Help for Medicare Advantage Patients Who Lose Doctors Is Shelved, for Now
RETIRING Nationwide, hospitals and other providers are leaving private Medicare Advantage plans, putting thousands of seniors at risk of higher costs and of losing trusted doctors.
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Amy Trojanowski liked the extra benefits her Humana Medicare Advantage plan provided — a $200 debit card replenished monthly to use toward groceries, over-the-counter pharmacy items and even her electric bill. She also appreciated the dental and vision coverage. But those things couldn’t compare to the doctor she had been seeing for nearly a decade.
“I love her so much,” said Ms. Trojanowski, 60, who lives near Raleigh, N.C. The doctor’s practice is part of UNC Health, a 20-hospital system affiliated with the University of North Carolina at Chapel Hill.
Last October, however, Humana informed her that UNC Health would no longer participate in the plan’s provider network in 2026….
In November, the Centers for Medicare & Medicaid Services proposed a regulation with a solution for Advantage members “who experience provider network changes midyear” and “may want to stay with their current provider,” according to a C.M.S. fact sheet. Officials would streamline a complicated process “to allow these enrollees to change their coverage more easily.” State insurance officials, the American Medical Association and the American Hospital Association, along with other provider and patient advocacy groups, generally supported the idea.
But early this month, C.M.S. abandoned the proposal, which would have taken effect in 2027, even as disruptions in provider networks continue. C.M.S. officials declined to explain the reason for the reversal. But in an email, a C.M.S. spokesman, Christopher Krepich, wrote that the agency “routinely proposes policies to solicit public input and carefully considers all feedback” before finalizing them. [Continued in The New York Times.]
Are Trump’s drug pricing policies saving anyone money?
Volume 407, Issue 10543
23 May 2026
WORLD REPORT Experts question the effectiveness of the Trump administration’s strategies to cut pharmaceutical costs in the USA. Washington Correspondent Susan Jaffe reports.
To lower prescription drug costs for Americans, the Trump Administration wielded tariff threats to gain confidential price agreements with pharmaceutical companies and promises from other countries to pay more for drugs. The lower prices are displayed on the government’s TrumpRx website but critics say that only a few brand name drugs are discounted exclusively on the website. They also say there is no guarantee that drug makers will apply any increased revenue from overseas sales to voluntarily cut prices in the USA. [Continued here.]
Congress compels the Trump Administration to spend science and health funding
Volume 407, Issue 10530
21 February 2026
WORLD REPORT Proposals for huge cuts to NIH and CDC budgets have been rejected, to the relief of scientists. Susan Jaffe reports from Washington, DC.
Congress rejected the Trump Administration’s request to cut the2026 budget of the National Institutes of Health by 40% and to slash nearly 50% from the Centers for Disease Control and Prevention budget. President Donald Trump signed the budget legislation into law on Feb 3. However, the relief of many research scientists and their supporters has given way to a new concern: can the Administration be trusted to spend funds as Congress intended—especially money it did not request for programmes it did not want? [Continued here.]
Millions of Americans lose health insurance as COVID-19 era subsidies end
Volume 407, Issue 10528
7 February 2026
WORLD REPORT With the spike in Affordable Care Act health insurance costs, around 4·8 million people could lose coverage. Susan Jaffe reports from Washington, DC.
The failure of Congress to continue premium subsidies is expected to make health insurance unaffordable for millions of Americans who do not qualify for other government insurance programs. As hospitals experience an increase in uncompensated care, the financial strain could force them to make difficult decisions to reduce services. [Continued here.]
Grants under threat at the US National Institutes of Health
Volume 406, Issue 10522
20 December 2025
WORLD REPORT Changes to how research grants are assessed and awarded are undermining the world’s largest public funder of biomedical research. Washington Correspondent Susan Jaffe reports.
So far this year, the Trump administration has fired more than 1000 scientists and grant administrators at the National Institutes of Health (NIH) and cut thousands of its research grants, including clinical trials with 74 000 patients. But long-time grant recipients and former institute directors worry that changes in how grants are awarded—and who receives them—threaten the pathways for new discoveries and the many academic research centres that train future scientists. [Continued here.]
Complaints About Gaps in Medicare Advantage Networks Are Common. Federal Enforcement Is Rare.
