US Officially Leaves the World Health Organization
Almost a year after President Trump signed EO 14155, the US has officially withdrawn from the World Health Organization (WHO) as of January 22, 2026. The administration has recalled US personnel and contractors from WHO offices worldwide, ended participation in WHO-sponsored work groups and committees, and suspended or discontinued US-WHO engagements. Based on a document published by the WHO, the US owes a total of $260M in dues for 2024 and 2025. The US’ departure from the organization is expected to have significant financial implications due to the United States’ past large financial contributions. The WHO is expected to cut over 2,000 jobs by mid-2026 and significantly scale back their work. A day after the United States’ exit, California Governor Gavin Newsom announced his state would join WHO’s Global Outbreak Alert and Response Network (HHS, January 22; Fierce Healthcare, January 23; The Hill, January 23).
State Leaders Warn Exchange Enrollment Numbers May Not Tell the Whole Story
While enrollment totals for health plans under the ACA Exchange are down only slightly compared to last year, state health exchange leaders are warning that this topline figure may be masking instability. State leaders report higher numbers of plan cancellations and more enrollees switching to lower-cost plans. They also note that consumers in subsidized plans have a three-month grace period to remain enrolled when they miss a payment, meaning that the full impact of increased prices on the exchange may not be known until the spring. While these impacts are largely due to the expiration of enhanced premium tax credits, state leaders urge that it is not too late for Congress to act and extend the credits (Inside Health Policy, January 23).
House Passes HHS Appropriations Bill with Significant PBM Reforms
On January 22, the House passed an appropriations package that would fund HHS through the end of the fiscal year with bipartisan support. Notably, the spending package includes significant pharmacy benefit manager (PBM) reforms, such as delinking PBM compensation from drug prices; reinforcing “any willing pharmacy” contracting requirements in Medicare Part D; requiring PBMs to submit detailed, semi-annual reports to group health plan sponsors on rebates, fees, discounts, and spread pricing arrangements; requiring PBMs to pass through 100 percent of rebates to group health plan sponsors. The bill now moves to the Senate for consideration (Fierce Healthcare, January 22; Health Payer Specialist, January 23).
CMS Adds New Restrictions on Certain DME Supplies
On January 13, CMS updated the master list of durable medical equipment (DME) items subject to increased documentation or review prior to use under Medicare, effective April 13. As outlined in the Federal Register, the new restrictions are aligned with the agency’s efforts to reduce fraud, waste, and abuse in the government programs. There will be 15 additional codes with new restrictions. Of the 15 new HCPCS codes, five are related to orthoses, two for pneumatic compression, and the remaining eight are for oxygen use. CMS states that oxygen supplies and equipment have the highest rate of improper payments, with an improper pay rate of 11.3% in 2024. These items will be subject to face-to-face encounters and written orders with the treating physician prior to delivery.
The remaining seven items outside of oxygen supplies and equipment will be subject to other prior authorization requirements. An additional 18 items will be added to the “Master List of DMEPOS Items Potentially Subject to Face-to-Face Encounter and Written Order Prior to Delivery,” which identifies them as vulnerable to fraud but does not automatically put restrictions in place. Notably, CMS recently finalized a prior authorization exemption process for DME suppliers that have a provisional affirmation rate of 90% or higher (Inside Health Policy, January 23).
MedPAC Analysis Finds MA Plans Increased Fed Costs by $76B Compared to Original Medicare
The Medicare Payment Advisory Commission (MedPAC) released a provisional report on Medicare Advantage payments on January 16 which found that compared to enrollees in Original Medicare, the federal government will pay an estimated $76B, or 114%, more for enrollees in Medicare Advantage in 2026. The $76B sum is smaller than previous estimates of $84B, largely due to a new risk adjustment model in Medicare Advantage that aims to curb upcoding. MedPAC researchers also highlighted that MA plans generally have favorable selection, where beneficiaries are healthier than their counterparts in Original Medicare.
Other research has shown that patients in MA plans use less medical care compared to patients in Original Medicare. Without upcoding or favorable selection, MedPAC analysts claim that MA plan payments would fall to 99% of Original Medicare. However, MA plans have criticized MedPAC’s report, alleging that the methodology is unsound and pointed out research which shows that MA is more cost-effective than Original Medicare. MedPAC analysts used data from individuals who switched from Original Medicare to MA to generalize estimates for the total MA population. Some MedPAC commissioners also agreed that the methodology was imprecise, impacting the magnitude of overpayments. Ultimately, MedPAC commissioners were in agreement that there is some degree of overpayment to MA plans from the federal government. This topic will be presented to Congress in MedPAC’s March 2026 Report (Healthcare Dive, January 16).
