Healthcare Affordability

CMS is pushing affordability through more compulsory payment reform, finalizing a 2027 inpatient hospital update alongside the first nationwide mandatory joint-replacement bundle launching in 2028—an escalation that hospitals view as underfunded and overly prescriptive, but that signals renewed federal appetite for specialty-led cost control under the Trump administration. At the same time, Medicaid and dual-eligible budget pressure is moving nursing-home care toward value-based arrangements, while Medicare Advantage plans such as Clover are leaning on Stars performance and membership growth to sustain the VBC business case. The core tension for ACOs, hospitals, and payers is sharpening: federal and state purchasers want faster savings from mandatory models, AI-enabled utilization management, and risk contracting, but providers are warning that thin rate updates and administrative burden could undermine participation and care transformation (CMS inpatient rule and mandatory joint-replacement model; dual-eligible nursing-home shift toward VBC