 | | | | | By Megan R. Wilson, Lena H. Sun and Rebecca Adams | Did someone forward this newsletter to you? Sign up here to get it in your inbox. In today’s edition: - What’s behind the Trump administration’s Medicare Advantage proposal?
- The planned meeting of federal vaccine advisers next week is no longer happening — for now.
- Why the U.S. wants to set up an alternative to the World Health Organization at triple the cost.
… And more. Good afternoon! We’re almost through the week. Let’s get into the Health Brief. Do you have any story tips or health policy intel? Shoot me a note at megan.wilson@washpost.com. If you prefer to message me securely, I’m also on Signal at megan. 434. This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from The Washington Post newsroom. Learn more about WP Intelligence. | | | |  | The Lead Brief | We’re digging into a topic that impacts more than 35 million Americans: Medicare Advantage. WP Intelligence Lead Health Analyst Rebecca Adams dives deep into the Trump administration’s proposed changes to Medicare Advantage payment rates in her latest report, which we’re putting in front of the paywall. The report follows the recent proposal from the Centers for Medicare and Medicaid Services to keep payments to private insurers that offer the plans relatively flat with last year — shocking Wall Street analysts and health insurance companies. In addition to the rate proposal itself, the Trump administration is also proposing to no longer allow insurers to take in more money for medical problems that plans identify through reviews of patients’ charts — unless patients actually receive care for those conditions. The change would further cut into insurers’ payout from the federal government. The Capitol Hill context: Some Republicans who typically support Medicare Advantage have raised concerns about big national insurers’ practice of documenting every possible medical condition their consumers may have (even if the patient never receives any treatment for them), because that provides more federal payments to plans. UnitedHealthcare was one of the main engineers of this tactic, according to an investigation by Sen. Chuck Grassley (R-Iowa) released last month. The Medicare plan echoes one proposed by UnitedHealthcare in a comment the company recently submitted on another rule: UnitedHealthcare suggested counting chart-review diagnoses toward higher payments only if they are linked to a specific medical claim. → While UnitedHealth has been lobbying lawmakers to urge regulators to increase the payment rate, it’s also telling them it supports the CMS plan on chart reviews. Medicare leader Chris Klomp, now also serving in the dual role of Health and Human Services chief counselor, said on a recent webinar that he’d gotten questions about whether the lower-than-expected rates were “a sign of unfriendliness or hostility” toward insurers. Key quote: “In no uncertain terms, let me make clear that we continue to believe Medicare Advantage will and must play an important role in the future of Medicare,” Klomp said on the webinar hosted by the conservative Paragon Health Institute. Why it matters: Medicare is one of the main drivers of the massive and growing federal debt, according to new Congressional Budget Office estimates released last week. The privately run Medicare Advantage program has drawn some criticism because it costs the government more than traditional Medicare, but it also offers more perks. “Medicare Advantage plans are in many ways more efficient than traditional Medicare, and yet they cost the federal government more,” Marc Goldwein, the senior vice president and senior policy director of the Committee for a Responsible Federal Budget, told Rebecca. What’s next: Public comments on the CMS proposal are due on Wednesday. CMS will finalize the payment rates and other updates in April. |  | | After a generous annual payment hike to Medicare Advantage plans last year, the Trump administration unexpectedly proposed an essentially flat 0.09 percent funding increase. (Pablo Martinez Monsivais/AP) | | | | | | Under the Radar | But wait, there’s more: Regional nonprofit insurers are concerned that larger national companies, such as UnitedHealthcare and Elevance Health, are scaling back their Medicare Advantage offerings in places that are less profitable, leaving smaller plans to care for seniors who have to switch insurers — and who may be sicker and more costly to care for. UnitedHealthcare expects to shed 1.3 million to 1.4 million of its 8.4 million Medicare Advantage members this year, CEO Tim Noel said in a Jan. 27 earnings call. Insurance companies warn that finalizing a flat base payment rate as the cost of care increases could accelerate the market departures. Now, the regional insurance plans will likely ask Medicare officials to allow chart reviews under certain conditions for new enrollees, such as those dumped by national plans, in addition to raising overall payments. “We need to make sure that those who are staying can actually survive,” said Michael Bagel, vice president of public policy at the Alliance of Community Health Plans, an industry group. “And that is a major challenge given the rates that CMS has put out.” New data: Research published in JAMA on Wednesday found the Medicare Advantage market has been disrupted in recent years by plans exiting markets around the country. What researchers found: - The average rate of “forced disenrollment” — a term for the beneficiaries who must find new plans after their Medicare Advantage plans leave the market — was about 10 percent nationwide in 2026. In 2025, there was a nearly 7 percent forced disenrollment rate.
- Contrast that with the average forced disenrollment rate for Medicare Advantage beneficiaries from 2018 to 2024: 1 percent.
- An estimated 2.9 million people experienced forced disenrollment from their Medicare Advantage plan in 2026. About 1 in 10 beneficiaries in HMO or PPO Medicare Advantage plans were forced to disenroll from their current plan after it had left the market.
- In 12 states, more than 20 percent of Medicare Advantage enrollees face forced disenrollment in 2026 — including a stunning 92.2 percent of enrollees in Vermont.
- Beneficiaries who experienced forced disenrollment in 2026 were more likely to be in PPO, non-Special Needs Plans or small carrier plans — and living in rural areas.
