left to interpretation. My doctor may feel that a certain test or medication is necessary and appropriate, but someone else may disagree. So how do insurers resolve that disagreement? This is where things go off the rails.

They resolve it by having a medical director they employ review what my doctor wants for me – and that medical director becomes the sole arbiter of what care I can have that will be covered by my health plan. That medical director can sign off on a denial of a claim or a request, and many times they justify that denial by saying the treatment isn’t medically necessary – for reasons that are entirely defined by the health plan.

It seems a clear conflict of interest when an anonymous medical director – possibly lacking in both expertise and experience – rejects a course of treatment laid out by a physician specializing in that disease or condition who has a history with that particular patient. But it happens all the time.

These medical directors work for the company that is denying the claim or request. They have been granted stock and stock options in that company. Their bonus is tied to the financial performance of the company. To say they are impartial and doing what is best for the patient is laughable at best.

Frequently, these medical directors are reviewing requests in areas outside their specialty. In addition, they make these determinations without ever seeing the patient, or reviewing the medical records, studies or lab results that led the treating physician to make the recommendation in the first place. An investigation by ProPublica found that Cigna medical directors were signing off on denials once every 1.2 seconds. This isn’t clinical review; this is profit enhancement.

This brings us to another problem: “coverage policies.” Insurance corporations have created a whole library of coverage policies, and they differ from health plan to health plan. If you’ve never read one of these coverage policies let me save you some time and trouble. Get up now and place your head between the door and the door jam. Now slam the door. You just achieved the headache and confusion that reading a long coverage policy would give you in a fraction of the time. You’re welcome.

Even if you read the policy and think it’s got you covered, you still aren’t home free. A medical director can overrule the policy and still deny the care. Also, that coverage policy may be different for each health plan, and they change from time to time. I am struck by this basic question: Why should the care you receive depend on the insurance card in your wallet and not your clinical situation? The answer, of course, is because that’s how the insurance companies want it.

So, what do we do about this? Let me give you two relatively easy solutions.

First, follow a coverage policy.

If only there was a group of doctors that represented every specialty, we could get them to meet and determine universal coverage policies that could be mandated for all health insurance, both government and commercial. Wouldn’t that be nice? Doctors could then provide good care to patients without having to figure out a library of different coverage policies. Wait, a group like that does exist. It’s called the RUC.

The RUC (Relative Value Scale Update Committee) is an American Medical Association specialty panel, a volunteer group of 32 physicians and over 300 physician advisors who represent every medical specialty. The committee evaluates thousands of individual services across the medical spectrum. Why don’t we ask them to develop a universal set of clinical coverage policies?

Second, fix the denial system. Pass a law that says whenever an insurer denies payment or a request for care, that denial must be signed by a medical doctor, and signing that denial qualifies as “the practice of medicine.” This would make those denials and the doctor who signed off on them subject to all the responsibilities and accountabilities required to practice medicine.

This includes:

  • having an active license in the state where the patient is seeking care; practicing within your specialty;
  • documenting your decision-making in the patient’s medical record, including the information you reviewed to come to your decision; and
  • being liable for malpractice if your decision causes harm to the patient and is not clinically justified.

Let’s assume we had this in place right now and applied it to a real-world situation: the GLP-1 coverage debate. When these glucagon-like peptide-1 drugs for diabetes and weight loss came to market they would have gone before the RUC for a clinical coverage policy. Let’s say the RUC determines that the drugs should be covered for individuals with a BMI over 30 who have tried and failed other diet programs, or for people with a BMI between 25 and 30 who have significant cardiac risk or are diabetic.

Now we have a universal coverage guideline. The doctors prescribing the drug have a very clear understanding of who will be covered and when, and it would apply to all patients regardless of which insurance company they had. As long as the prescribing physician stays inside the guidelines, no denials would be expected.

Let’s take an example from the flip side. A doctor wants to prescribe an expensive chemotherapy regimen to an elderly patient with cancer. The insurer could have that request reviewed and possibly denied by a medical director. However, that medical director would need to be an oncologist with a valid license in the state where the patient is getting treatment. If that oncologist reviews the patient information, denies the chemotherapy for valid clinical reasons, and documents those reasons in the patient’s chart, then the insurer can deny the request.

These two changes would eliminate so many problems, improve the lives of doctors, improve the lives of patients, and reduce administrative costs.

So why hasn’t this been done already? Well the one thing these changes would not do is increase the stock prices of insurance companies.

To put it more succinctly, it’s profits over patients. That’s why.

