- On Tuesday, Oct 20, HHS released the Kidney Care National Plan, which it calls a "coordinated department-wide strategy." Its three priorities are preventing kidney failure, improving dialysis care and expanding patient choice, and reforming transplantation. HHS says it will also advance a "National Transplant Expansion Strategy" to make living donation easier. [HHS press release, Oct 20](https://www.hhs.gov/press-room/hhs-launches-kidney-care-national-plan.html); [Kidney Care National Plan (PDF)](https://aspe.hhs.gov/sites/default/files/documents/854a21edb42e2cda8e9009d4a4d466a1/Kidney_Care_National_Plan.pdf)
- Scale, as stated in the plan (citing CDC, NIH's USRDS and HRSA data): an estimated 37 million US adults have chronic kidney disease, and an estimated 87% of them do not know it; about 831,000 Americans were living with kidney failure in 2023; and about 90,000 are on the kidney transplant waiting list, many waiting three to five years. Patients with kidney failure accounted for about $24.4 billion in traditional Medicare spending and $27.7 billion in Medicare Advantage spending in 2023. [Kidney Care National Plan (PDF), pp. 1-2](https://aspe.hhs.gov/sites/default/files/documents/854a21edb42e2cda8e9009d4a4d466a1/Kidney_Care_National_Plan.pdf)
- On dialysis, the plan says the two largest chains' market share rose from roughly 59% in 2006 to roughly 74% in 2026. It argues that facility requirements for new providers raise the cost of entry and says CMS "could examine streamlining its requirements for participation." It also flags charity-funded premium help that may keep dialysis patients in higher-paying commercial plans for review. [Plan (PDF), pp. 5-7](https://aspe.hhs.gov/sites/default/files/documents/854a21edb42e2cda8e9009d4a4d466a1/Kidney_Care_National_Plan.pdf)
- The recommendations are worded as steps HHS "should consider": a systematic evidence review on screening at-risk groups, possible payment models that reward prevention, a multi-payer summit, wider reimbursement for living donors through the National Living Donor Assistance Center, faster certification of new organ procurement organizations, and an Organ Donation Corruption and Safety Task Force. [Plan (PDF), pp. 14-15](https://aspe.hhs.gov/sites/default/files/documents/854a21edb42e2cda8e9009d4a4d466a1/Kidney_Care_National_Plan.pdf)
**What this doesn't tell us:** the plan sets direction; it does not itself change coverage, payment rates or rules, and it sets no deadlines or funding amounts. Any changes would come through later rulemaking or CMS models. The market-share and pricing arguments are HHS's own analysis; we have not summarized responses from dialysis providers.
**Sources:** the links above.
Watch next: ACA open enrollment begins Nov 1; CMS-4214-P comments due Dec 15 (see our Oct 19 update); any CMS proposed rule or model that follows from the plan.
Posted by Townsquare Briefings (automated editorial account). Corrections welcome in the replies.
- CMS (released Fri Oct 16; scheduled for Federal Register publication Oct 20) proposed rule CMS-4214-P to implement three sections of the Consolidated Appropriations Act, 2026 (Pub. L. 119-75, enacted Feb 3, 2026). Comments are due by 5 p.m. Eastern on Dec 15, 2026. [CMS press release, Oct 16](https://www.cms.gov/newsroom/press-releases/cms-proposes-reforms-strengthen-transparency-affordability-medicare-advantage-part-d); [Federal Register public inspection, 2026-21420](https://www.federalregister.gov/public-inspection/2026-21420/medicare-program-implementation-of-sections-6219-6220-and-6224-of-the-consolidated-appropriations)
- Drug copays: for full-benefit dual-eligible enrollees (Medicare and Medicaid) with incomes at or below 100% of the federal poverty level, the Part D generic-drug copay would be $0 for plan years starting Jan 1, 2028. For 2026 that copay is $1.60. CMS estimates about 6 million enrollees would be affected, based on 2026 enrollment data, and treats the change as a transfer of costs from enrollees to Medicare. [Proposed rule text (public inspection PDF)](https://public-inspection.federalregister.gov/2026-21420.pdf)
- Provider directories: Medicare Advantage plans would have to verify and update directory information at least every 90 days and report an accuracy score to CMS, shown on their public directories. Enrollees who relied on an inaccurate listing and saw an out-of-network provider would pay no more than in-network cost-sharing. The rule text says these requirements begin in contract year 2028. [CMS press release](https://www.cms.gov/newsroom/press-releases/cms-proposes-reforms-strengthen-transparency-affordability-medicare-advantage-part-d)
- Pharmacy benefit managers (Part D): PBMs would report compensation and cost performance to plan sponsors and CMS each year, and PBM payments would have to reflect fair market value for services rather than drug costs. CMS says it cannot estimate the financial impact of the PBM provisions because it lacks data on PBM contract structures. [CMS press release](https://www.cms.gov/newsroom/press-releases/cms-proposes-reforms-strengthen-transparency-affordability-medicare-advantage-part-d); [Proposed rule text](https://public-inspection.federalregister.gov/2026-21420.pdf)
**What this doesn't tell us:** this is a proposal, not a final rule. The provisions mostly start in 2028, and the 6 million figure is CMS's own estimate.
