RISE summarizes recent regulatory-related headlines and reports.
NCQA unveils 2025 health plan ratings
The National Committee for Quality Assurance (NCQA) has released its 2025 health plan ratings, an annual report that evaluates commercial, Medicare Advantage and Medicaid health plans based on measures of clinical quality and patient experience.
The ratings are primarily based on 2024 performance data, with some Medicare Advantage metrics reflecting 2023 results due to reporting schedules.
This year, 11 out of 998 rated plans achieved a 5-star rating, more than double last year’s total of five. Fifty-five plans earned a 4.5-star rating. Other key findings from the report:
- Stronger transitions of care in Medicare: Year-over-year improvements highlight stronger coordination and continuity of care for beneficiaries.
- Progress in diabetes and kidney health: Nearly all six diabetes-related measures showed improvement, with the Kidney Health Evaluation for Patients with Diabetes (KED) measure showing an average increase of more than five percent across all product lines.
- Improving immunization trends: Adult and adolescent immunization rates trended upward, while childhood immunization rates continue to decline—though at a reduced pace compared to last year.
Urban Institute: 4.8M will lose coverage in 2026 if enhanced premium tax credits expire
A new Urban Institute report estimates the impact on coverage if the enhanced premium tax credits (PTCs), which were extended via the Inflation Reduction Act of 2022, expire in 2026 without Congressional action.
The enhanced PTCs helped to reduce net premiums to zero for some people with low incomes and made subsidies available to people with higher incomes for the first time. As a result, marketplace enrollment increased, reaching a high of over 24 million plan selections for 2025.
Researchers found that if the credits are not extended:
- 7.3 million fewer people will receive subsidized marketplace coverage in 2026. Eight states, Georgia, Louisiana, Mississippi, Oregon, South Carolina, Tennessee, Texas, and West Virginia, would see their subsidized marketplace enrollment fall by more than half.
- 4.8 million more people will be uninsured in 2026, an increase in the uninsured population of 21 percent. Non-Hispanic Black people, non-Hispanic White people, and young adults would see the largest increases in uninsurance.
- In 2026, average net premiums, the portion paid by individuals or households after PTCs, will be over four times as large ($919 versus $169) for people with subsidized Marketplace coverage and incomes below 250 percent of the federal poverty level.
- Net premiums will more than double, from $1,171 to $2,455, for people with incomes from 250 percent of federal poverty level. to 400 percent of federal poverty level.
- Net premiums will nearly double, from $4,436 to $8,471, for people with incomes above 400 percent of federal poverty level who receive subsidized Marketplace coverage under enhanced PTCs, but who would pay the full premium were they to expire.
Harris Poll survey: Burnt out health care workers plan to switch jobs next year
A new Harris Poll survey finds that five years after the peak of the COVID-19 pandemic, the health care workforce remains burnt out, with many planning their exits at the same time the U.S. is projected to have a shortage of nearly 700,000 critical health care workers, including physicians, RNs, and LPNs by 2037. However, health workers also indicate that opportunities for education and growth may convince them to stay.
The Harris Poll on Strategic Education Inc. survey of 1,504 health care employees and 304 health care employers was conducted online between June 26-July 21. The survey found that 8 in 10 health care workers (84 percent) feel that they are taken for granted. Fifty-five percent admit that they’ll look for job openings, interview for, or switch to a new role in the next year. However, 63 percent of health care employees agree that they’d be more likely to stay with their employer if they provided tuition support.
“This research paints an alarming picture of a workforce at a crossroads experiencing high burnout, accelerating turnover, and intensifying demands,” said Jennifer Musil, global president of research at The Harris Poll in the announcement. “Given the unprecedented need for care driven by the aging Baby Boomer population, these findings offer critical insights into how to better retain, support, and prepare the people at the heart of our nation’s health care system.”
Employees and employers agree that education and advancement opportunities could encourage workers to stay. Sixty-three percent of health care employees agree that they’d be more likely to stay with their employer if tuition support were provided and 48 percent of employers note that lack of advancement and education opportunities are reasons that health care employees leave their organization.
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