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Along with the occasional aches and pains, growing older can bring surprise setbacks and serious diseases. Longtime relationships with doctors people trust often make even bad news more tolerable. Losing that support — especially during a health crisis — can be terrifying. That’s why little-known federal requirements are supposed to protect people with privately run Medicare Advantage coverage when contract disputes lead their health care providers and insurers to part ways.
But government documents obtained by KFF Health News show the agency overseeing Medicare Advantage does little to enforce long-standing rules intended to ensure about 35 million plan members can see doctors in the first place.
In response to a Freedom of Information Act request covering the past decade, the Centers for Medicare & Medicaid Services produced letters it sent to only five insurers from 2016 to 2022 after seven of their plans failed to meet provider network adequacy requirements — lapses that could, in some cases, harm patient care. [Continued on KFF Health News, CBS News, US News & World Report and MedpageToday.]
Health experts condemn US vaccine recommendations
Volume 406, Issue 10510
27 September 2025
WORLD REPORT The Advisory Committee on Vaccine Practices’ recommendations for COVID-19 vaccination prompt questions and concern. Washington Correspondent Susan Jaffe reports.
The first meeting of a vaccine advisory committee with all 12 of Health and Human Services (HHS) Secretary Robert F Kennedy Jr.’s handpicked members — bypassing the usual vetting process — produced confusing recommendations, condemned by medical associations and public health experts. Even some members were puzzled at times: they decided to delay a vote on one proposal and approved another after earlier rejecting it. They recommended that Americans should still be vaccinated to prevent serious complications of COVID-19, but added that patients should first discuss the benefits and risks with a health-care provider. Physician groups and public health advocates say the prerequisite is unnecessary and will restrict access. [Continued here.]
CDC is “in the ICU right now” former officials say
Volume 406, Issue 10508
13 September 2025
WORLD REPORT Senior officials say HHS Secretary Robert F Kennedy Jr is eviscerating the CDC. Washington Correspondent Susan Jaffe reports.
The US Centers for Disease Control and Prevention (CDC) implosion was months in the making, senior officials tell The Lancet after they resigned in protest following the dismissal of CDC Director Susan Monarez by Health and Human Services (HHS) Secretary Robert F Kennedy Jr. They describe a gutted agency so damaged that it might not be able to fulfil its core mission to protect Americans from public health threats. An HHS spokeswoman called their comments “the gripes of disgruntled former employees.” [Continued here.]
Millions to lose Medicaid coverage under new law
Volume 406, Issue 10500
19 July 2025
WORLD REPORT President Trump’s One Big Beautiful Bill Act makes the largest cuts to Medicaid since its creation, with doctors warning that patients will suffer. Susan Jaffe reports.
Republicans in the US Congress gave President Donald Trump his first major legislative victory, which provides the largest amount of tax and spending cuts in US history. The One Big Beautiful Bill Act (OBBB) slashes nearly $1 trillion over a decade from Medicaid—the most sweeping cuts since the health insurance programme for people with low incomes was created 60 years ago. The law will hit another historic first by taking health insurance away from more US residents than ever before—nearly 17 million, according to the Congressional Budget Office.
This seismic shift in the US health-care system was opposed by patient advocacy groups and nearly every major health-care provider and industry organisation. Despite their significant collective influence during previous administrations, the groups’ arguments failed to deter Republicans eager to implement Trump’s domestic agenda. {Continued here]
US Supreme Court upholds Tennessee law denying adolescents gender-affirming care
Volume 405, Issue 10497
28 June 2025
WORLD REPORT Conservative justices agreed with the state and Trump administration that banning minors’ treatment for gender dysphoria is not discriminatory. Susan Jaffe reports.
On behalf of the court’s five other conservative members, Chief Justice John Roberts wrote that the law is not discriminatory because the ban restricts specific medical treatment for a specific purpose and applies equally to boys and girls. “The law does not prohibit conduct for one sex that it permits for the other.” But he also wrote that since the treatment is controversial (despite support from major medical associations), the court should defer to the judgement of state lawmakers. “Questions regarding the law’s policy are thus appropriately left to the people, their elected representatives, and the democratic process”, he wrote.[Continued here.]
