On the Margins — 2026-03-11
On the Margins
Your daily health economics & actuarial brief
Wednesday, March 11, 2026
What's happening today
| ■ | Idaho lawmakers introduced H 850 to repeal Medicaid expansion in 2028; enrollment is nearing 80,000. |
| ■ | Mississippi put a state-based ACA exchange on hold, citing a smaller user-fee base as subsidy changes narrow. |
Key Stories
Idaho H 850 targets 2028 Medicaid expansion repeal, enrollment near 80,000
On March 9, 2026, an Idaho House committee introduced H 850 to repeal the state's voter-approved Medicaid expansion starting Jan. 1, 2028. Boise State Public Radio reported 79,418 Idahoans were enrolled as of February 2026, and eligibility for a single adult caps income at $22,032. Supporters argue the program strains the budget, but Idaho's current-year expansion state share is $91.7 million, a small slice of total Medicaid spending. Because the expansion group's federal match is 90%, repeal would shift costs into uncompensated care and premium pressure, especially for rural systems.
Mississippi shelves state ACA exchange as subsidy cliff shrinks user-fee base
On March 3, the Mississippi Senate effectively killed HB 605, which would have required Insurance Commissioner Mike Chaney to stand up a state-run ACA exchange. Chaney told Mississippi Today the enhanced premium tax credit expansion expired January 1, 2026, making an exchange "too little, too late" as enrollment falls. CMS reported 313,392 Mississippi Marketplace plan selections for 2026, and Becker's cited a 7% year-over-year dip as of January 15. With Chaney estimating $15M-$20M to launch and limited user-fee upside, subsidy-driven attrition shifts fixed costs onto fewer lives and pressures premiums.
Significant Digit
MedPAC estimates Medicare will pay $76B more for Medicare Advantage in 2026 than it would have spent for the same beneficiaries in fee-for-service Medicare.
MedPAC estimates MA payments will be $76B above what spending would have been in fee-for-service Medicare in 2026, even after the V28 risk model phase-in. The gap is largely coding intensity plus favorable selection, which is a polite way of saying the math is doing the lifting. If you price, reserve, or forecast Medicare revenue, assume RADV and coding policy are now core actuarial assumptions, not back-office drama.
Other Relevant Headlines
Policy & Regulation
| Part D hits 56.1M enrollees as retirees chase PDP subsidies | KFF |
| Medicaid work requirements leave states scrambling for 2027 | Modern Healthcare |
| CMS gives states two options to transition to six-month Medicaid eligibility checks | Inside Health Policy |
| GOP senator is investigating the FDA over rejections of rare disease drugs | STAT |
Payer Operations
| Centene's stock falls as CEO London outlines ongoing ACA headwinds | Fierce Healthcare |
| Elevance expands policy penalizing out-of-network referrals | Modern Healthcare |
| $13.4B premium increase in 2025 tied to Medicare Advantage overpayments, report says | Becker's Payer |
Pharmacy & Drug Pricing
| Novo Nordisk, Hims reach deal to sell GLP-1 drugs together | Healthcare Dive |
| Omada Health swings to a profit in Q4, offers new GLP-1 cash-pay option for employers | Fierce Healthcare |
Provider Economics
| UHS to acquire Talkspace for $835M as hospital operator pursues behavioral health growth | Healthcare Dive |
| Providence plans California hospital sale as it pursues turnaround efforts | Modern Healthcare |
Digital Health & AI
| AI is moving at lightning speed. Can regulation keep up? | Healthcare Dive |
ICYMI (Recent Key Stories)
- CMS launches BALANCE: voluntary GLP-1 price talks for Part D and Medicaid -- CMS introduced BALANCE, a voluntary program to negotiate GLP-1 drug prices for Part D and Medicaid. (2026-03-10)
- Florida pushes Medicaid work requirements despite not expanding Medicaid -- Florida advanced plans for Medicaid work requirements even though it has not expanded Medicaid eligibility. (2026-03-09)
- Clover says it is first payer live on CMS-aligned network -- Clover reported it is the first insurer operating on a provider network aligned with CMS standards. (2026-03-06)
- West Virginia probe hits Express Scripts with $1.5M penalty, pharmacy repayments -- A West Virginia investigation penalized Express Scripts $1.5M and ordered repayments to pharmacies. (2026-03-05)
- Wakely: Medicaid MCO margins flip to losses as enrollment drops -- Wakely reported Medicaid managed-care margins turned negative as enrollment declined. (2026-03-04)