This Week: Prior Authorization Metrics Provide New Insights into Insurer Practices

Plus, the White House’s executive order seeking to reshape U.S. childhood vaccine recommendations unlikely to have immediate or sweeping effect ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏  ͏ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­  

View in browser This Week The independent source for health policy research, polling, and news. Prior Authorization Metrics Provide New Insights into Insurer Practices, but Gaps Remain This analysis of available 2025 prior authorization data finds insurers denied at least 1 in 8 standard requests for prior authorization across three insurance markets: Medicare Advantage, Medicaid managed care, and the federally facilitated ACA Marketplaces. Denial rates varied widely by insurer. The analysis highlights limitations of the data and challenges for consumers in interpreting it.   Read more → The White House Takes Another Shot at Changing U.S. Childhood Vaccine Recommendations   This policy watch examines the White House’s latest executive order seeking to reshape U.S. childhood vaccine recommendations, including a directive to separate MMR vaccines and use a new HHS task force for federal recommendations. It finds that the order is unlikely to have an immediate or sweeping effect on U.S. vaccine policy, given that courts have blocked similar administration actions and states are increasingly decoupling their policies from federal recommendations. Learn more →   Also, this week's episode of KFF Health News' What the Health? podcast unpacks President Trump's vaccine agenda. Listen → New Regulation Prohibits Federal Medicaid Funds From Covering Gender-Affirming Medical Care for Young People   In a new Quick Take, Lindsey Dawson, associate director for HIV policy and director for LGBTQ health policy, examines the Centers for Medicare & Medicaid Services' (CMS) final rule prohibiting federal Medicaid or Children's Health Insurance Program funds from covering certain gender-affirming care services. She writes "If states do not provide coverage with state-only dollars and [gender-affirming] care cannot be financed in other ways, thousands of young people could be without a way to access what remains a recommended medical intervention."   Learn more → Trump Team’s Use of Arcane Budget Rule Threatens Medicaid Coverage   Coverage for hundreds of thousands of Arkansas Medicaid enrollees next year is in question after the Trump administration refused to renew a key state waiver. The state might not be the last to have to adjust to an arcane rule change under the One Big Beautiful Bill Act.    Read the story → The Monitor: Many Adults Are Unaware of the Abortion Pill’s Safety and Prevalence as Misleading Claims Link the Medication to Wastewater Contamination   The latest Monitor, tracking health information and trust, explores findings from KFF’s July Health Tracking Poll that show much of the public is unsure about the safety of the abortion pill mifepristone. Plus, some groups opposed to abortion are citing a misleading paper in an effort to classify mifepristone as a water contaminant, despite criticism of the paper’s methodology.   Read more → Question of the Week   Last week, 30% of readers correctly answered that 20% was the finalized median premium increase for ACA Marketplace insurers in 2026. Among Medicare Advantage enrollees, what share of prior authorization denials that were appealed were ultimately overturned by insurers? 33% 51% 67% See how many readers answered correctly in the next edition of This Week. Health News Hospital Prepayment Requirements Add New Wrinkles to Patients’ Financial Responsibility   A Federal Policy Is Complicating How Organizations Battle the Opioid Crisis   Patients Wary of Governments, Companies Pushing AI as a Rural Healthcare Solution   Same Knee Surgery, Twice the Price: Hospital Monopolies Push Up Healthcare Costs   Hospitals Say They Found a Tool To Help Reduce Childbirth Risks: Wristbands   Years After He Quit Smoking, a Lung Cancer Scan Saved His Life More on Health Policy   At Least 37 States Have Medicaid State Directed Payments for Hospital Services That Could Be Reduced by the 2025 Reconciliation Law Limits Optional Medicaid and CHIP Coverage for Lawfully Present Immigrant Children Could Mitigate Coverage Losses Due to 2025 Reconciliation Law    Medicare Will Spend More Than $13 Billion on the Medicare Advantage Quality Bonus Program in 2026 Did someone forward this to you? Subscribe to This Week. This email was sent to albarkahslamet.ssss@blogger.com. Update your email preferences to choose the types of emails you receive. Or, permanently unsubscribe from all future emails. Need assistance? Email subscriptions@kff.org; do not reply to this email. The independent source for health policy research, polling, and news. KFF, 185 Berry Street, Suite 2000, San Francisco, CA 94107