Get Your Healthcare at … Costco?

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Large companies have been spending the last several years getting into—and sometimes subsequently shrinking—their footprint in the healthcare business. Some of them, such as pharmacy retailers like CVS and Walgreens, could be considered “healthcare adjacent” because of their pharmacy component, which is already considered healthcare. As discussed below, these entities have been entering the healthcare space in a few different ways—although primarily through the expansion of primary care and clinic services. This blog provides a high-level overview of how and where these expansions have taken place, how Costco’s latest venture differs from others, and considers important questions for policymakers that these shifts raise.

Both Walgreens and CVS began providing “direct-to-consumer” retail healthcare clinic services within their stores in 2013 and 2016, respectively. Over time, Walgreens expanded the ability of its clinics to provide not just primary care but services for people with chronic health conditions in 2013. Then, in 2020/2021, they created a partnership with an entity known as VillageMD to staff and run hundreds of their healthcare clinics. The growth of these clinics has reversed in recent years, with many closings happening across the country after the company was acquired by private equity firm Sycamore Partners in 2025. As of August 2026, Walgreens was still operating in the neighborhood of 8,000 clinics nationwide.

In the case of CVS, it began providing primary care clinic services in 2016 through the acquisition of MinuteClinic. According to its website and the National Retail Federation, CVS grew to be the largest provider of “retail” healthcare in the US. Perhaps more significant for CVS was its acquisition in 2018 of Aetna health insurance company. The intent of the merger was to provide more coordinated care to a larger share of the population, building on Aetna’s and CVS’s respective strengths. Additionally, in 2023, CVS acquired Oak Street Health, which focuses on helping older adults stay healthy through routine primary care like vaccinations and screenings.

But the growth of these large entities may slow. Just this week, it was reported that CVS plans to split its insurance and pharmacy businesses. David Joyner, the current chairman and CEO of CVS Health, noted of the reason behind the move that “each company will have greater flexibility to adopt the technologies that best fit its needs, improve efficiency and more effectively adapt to the regulatory and other dynamics.” This kind of decision may therefore draw in part from broader public concerns that the size of such entities may result in further scrutiny on the insurance side of their business.

Other big retail companies, such as Walmart and Amazon, have also launched healthcare services. Walmart was operating health clinics as well, but began discontinuing and closing retail clinic services in 2024 because of financial losses. Currently, however, they still provide pharmacy services as well as preventive and health insurance coverage services. Amazon, on the other hand, dramatically expanded its footprint in 2023 when it partnered with One Medical to offer AI-powered in-person and virtual care options with various health systems across the US.

Another way these companies are entering the healthcare space is through partnerships with or acquisition of existing healthcare companies. The latest company to do so via a strategic partnership is Costco, a large wholesale membership company known for selling groceries and other items such as gasoline, eyeglasses, and pharmacy products, at lower cost. In August 2026, Costco announced a partnership with the SCAN Group, which, according to SCAN’s website, provides new ways to deliver evidence-based patient-centered care to older adults. SCAN, a not-for-profit, has several companies that provide everything from healthcare for the unhoused, in-home care, insurance coverage, and primary care—all focused on older adults. They operate in states such as California, Nevada, Texas, Washington, and New Mexico.

What is different about Costco’s arrangement compared to CVS, Walgreens, Amazon, or Walmart is threefold: Costco’s venture into healthcare is (1) not-for-profit, (2) focused on the aging/senior population, and (3) delivering services in the long-term care space such as care management and insurance products (including a Medicare Advantage plan).

With all these nontraditional entities entering the healthcare space in various forms, there are important questions for policymakers and regulators to consider. These include:

  • What are the goals of these entities that are more recently entering the healthcare space versus traditional healthcare providers?
  • What is the impact of these entities on the healthcare marketplace?
  • What is the impact of these healthcare entities on health outcomes for people, and is this a good or bad development generally?
  • What other role should government play as it relates to these changes?
a large sign spins on top of a Caduceus. the five panels of the sign show the logos of amazon, CVS, Costco, Walmart, and Walgreens.
What are the goals of these entities that are more recently entering the healthcare space versus traditional healthcare providers?

The goals of these companies’ ventures into healthcare are not always explicitly stated. For some, the goal was to expand customized consumer experiences. Presumably, each saw a need/demand by customers for more services. For others, entering healthcare may be part of an overall business growth strategy. Still, for others, it may be about integrating care and moving toward value-based outcomes. In the case of Costco, it is targeting a specific market (the aging population) in a different way (insurance). Given the footprint of these entities in healthcare, policymakers may want to consider what is in the best interest of the public good and whether such organizational ventures are resulting in positive or negative impacts—or perhaps a little of both. This leads one to ask a few more questions…

What is the impact of these entities on the healthcare marketplace?

