RISE summarizes recent regulatory-related headlines and reports.
Trump reveals new health care plan that aims to lower cost and hold insurers accountable
President Donald Trump on Thursday announced what he coins “The Great Healthcare Plan,” calling on Congress to enact a framework that aims to lower drug prices, lower insurance premiums, hold big insurers accountable, and maximizes price transparency.
The one-page fact sheet explains that the plan would codify the administration’s most-favored national deals to ensure Americans pay the same prices for prescription drugs that people in other countries pay. It would also make more verified safe pharmaceutical drugs available for over-the-counter purchases. Trump said this would lead to lower health care costs and increase consumer choice via price transparency, increased competition, and reducing the need for doctor’s visits.
The plan also calls for the administration to send money directly to Americans instead of subsidized payments to insurers to lower health insurance premiums. The plan would also fund a cost-sharing reduction program, which Trump said will save taxpayers at least $36 billion, and end kickbacks paid by pharmacy benefit managers to the large brokerage middlemen.
To hold “big insurance companies accountable,” the plan would create a “Plain English” insurance standard and require insurance companies to post the profits they take out of premiums and information on the frequency with which they deny care.
To maximize price transparency, the plan would require providers or insurers that accept Medicare or Medicaid to post their pricing and fees on their websites and comply with price transparency requirements.
In a quick take article, Cynthia Cox, senior vice president and director of the program on the Affordable Care Act (ACA) for KFF, said the plan is vague and it’s unclear what the implications would be for people with pre-existing conditions because framework doesn’t explicitly say that people with pre-existing conditions are protected.
“Until the ‘Great Healthcare Plan’ takes shape and details are filled in, it leaves open questions about out-of-pocket costs, premiums, federal spending, and health coverage for people with pre-existing conditions,” she wrote.
CMS: Medicare paid $28.8B in improper payments in FY2025
The Centers for Medicare & Medicaid Services (CMS) estimates that traditional Medicare made improper payments of 6.55 percent or28.23 billion in fiscal year 2025, down from fiscal year 2024’s reported rate of 7.66 percent or 31.7 billion.
This is the ninth consecutive year that the improper payment figure has been below the 10 percent threshold for compliance established by improper payment statutory requirements.
Improper payment measurement, CMS said in a fact sheet, is not a measure of fraud but payments that do not meet CMS program payment requirements. They may be overpayments, underpayments, payments made with insufficient information, or in some cases, a state or contractor missed an administrative step.
Other notable figures:
- The Medicare Part C estimated improper payment rate was 6.0 percent or $23.67 billion, compared to the FY 2024 reported rate of 5.61 percent or $19.07 billion. Most of the improper payments are attributed to the failure of Medicare Advantage organizations to provide supporting documentation that substantiates the diagnoses data submitted for payment.
- The Medicare Part D estimated improper payment rate was 4.00 percent or $4.23billion, compared to the FY 2024 reported rate of 3.70 percent, or $3.58 billion.
- The Medicaid estimated improper payment rate (comprised of the past three cycles of approximately 17 state per cycle from reviews in 2023, 2024, and 2025) was 6.12 percent, or $37.39 billion, compared to the FY 2024 reported rate of 5.09 percent Mo, or $31.10 billion. Seventy-seven percent of these payments were due to insufficient documentation, which is not an indicator of fraud or abuse.
- The Children’s Health Insurance Program (CHIP) estimated improper payment rate (comprised of reviews in 2023, 2024, and 2025) was 7.05 percent, or $1.37 billion, compared to the FY 2024 reported rate of 6.11 percent, or $1.07 billion. Approximately 56 percent of these improper payments were due to insufficient documentation.
House committees schedule hearing with health insurance CEOs to discuss affordability
The House Committee on Ways and Means and the Committee on Energy and Commerce Subcommittee on Health will meet on January 22 with a panel of health insurance executives to discuss how to make health care more affordable in America. The hearings are the first in a series to examine the root causes that are driving health care prices and discuss policies to lower the cost of care. The panel will include CEOs from UnitedHealth Group, CVS Health, Elevance Health, The Cigna Group, and Ascendiun (the parent company of Blue Shield of California).
UnitedHealth will test MA accelerated payments to rural hospitals
UnitedHealthcare will launch a six-month targeted initiative in Oklahoma, Idaho, Minnesota and Missouri that accelerates Medicare Advantage payment timelines to rural hospitals by 50 percent, from less than 30 days to less than 15 days.
The Rural Payment Acceleration Pilot is designed to support independent rural hospitals facing financial challenges. The program will deliver immediate cash‑flow relief and support the sustainability of rural hospitals.
“Rural hospitals are the backbone of their communities,” said Bobby Hunter, CEO of UnitedHealthcare government programs in the announcement. “By speeding up payments to these critical facilities, we’re helping providers focus on what matters most: patient care. Our goal is to co-create solutions with rural providers that support accessible care close to home. Together, we will learn quickly and scale what works.”
Report: U.S. health care spending increases to $5.3T in 2024
Health care spending in the United States reached $5.3 trillion and increased 7.2 percent in 2024, according to the latest analysis from CMS’ Office of the Actuary. The report, published in Health Affairs, finds that the growth is similar to the 7.4 percent in 2023 and is due to increased demand for care, particularly for hospital care, physician and clinical services, and retail prescription drugs. Health care spending growth continued to outpace overall economic growth in 2024, and as a result, the health care share of the economy increased from 17.7 percent in 2023 to 18 percent in 2024.
The report also found:
- Private health insurance accounted for $1.6 trillion and 31 percent of total national health care expenditures in 2024.
- Medicare spending accounted for 21 percent of total national health care spending and reached $1.1 trillion in 2024, an increase of 7.8 percent. Medicare Advantage private plan spending dropped from 16.1 percent in 2023 to 8 percent in 2025 because of policy changes lowering benchmark payment rates. Medicare fee-for-service spending increased 6.4 percent.
- Medicaid spent $931.7 billion, accounting for 18 percent of total national health care expenditures.
SAMHSA: $231M funding opportunity available to administer 988 lifeline
The Substance Abuse and Mental Health Services Administration (SAMHSA), a division within the U.S. Department of Health and Human Services (HHS), announced a $231M funding opportunity to administer the 988 Suicide & Crisis Lifeline. The 988 Lifeline is comprised of a national network of more than 200 local crisis contact centers managed by a SAMHSA-funded 988 network administrator. In 2025, 988 received more than eight million contacts from help seekers via call, text, chat, and ASL videophone.
The lifeline, which officially launched in July 2022, offers help to anyone in the United States experiencing a mental health, substance use or suicidal crisis. Studies indicate that after speaking with a trained crisis counselor, most people who contact 988 are significantly more likely to feel less depressed, less suicidal, less overwhelmed, and more hopeful.