AHA sues to block ‘unlawful’ 340B changes: 4 things to know
What’s happening: The American Hospital Association, Maine Hospital Association and four safety-net hospitals have filed a federal lawsuit in the District of Maine seeking to stop HHS from implementing a new rebate-based 340B model on Jan. 1, 2026. The rule would replace longstanding upfront discounts with a system in which hospitals pay full market price for drugs and seek reimbursement later, a shift the plaintiffs say was adopted through a “rushed, opaque process” that ignored extensive hospital opposition and violates administrative law. In 2022, 340B hospitals provided nearly $100 billion in community benefits that rely in part on current drug savings.
Why it matters: Moving to a rebate model could saddle safety-net and rural hospitals with “hundreds of millions” in additional carrying costs and administrative burdens, undermining the financial engine that funds uncompensated care, behavioral health, opioid services and social supports. Health system leaders should prepare contingency plans in case the rule proceeds on schedule, including liquidity modeling for drug purchasing, while also deciding how visibly to align with AHA’s legal and advocacy strategy to protect 340B margins.
Rural health fund applications being withheld by some states. Why?
What’s happening: All 50 states have applied for the five-year, $50 billion Rural Health Transformation Program created under the One Big Beautiful Bill Act, but many are refusing to release their full applications despite the Trump administration’s promises of “radical transparency.” While some states have published project summaries showing investments in telehealth, drones, telerobotics, workforce initiatives and food access, others cite confidentiality or “proprietary” concerns and are withholding details even as Medicaid cuts of $137 billion over 10 years loom over rural providers. Only a handful of states have released full applications, and HHS and CMS say they will follow standard federal rules that keep competitive grant materials confidential during the review process.
Why it matters: Rural hospitals are facing a simultaneous hit of deep Medicaid cuts and tightly restricted grant dollars, only 15 percent of which can be used to pay providers directly for patient care. Health systems with rural footprints will need to engage aggressively at the state level to influence how funds are deployed, push for transparency around project and budget narratives and align their own proposals with “transformational” priorities such as technology, workforce and community-based care instead of simple financial backfill.
Federal bill would recognize NPs, PAs in Medicare ACO models
What’s happening: The bipartisan ACO Assignment Improvement Act, introduced by Sens. Sheldon Whitehouse (D-R.I.) and John Barrasso (R-Wyo.), would allow Medicare beneficiaries who receive primary care from nurse practitioners, physician assistants or clinical nurse specialists to be attributed to accountable care organizations. Current Medicare rules generally attribute patients only based on physician primary care, excluding many patients in APP-led practices from ACO models.
Why it matters: Recognizing advanced practice providers in ACO attribution would expand the attributed population and better reflect how primary care is actually delivered, especially in rural and underserved areas. Systems with large NP/PA panels could see higher ACO enrollment, greater shared-savings potential and stronger incentives to integrate APPs into care redesign and quality strategies.
States get creative as exchange subsidies expiration looms
What’s happening: With enhanced Affordable Care Act exchange subsidies set to expire at year’s end and average net 2026 premiums more than doubling for many consumers, states are deploying limited tools to blunt the impact. Strategies include state-funded premium “wraparound” assistance (e.g., New Mexico’s expanded Health Care Affordability Fund and similar programs in California and other state-based exchanges), beefed-up reinsurance, new benefit designs, and intensified outreach to encourage shopping and plan switching. Some states are also promoting public-option–style products, Basic Health Programs and even short-term limited-duration plans as cheaper alternatives.
Why it matters: Even with creative state action, experts warn it is “very, very difficult, if not insurmountable” for states to fill the federal subsidy gap in the short term, making coverage losses and risk-pool deterioration likely. Health systems should anticipate higher uncompensated care, more underinsured patients and increased churn between plan types, and may need targeted communications and financial counseling to retain access-sensitive patients, especially in markets leaning into non-ACA-compliant coverage.
1 in 4 Affordable Care Act enrollees would ‘very likely’ forego health insurance if premiums double: Poll
What’s happening: A new KFF poll of ACA enrollees finds that one in four say they would be “very likely” to go without health insurance if their premiums doubled, and one in three would switch to a cheaper plan under that scenario. A majority say they cannot afford even a $300 annual premium increase without serious financial strain; if total health costs rise by $1,000, two-thirds would cut basic household needs and 41 percent would likely delay other bills. Stories from enrollees with chronic conditions illustrate how looming 2026 premium hikes and the possible end of enhanced subsidies are forcing families to “judge the value” of their health.
Why it matters: These data signal a real risk of rising uninsurance and underinsurance that would reverse a decade of coverage gains under the ACA, particularly among patients with complex, high-cost conditions. Health systems should anticipate more cost-related nonadherence and delayed care, and can use this polling data to inform payer negotiations, charity-care policies and advocacy efforts that highlight the connection between premium affordability, continuity of care and hospital financial stability.