Welcome to the first Gist Weekly of 2025! Back from break and recharged, we’re excited to be bringing you another year of healthcare news and analysis. As always, we appreciate your continued readership and invite you to forward this email to friends and colleagues—please encourage them to subscribe as well!
In the News
What happened in healthcare recently—and what we think about it.
- CFPB removes medical debt from consumer credit reports. On Tuesday, the Consumer Financial Protection Bureau (CFPB) finalized a rule that bans the inclusion of medical bills on credit reports and prohibits lenders from using medical information in their lending decisions. The rule is expected to remove about $49B in medical bills from the reports of about 15M Americans, raising their credit scores by an average of 20 points. The CFPB first proposed this rule in June 2024, going a step further than the three nationwide credit reporting companies, which collectively removed medical collections under $500 from credit reports in April 2023. Twelve states have also recently enacted medical debt legislation, often protecting consumers from certain collection practices, and in some cases forgiving residents’ debts directly.
- The Gist: The CFPB justifies this policy by pointing to evidence that someone owing medical debt is not predictive of their ability to pay back another loan. Due to credit reporting changes, policy efforts, and an overall increase in insurance coverage, the amount of medical debt on credit reports had already declined significantly over the last decade. As long as this rule stands, medical debt will no longer be a factor on creditworthiness, but it will still impact people in a variety of other ways while being paid off, such as by depleting savings, eating into household spending, and delaying further medical care. For health systems, their commitment to working with patients to minimize these adverse consequences remains unchanged, regardless of this latest rule.
- ACA marketplace hits record enrollment with almost 24M. For the fourth consecutive year, Affordable Care Act (ACA) marketplace enrollment reached a new high, the Centers for Medicare & Medicaid Services (CMS) announced on Wednesday. With less than a week of Open Enrollment remaining, 23.6M consumers have selected a 2025 ACA plan, up from 21.4M in 2024. This includes 3.2M people who enrolled in an ACA plan for the first time in 2025. The Biden administration attributes the consistent year-over-year growth to the enhanced ACA subsidies, first passed in 2021 and set to expire at the end of 2025. These subsidies have helped shield most enrollees from experiencing premium increases, which are up an average of 7% this year.
- The Gist: The ACA marketplace took some time, and some tweaks, to find its footing, but enrollment has nearly doubled since the enhanced subsidies were implemented in 2021. More people are now enrolled in ACA plans than have gained insurance through Medicaid Expansion. Thanks in part to these two ACA policies, the US uninsured rate hit an all-time low of 7.7% in early 2023, although it has rebounded slightly with Medicaid unwinding. Whether this progress is mostly maintained, or the recent reversal is set to accelerate, depends on the incoming Trump administration. Having promised tax cuts and rollbacks on public spending, Congress may select the enhanced ACA subsidies and Medicaid funding as sources for budgetary savings. However, at least some prominent Republicans have voiced awareness that they don’t want to be seen as “tak[ing] healthcare away from people.”
- US records first death from bird flu outbreak. On Monday, the Louisiana Department of Health (LDH) announced the first human death related to the H5N1 avian influenza outbreak. The patient, who reportedly was a man over 65 with underlying health conditions, was admitted to a hospital weeks ago with a severe respiratory illness. The LDH confirmed that the patient was exposed to the illness directly from birds, and that no human-to-human transmission has taken place. There have been 66 detected bird flu cases since the 2024 outbreak began, stemming from two different variants. At least 40 of these cases came from dairy herds, caused by the other variant from the one infecting the Louisiana man, marking the first time a “highly pathogenic” bird flu has infected cows.
- The Gist: Public health officials maintain that the current risk to the general public is low, but they are watching this outbreak carefully in case the threat profile evolves. Viruses like H5N1 may only take a few, specific changes to allow for human-to-human transmission, and the conditions of modern livestock are ripe for facilitating these mutations. Additionally, once a virus infects a human, more genetic changes are often observed, as was the case with the Louisiana man. The COVID pandemic was in many ways a perfect storm of lethality and virality, but outbreaks like this are a far more common test of our public health infrastructure. The longer it takes to contain the outbreak, the more chances the virus has to develop a critical mutation.