The entry of these entities is seen as disruptive to the traditional healthcare system. But disruption may be viewed as both a positive and negative development for the industry. Disruption can force innovation and broaden choice. At the same time, it is possible it may shift where and from whom consumers access healthcare. One such example is the company created by Mark Cuban, Cost Plus Drugs, which is meant to disrupt the pharmacy industry and lower costs for consumers. Developing a rubric and measures by which to gauge impacts on things such as quality, cost, and outcomes in health should be a consideration for policymakers. Policymakers may also choose to allow new marketplace entrants to see if there might be a positive impact, such as more choice of providers by consumers or a better consumer experience. Monitoring these impacts may be difficult, but some states have started such efforts by better understanding who is entering the market. They are doing so by requiring the reporting of what are known as “material transactions” (i.e., purchases or acquisitions between businesses of a certain amount). Ultimately, if a venture is not needed, is not sustainable, or is done suboptimally, consumers may “vote with their feet” and choose not to use the service.

What is the impact of these healthcare entities on health outcomes for people? And relatedly, is this a positive development generally?

Many of the objective analyses on the entry of nontraditional companies into healthcare have focused on market impacts and not necessarily overall outcomes for consumers. This is, in part, because population health impact is harder to track. But the individual companies that have entered healthcare have done their own monitoring of outcomes. For example, CVS reports that they saw an average reduction in A1C of 1.9 percent (i.e., lower blood sugar, which reduces harm from Type 2 Diabetes) through their Transform Diabetes Care initiative and a 44 percent reduction in hospital admissions through Oak Street Health, which provides primary and specialty care for older adults. One broader positive impact has been on increasing access—primarily to primary care and pharmacies—although many companies have pulled back on their in-person retail clinics. Policymakers could consider requiring any entities in healthcare, including those considered to be nontraditional, to report all the same quality measures that traditional providers do. These measures are largely overseen nationally by the National Committee on Quality Assurance. States also mirror these quality and outcome reporting requirements with their state-based quality measurement systems, such as New York’s Quality Assurance Reporting Requirements.

What other roles should government play as it relates to the growth of nontraditional healthcare providers?

Traditional healthcare (e.g., hospitals, nursing homes, federally qualified health centers, etc.) is highly regulated. To bill for services, providers must enroll in programs to get a National Provider Identifier (NPI number) and be credentialed. In some cases, companies may do this themselves, while others have chosen to buy or partner with entities that are already enrolled providers.

In the case of Costco’s latest venture with SCAN to serve the 65+ year-old Medicare population, the service being offered is itself different because it is a Medicare insurance product. These products have regulations governing participation, marketing practices, and compliance. Should any of the aforementioned companies decide to serve the Medicaid population, which is primarily lower-income individuals or people with disabilities, the regulatory requirements may vary by state because this program is jointly administered by the federal and state government.

Conclusion

As this blog reflects, a growing number of companies that are not traditional healthcare providers have been entering the healthcare marketplace. As discussed, there are new ways companies are entering this space (from retail healthcare to pharmacy to insurance for aging services), and there are potential pros and cons to this development. To ensure that the entry of these companies into healthcare is a more positive development, policymakers may want to consider more evenly applying regulatory requirements and oversight across the marketplace. They may also want to more closely monitor impacts on access to services, costs, and outcomes for consumers to the same degree as is done for traditional providers. In the meantime, it will be interesting to watch how and to what extent these larger retail companies evolve in the healthcare marketplace.

Campaign 2026 and Health Industry Issues: What’s Next?

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Campaign 2026 and Health Industry Issues: What’s Next?

Election day is finally here though final results may not be known this week due to election protocols and likely challenges in states. Per polls and commentary across the ideological spectrum, Campaign ‘26 is unprecedented for the money spent ($11.9 billion per Open Secrets), the acrimony between candidates and the blatant disinformation featured in campaigns on both sides.

Like most, I am happy it’s behind us. I value civil debate. I don’t think complex issues are explained in soundbites.  I value data that’s not cherry-picked and polls that are honest. I hate campaigns that justify any means necessary to win. I respect candidates willing to debate. And I worry that statesmanship in local, state and federal policy-setting has been sacrificed to political brinksmanship.

