State Policymakers Act to Reform Health Plans' Downcoding Practices Reducing Physician Payments

• The Environmental Protection Agency has classified microplastics and antidepressants as drinking water contaminants, responding to advocacy from the MAHA movement and public health concerns. • The classification marks a significant regulatory step in addressing emerging contaminants in U.S. water supplies that have raised concerns among health experts and environmental advocates. • The designation may prompt future regulatory actions to establish drinking water standards and treatment requirements for these substances.

• Raksasa asuransi Cigna mengumumkan akan keluar dari pasar individu Affordable Care Act pada tahun 2027, berdampak pada 369.000 anggota di tengah laporan jutaan orang menghentikan cakupan Obamacare akibat biaya jangka panjang yang lebih tinggi. • Pejabat negara dan analis industri mencatat bahwa lonjakan premi mendorong penurunan pendaftaran, memperburuk masalah akses bagi pemegang polis yang tersisa. • Cigna melaporkan laba sebesar $1,65 miliar saat mengumumkan penarikan diri tersebut, menyoroti ketegangan antara profitabilitas dan keberlanjutan pasar.

• American Heart Association merilis Presidential Advisory pada 30 April 2026, yang menyatakan keterjangkauan layanan kesehatan AS berada pada titik krisis akibat kenaikan biaya yang didorong oleh penyakit kronis. • Biaya tersebut memaksa warga Amerika untuk menunda atau menghindari perawatan, sehingga memperburuk hasil kesehatan dan meningkatkan utang medis; survei Gallup menunjukkan kekhawatiran yang meluas mengenai akses ke perawatan yang terjangkau. • Jajak pendapat McLaughlin & Associates menemukan bahwa 51% pemilih menyebut asuransi kesehatan sebagai kekhawatiran utama mereka, diikuti oleh tagihan rumah sakit (11%) dan biaya obat-obatan (10%).

• The Trump administration filed an appeal Wednesday evening against a Massachusetts federal judge's March 16 ruling that blocked Health Secretary Robert F. Kennedy Jr.'s overhaul of the nation's childhood vaccine schedule. • Judge Brian Murphy had ruled that Kennedy replaced the CDC's vaccine advisory committee "unlawfully" and placed any decisions made by the committee on hold. • The appeal signals the administration's intention to proceed with restructuring the vaccine advisory process despite legal challenges to its authority.

• The Department of Justice announced last week it loosened legal restrictions on medical marijuana, aiming to expand research and treatment options across the US. • This policy shift is expected to facilitate more clinical studies and access for patients in states with medical programs. • The change addresses longstanding barriers to federally approved marijuana research, potentially accelerating therapeutic developments.

• South Carolina health officials ended the nation's largest measles outbreak after six months, with 997 infections and 21 hospitalizations but no deaths. • The outbreak concluded Sunday following over a month without new cases. • This marks a significant public health milestone amid rising national vaccination concerns.

• Backers introduced over three dozen bills in statehouses to expand raw milk access, despite public health warnings and at least five outbreaks in the past year. • Current E. coli outbreak linked to raw milk cheddar cheese from California-based Raw Farm has sickened nine people, half children under 5, with one developing lifelong kidney complications. • Public health officials warn unpasteurized milk harbors risky germs, alarming experts as more states legalize sales.

• Nearly two-thirds (64%) of U.S. adults worry about affording health care costs, with 30% very worried, topping affordability concerns over gas prices. • Health care affordability remains the public's primary worry despite other economic pressures. • Poll highlights ongoing financial strain on households amid rising medical expenses.

• Investigators from Ann & Robert H. Lurie Children’s Hospital analyzed over 3.9 million hospitalizations to estimate sepsis in 1.3% of pediatric cases, equating to more than 18,000 U.S. occurrences yearly. • Sepsis carries a 10% mortality rate, resulting in over 1,800 child deaths annually, with no significant change in incidence or mortality from 2016 to 2022. • 72% of cases began before hospitalization, highlighting risks to otherwise healthy children and the urgent need for better prevention strategies.

• Connecticut Governor Ned Lamont signed HB 5044 into law on April 28, 2026, expanding the state health commissioner's authority to issue vaccine recommendations independent of federal guidance. • The bill includes provisions clarifying the state's Religious Freedom Restoration Act (RFRA), which had sparked significant controversy during legislative debates. • The law also prevents insurance companies from penalizing clinicians who treat patients declining vaccines, protecting physician practice autonomy.

• A new report from Harris County Public Health reveals Houston has the highest tuberculosis rates in Texas, highlighting urban transmission risks. • The data shows elevated cases linked to dense populations and socioeconomic factors in the Houston area. • Rising TB incidence demands targeted screening and treatment expansions to curb spread in high-risk communities.

• Medicare underpayments to hospitals totaled more than $100 billion in 2024, according to testimony provided to the House Ways and Means Committee by the American Hospital Association. • Hospitals are managing significant cost pressures while treating a sicker, more medically complex, and aging patient population, with persistent misalignments between care provision and reimbursement rates. • The financial strain reflects broader healthcare system challenges as providers struggle with inadequate government reimbursement alongside rising operational costs.