Here are five updates on payers for ASC leaders and physicians to know:
1. Around one-quarter of small businesses that purchased health insurance in 2022 discontinued coverage in 2023, according to a report from JPMorganChase. Among small businesses with no employees, 26% stopped paying health insurance premiums between 2022 and 2023. Among businesses with employees, this share was 27%.
2. The Justice Department’s lawsuit challenging UnitedHealth Group’s planned $3.3 billion acquisition of home health company Amedisys is moving to mediation Aug. 18, according to court records.
3. At least 11 states are considering work requirements for their Medicaid programs. President Donald Trump backed Medicaid work requirements during his first administration and they are currently being evaluated by federal lawmakers as a part of a planned overhaul of government spending. During Mr. Trump’s first term in office, 13 states chose to implement work requirements in their Medicaid programs according to KFF. The Biden administration later withdrew these waivers. Three states, Arkansas, Arizona and Ohio, have submitted waiver requests to CMS, though these programs have yet to be approved, according to KFF. Georgia is the only state with an active work requirement, as of April 2025.
4. A New York federal judge recently dismissed an antitrust lawsuit against UnitedHealthcare and MultiPlan that alleged the companies conspired to reduce reimbursement rates for an anesthesia services provider.
5. Several states are considering regulating how insurers can use AI in prior authorization. In January, a California law took effect that prohibits payers from making coverage decisions based solely on artificial intelligence algorithms. The law requires any denial, delay or modification of care to be reviewed by a physician or other qualified healthcare provider. Other states are considering similar actions. So far in 2025, lawmakers in Illinois, Georgia, Texas, Rhode Island, Minnesota and Florida have introduced laws that would restrict the use of AI in prior authorization decision.
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