But while uncertainty may dog the outcome this week and potentially in the weeks ahead, there’s certainty for healthcare in the lame duck session of Congress starting next week and in states:

  • State ballot measures and fed mandates will get immediate attention by Governors and state legislatures: implementation of Medicaid work requirements in every state, abortion rights (ID, NV, VA) and referenda that address healthcare funding, school health, vaccines and more in others. CA, CO, MA, MO, NM, NC, RI, SD, WA, and WI). And governors in every Blue State and a few Red States will revisit recission of Medicaid cuts in the Big Beautiful Bill (HR1) slated to start January 1, 2027.
  • Trade associations will update their 2027 advocacy agendas and health committee profiles to prepare for the 120th Congress starting in 60 days.
  • Lobbyists and consultants will be active with their clients–trade groups, special interests, single issue advocacy 501C3s, municipalities, corporate interests et al—around (1) potential low-hanging legislative wins before the 119th Congress adjourns, (2) potential regulatory shifts in 2027 and (3) extension/expansion of their contracts with clients.
  • And the Executive Branch will sequester its key leaders across its agencies (HHS, CMS, FDA, FTC, USDA, DOJ, Commerce, et al) to protect its priorities via prepare Executive Orders, Administrative Actions, Court filings, budget appropriations and key appointments. Price transparency, competition, lower drug costs, less consolidation and stepped-up fraud, waste and abuse efforts will be its emphasis.

Looking to 2027, healthcare will be lightening rod in legislative circles and posturing by White House hopefuls in Campaign 2028. Importantly, two overarching realities will frame politics and policy discussions:

Healthcare is a major contributor to household affordability concerns. Healthcare is one of four major sources of affordability pressure on households along with housing, fuel and groceries. But unlike the other three, healthcare costs are considered unmanageable to voters because they’re often unpredictable, inexplicable and rarely transparent. It’s an issue that garners bipartisan repudiation in politics and unflattering attention to the industry’s opaque business practices.

Healthcare is seen as big business, not public service. The persona of rural hospitals, primary, behavioral and public health, nursing and home care and others is typified by many that struggle and the few that prosper. Stoked by disgruntled employees, physicians and large self-insured employers, bipartisan criticism of consolidation, vertical integration, private equity ownership, board independence, executive compensation, non-profit tax exemptions and more. Corporatization in every sector and regardless of ownership (non-profit, for-profit, or public) will be blamed and capital deployment in healthcare will reflect caution.

Healthcare will be prominent in the election post-mortem this week. Industry leaders face headwinds in the public square with voters and legislators in local, state and federal chambers. Some operate on the assumption that voters will defend the U.S. system against major changes believing it the world’s best. It’s been a safe bet historically, but the future may not be a repeat of the past.

How Democrats’ Big Win Could Reshape Health Care

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https://mailchi.mp/e7ac0bb13b2c/how-democrats-big-win-could-reshape-health-care?e=ad91541e82

Some people are calling the 2026 midterms a “blue tsunami” or even a “Democratic wildfire.”

Whatever you call it, Democrats will have big majorities in the House and the Senate for the end of President Trump’s second term, which could have major implications for health policy over the next two years and beyond.

Democrats have their sights set high. They’ve pledged to repeal Republicans’ health care cuts in their first 100 hours in power — starting with restoring enhanced premium subsidies for people who buy insurance through Obamacare marketplaces and reversing nearly $1 trillion in Medicaid cuts and coverage restrictions set to take effect in January.

Achieving any of that will still require support from at least a few Republicans in Congress and President Trump. But even if they fail to roll back Republican cuts, Democrats will have far more power to influence the country’s health policy conversation, says Katie Keith, director of the Center for Health Policy and Law at Georgetown Law and a contributing editor at Health Affairs.

We spoke with Keith on Wednesday morning about Democrats’ health care affordability agenda in Washington and what the party’s strong showing at the state level could mean on issues such as abortion rights and Medicaid.

Here are some of the key takeaways from our conversation:

  • Republicans and Democrats could become “strange bedfellows” on certain health care issues — like lowering prescription drug costs or even delaying some changes to Medicaid. The size of Democrats’ margins in Congress could allow them to add pieces of their health care agenda to must-pass legislation. The question, Keith says, is, “What is the trade that could bring President Donald Trump along to agree to that?”
  • Democrats have a chance to take control of the health care agenda ahead of the 2028 presidential election — communicating to voters that “Congress hears the concerns of the American people and is doing something about it,” Keith says. She compared it to Republicans’ repeated attempts to repeal the Affordable Care Act after routing Democrats in 2010. Others have drawn comparisons to Democrats’ 2006 midterm victory, which put health care center stage in 2008 and led to the creation of Obamacare.
  • Beyond legislation, Democrats in Congress are likely to go big on oversight and transparency, Keith says, to scrutinize the actions of the Trump administration and the private health sector. For example, Congress could subpoena drug manufacturers for copies of the deals they’ve made with the White House to, among other things, charge state Medicaid programs less than they charge in other countries around the world. The specifics of these deals, which have been cut with more than two dozen drugmakers, have been kept private.
  • Democratic gains in state elections could have big implications for Medicaid. Democrats gained full control in at least five states and won a majority of races for governor and attorneys general. Keith says this red-to-blue shift could mean “a completely different approach to implementing Medicaid work requirements, eligibility and redeterminations.” New blue leadership in Wisconsin, Texas and Georgia could even, theoretically, open the door to Medicaid expansion. “The fact that you could even say maybe it’s something to look at was not something I was expecting to say the morning after [the election],” Keith says.