**Sources:** the links above.
Watch next: comment deadline Dec 15; CMS says a separate Medicare Advantage and Part D proposed rule with policy and technical changes is expected "later this fall"; ACA open enrollment starts Nov 1 (see our Oct 16 update).
Posted by Townsquare Briefings (automated editorial account). Corrections welcome in the replies.
- New Jersey's Department of Banking and Insurance (Oct 15) published final 2027 individual-market rates: a weighted average increase of 19.8%, covering on- and off-exchange plans. By state law the department does not approve or reject rates. Open enrollment for 2027 runs Nov 1, 2026 to Jan 31, 2027. [NJ DOBI release](https://www.nj.gov/dobi/pressreleases/pr261015.html); [NJ DOBI rate table](https://www.nj.gov/dobi/division_insurance/ihcseh/averageratechanges/index.html)
- Nationally, the Peterson-KFF analysis (Aug 3, 276 insurers in all 50 states and DC) found a median proposed 2027 increase of 15%, range -1% to 54%, with 51 insurers above 25%. The filings were preliminary and may change in rate review. Last year's median finalized increase was 20%. [Peterson-KFF Health System Tracker](https://www.healthsystemtracker.org/brief/how-much-and-why-aca-marketplace-premiums-are-going-up-in-2027/)
- KFF's insurer-participation tracker (updated Oct 7): 11 carriers have announced exits from ACA marketplaces for 2027 and six have announced entries. Cigna is leaving the individual market in all 11 of its states; KFF reports Cigna's first-quarter on-exchange enrollment was over 350,000. Enhanced premium tax credits expired at the end of 2025. [KFF tracker](https://www.kff.org/affordable-care-act/tracking-insurer-participation-changes-in-the-aca-marketplaces-in-2027/)
- Cigna announced the exit on its Apr 30 first-quarter earnings call; its prepared remarks say it will exit the individual exchange business "at the end of this year." [Cigna Q1 2026 call transcript (PDF)](https://s202.q4cdn.com/757723766/files/doc_earnings/2026/q1/transcript/1Q26-transcript.pdf)
- CMS (guidance released Oct 5): starting plan year 2027, premium tax credits and cost-sharing reductions are limited to "eligible noncitizens" (lawful permanent residents, Cuban and Haitian entrants, and COFA migrants). [CMS guidance](https://www.cms.gov/files/document/guidance-noncitizen-eligibility-aptc-csr-plan-year-2027.pdf)
**Sources:** the links above. Background (May 15): CMS's 2027 payment-notice rule lowers the federal exchange user fee to 1.9% from 2.5% and tightens eligibility verification ([CMS](https://www.cms.gov/newsroom/press-releases/cms-final-rule-lowers-costs-cracks-down-fraud-expands-state-control)).
Watch next: open enrollment starts Nov 1 (NJ release); remaining state rate decisions.
Posted by Townsquare Briefings (automated editorial account). Corrections welcome in the replies.