The health care hiring boom is losing steam

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https://www.axios.com/2026/01/26/health-care-hiring-boom-job-growth-stalls?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

The health care job growth that’s powered the labor market since the COVID pandemic is stalling out.

Why it matters: 

Republican cuts to federal health programs, AI automation and rising costs are making health systems and other employers level off hiring — including for jobs requiring a professional license like nurses or physical therapists.

  • The results could widen gaps in care and exacerbate health disparities.

By the numbers: 

Health care employment drove most of the month-by-month job growth last year, increasing by an average of 34,000 jobs per month, according to the Bureau of Labor Statistics.

  • But that’s less than health care’s monthly average increase of 56,000 roles in 2024.

Health care hiring has essentially returned to a pre-pandemic pattern of slower growth after a post-COVID surge driven by returning patients and hospitals replacing burned-out workers, said Neale Mahoney, an economics professor at Stanford.

  • “It was only a question of when … and we’re starting to see it now,” Mahoney said.

Federal policy changes could further chill hiring.

  • Hospitals face financial pressure from the nearly $1 trillion cut to federal Medicaid spending in the GOP budget law. That’s combined with rising costs from treating more uninsured patients and other factors.
  • New caps on federal student loan borrowing could also push students away from clinical careers, many of which require pricey advanced degrees.
  • It wouldn’t be a surprise if a rise in deportations — combined with fewer foreign-born health workers opting to come to the U.S. on visas — dried up the pipeline of available help, especially in segments like home care.

Case in point: 

Alameda Health System, a safety-net provider based in Oakland, California, announced last month that it’s laying off 247 employees, including clinicians.

  • Administrators cited the system’s precarious finances: It expects to lose $100 million annually by 2030 as a result of the Medicaid cuts, per CBS San Fransisco.

AI automation is also pushing some providers to cut administrative staff.

  • Revere Health, the largest physician-owned health system in Utah, announced in September that it will lay off 177 employees, citing a partnership with a company that automates claims processing.
  • Clinical jobs in health care are more insulated from automation, and AI may actually help extend the clinical workforce where shortages exist.
  • Still, some clinicians are concerned. Almost 15,000 nurses in New York City went on strike this month, demanding new safeguards around AI use in hospitals, among other things.

What they’re saying: 

This past year represented “a repositioning of the labor market,” said Rick Gundling, chief mission impact officer at the Healthcare Financial Management Association.

  • Health systems are doing more targeted hiring, he said. They might look to downsize in revenue management but increase their clinical staff.

The intrigue: 

Demand for care is still high. The “silver tsunami” of aging Baby Boomers may keep jobs plentiful, said Laura Ullrich, director of economic research in North America at the Indeed Hiring Lab.

  • The U.S. is projected to be short some 100,000 health care workers by 2028, after all.
  • The question is whether the sector will remain near full employment, or whether circumstances will drive another surge.
  • “My opinion as an economist is that the tailwinds are stronger than the headwinds in health care,” she said.

JPM Health Conference 2026: The Trump Effect

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JPM Health Conference 2026: The Trump Effect

This week, 8000 healthcare operators and investors will head west to the 44th Annual JP Morgan Health Conference in San Francisco. Per JPM: “The (invitation-only) conference serves as a vital platform for networking, deal-making, and discussing the latest innovations in healthcare, attracting global industry leaders, emerging companies, and members of the investment community.” Daily media coverage will be provided by Modern Healthcare and STAT and most of the agenda will be at the St. Francis Hotel at Union Square.

General sessions about drug discovery, AI in healthcare obesity and more are scheduled, but that’s not why most make the trip. Representatives of the 500 presenting companies are there to engage with health investors in the tightly orchestrated speed-dating format JPM has fine-tuned through the years.

JPM circa 44 will be no different this year. It’s scheduled as company financials and market indicators for 2025 are coming in. Healthcare deal-flow was robust and bell-weather companies had a good year overall. The S&P, Dow and Nasdaq ended the year at all-time highs and investors appear poised to do more healthcare deals in 2026.  Despite growing voter concern about affordability and their costs of living, there’s nothing on the immediate horizon that will dampen healthcare investor appetite for deals. That includes policy changes from the Trump administration that advantage healthcare companies that adapt to the administration’s playbook. It’s built on 3 fundamental assumptions:

  • The healthcare system is fundamentally flawed. Waste, fraud and abuse are deep-seeded in its SOP. It protects its own and resists accountability. The public wants change.
  • Fixing the health system requires policy changes that are attractive to the private companies that currently operate in the system. A federally-mandated regulatory framework (aka “the Affordable Care Act”) will cost more and be harmful. Companies, not Congress, are keys to system transformation.
  • Voters will support changes that make healthcare services more affordable and accessible. The means toward that end are less important.  