Plus—what we’ve been reading.
- The ever-changing human genome. Published last week in The Atlantic, this piece illustrates how our understanding of what constitutes a genetic disease is transforming. Some patients are discovering that their mysterious, unexplainable symptoms are rare diseases caused by somatic mutations, or genetic modifications that were not inherited and are only present in certain cells. The author details how innovation in genetic sequencing enabled researchers to learn that these kinds of mutations and genetic variations are more prevalent than previously understood, with each person having about 30 trillion different genomes. However, while physicians now have all the genetic data that they could need, researchers “don’t understand the machinery that makes this so,” limiting physicians’ ability to make these rare diagnoses.
- The Gist: This piece illustrates both the immensity of data describing a person’s health and the challenge healthcare providers face in processing that information. The promise of AI—and quantum computing, as it continues to develop—is to rapidly and accurately record and summarize this genetic information on a provider’s behalf. But first, researchers need to catalogue an “atlas of somatic mutations,” so that changes can be interpreted meaningfully. This will be a difficult endeavor, but we could soon live in a world where physicians across specialties can pinpoint a singular, disease-causing cell and prescribe a unique treatment targeted to a specific, somatic mutation.
Graphic of the Week
A key insight illustrated in infographic form.
MA enrollees continue to choose highly rated plans
With the new year marking the official start of another record-breaking year for Medicare Advantage (MA) enrollment, this week’s graphic takes a look at MA star ratings. Star ratings indicate for consumers the quality of an MA plan and determine for payers the bonus payments their plans receive. The average MA star rating increased from 2019 through 2022 then decreased from 2023 through 2025. These highs were eroded away by the expiration of pandemic-era adjustments and changes to cut points that made it more challenging to attain 4 and 5 star ratings. Throughout this entire period, however, provider-sponsored health plans (PSHPs) have consistently earned higher star ratings than their competitors. The average star rating for a PHSP in 2025 is 3.75, which compares favorably to the 3.58 average for BUCCAH plans (referring to six of the largest traditional payers), and a 3.67 average for all other plans. PSHPs are likely reaping the benefits of vertically integrating their payer and provider arms, better positioning them to offer higher-quality plans and outperform their rivals. The continued popularity of MA with seniors has only increased competition and growth among MA plan providers, with the number of MA contracts increasing nearly 30% between 2020 and 2025. Notably, consumers continue to prioritize the selection of high-quality MA plans, with more than 60% of enrollees selecting 4-star-or-higher plans for 2025. Although not necessarily the right fit for all providers, PSHPs have a distinct competitive advantage in a market that clearly values quality, lending them the potential to be part of a successful growth strategy for health systems.
This Week at Kaufman Hall
What our experts are saying about key issues in healthcare.
Despite industry stabilization, significant pockets of distress still exist among U.S. healthcare organizations. This fact was borne out in the data from hospital and health system M&A activity in 2024.
Published earlier this week, Kaufman Hall’s Hospital and Health System M&A report highlighted some striking data points. The percentage of announced transactions involving a financially distressed party reached a record high in 2024, as did the percentage of announced transactions involving a divestiture (in which a health system or healthcare-related governmental entity sells off a portion of its assets). At the same time, 2024 saw the emergence and growth of new transformative partnership models intended to put the U.S. healthcare system on a more sustainable footing.
On Our Podcast
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Thanks for reading! We’ll see you next week, but in the meantime, check out our Gist Weekly archive to peruse past editions. We also have all of our recent “Graphics of the Week” available here. We greatly appreciate your subscribership as we take on what’s sure to be yet another eventful year in healthcare.
Best regards,
The Gist Weekly team at Kaufman Hall