I hope you’ll listen to our entire episode or read the transcript.

Midterm Elections Won’t Fix Hospitals’ Financial Challenges in 2027

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https://www.healthleadersmedia.com/ceo/midterm-elections-wont-fix-hospitals-financial-challenges-2027

Democratic healthcare priorities could ease some financial pressures facing providers, but congressional constraints will limit the changes lawmakers can make.

KEY TAKEAWAYS

Hospitals will continue to face financial headwinds from federal healthcare policy changes already enacted.

Medicaid and ACA Marketplace coverage remain central to Democrats’ efforts to address the financial impact on providers.

Congressional oversight and budget negotiations give lawmakers avenues to influence policy implementation even when a full reversal is out of reach.

The midterm elections will give Democrats greater influence over federal healthcare policy, creating an opening to address some of the financial pressures facing hospitals.

Party leaders have signaled interest in restoring funding for programs affected by the One Big Beautiful Bill Act (OBBBA), particularly Medicaid and the Affordable Care Act (ACA) Marketplace. Those priorities could offer some relief to hospitals as they prepare for 2027.

However, Democratic control of Congress does not guarantee a reversal of the healthcare provisions already enacted, leaving hospitals and health systems to contend with the financial consequences of those policies.

“While the election has changed who controls Congress, it doesn’t change the financial challenges hospitals will face in 2027,” Chris Van Gorder, president and CEO of Scripps Health, said in a statement. “Democrats won’t have the votes to simply reverse major federal health care cuts over a presidential veto. But Congress is far from powerless. Lawmakers can use their oversight and budget authority to press for changes in how those cuts are carried out, protect critical health care funding where possible and work across party lines to ease the growing financial pressures on hospitals and impact on patients.”

Democrats could offer a lifeline

Two areas of potential focus are Medicaid and ACA Marketplace coverage. Democrats have indicated they want to address cuts to these programs, which could have direct consequences for hospitals’ finances.

Reversing or mitigating Medicaid reductions could limit the number of people who lose coverage and help hospitals avoid further growth in uncompensated care. For health systems serving large Medicaid populations, changes to eligibility and federal funding can affect both patient coverage and the reimbursement hospitals receive for care.

Restoring enhanced ACA premium tax credits is another potential priority. The expiration of those subsidies could make Marketplace coverage more expensive for many enrollees, potentially leading some to drop their plans. A congressional effort to restore the subsidies could help preserve enrollment and reduce the number of patients who arrive at hospitals without insurance.

The financial effects will depend on the scope of any legislative changes and how quickly they take effect. Even if Democrats pursue these priorities, hospitals should not assume that coverage losses or funding reductions already set in motion will be fully reversed.

Congressional authority has limits

Democratic control of Congress gives the party greater power to mold the legislative agenda and scrutinize the administration’s implementation of federal healthcare policy. Reversing major provisions of OBBBA, however, would face significant obstacles.

Even with majorities in both chambers, Democrats would need enough votes to overcome a presidential veto. The party’s Senate majority falls short of the two-thirds threshold required, making a wholesale reversal of the law unlikely while President Trump remains in office.

Congressional Democrats could still use committee oversight and budget negotiations to influence how federal healthcare policies are carried out. They could press the administration on implementation decisions and pursue targeted legislation where bipartisan support exists.

For hospital leaders, the election changes the policy environment, but the financial outlook for 2027 remains difficult. Medicaid funding reductions and changes to Marketplace coverage will continue to influence hospitals’ financial planning as the new Congress considers its priorities. Any relief will depend on what lawmakers can pass and what the administration allows to take effect.

Risant Health’s Integris Deal Tests its Value-Based Care Strategy

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https://www.healthleadersmedia.com/ceo/risant-healths-integris-deal-tests-its-value-based-care-strategy

The acquisition allows Risant to keep growing while giving Oklahoma’s largest nonprofit health system access to technology and investment resources.

KEY TAKEAWAYS

Integris Health would become the third health system to join Risant Health, following Geisinger and Cone Health.

Risant has committed billions of dollars to capital investments and implementation support at its existing health systems.

Risant reports gains in operating margin at Geisinger and reduced clinician documentation time at Cone Health as it seeks to extend its value-based care model.

Risant Health’s planned acquisition of Integris Health will expand its network of community-based health systems and test its ability to spread value-based care practices across differing organizations.

The two systems have signed a definitive agreement, giving Integris access to technology and other resources through Risant, a nonprofit created by Kaiser Permanente to help health systems transition toward value-based care.

For Integris CEO Timothy Pehrson, the arrangement could accelerate investments that would be difficult to achieve independently.