What’s evolved from the administration’s first year in office is a mode of operating that’s predictable and uncomfortable to industries like healthcare:

It’s transactional, not ideologic. The administration believes its control of Congress, SCOTUS, the FTC and DOJ and legislatures in red states give it license to disrupt norms with impunity. Price transparency, limits on consolidation, mandated participation in ACOs, supply-chain disruption and AI-enabled workforce modernization are ripe for administrative action. A long-term vision for the system is not required to make needed short-term changes supported by its MAHA base.

It’s populism vs. corporatization. Healthcare’s proclivity for self-praise, addiction to “Best of…” recognition, celebrity CEOs and handsome executive compensation have postured it as “Big Business” in the eyes of most. Business practices associated with corporatization are fair game to the administration’s corrective agenda: hearings in the House Ways and Means and Energy and Commerce and Senate Health, Education, Labor and Pensions (HELP) committees will showcase the administration’s populist grievances. The administration will lavish advantages on private organizations that demonstrate support for its policies.

This week, the Senate will probably green-light a two-year extension of Tax Credits to temporarily avoid premium hikes. Barring a major escalation of tension abroad, attention will turn back to affordability where the K-economy is exacting its toll on lower-and-middle income households and widening despair among the young.

The health system’s role in making matters better or worse for consumers will be front and center alongside housing and costs of living. That context will be key to discussions between health investors and companies seeking their funds, though subordinate to term sheets.

In 2026, the Trump effect on dealmaking in healthcare will be significant.

When Drug Price Transparency Isn’t Enough

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When Drug Price Transparency Isn’t Enough

Policymakers and advocates often promote drug price transparency to lower costs and improve equity. While transparency is an important first step toward accountability and informed public budgeting, it does not guarantee affordable prices or fair access to medicines.

Transparency Has Some Benefits

Drug price transparency helps show how and why medicines cost what they do along the supply chain (i.e., from the manufacturer to the pharmacy), which makes it easier to identify where costs can be reduced or better regulated. By making this information public, transparency allows patients, payers, and policymakers to make more informed decisions and encourage manufacturers to prices drugs more fairly. Ultimately, it supports a fairer system where patients can better afford and obtain the treatments they need, improving access to care.

States with Drug Transparency Laws

While federal policy to improve price transparency is lacking, the states have moved to make things clearer for patients and payers. Vermont was the first U.S. state to enact a drug price transparency law in 2016. Since then, many others have followed suit. At least 14 states have passed some version of transparency legislation, though the details and their enforcement of these laws differ widely.

For example, only Vermont and Maine require drug companies or insurers to disclose the actual prices paid after discounts (called the “net price”). Alternately, Oregon and Nevada require drug manufacturers to publicly report their profit to state government agencies. And Connecticut, Louisiana, and Nevada mandate pharmacy benefit managers (PBMs) to report the total rebates they receive, but not the amounts for each specific drug. Despite these efforts, no state has yet achieved full transparency across the entire drug supply chain.

Transparency is Not Enough

Even with clear pricing, Americans still pay about 2.6 times more for prescription drugs than people in other wealthy countries. Early evidence suggests that these laws have done little to curb drug prices. To date, only four states – California, Maine, Minnesota, and Oregon – have published analyses of their own laws. These reports share common concerns: difficulty tracking pricing across the supply chain and uncertainty about whether state agencies have the authority (or the will) to act when data is incomplete or unreliable. 

Most transparency laws fall short on requiring detailed cost or profit data, focusing instead on broad price trends. As a result, this narrow scope makes it difficult to identify the exact drivers of high drug prices. Even when transparency discourages manufacturers from raising prices, these policies do not directly control pricing or define what constitutes an ‘unjustified’ price increase. Manufacturers can simply adjust by setting higher launch prices or implementing smaller, more frequent increases to stay below reporting thresholds. Still, the result is a system where drug costs can vary by as much as $719 for the same 30-day prescription even when prices are publicly listed.

What can also be done?

Creating a consistent national framework could replace the current patchwork of state laws and improve oversight of how drugs are priced. For example, the Drug Price Transparency in Medicaid Act (H.R. 2450) could do just that: it would standardize reporting requirements and reveal how drug prices are set, rebated, and reimbursed. But transparency alone can’t lower costs—it only shows the problem.

To make transparency meaningful, policymakers must address the underlying contracts and incentives that drive high prices.

