Last week, during the U.S. Senate and House recess and back-to-school rush, media attention to healthcare was negligible. Healthcare trade media noted impressive earnings for Moderna and Bon Secours and the WSJ Journal announced a Medicare Advantage partnership between Costco and SCAN.  No major Executive Orders from the White House or CMS rule changes. No major clinical breakthroughs, vaccine policy changes or lawsuits. But a couple of new reports frame the existential risk facing the industry: spending.

• AON forecast for employer health spending: AON forecasts employers will see a 9.5% increase in 2027–the same as this year after increases of 9% in 2025 and 8.5% in 2024.
• U.S. National Debt: The national debt officially passed the $40 trillion mark Wednesday, which includes $2 trillion this year. Note: Healthcare spending is a major contributor representing 27% of total federal spending.

The common theme in both is the steady growth of healthcare spending—faster than wages, higher than inflation and GDP growth and increasingly the result of higher prices for drugs, specialty services, facility modernization, technology and administrative overhead.

The industry’s aversion to transparency, protection of its business-to-business economics and dependence on private investment perpetuate four myths that justify its proclivity for uncontested spending:

• Myth One: Healthcare utilization is the result of verifiable (true) demand despite evidence that induced demand from financial incentives is significant and unnecessary care widespread.
• Myth Two: Healthcare spending above overall economic growth is necessary because demand is increasing though unit price increases for drugs, specialty care and hospital outpatient services exceed demand routinely.
• Myth Three: Healthcare spending growth is unavoidable as the population ages, medical problems become more complex and clinical breakthroughs (like GLP-1 obesity drugs) are integrated in the system though the industry enjoys legal protections to insiders that limit competition.
• Myth Four: Healthcare spending in the U.S. system is necessary to our performance as the world’s global leader for quality though at least 15 other systems outperform the U.S. in key measures of mortality, morbidity, life expectancy and satisfaction while spending 30-50% less per capita on healthcare.

As the midterm election November 3 nears, affordability and costs of living will be prominent in campaign rhetoric. Polling indicates healthcare costs, especially insurance premiums, prescription drug costs and hospital care, factor heavily in how voters assess promises on the campaign trail. Both parties espouse the need for systemic change in healthcare citing affordability for their reasoning. Three general solutions have found their way into this election cycle:

• Price controls imposed selectively by state/federal government applied to hospitals, insurance premiums, physician services and prescription drugs.
• Increased competition enacted through mandatory price transparency, constraints on consolidation and incentives based on value (price + outcome) instead of volume.
• Government control of healthcare payments (single payer) to providers to align spending with budgets while lowering administrative costs for participation.

The reality is none of these is without risk, and voters are wildly misinformed about all. But there’s no doubt they’ll be on the table as a majority consensus forms around a better system. They’re sick of the status quo. They see little difference between not-for-profit and for-profit operators and want something better. They see healthcare spending increases as the product of an industry that cares about its profit first and everything else second.

Healthcare spending—contributing factors and mitigation– is a topic every organization in healthcare must address candidly and holistically. There should be no delusion that interest will subside anytime soon. Just as consumers are rewarding organizations in financial services, retail, higher education and organized religion that offer “newer, better” alternatives, the healthcare landscape will be re-defined by those that do more than opine about affordability and conduct business as usual.

New data finds rapidly declining satisfaction and trust among Medicare Advantage enrollees, particularly around costs and coverage.

Americans enrolled in Medicare Advantage plans are becoming increasingly less satisfied with their coverage (and increasingly skeptical that their insurers are looking out for them) according to the new 2026 U.S. Medicare Advantage Study from JD Power.

The study found that overall satisfaction with Medicare Advantage plans fell for the second year in a row (dropping 12 points) and has dropped 41 points since 2024. On JD Power’s 1,000-point scale, the average Medicare Advantage plan now scores 611.

JD Power surveyed 14,559 Medicare Advantage health plan enrollees across 12 major markets between January and June. Researchers evaluated insurers on eight parts of the enrollees’ experience, including trust, access to health services, whether plans save them time and money, whether coverage meets their needs, customer service and how well complaints are resolved.

Satisfaction with plans’ ability to help enrollees save time and money fell 51 points. Their level of trust fell 49 points, while satisfaction with whether a plan’s coverage actually met their needs dropped 47 points.

And fewer than half — just 43% — of people enrolled in Medicare Advantage plans strongly agreed that their insurer was a “trusted partner” in their health and wellness.

One of the clearest differences between higher- and lower-performing plans came down to something relatively basic: helping people understand the insurance they just bought.

So, which plans came out on top?