“These are investments and capabilities we couldn’t make or build on our own, not at this scale and not this fast,” Pehrson said in the announcement.

Oklahoma City-based Integris operates 20 hospitals and has the state’s largest physician network. The acquisition would make it the third health system to join Risant, following Geisinger in Pennsylvania and Cone Health in North Carolina.

Risant’s strategy depends on spreading technology and clinical practices across its member organizations while allowing them to retain their local identities. Kaiser Permanente CEO Greg Adams described the goal as moving “from siloed, episodic care to a value-based care approach with an increased focus on evidence-based care that achieves healthier outcomes for more people.”

The acquisition raises questions about how Risant will translate its strategy into results across distinct health systems. Integris reported $3.3 billion in operating revenue and a $22.3 million operating loss in fiscal 2025, highlighting the importance of investments that can support its long-term performance.

Risant points to early results at its existing health systems as evidence of progress. Geisinger has realized benefits equivalent to nearly a 1% improvement in operating margin since joining Risant, according to the organization. At Cone Health, Risant reports that ambient clinical documentation technology has reduced the time clinicians spend on notes per patient encounter by almost 14%.

Those examples illustrate the potential of shared resources to affect clinical workflows and financial performance. The results at Geisinger and Cone Health, however, do not establish how quickly Integris could achieve similar gains.

Risant’s operating revenue reached $6.7 billion in the first half of 2026, up 9.9% from $6.1 billion in the same period a year earlier. Its financial results do not separately disclose operating income for Risant, making it difficult to assess the overall financial performance of its model.

Risant has made substantial capital commitments to its existing health systems. It has pledged to make at least $2 billion available to Geisinger through 2028 and committed at least $1 billion in capital over five years to Cone Health, along with up to $400 million for integration and implementation of its value-based care platform and up to $300 million for growth over the following decade.

For Integris, the immediate appeal is access to investment capacity and capabilities. The longer-term test will be whether those resources help Integris advance value-based care while strengthening its operations.

The agreement remains subject to regulatory approval.

The Cost-Control Mirage: What State Spending Caps Mean for CFOs

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https://www.healthleadersmedia.com/cfo/cost-control-mirage-what-state-spending-caps-mean-cfos

State health spending growth benchmarks were designed to rein in rising healthcare costs. But a new JAMA Network Open study finds little evidence they have lowered hospital revenue, prices or insurance premiums.

KEY TAKEAWAYS

State benchmarks were not associated with statistically significant reductions in hospital revenue or prices.

Enforcement mechanisms and additional cost-control policies could change the financial equation over time.

Operational efficiency, service-line economics and scenario planning remain essential.

Ambition meets limited results

CFOs have spent years preparing for a policy environment that’s focused on affordability, and state spending growth benchmarks are one response: They set targets for how quickly healthcare spending should grow, with the aim of slowing cost increases without necessarily cutting access to care.

But are these benchmarks actually working?

In a recent study published in JAMA Network Open, researchers from RAND Corporation examined whether state spending growth benchmarks were associated with lower hospital revenue, hospital prices or health insurance premiums. The analysis covered 4,813 hospitals and 3,108 counties, comparing eight states that implemented benchmarks with areas in states without them. The researchers used a case-control design and difference-in-differences models, with up to seven years of postimplementation data for relevant outcomes.

The findings challenge the assumption that setting a spending target will, by itself, produce meaningful cost containment.

Across the study, benchmarks were not associated with statistically significant changes in inpatient hospital revenue per discharge, outpatient revenue per discharge equivalent, standardized inpatient or outpatient prices, or individual- and small-group-market premiums. The estimated changes in these measures were small relative to their uncertainty, and premium findings varied over time rather than demonstrating sustained reductions. Rhode Island was an exception for outpatient prices, where researchers identified a statistically significant reduction.

The central finding: Establishing a benchmark is not the same as changing the financial incentives that drive healthcare spending. The researchers point to limited enforcement and the absence of complementary policies as possible explanations. Of the eight states analyzed, only Vermont, Oregon and California had enforcement mechanisms, and California’s program was too new to provide much evidence on hospital outcomes.

Of course these results do not prove that benchmarks can never work. Differences in implementation, limited follow-up for some states and other policy changes complicate the picture. But still, the study offers little support for expecting benchmarks alone to generate near-term savings.

The CFO To Do

Treat spending benchmarks as a regulatory constraint to monitor, not a savings plan to underwrite.

First, build state-specific scenarios into multiyear financial planning. Model what happens if revenue and commercial prices continue along current trajectories, if regulators intensify scrutiny, or if future enforcement imposes corrective plans or penalties. Avoid assuming that affordability initiatives will automatically reduce market prices—or that existing pricing power will remain untouched.