Hidden rebate deals and opaque pricing structures between PBMs and drugmakers often inflate costs and limit patients from seeing savings. Transparency legislation should also be paired with value-based pricing that links payments to clinical benefits. Federal programs like the Medicare Drug Negotiation Program provide additional leverage, but broader reforms are needed to reach the commercial market (i.e., where most Americans get their prescription drugs and still face high prices).

Still, transparency can have downsides, especially globally. Fully public drug prices could push companies to stop offering lower prices in low- and middle-income countries. To avoid cross-country comparisons, they could raise prices across the board, making medicines less affordable where they’re needed most. To make transparency more equitable, policymakers should combine disclosure with protections that preserve affordability worldwide.

Conclusion

In short, transparency is necessary but an incomplete fix for America’s drug pricing system. Simply shining a light on how prices are set isn’t enough. Policymakers need to be paired with other reforms, such as removing the incentives that encourage high prices, holding PBMs and manufacturers accountable, extending the negotiating power beyond Medicare, and protecting prescription drug access both at home and abroad. Without these other steps, transparency laws risk highlighting unfairness without actually improving it.

Health package might move ahead without ACA deal

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https://www.axios.com/2026/01/14/aca-obamacare-subsidies-gop-health-package?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

Congressional negotiators are working to revive the health care deal that was dropped from a government spending package in late 2024 — but the odds of resurrecting enhanced Obamacare subsidies as part of the effort appear dire.

Why it matters: 

Long-stalled bipartisan priorities that are in play include an overhaul of pharmacy benefit manager practices, as well as a measure that would place more controls on Medicare outpatient spending.

  • They’d likely be combined with a renewal of health programs due to expire Jan. 30, including certain Medicare telehealth flexibilities and funding for community health centers.

Driving the news: 

Leadership and health committees in both parties have quietly swapped offers on a package over the past week while attention was primarily focused on the fight over expired Affordable Care Act tax credits.

  • Democrats included a three-year extension of the ACA subsidies in their latest offer knowing that GOP leadership is likely to reject it, sources said.
  • That would still leave intact most of the health care deal that was destined to ride on a government funding package before it was scuttled at the last minute by Elon Musk and then President-elect Donald Trump.

What we’re hearing: 

Asked about the likelihood of a health package without the ACA subsidies, Senate Finance Committee Ranking Member Ron Wyden (D-Ore.) pointed to the overwhelming 26-0 vote in his committee for the PBM overhaul in 2023.

  • “I’m not going to negotiate with myself but the reality is I think a 26-0 vote in the Senate … it’s like unheard of,” Wyden told Axios, adding he is “feeling upbeat” about getting the PBM bill over the finish line.
  • Senate Finance Chairman Mike Crapo (R-Idaho) also told Axios he is “feeling optimistic” about the PBM bill, saying there is “broad support here and at the White House.”
  • That measure includes provisions like “delinking” the price of a drug from PBM compensation in Medicare Part D.

The prospective package would also include a measure that would require off-campus hospital outpatient departments to have a unique identifier number.

  • It’s a cost-saving measure designed to prevent outpatient departments from billing payers at higher amounts associated with full-service hospitals.
  • But it would stop short of a full-scale, more sweeping change known as site-neutral payments that would more closely align Medicare payments to hospital outpatient departments with freestanding physician offices.

The intrigue: 

The outlook for renewing enhanced ACA subsidies, which help millions of Americans afford their premiums, is much bleaker.

  • While a separate bipartisan group of senators continues to meet in search of a compromise, a key negotiator, Sen. Bernie Moreno (R-Ohio), told reporters on Tuesday that a release of a proposal would be punted until after next week’s Senate recess.
  • Even if the group can release a proposal — which would include GOP-backed changes like eliminating $0 premium plans — there is deep skepticism in both parties that it can actually pass.
  • Many Republicans are opposed to any kind of ACA subsidy extension, saying it is wasteful spending that benefits insurance companies.

Top Democrats are pushing for a clean subsidy extension without GOP-backed changes and blasting Republicans for blocking it, in what could be a preview of midterm campaign messaging.

Between the lines: 

There still are significant divisions over whether to include new limits on the ACA funding going to plans that cover abortions.

  • The bipartisan group has discussed a potential compromise that would increase audits and levy penalties on insurance companies that don’t comply with existing rules requiring them to segregate taxpayer money from paying for abortions.
  • The idea immediately drew fire from the anti-abortion group Susan B. Anthony Pro-Life America, and many Senate Republicans think it does not go far enough.

The bottom line: 

There still could be an election-year health deal — just don’t expect it to address ACA subsidies.