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Much has been noted about the new work requirements that will be imposed on Medicaid enrollees. Understandably, there is an exemption for those who are unable to work or volunteer. However, KFF Health News reported on complications presented by the requirements for enrollees to get a medical waiver.

Notably, doctors may not feel qualified to determine if patients are too "medically frail" to work, especially since no firm guidelines have been published. The article notes that doctors who might be asked for these assessments "are not necessarily trained in occupational medicine." There is concern that incorrect assessments might incur punishments in the future. Beyond that, "The country is short thousands of primary care providers, and it could be hard for people seeking an exemption to find a clinician to help them document that they're too sick to work," with one doctor asking "How could an applicant who doesn't have health coverage get a doctor's note?" Hammering out the policy and logistical details for a seemingly simple phrase can actually be quite complicated.

Patients and providers have been complaining about preauthorization requirements, which are used by insurance companies to help contain costs. KFF Health News reports that about a year ago, the federal government "announced that dozens of health insurers had signed a six-part pledge promising to reduce barriers to doctor-recommended care," and perhaps to the surprise of very few people, "some insurers now say they won't implement all the promised initiatives" and that "patients, their advocates, and clinicians say little has improved." Of concern, the article reports on insurers "retroactively denying payment, even when care is preapproved."

The industry might be able to delay regulation by voluntarily agreeing to some reforms, but if patients continue to encounter challenges with getting their medical care, there could be some legislative efforts to address the pain points. Addressing certain aspects of medical care seems to be one of the few issues that are popular with both major political parties, as evidenced by the legislation to prevent surprise billing.

Affordable Care Act (ACA) patients saw large out-of-pocket premium increases coming into 2026. Insurers were concerned that given the expiration of the temporary premium subsidies, healthier patients would forgo coverage, meaning a remaining patient population that is likely to require more medical care, and therefore, more expense. KFF Health News reported that "insurers are seeking a median rate increase of 14% for 2027." Apparently, there is some concern that new policy changes and regulation will "make it harder for some people to enroll." UnitedHealthcare wrote that the changes "account for 12.7% of the requested rate change." However, the article notes that "There's growing demand for costly specialty medications and for the weight loss drugs known as GLP-1s."

Although general inflation is high, growth in health insurance premiums continues to be much higher. Increasing subsidies helps patients in the short-term, but addressing the underlying cost of care seems to be the correct long-term policy. Unfortunately, slowing the growth of medical care might involve the curbing of benefits and less profit for providers and payers.

Healthcare affordability seems to be a growing concern, especially after a temporary healthcare exchange subsidy expired and the federal government's adding work requirements for Medicaid eligibility. KFF Health News published a brief on the state of Indiana attempting to rein in healthcare costs by establishing a price cap for hospital procedures. The brief notes that "Indiana isn't the only state targeting hospital prices, but it's a rare Republican-controlled state doing so." The governor indicated that "the healthcare system is too broken to leave alone."

KFF Health News also published an article about how healthcare affordability might play a big role in gubernatorial race in Nevada. Understandably, people can be very afraid when they lose access to health care, and it would not be surprising if it turns out to be a major enough issue for politicians of both parties to be concerned.

The practice of requiring providers to secure approval before performing a procedure is known as prior authorization. It is a tool for insurance companies to help control costs, but as one KFF Health News article points out, "Consumers and clinicians largely detest prior authorization." Perhaps unsurprisingly, in the current federal administration's effort to reduce costs, the practice of prior authorization is being tested out in traditional Medicare, which previously did not employ that practice. One point of irony is that this is happening as the federal government is currently trying to get commercial insurers to curb the practice.

This pilot seems to have been complicated by a rushed implementation and the seeming use of unreliable artificial intelligence. The article also points out that denials have been appealed, raising government costs. It is unfortunate that patients and providers bear the cost of a shaky rollout in terms of time and effort.