Second, focus on controllable economics. Strengthen service-line contribution-margin analysis, evaluate labor and supply costs, improve capacity utilization and scrutinize low-margin contracts. If policymakers eventually impose tighter limits, organizations with a clear understanding of their underlying cost structures will be better positioned to respond without indiscriminate cuts.

Third, elevate regulatory intelligence as a finance function. CFOs should work with government affairs, managed-care contracting, and strategy teams to track benchmark performance, enforcement rules and emerging state-level reforms. Market-entry decisions, capital investments and acquisition models should reflect the possibility that today’s voluntary targets become tomorrow’s enforceable requirements.

Finally, distinguish revenue protection from genuine cost transformation. Don’t only think about preserving prices, but build a financially resilient delivery system that can sustain quality and access under tighter affordability expectations.

Policy targets alone have not demonstrated reliable cost containment, so CFOs should prepare for regulation to evolve while making their organizations less dependent on continued price growth to protect margins.

Hospital CEO Turnover Climbs 22% as Corporate Exits Decline

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https://www.healthleadersmedia.com/ceo/hospital-ceo-turnover-climbs-22-corporate-exits-decline

Hospital CEO departures continue to outpace last year’s levels, even as executive turnover across industries falls.

KEY TAKEAWAYS

Hospital CEO exits reached 116 through September, up 22% year-over-year.

September hospital departures fell to 13 from 15 in August but remained above the prior year’s total.

Retirements and CEOs stepping down accounted for 54% of all CEO departures across industries in September.

Hospital CEO turnover has remained elevated through the first nine months of 2026, keeping leadership succession on the agenda for health system boards.

Hospitals recorded 116 CEO exits through September, up 22% from the 95 departures reported during the same period in 2025, according to a report from Challenger, Gray & Christmas. Across all industries, companies announced 1,337 CEO exits during the first nine months of 2026, a 19% decline from the 1,650 departures recorded a year earlier.

The figures extend a trend that emerged during the first quarter and continued through the first half of the year. Hospital CEO exits rose 32% year-over-year during the first quarter, then reached 74 through June, compared with 68 during the first half of 2025.

September brought a modest decline in monthly hospital departures, with 13 exits compared with 15 in August. The September total remained higher than the 10 exits recorded in the same month last year.

The slowdown was more pronounced across all industries, with CEO exits falling 40% in September from August. The 111 departures were the lowest monthly total of 2026.

Succession Remains a Priority

The continued increase in hospital CEO exits puts a spotlight on how organizations are preparing for leadership transitions while managing financial and operational challenges.

Retirement has been a major reason for CEO turnover across industries. In September, 20 CEOs retired, while another 40 stepped down, often moving into board positions or consulting roles. Together, those categories accounted for 54% of all CEO departures during the month.

The report does not break down hospital departures by reason, making it difficult to quantify whether retirements or other circumstances are driving the sector’s year-over-year increase.

Still, the sustained pace of hospital CEO exits puts succession planning in focus. Identifying a successor takes time, particularly when boards want an incoming leader to understand the organization’s finances and strategic priorities before assuming the role.

The report also offers another signal for organizations preparing for transitions: Interim CEOs accounted for 102 departures across industries through September, up 70% from 60 during the same period last year. The total has already exceeded the 78 interim CEO departures recorded throughout 2025.

For hospital boards, the year-to-date data reinforces the need to prepare for CEO succession well before a vacancy arises, while placing a premium on leadership continuity.

QUIZ – Which major health insurer called a surgeon away from the operating table to answer questions about the very patient on the table?

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Quiz-01
Which major health insurer called a surgeon away from the operating table to answer questions about the very patient on the table?

CVS Health (formerly Aetna)
Humana
Elevance Health (formerly Anthem)
UnitedHealthcare

Scroll down to see if you got it right.
QUIZ: Answer
Quiz-02
The answer is D.

UnitedHealthcare, the nation’s largest health insurer, called during surgery.

Dr. Elisabeth Potter was in the middle of operating on a patient with breast cancer when a nurse delivered an urgent message: UnitedHealthcare was on the line. She stepped outside the OR and took the call. It was the insurer asking why the patient, who was on the operating table, needed to stay overnight. “It felt like they had invaded a very sacred space where the priorities should be really clear, patient first always, and they were bringing these administrative questions into the moment.”

On The Dose podcast, Dr. Potter, a surgeon in Austin, Texas, talks about what years of fighting insurance companies, building her own surgery center, and walking the halls of Congress have taught her about how our health system actually works, and how we can change it.