AMA protests changes to key vaccine advisory committee
Volume 405, Issue 10496
21 June 2025
WORLD REPORT The organisation, which represents more than 270 000 physicians and medical students, has
been reluctant to criticise the Trump administration’s actions, until now. Susan Jaffe reports.
After months of relative quiet while the Trump administration overhauls US health and science agencies, the American Medical Association has had enough. When Health and Human Services Secretary Robert F Kennedy Jr dismissed all 17 members of the independent Advisory Committee on Immunization Practices, delegates attending AMA’s annual meeting strongly condemned the action. On June 10, more than 700 delegates approved an emergency resolution calling on Kennedy to reverse his decision [and] required AMA leadership to “immediately” ask the Senate committee overseeing HHS to investigate Kennedy’s actions “regarding his administration of the Centers for Disease Control and Prevention and Advisory Committee on Immunization Practices”. [Continued here.]
When Hospitals Ditch Medicare Advantage Plans, Thousands of Members Get To Leave, Too
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For several years, Fred Neary had been seeing five doctors at the Baylor Scott & White Health system, whose 52 hospitals serve central and northern Texas, including Neary’s home in Dallas. But in October, his Humana Medicare Advantage plan — an alternative to government-run Medicare — warned that Baylor and the insurer were fighting over a new contract. If they couldn’t reach an agreement, he’d have to find new doctors or new health insurance.
“All my medical information is with Baylor Scott & White,” said Neary, 87, who retired from a career in financial services. His doctors are a five-minute drive from his house. “After so many years, starting over with that many new doctor relationships didn’t feel like an option.”
After several anxious weeks, Neary learned Humana and Baylor were parting ways as of this year, and he was forced to choose between the two. Because the breakup happened during the annual fall enrollment period for Medicare Advantage, he was able to pick a new Advantage plan with coverage starting Jan. 1, a day after his Humana plan ended.
Other Advantage members who lose providers are not as lucky. Although disputes between health systems and insurers happen all the time, members are usually locked into their plans for the year and restricted to a network of providers, even if that network shrinks. Unless members qualify for what’s called a special enrollment period, switching plans or returning to traditional Medicare is allowed only at year’s end, with new coverage starting in January.
But in the past 15 months, the Centers for Medicare & Medicaid Services, which oversees the Medicare Advantage program, has quietly offered roughly three-month special enrollment periods allowing thousands of Advantage members in at least 13 states to change plans. They were also allowed to leave Advantage plans entirely and choose traditional Medicare coverage without penalty, regardless of when they lost their providers. But even when CMS lets Advantage members leave a plan that lost a key provider, insurers can still enroll new members without telling them the network has shrunk.
…CMS would not identify plans whose members were allowed to disenroll after losing health providers. The agency also would not say whether the plans violated federal provider network rules intended to ensure that Medicare Advantage members have sufficient providers within certain distances and travel times. [Continued in KFF Health News, Fortune, MSN, Medpage Today, Boston Herald, Los Angeles Daily News, and Yahoo News.]
Trump works towards US tariffs on drug imports
Volume 405, Issue 10490
10 May 2025
WORLD REPORT Observers warn of the negative health consequences if US President Donald Trump follows through on his promise to impose tariffs on pharmaceuticals. Susan Jaffe reports.
Prescription drugs were excluded from US President Donald Trump’s tariffs that have rocked global markets and fuelled trade wars. But two recent actions signal the administration’s intention to eliminate that protection. Last month, Trump ordered the Department of Commerce to investigate whether the USA’s dependence on imported pharmaceuticals is a potential national security threat. If so, imposing tariffs would be a likely defence against imports. [Continued here.]
Can the FDA fulfil its mission with a smaller workforce?
Volume 405, Issue 10488
26 April 2025
WORLD REPORT The US Food and Drug Administration’s new commissioner promises to restore public trust despite mass layoffs. Washington Correspondent Susan Jaffe reports.
Martin Makary fielded questions for nearly 2 h from a Senate committee last month before winning approval to take the helm as commissioner at the Food and Drug Administration (FDA). His early actions have provided some additional answers about how he will likely run an agency that impacts Americans’ daily lives but is depleted by the forced departure of at least 3500 scientists and other staff. [Continued here.]