Senate fails to pass competing health care bills ahead of ACA subsidy expiration
What’s happening: Both Republican and Democratic health care proposals failed to advance in the Senate on December 11, with neither reaching the required 60 votes. The Republican plan failed 51-48, while the Democratic proposal to extend ACA subsidies also fell short. Enhanced ACA subsidies are set to expire at the end of 2025 and are expected to cause premium prices to skyrocket.
Why it matters: The fight over subsidies has exposed a split inside the GOP over how to control rising healthcare costs, creating uncertainty for millions of enrollees as 2026 open enrollment progresses. Health systems should prepare for potential coverage losses, increased uncompensated care and patient churn if subsidies lapse, while also monitoring House discharge petition efforts that could force votes without leadership approval. Systems may need enhanced financial counseling and charity care policies to support patients facing dramatic premium increases.
Over 100 provider groups urge HHS to withdraw proposed HIPAA cybersecurity update
What’s happening: More than 100 health systems and provider organizations, led by the College of Healthcare Information Management Executives (CHIME), sent a letter to HHS Secretary Robert F. Kennedy Jr. on December 8 calling for immediate withdrawal of proposed HIPAA Security Rule updates. The groups warned that the financial burdens and “unreasonable implementation timelines” outlined by the prior administration run counter to President Donald Trump’s deregulatory agenda. The proposed rule, released in January 2025, would eliminate the distinction between “required” and “addressable” security measures, mandate encryption for all protected health information, require annual network mapping and technology asset inventories, and impose 180-day implementation timelines after finalization.
Why it matters: The proposed rule would create an estimated $34 billion in compliance costs over five years ($9 billion in year one alone), creating significant budget pressure for hospitals and health systems already dealing with thin margins. Major signatories including Advocate Health, Yale New Haven Health System, Cleveland Clinic and the American Medical Association argue the rule’s tight timelines don’t account for the complexity of modern healthcare IT systems. Health system CIOs should monitor whether the Trump administration withdraws or modifies the proposal.
ACA enrollment up despite subsidy uncertainties
What’s happening: Federal data shows nearly 5.8 million Americans signed up for ACA plans by day 29 of the 2026 open enrollment window; roughly 400,000 more than at the same point last year, though still 1.5 million below the enrollment pace from two years ago. Out-of-pocket maximums are slated to increase, reaching $10,600 next year, roughly $1,200 more than in 2025. Analysts suggest enrollment numbers could reflect consumers swapping higher-tier plans for less expensive options with higher deductibles, with potential cancellations occurring later as premium increases take effect.
Why it matters: The enrollment data shows consumers are still shopping for coverage despite uncertainty about subsidy extensions, but the shift toward high-deductible plans signals growing underinsurance concerns. Health systems should anticipate more cost-related barriers to care, increased patient financial assistance requests, and potential mid-year coverage churn if subsidies expire and patients drop coverage.
Florida hospitals’ opioid case against major pharmacies ends in mistrial
What’s happening: A Florida judge declared a mistrial on December 8 after jurors deliberated for 14 days but could not reach a unanimous verdict in a lawsuit filed by 16 Florida hospitals including Broward Health, Tampa General Hospital and Good Samaritan Medical Center against Walmart, CVS and Walgreens. The hospitals had accused the pharmacy chains of violating Florida’s anti-racketeering law by working with drugmakers and distributors to drive up opioid sales, which they claimed led to injuries they had to treat, often without reimbursement.
Why it matters: The mistrial represents a setback for hospitals seeking compensation for uncompensated care costs related to the opioid epidemic, though the case could be retried. Separately, West Virginia Attorney General JB McCuskey filed suit against UnitedHealthcare, Optum and affiliates for their alleged role as pharmacy benefit managers in oversupplying the state with opioids starting in 2010. These cases reflect ongoing efforts by states and hospital systems to hold various players in the pharmaceutical supply chain accountable for opioid crisis costs.
Number of hospitals equipped for pediatric care declining
What’s happening: Data from the Healthcare Cost and Utilization Project Kids’ Inpatient Database shows that from 2003 to 2022, the proportion of U.S. hospitals with the broadest range of pediatric services (Level 1) decreased by 38 percent, while hospitals with the lowest pediatric capability (Level 4) increased by 137 percent, according to research published in Pediatrics by Dr. Kenneth Michelson of Ann & Robert Lurie Children’s Hospital in Chicago and colleagues.
Why it matters: This trend reflects the ongoing consolidation and specialization of pediatric services, with implications for access to care, particularly in rural and underserved areas. Health systems should assess their pediatric service lines and consider strategic partnerships or referral networks to ensure children can access appropriate care levels, while also monitoring how this consolidation affects emergency department preparedness and transfer patterns for pediatric patients.