The research was authored by academics at the Johns Hopkins Bloomberg School of Public Health, Georgetown University’s McDonough School of Business and the Carey Business School at Johns Hopkins University. It was supported with funding by Arnold Ventures. | | | |  | Agency alert | Lena H. Sun sends this dispatch from The Washington Post newsroom: An influential federal vaccine advisory committee will not hold its scheduled meeting next week. The Advisory Committee on Immunization Practices, which advises the Centers for Disease Control and Prevention on vaccine policy, had been set to hold a regularly scheduled meeting Feb. 25-27 at CDC headquarters in Atlanta. However, a spokesman for the Department of Health and Human Services confirmed the meeting is off — for now. It’s unclear when the meeting will be rescheduled. “Further information will be shared as available,” Andrew Nixon, the spokesperson, said. → Medical and health groups led by the American Academy of Pediatrics are suing Health Secretary Robert F. Kennedy Jr. and the agencies he oversees. They have asked a federal judge to block Kennedy’s handpicked ACIP panel from holding the meeting next week. They are also asking the judge to issue a preliminary injunction that would prevent the CDC from implementing a revised childhood immunization schedule. During ACIP’s last meeting, it recommended the federal government nix the birth dose of the hepatitis B vaccine for all newborns, which sparked concern from medical groups and public health experts who argued it could lead to an increase in the disease. In December, the CDC updated childhood vaccination guidelines to adopt the recommendation. The following month, the agency bypassed ACIP and overhauled the entire childhood vaccine schedule by recommending fewer shots for all children. | | | | | | Executive Health Brief | Upon taking office last year, President Donald Trump announced the U.S. would leave the World Health Organization, saying it demanded “unfairly onerous payments.” Now, the administration wants to set up its own organization at triple the annual cost, according to an exclusive report from Lena H. Sun and Jacob Bogage. The new U.S.-run alternative is expected to cost about $2 billion each year, compared to the roughly $680 million paid in dues and other contributions to the WHO. - The effort would recreate labs, data-sharing networks and rapid-response systems that WHO had already offered, three administration officials briefed on the proposal told Lena and Jacob.
- The U.S. would build on bilateral agreements with other countries and expand the presence of its health agencies to more than 130 countries, according to the officials. But it comes as global health expertise in the federal government under the Trump administration has been depleted by repeated layoffs, deferred resignations and retirements.
- HHS “is working with the White House in a deliberative, interagency process on the path forward for global health and foreign assistance that first and foremost protects Americans,” said Nixon, the department spokesperson. He did not answer detailed questions about the proposed WHO replacement sent by my colleagues at The Post.
Public health experts were shocked by the U.S. withdrawal from WHO, a 200-member agency of the United Nations, and now argue that setting up an alternative is unlikely to be as effective as the old collaboration. “We’re not going to get the same quality or breadth of information we would have by being in the WHO, or have anywhere the influence we had,” Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, told The Post. Inglesby served as a senior covid-19 adviser during the Biden administration. In the executive order withdrawing from WHO, Trump said the organization had mismanaged the covid-19 pandemic, and criticized “its failure to adopt urgently needed reforms, and its inability to demonstrate independence from the inappropriate political influence of WHO member states.” Inglesby told The Post that the administration should specify what reforms it seeks and reengage with the agency rather than trying to build something else. → The Trump administration has previously insisted that the U.S. still wants to remain a player in public health on the world stage, pointing to federal agencies — including the Centers for Disease Control and Prevention, the National Institutes of Health, and the Food and Drug Administration — that have a presence in 63 countries and bilateral agreements with “hundreds of countries.” “I just want to stress the point that we are not withdrawing from being a leader on global health,” a senior HHS official said last month, speaking on the condition of anonymity under the ground rules for the briefing. | | | | | | Industry Rx | Scientists showed in a new study that they could use blood draws to build a “clock” for Alzheimer’s disease that could roughly predict when symptoms will develop, reports my colleague Carolyn Y. Johnson in The Washington Post newsroom. There are simple blood tests that can help diagnose Alzheimer’s. However, in the study published in the journal Nature Medicine on Thursday, researchers built a model that could use blood test results to forecast symptom onset within a margin of three to four years. Why it matters: While the technique is not yet precise enough to predict how a patient will fare in the longer term, it could be used to identify people who could benefit if companies are able to develop drugs to treat the disease before symptoms develop. The benefit for industry: The approach could accelerate the research to identify such treatments by recruiting the ideal study participants: people with no symptoms but who are at high risk for developing them soon. → In 2025, there were more than 180 clinical trials and 138 new drugs in the Alzheimer’s disease treatment pipeline, according to a review of trial data. That’s an increase over 2024, the study found. Developing an Alzheimer’s treatment can cost a company billions of dollars and take about 13 years from the first studies until approval by federal regulators, according to a study from 2014. But it’s turning into an attractive treatment area for the pharmaceutical industry: - Korsana Biosciences, a company developing an Alzheimer’s medication, announced on Wednesday it had raised $175 million in venture capital funding.
- Sanofi acquired Vigil Neuroscience, a company with an early-stage Alzheimer’s treatment in development, for $470 million last year.
- In 2024, AbbVie acquired Aliada Therapeutics, which is working on an Alzheimer’s medication, for $1.4 billion.
The benefit for patients: “When treatments for this population have received regulatory approval, those individuals who are at highest risk of developing symptoms will inevitably be prioritized for treatment,” Clifford Jack, a neuroradiologist at the Mayo Clinic who was not involved in the study, told Carolyn in an email. “How soon a currently asymptomatic person is to developing symptoms will be a key piece of the decision-making matrix.” | | | | |
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