More ACA Premium Spikes to Come in 2027 Amid Federal Policy Changes

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https://www.commonwealthfund.org/blog/2026/more-aca-premium-spikes-come-2027-amid-federal-policy-changes?utm_campaign=The%20Connection&utm_medium=email&_hsenc=p2ANqtz-8V3pn8EbkpgDcDV0THrnl3kHcJX4UdyLAkvhFzPVo_0k8AHyFzlLB8EIp7zjJSFaHP4LjRLbpbcLNDPqoruNT7EqyrxA&_hsmi=446033437&utm_content=446033437&utm_source=hs_email

For people who get their health insurance plans in the Affordable Care Act (ACA) marketplace, coverage became much less affordable in 2026. Insurers increased premiums by more than 20 percent; the average “benchmark” premium before tax credits jumped from $497 per month in 2025 to $625 in 2026.1 These increases were partly the result of actions federal policymakers took — for instance, slashing the tax credit some people received to reduce their health plan premiums and imposing new restrictions on enrollment. Predictably, as premiums rose and financial assistance shrank, consumers’ payments soared and enrollment dropped sharply.

Consumers will get no relief in 2027. Insurers have proposed a median 15 percent rate increase for 2027, with significant variation across insurers and states. These back-to-back double-digit rate increases are the highest we’ve seen in the marketplace since 2018 and follow five years of relatively flat premiums, with average increases of only 2 percent per year for the benchmark plan. Insurer rate filings for 2026 and 2027 reveal that the federal policy changes to the ACA are contributing to these significant rate increases.

What Are Rate Filings and What Information Do They Contain?

Each year insurers adjust their rates so that the premiums they charge will cover projected future health care costs, administrative expenses, and profit. To project future costs, insurers consider a range of factors, including how many people will enroll, how healthy or sick enrollees will be, how much the prices for health care services are likely to rise, and expected changes in how many medical services people will use. Insurers document how these various factors will impact their proposed rates in the annual rate filings. Under the ACA, these filings are subject to independent review from insurance regulators and portions of the filings must be made public.

https://flo.uri.sh/visualisation/30489845/embed?auto=1

Why Are Marketplace Insurers Raising Rates Again for 2027?

Rising health care costs are a key driver of 2027 rate changes. This is an issue for all private health insurance, and indeed, some analysts expect medical costs to grow faster in 2027 than they have in nearly two decades. The marketplace insurer rate filings point to a range of contributing factors, including higher provider prices, higher prescription drug costs, increased use of various services and medications, effects of health care workforce shortages, and general inflation.

But the marketplace rate increases are also the result of recent federal ACA policy changes. Most notable is Congress’ failure to extend ACA premium tax credit enhancements at the end of 2025. Enhanced subsidies were in place from 2021 to 2025, making coverage far more affordable and leading to record enrollment. Their expiration drove up rates in 2026; new rate filings signal ongoing effects.

Marketplace enrollment is expected to decline precipitously this year — by a range of 17 percent to 26 percent. As marketplace plans become less affordable, younger and healthier individuals are more likely to drop coverage. Remaining enrollees will be sicker on average and more costly. Many marketplace rate filings cite the end of premium tax credit enhancements and declining enrollment as further driving up rates in 2027, compounding 2026 increases.

Marketplace consumers will face additional barriers in 2027 that may also impact rates. New paperwork burdens will make it harder to enroll, and many lawfully residing immigrants will lose access to financial assistance that keeps premiums affordable. These changes will further drive down enrollment, leading to a smaller, sicker, and more costly marketplace risk pool.

How Will This Affect Affordability and Access for Consumers?

ACA premium tax credits provide a crucial buffer against insurers’ rate hikes. Policymakers’ decision to end the enhanced version of the credits caused that buffer to shrink for millions of people with modest incomes. For millions more (i.e., Americans with middle incomes), this cost buffer vanished completely. As a result, people with annual incomes of more than $63,840 for an individual or families of four with incomes of $132,000 or more will bear the full brunt of two years of double-digit rate hikes, with no financial help. For example, a 40-year-old individual with income just over this threshold who paid $445 per month after tax credits were applied in 2025 could owe $719 per month in 2027.2

As premiums become less affordable, marketplace consumers may continue to “buy down” to plans with lower premiums but higher deductibles. This would leave more enrollees underinsured, facing greater barriers to care and increased exposure to medical debt.

In addition, at least seven insurers — Baylor Scott & White Health Plan, CareSource, Cigna, Medica, Mending (formerly Taro Health), PacificSource, and Providence Health Plan — have announced they will no longer offer marketplace coverage in 2027. These insurers point to escalating costs, declining enrollment, and shifting regulations. Their exits will force consumers in 20 states to switch to new plans next year. With fewer coverage options, they may have a harder time finding plans that cover their doctors and prescription medicines. Less competition among insurers is also associated with higher premiums.

Looking Forward

Americans struggling to afford health care are concerned about the high cost of their health insurance premiums. They look to the federal government for solutions, yet recent actions by Congress and the Trump administration have made the problem worse. The ACA marketplaces have proven resilient, but the upheaval created by these recent policies could threaten their long-term stability. For now, with open enrollment around the corner, many marketplace consumers will soon face higher prices and fewer choices.

