Below is a roundup of payer-centric news headlines you may have missed during the month of June 2025.
Leading stories
Health plan slams Medicaid data sharing with Homeland Security
A California-based Medicaid plan criticized the Trump administration for sharing sensitive enrollee information with the Department of Homeland Security.
Gold Coast Health Plan cited an article from the Associated Press indicating the administration offered personal information and immigration status of Medicaid enrollees, despite pushback from state Medicaid officials. The data set provided also impacted members living in Illinois, Washington and Washington, D.C.
The insurer denied turning over the data with the government.
“This breach is not just a policy failure—it is a moral one,” said Felix Nuñez, M.D., CEO of GCHP, in a statement. “Trust is the foundation of our health system. Undermining that trust by turning health care into a tool of immigration enforcement jeopardizes the well-being of entire communities. We must protect the right to seek care without fear.”
Expect higher premiums from tariffs: KFF
Health plans say higher spending from prescription drug costs will naturally lead to higher premiums for enrollees, a policy analyst at KFF reported.
Prescription drugs account for 12% of private health insurance spending, he explained. Insurers in three states have already admitted tariffs have a significant impact on premium rates. They include Optimum Choice of Maryland, Independent Health Benefits Corporation of New York and UnitedHealthcare of New York.
“To account for uncertainty regarding tariffs and/or the onshoring of manufacturing and their impact on total medical costs, most notably on pharmaceuticals, a total price impact of 2.20% is built into the initially submitted rate filing,” said an executive with UnitedHealthcare of Oregon.
Legislation
Nebraska enacts prior auth law
The state of Nebraska is changing its approach to prior authorization, starting January 2026.
Supported by state industry heavyweights such as the Nebraska Hospital Association, the Nebraska Medical Association (NMA) and Blue Cross and Blue Shield of Nebraska (BCBSNE), the approved bill bans prior auth requirements for emergency services and ground transportation as well as preventive services, the NMA said. The prior auth form can also be no longer than two pages in length and should embrace the use of digital tools.
By 2028, the time frame for urgent request responses will be cut to 48 hours, with a 72-hour leeway starting next year.
“[The bill] brings some standardization to prior authorization processes for all health insurers and makes things simpler and more straightforward for patients and providers,” said Jeff Russell, president and CEO of BCBSNE.
Iowa signs Medicaid work requirements bill
Mirroring intentions from congressional Republicans, the state of Iowa is employing more stringent Medicaid work requirements.
Eligible enrollees must maintain at least 80 hours of work per month. Exemptions include people who under the age of 19, older than 65, disabled or medically exempt, pregnant, a caretaker or if the person is already enrolled in unemployment compensation.
“If you are an able-bodied adult who can work, you should work,” said Iowa Gov. Kim Reynolds in a statement. “We need to return Medicaid back to its intended purpose—to provide coverage to the people who truly need it.”
Legal
Iowa businesses challenge new PBM law
Health plans Iowa Bankers Benefit Plan and the Iowa Laborers District Council Health and Welfare Fund joined businesses to fight Iowa’s new pharmacy benefit manager law in court.
The plaintiffs said the law “used a sledgehammer” to favor independent pharmacies through “sweeping regulation” and “affecting prescription drug benefits” in the state. They said the law will cost the health benefits industry in the state $300 million and should be illegal under federal law.
Iowa’s law bans PBMs from steering patients to specific pharmacies or excluding pharmacies from a network and requires PBMs to reimburse independent pharmacies at equal rates.
Quick Hits
- Economist Ryan Ellis urged Congress to re-include health savings account reform to Trump’s massive reconciliation bill.
- Medicare Advantage (MA) trade group Better Medicare Alliance found the average MA enrollee spent nearly $3,500 less on out-of-pocket costs and premiums than people in traditional Medicare in 2022. But an independent analysis from the NORC, a research organization at the University of Chicago, finds MA enrollees are less likely to be discharged to post-acute care settings, resulting in 40% longer hospital stays.
- In other MA news, research out of USC found deductibles increased from $62 in 2024 to $224 in 2025, and the share of enrollment in plans with coinsurance for brand drugs increased from 2.6% to 27.5% in MA prescription drug plans.
- Nonprofit health plan Medica has expanded to the St. Louis region, the company announced.
- More than 8 in 10 cancer patient respondents said insurance companies required prior authorization, with 95% of requests eventually approved, a survey from CancerCare finds.