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Cigna will exit the ACA exchanges after 2026, leaving 369,000 members in 11 states; Nebraska becomes the first state to implement Medicaid work requirements; Q1 earnings show carriers prioritizing margin.

Q1 2026 earnings showed UnitedHealth, Elevance, Molina, and HCA stabilizing margins—just as CMS launched a Medicaid revalidation order and lawmakers revived the MA Improvement Act.

PBGH's April 15 survey of America's biggest employers names affordability the dominant concern as 37% pursue medical RFPs and 27% turn to non-traditional PBMs.

CMS launched its HealthTech Ecosystem First Wave on Apr 9 and proposed a sweeping drug prior authorization interoperability rule on Apr 10, anchoring a digital reset.

CMS finalized a 2.48% MA rate bump on Apr 6 and the CY2027 MA final rule on Apr 2, while hospital price transparency enforcement began Apr 1 and Highmark-Blue KC closed.

March 27 brought 18 names to a new HHS-CMS advisory committee, a Senate letter demanding the 2027 NBPP withdrawal, and Highmark's $175M loss as the Blue KC clock runs out.

Missouri's March 17 sign-off on the Highmark/Blue KC affiliation creates the No. 3 Blues organization just as a KFF poll exposes ACA enrollee distress.

CMS's March 13 NBPP 2027 deadline drew unified pushback against non-network plans and network adequacy rollback as MedPAC, MACPAC and Optum Rx made news.

Mount Sinai's hospitals went out-of-network at midnight March 3, Cigna anointed a new CEO the same day, and a $1,016 ACA premium gap began landing on enrollees.