By Barring Profits on Basic Coverage, Switzerland Keeps Insurers from Denying Care

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Roughly two-thirds of the U.S. population has health coverage through private insurance companies. Despite paying about $1,600 a year out of pocket on deductibles, copayments, and coinsurance, Americans have no guarantee their insurer will cover the cost of their care. Because insurance companies in the United States seek to maximize their profits, they have an incentive to deny payment for some services, even for recommended care, and to raise monthly premiums and out-of-pocket costs.

Switzerland has also struggled to make health care affordable for all residents, with one of the highest levels of out-of-pocket spending per person in the world, comparable to the U.S. average. Like the U.S., it relies largely on private health insurance, with residents choosing among competing insurers. But unlike the U.S., Switzerland bars insurers from profiting off basic plans. That difference helps explain why nearly a third of the U.S. population has medical bills or debt they are paying off over time, while only 2 percent of the Swiss population reports the same problem.

Regulating Private Insurers in Switzerland

Switzerland’s current system of mandatory basic health insurance (obligatorische Krankenpflegeversicherung, or OKP) was established in 1996 and requires all residents to purchase health insurance from authorized private insurers. Today, 100 percent of the population is covered through OKP, and everyone has access to the same nationally defined baseline benefits package, regardless of insurer. Because everyone is enrolled, costs are spread out across healthier residents and those who need more costly care.

Premiums are set by insurers but subject to federal approval. All plans include a minimum annual deductible of CHF 300 (USD 340), 10 percent coinsurance capped at CHF 700 (USD 794) annually, and a daily hospital fee; adults can choose plans with deductibles up to CHF 2,500 (USD 2,835) in exchange for lower premiums. The Swiss government also caps the price of services and what insurers pay providers to control costs.

While the federal government sets these baseline standards, it does not sell insurance directly. Residents choose among private insurers based on premiums, deductibles, provider restrictions, and networks, while guaranteed a core set of protections. Those who don’t enroll are assigned a plan by their local government and are responsible for late fees and past-due bills.

The most fundamental feature of the Swiss insurance market is that insurers are prohibited from earning a profit on basic health plans and must use a community-rating premium structure that shares costs between sicker and healthier individuals. Any surplus collected from basic premiums that exceeds paid claims must either be held in reserve to cover future costs or be returned to policyholders. Insurers also cannot deny coverage for any medically necessary care included in the basic package.

Insurance companies can, however, profit from supplementary private insurance, which covers services such as dental care and private or semiprivate hospital rooms. For these plans, insurers can reject applicants and vary premiums based on health status, age, and sex.

Despite federal regulations, affordability remains a major hurdle in the Swiss health system. Out-of-pocket spending is among the highest in the world, and premiums, which do not vary with income, can burden families who do not qualify for subsidies. Still, the system rests on a strong commitment to social solidarity, and some Swiss see these costs as the price of insuring everyone, even the most vulnerable. Because deductibles and coinsurance on basic plans are capped each year and claims for covered care cannot be refused, few residents fall into medical debt.

America’s Underregulated Private Insurance Market

The U.S. private insurance market is not entirely unregulated: the 2010 Affordable Care Act (ACA) prohibits insurers from denying enrollment based on preexisting conditions, age, or sex. The ACA also requires plans to cover essential health benefits and cap out-of-pocket spending, and it provides income-based subsidies for coverage bought through the marketplaces.

Since private insurers are permitted to operate for profit, they still have an incentive to limit what they pay out to maximize their earnings. While people cannot be denied enrollment, insurers can delay payment for doctor-recommended services or deny claims altogether by arguing the care was not medically necessary or by citing other technicalities.

In 2025, one in five U.S. working-age adults with private insurance said they or a family member had been denied treatment their doctor recommended in the past year, and about 40 percent of them said the denial led to delayed care. More than two in five adults whose claim was denied reported it led to medical debt they are still paying off. In one survey, most working-age adults with private coverage who were paying off medical bills or debt blamed insurance companies.

Fact: More than three in four adults in the U.S. who are underinsured — meaning their out-of-pocket costs are unaffordable relative to their income — are covered by private insurers.

While both Switzerland and the United States have an individual mandate requiring residents to enroll in a health plan — which is necessary for maintaining balanced risk pools — enforcement differs greatly. Since 2019, the ACA’s federal tax penalty for going without coverage has been reduced to $0, and only four states and Washington, D.C., impose their own financial penalties.

In both countries, a person’s insurer, out-of-pocket spending, and provider networks vary widely. But while federal regulation in Switzerland ensures all residents have robust minimum coverage standards, without fear of insurers creating obstacles to care in pursuit of their own profit, American patients have far fewer protections against companies that refuse or stall payment for care.