Hello, and welcome back to this week’s edition of the Gist Weekly. We immensely appreciate your continued readership and invite you to forward this email to friends and colleagues—please encourage them to subscribe!
In the News
What happened in healthcare recently—and what we think about it.
- Attorneys general and other officials sue Department of Health & Human Services (HHS) to keep $11B in public health funding. On Tuesday, 23 states and the District of Columbia filed a lawsuit to block HHS from rescinding about $11 billion in public health funds awarded during the Covid-19 pandemic. This lawsuit follows upon grant termination notices that HHS sent on March 24. The plaintiffs argue that HHS does not have the authority to rescind the funds and that its actions did not follow the Administrative Procedure Act, stating the end of the Covid-19 pandemic “is not a lawful basis to terminate ‘for cause.’” The funds were predominantly being used for Covid testing, Covid vaccination efforts, and addiction and mental health programs. On Thursday, a federal judge issued an emergency restraining order temporarily blocking HHS from terminating these funds. The parties will return to court on April 16.
- The Gist: Separation of powers battles have been brewing in Washington since President Trump retook office and this action is just the latest change that affects our healthcare system. So far, taking the Trump administration to court has been an effective challenge on its power, although Republican Senator Susan Collins has also come out against part of President Trump’s fund impoundment strategy. This money was very impactful at the local level and its cessation leaves communities less equipped to address future public health challenges. Abruptly ending funding like this often leads to wasteful, partially finished projects with limited benefits. As this case makes its way through the courts, it could further stress the already tense relationship between the executive and judicial branches.
- Oracle Health hacked; personal health information exposed. Last Friday, Bloomberg reported that hackers accessed Oracle’s systems and stole patient data. Reportedly, Oracle Health sent a notice to affected parties on February 20, stating that sometime after January 22, a malicious actor used compromised customer credentials, breached legacy Cerner servers that had not yet migrated to the Oracle Cloud, and copied data to a remote server. The complete scope of the hack is unclear. Oracle has yet to publicly confirm the data breach.
- The Gist: There is still a lot we do not know about the breadth of this hack, but as the second largest electronic health record (EHR) vendor, this breach has huge implications for providers. Hackers appeared to take advantage of older Cerner servers that had yet to be migrated to a more secure environment, illustrating once again that one’s cybersecurity is only as strong as its weakest link. Unfortunately, despite attempts to innovate, this is yet another bad headline for a company that has struggled to compete with increasingly dominant Epic and has been bogged down for years with its Department of Veterans Affairs EHR overhaul. Healthcare data breaches continue to be the most expensive across all industries, although the exact cause for this is not as clear-cut as one may think.
- Utah bans fluoride in water. Last Thursday, the governor of Utah signed legislation that prohibits cities and communities from adding fluoride to public drinking water, becoming the first state to pass such a ban. Water fluoridation is widely considered safe and beneficial to dental health by leading public health agencies. However, Secretary Kennedy supports removing fluoride from water, claiming—without substantial evidence—that fluoride is “an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.” As of 2022, an estimated 72.3% of Americans have access to fluoridated water. The bill will take effect on May 7. Several other states are considering similar bans.
- The Gist: The facts on fluoride safety do not support this growing aspect of the “Make America Healthy Again” movement. The recommended fluoride level of 0.7 mg/L in community water is less than half of the 1.5 mg/L amount that was found to have a negative effect on children’s IQ. This action further highlights the power states hold to enact aspects of the Make America Healthy Again agenda. West Virginia, for example, recently banned artificial food dyes, a move that was widely lauded. While this change affects dental health, it offers a stark warning for all providers. If misinformation can sow substantial doubt on decades of evidence, who is to say what policy or consensus opinion could be undone next?
Plus—what we’ve been reading.
- The numbers behind Medicaid fraud. Published last week in The Wall Street Journal, this piece details a Journal investigation that found that insurers had been paid $4.3 billion in duplicative Medicaid payments between 2019 and 2021. In most cases, patients had been signed up in two states—usually because they moved—but insurers were getting paid to cover these patients in both states even though they were no longer utilizing coverage in the original state. While patients are supposed to cancel their old Medicaid coverage when signing up for new coverage, this does not always happen, “leaving states to play catch-up.” Insurers criticized the analysis, citing pandemic rules that limited disenrollments in the period studied; they also said the study “ignores the financial safeguards in place to address potential overpayments.” The article describes obstacles that make correcting the problem particularly challenging but acknowledges that preventing this wasteful spending “should be low hanging fruit.”
- The Gist: There is wasteful spending in Medicaid, but fraud and abuse represent only a small portion of total Medicaid spending. Notably, the total of this fraud is nowhere close to the $880 billion cut the House Energy and Commerce Committee is tasked with making. Further, most of this waste appears to be bureaucratic, not fraudulent or malicious, in nature. Individuals have no incentive to notify the state in which they previously received Medicaid coverage because they are not prevented from getting coverage in a new state, and they may be unaware of backend Medicaid funding mechanisms. Unfortunately, states will likely not have resources to create such incentives to prevent wasteful spending should there be substantial cuts to their Medicaid funding, perpetuating this cycle.
Graphic of the Week
A key insight illustrated in infographic form.
Health system talent retention in 2025
This week’s graphic, highlighting data from NSI Nursing Solutions, Inc., details the current state of hospital turnover and nursing talent retention. The average hospital’s registered nurse (RN) and all-employee turnover rates have returned to 2019 levels, 16% and 18%, respectively. This is notable because staffing turnover substantially increased during the pandemic, with many nurses attributing their departures to dissatisfaction with management, better pay and more flexible hours elsewhere. This left many hospitals in a labor crisis, with soaring contract labor costs and persistent staffing shortages. Thankfully, these shortages are also improving, with RN vacancy rates nearly returning to pre-pandemic levels. Almost half of hospitals had an RN vacancy rate under 7.5% in 2025, a remarkable recovery given that more than half of hospitals reported RN vacancy rates higher than 15% in 2023. Health systems have made significant investments in workforce retention in recent years; this strategy appears to be paying off.
This Week at Kaufman Hall
What our experts are saying about key issues in healthcare.
On Wednesday, President Trump announced a wide-ranging set of tariffs that will touch many of the goods imported into the U.S. and are likely to produce a set of retaliatory tariffs by foreign governments.
In response to this announcement, we have updated our recent article, co-authored by Scott Eber and Bonnie Lai, on “no regret” actions healthcare organizations can take now to help mitigate the impact of tariffs, as well as actions that may make sense down the road.
On Our Podcast
The Gist Healthcare Podcast—all the headlines in healthcare policy, business, and more, in ten minutes or less every other weekday morning.
Last Monday, we heard the first part of host J. Carlisle Larsen’s conversation with Christian Dameff, MD, emergency physician and Co-Director of the University of California-San Diego’s Center for Healthcare Cybersecurity, about common misconceptions about cyberattacks on healthcare organizations and why we’re still in the dark about the motivations behind these attacks.
This Monday, we hear the second part of their conversation, as Larsen and Dr. Dameff talk more about the takeaways from last year’s cyberattack on UnitedHealth Group’s Change Healthcare clearinghouse and legislation proposed last year to bolster cybersecurity in healthcare.
To stay up to date, be sure to tune in every Monday, Wednesday, and Friday morning. Subscribe on Apple, Spotify, Google, or wherever fine podcasts are available.
Thanks for reading! We’ll see you next Friday with a new edition. In the meantime, check out our Gist Weekly archive if you’d like to peruse past editions. We also have all of our recent “Graphics of the Week” available here.
Best regards,
The Gist Weekly team at Kaufman Hall
