ACA subsidy vote planned as government reopens

Senate leaders have committed to a vote by mid-December on extra ACA marketplace subsidies as part of the deal to re-open the federal government.

A Senate Finance Committee hearing today is expected to feature discussion of a GOP proposal to fund health accounts instead of providing premium subsidies for the ACA marketplace.

The deal to fund government operations through Jan. 30 included:

• Funding Medicare coverage of telehealth
• Funding hospital-at-home services
• Delaying a $24 billion cut to Medicaid disproportionate share hospital payments
• Paying for low-volume and Medicare-dependent hospitals

Colorado reverses ED volume trend

Colorado hospitals saw their ED volumes decrease in 2024 — their first reduction since 2020.

Emergency department volumes at Colorado hospitals increased 31% from 2020 to 2023 before decreasing 1% in 2024. New data indicate that volume cut was helped by steadily decreasing ED visits by the uninsured since the middle of 2024.

Tom Rennell, a senior vice president for the Colorado Hospital Association (CHA), credited the decrease in uninsured visits, specifically, to Medicaid redeterminations ending mid-2024 and the ability of some residents who lost coverage to regain either Medicaid or other state coverage.

Nationwide, emergency department visits per calendar day are 6% higher this year than they were year-to-date in 2022 and 2% higher year over year compared to 2024, according to the latest Kaufman Hall National Hospital Flash Report, which uses data from Strata Decision Technology.

Hospitals face a “dual bottleneck” of critically ill patients waiting too long for inpatient beds, while low-acuity patients lacking access to primary or urgent care flood the ED for conditions that could be addressed elsewhere, according to one analysis.

Source: Colorado Hospital Association, Q2 2025 Financial and Utilization Trend, Oct. 28, 2025.

Where low commercial pay hits rural hospitals

The most-rural and independent hospitals, as well as government-run rural hospitals, face the worst commercial payment rates among all hospitals, according to a new analysis.

Findings of an analysis of price transparency data from more than 5,000 U.S. hospitals by Dan Snow, a researcher and data scientist at Turquoise Health, included:

• Median commercial rate at a rural hospital is 232% of Medicare, versus a 253% rate at urban hospitals
• Most-rural hospitals reimbursed 33 percentage points less than urban hospitals
• Most-rural hospitals paid 23 percentage points less than rural hospitals closer to urban areas

The rural-urban hospital commercial rate gap extended to most service lines.

Source: Price Points blog, Rural hospitals are paid less than urban hospitals, Nov. 6, 2025.

NUMBER TO KNOW

Increase in the conversion factor for Medicare physician payments in 2026 when they are in an advanced alternative payment model vs. 3.26% for those who are not. It’s the first increase in six years for physicians.  LEARN MORE.

Crucial Date

REGULATORY

Jan. 1: Launch of 340B Discount Drug Program rebate model

Jan. 1: Launch of Transforming Episode Accountability Model (TEAM)