Republicans are standing firmly against extending the enhanced Affordable Care Act subsidies, instead advocating for a plan that would redirect funds directly to consumers. This stance is supported by President Donald Trump, who insists on sending money back to people rather than continuing subsidy extensions. Sen. Bill Cassidy, R-La., chair of the Senate Health Committee, introduced a plan to redirect the subsidy funds to health savings accounts for people with high-deductible ACA plans.

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Health plans are increasingly insourcing utilization management to address issues such as administrative gridlock and provider issues associated with prior authorizations, which AHIP is working to modernize. This shift involves adopting hybrid models that combine internal oversight with selective vendor support, leveraging technologies such as AI to enhance transparency and efficiency. Health plans are also aiming to exceed regulatory requirements, viewing compliance as a starting point for broader modernization efforts.

A record 47% of Americans are anxious about affording health care in 2026, marking the highest level since tracking began in 2021, according to a West Health-Gallup survey. The survey, based on about 20,000 adults across the US, highlighted concerns about prescription drug costs, with 15% of adults saying prescription costs cause significant stress.

The New York Times is reporting that for the first time, the CDC told state health departments it is linking the measles outbreak in Texas to one in Utah and Arizona. If the outbreak does not end by January, the one-year anniversary of the start of the Texas outbreak, the US will lose its World Health Organization "elimination status" for the first time in 25 years. CDC data show 1,723 confirmed cases of measles in the US as of Nov. 13, with 87% linked to a record 45 outbreaks.

The American Medical Association is debating whether to form its own vaccine advisory committee or to push for the reinstatement of the original Advisory Committee on Immunization Practices, which was disbanded by HHS Secretary Robert F. Kennedy Jr. Some members support the creation of a new committee to provide evidence-based vaccine guidance, while others cite cost and conflict of interest concerns, urging the AMA to focus on restoring the original committee.

A study in Clinical Infectious Diseases found Pfizer's RSV vaccine RSVpreF was 92% effective among adults ages 60 and older, including those with severe disease and underlying conditions. The CDC recommends the vaccine for adults 75 and older and those 50 to 74 at increased risk. "Reassuringly, our study similarly found a VE (vaccine effectiveness) of 90% against critical outcomes (ie, ICU admission or mechanical ventilation), similar to the VISION study's results: 81% VE against RSV-related critical illness (ie, ICU admission or in-hospital death)," researchers wrote.

The Obesity Society, the Obesity Medicine Association and the Obesity Action Coalition will jointly issue evidence-based guidelines for pharmacologic management for patients with obesity and overweight. The guidelines will cover the use of medications and address quality of life as a key metric. The guidelines were previewed at ObesityWeek.