Health Care System

The United States health care system encompasses a mixture of private and public entities that are either non-profit or for-profit. Health care coverage may be financed through federal and state government programs or can be purchased through the health insurance marketplace. In contrast, a smaller proportion of the U.S. population is uninsured. The resulting effects of a decentralized system has led to considerable challenges for provider organizations—including cost pressures, a push towards alternative payment models, and market consolidation. Despite these challenges, there are opportunities for provider organizations in reducing excess costs and utilization, particularly as payers look for innovative approaches that can demonstrate a return-on-investment in terms of cost and consumer outcomes.

Latest Resources

• ‘Choose Medicare Act’ Introduced To Create ‘Part E’ Opt-In Program For Individuals & Employers 
• UnitedHealthcare Loses Challenge Over Minnesota Law Banning For-Profit Medicaid Plans 
• Order In The Case Of UnitedHealth Group Incorporated v. State of Minnesota
• Virtua Health & ChristianaCare Sign Letter Of Intent To Explore The Co-Founding Of A New Regional Not-For-Profit Health System 
• Oregon Council For Behavioral Health Services Adds Netsmart As A Preferred Partner 
• June Health Launches To Redefine Women’s Health As A Strategic Employer Benefit 
• Yamhill County, Oregon HHS Chooses EnSoftek’s DrCloudEHR To Enhance Integrated Health Services 
• Federal Court Grants Partial Relief To Planned Parenthood ‘Defunding’ Resulting From The Federal 2025 Funding Bill  
• 760 Rural Hospitals Nationwide At Risk Of Closure 
• Wellstar Invests In Venteur Individual Coverage Health Reimbursement Arrangement Plans 
• Planned Parenthood Federation of America, Inc. v. Kennedy, et al.
• Virginia Medicaid Launches Cardinal Care Health Plans & Member Options  
• Florida To Expand Managed Care For I/DD Statewide & Increase Enrollment Capacity With Waiver Amendment 
• Joint Commission Launches Simplified Accreditation Standard With Fewer Requirements & New Focus On Consumer Outcomes 
• Knipper Health Acquires eBlu Solutions To Create Infusion Therapy Initiation Platform 

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Federal Budget Bill Brings Major Administrative & Financing Changes To Medicaid, ACA Marketplace & Medicare 

On July 4, 2025, President Trump signed the 2025 federal budget reconciliation package called the One Big Beautiful Bill (OBBB) Act, which enacts significant administrative and financing changes to health care policy affecting Medicaid, Medicaid expansion plans, Affordable Care Act (ACA) Healthcare Marketplace plans, and Medicare. An early analysis by the Congressional Budget Office (CBO) projected that the overall number of uninsured people will increase and health insurance premiums will likely increase as a result.   Medicaid … Read

• Citing Financial Challenges, UCare To Withdraw From Non-Senior Minnesota Medicaid In 11 Counties  
• Ascension Saint Thomas Partners With Unity Medical Center In Rural Tennessee 
• Innovation Adoption Among Specialty Care & Primary Care Provider Organizations: The Results Of The 2025 OPEN MINDS Innovation Adoption Survey
• Samsung Acquires U.S. Health Care Data Integration Company Xealth 
• Los Robles Regional Medical Center Shutters Children’s Unit 

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