JD Power did not produce one nationwide ranking of every Medicare Advantage insurer. Instead, it compared plans within 12 individual markets. Below the simple version of which insurer scored highest in each:

• California: Kaiser Permanente — 665
• Florida: UnitedHealthcare — 621
• Georgia: UnitedHealthcare — 656
• Illinois: Blue Cross Blue Shield of Illinois — 638
• Kentucky: Humana — 625
• Michigan: Blue Cross Blue Shield of Michigan — 676
• New York: Excellus BlueCross BlueShield — 618
• North Carolina: UnitedHealthcare — 645
• Ohio: Aetna Medicare — 639
• Pennsylvania: UPMC For Life — 689
• Tennessee: Blue Cross Blue Shield of Tennessee — 690
• Texas: Humana — 641

Tennessee’s Blue Cross Blue Shield plan received the highest score of any market winner, at 690, narrowly ahead of Pennsylvania’s UPMC For Life at 689. The results have also been summarized by Becker’s, which published both the highest-rated plans and lowest-rated plans in each market.

The rankings also show how much people’s experiences with national insurance companies can vary from state to state. UnitedHealthcare, for example, finished first in Florida, Georgia and North Carolina and second in Illinois, Kentucky, Texas and some other markets included in the study. Yet its Michigan plan received a score of just 571, making it the lowest-rated plan JD Power measured in that market.

Humana showed an even wider divide. It finished first in Kentucky and Texas, but its New York plan received a score of 554 — the lowest score reported across all 12 markets.

The federal government has also changed how Medicare Advantage plans are evaluated. Earlier this year, the Centers for Medicare & Medicaid Services (CMS) finalized a significant overhaul of its Star Ratings system, which is supposed to measure the quality and performance of Medicare Advantage and Part D plans. Insurers watch the measures closely because they affect bonus payments they receive. CMS claims the changes will simplify the ratings and focus them more heavily on clinical care, health outcomes and patient experience. The changes include eliminating 11 measures — several related to complaints, appeals and call-center performance — and abandoning a planned Health Equity Index reward intended to incentivize better performance for certain enrollees, including people who are low-income, disabled or dually eligible for Medicare and Medicaid. Instead, CMS will retain its older reward system for plans that perform consistently well across measures.

CMS argues that some of the measures being eliminated are administrative, duplicative or do little to distinguish one plan from another, and that trimming them will make Star Ratings more useful to beneficiaries. But the changes have drawn criticism from Democratic lawmakers and Medicare consumer advocates, who argue that CMS is removing some of the very measures that can help hold insurers accountable for how they treat patients.

In an April letter to CMS Administrator Mehmet Oz, Sen. Elizabeth Warren and seven other Democratic senators specifically objected to the removal of administrative measures that track complaints involving the timeliness or accuracy of prior authorization decisions. The senators argued that weakening those measures is particularly concerning at a time when Medicare Advantage insurers are facing scrutiny over care denials and billions of dollars in estimated overpayments from the federal government.

The letter also pointed out that Oz has publicly acknowledged that prior authorization can significantly delay care and erode trust in the health care system, yet CMS is removing some Star Ratings measures related to prior authorization while the administration is simultaneously testing A.I-powered prior authorization in traditional Medicare via the Wasteful and Inappropriate Service Reduction (WISeR) program.

The Medicare Rights Center, an advocacy organization representing Medicare beneficiaries, has criticized CMS’s decision to scrap the Health Equity Index before it ever took effect and return to the previous reward factor. The group also objected to CMS eliminating a requirement that plans notify members midway through the year about supplemental benefits they are eligible for but have not used.

And the rollback extends beyond the Star Ratings themselves. The final rule eliminates requirements for Medicare Advantage utilization-management committees to include a health-equity expert, analyze how their policies affect certain populations and publicly report those analyses.

The Alliance of Community Health Plans, which represents nonprofit regional health insurers, praised CMS for eliminating the Health Equity Index and said the broader Star Ratings changes would shift the program away from “documentation and paperwork” and toward patient experience and health outcomes.

For insurers, there is a lot of money riding on those Star ratings. CMS estimates that Medicare Advantage plans will receive more than $13 billion in additional federal payments next year — even as the government adjusts how plans are scored (and paid) and results like JD Power’s get released. That is in addition to the $76 billion in overpayments that MedPAC, an independent organization that advises Congress on Medicare issues, says the government is paying Medicare Advantage insurers this year alone.

The JD Power results, however, offer another way of looking at the program: not simply whether insurers are meeting government quality metrics, but whether the people enrolled in their plans actually feel that the coverage is working for them. And by that measure, satisfaction is moving fast in the wrong direction.