The Scan
CMS data confirmed Friday: about 4 million people dropped ACA plans after enhanced subsidies expired, pushing effectuated enrollment down 13 percent. More attrition is expected by year-end. →
Senate HELP Committee Chair Cassidy released a 340B reform discussion draft on June 25, proposing patient eligibility limits, rebate model shifts, and new contract pharmacy rules that would directly reshape hospital finances. →
CMS released guidance for the Medicare GLP-1 Bridge Program, launching July 1, giving certain Medicare patients a new coverage pathway for weight-management medications with retrospective prior authorization. →
Nursing strike authorizations at Brigham and Women's Hospital and Jefferson Einstein Philadelphia reached 99.6 percent and 96 percent respectively, as the Henry Ford Genesys strike in Michigan extends past nine months. →
Experts at the HIMSS AI in Healthcare Forum warned that hospitals using AI only for administrative tasks are missing its clinical potential, and that a digital divide may soon stratify care quality by system size and resources. →
A new ZS Impact Institute report found that 90 percent of patients who use AI health tools trust the information they receive nearly as much as their physician, meaning patients increasingly arrive having already made decisions. →
A proposed federal policy would give political appointees authority to direct which research gets funded based on ideology rather than scientific merit, with direct implications for clinical trial and nursing research funding. →
The Brief
1. The coverage floor just cracked open
New CMS data released June 26 shows ACA Marketplace enrollment fell to 19.2 million people in February 2026, down from 22.1 million in 2025. That is a 13 percent drop, the steepest single-year decline since the ACA Marketplaces launched, and it follows the expiration of enhanced premium tax credits that caused double- and triple-digit premium increases for millions of people.
What it means for you: This is not an abstract policy number. This is 3 million people who had insurance and now do not, and KFF projects the final count could reach 5 million by year-end. Your emergency department will feel this before any policy response arrives. Patients who dropped coverage do not stop getting sick. They delay care, arrive sicker, and consume more uncompensated resources when they do come through your doors. Every hospital leader should be running an uncompensated care projection right now based on their service area's coverage loss exposure. This is also a workforce and morale issue. Your nurses and techs are watching patients fall through the safety net in real time. That wears on people. Name it, address it, and make sure your advocacy voice is on record. Silence at the executive table right now is a choice. Read the KFF analysis
2. Congress puts 340B in its crosshairs. And this one has teeth
On June 25, Senate HELP Committee Chair Bill Cassidy released the 340B Drug Pricing Integrity and Affordability for Patients Act discussion draft, proposing the most significant statutory overhaul of the 340B program since its creation. The draft would allow manufacturers to switch from upfront discounts to retroactive rebates, narrow the definition of a qualifying patient, limit contract pharmacy arrangements, and require hospitals to pass 340B savings directly to patients on a sliding income scale.
What it means for you: The 340B program, which allows qualifying hospitals and safety-net clinics to purchase prescription drugs at steeply discounted rates, is a meaningful revenue stream for many health systems, particularly those serving low-income populations. This draft, if it moves forward, would change the financial mechanics of that program significantly. Hospitals advocate groups have already said provisions narrowing patient eligibility and limiting contract pharmacies would reduce the savings hospitals can access to fund charity care. The political context matters here: Cassidy lost his Senate primary and will leave the HELP chair at the end of this Congress, which makes the legislative path uncertain. But legal and compliance experts are unanimous that dismissing this as a lame-duck effort would be a mistake. The draft signals where Congress wants to go, and the regulatory environment around 340B will continue moving in this direction regardless of whether this specific bill passes. Start your impact analysis now. Comments are due August 28. Read the full discussion draft analysis
3. The nursing strike wave is not cooling down
As of late June 2026, at least four major nursing labor actions are live or imminent. Nurses at Brigham and Women's Hospital in Boston voted 99.6 percent to authorize a potential strike. Nurses at Jefferson Einstein Philadelphia Hospital voted 96 percent to authorize one. Corewell Health East in Michigan saw nearly 90 percent strike authorization. The Henry Ford Genesys strike in Grand Blanc, Michigan, entered its tenth month, making it one of the longest-running nursing strikes in the country.
What it means for you: The common thread across all four situations is the same: staffing ratios, workplace safety, and wages. These are not isolated grievances. They are the accumulated pressure of a workforce that spent years being asked to do more with less, watched colleagues burn out and leave, and is now drawing a line. For leaders watching this from other systems, the lesson is not to wait for a strike authorization vote to start listening. The staffing and retention issues driving these actions exist in some form in nearly every health system in the country. The leaders who get ahead of this are the ones running real stay conversations with their clinical staff right now, not surveys, not town halls, but direct one-on-one conversations about what would make people stay. The leaders who wait are the ones who will be bargaining at the table in six months. See the full strike tracker
4. AI experts at HIMSS say most hospitals are barely scratching the surface, and a divide is forming
At the HIMSS AI in Healthcare Forum in Boston on June 25, clinical leaders from Stanford Healthcare and UMass Memorial Health told attendees that most hospitals are using AI almost exclusively for administrative tasks, while the real clinical value, meaning diagnostic support, real-time chart querying, and precision care, remains largely untapped. Experts also warned that a digital divide is forming, with larger, better-resourced systems building AI infrastructure that smaller systems simply cannot afford.
What it means for you: This is the conversation healthcare leaders need to be having right now, not about whether to adopt AI, but about what problem you are actually solving with it and whether your foundational infrastructure can support it. The message from the forum was plain: deploying AI on top of broken workflows or inadequate data governance will not produce the outcomes you are promising your board. Start with your highest-burden, lowest-risk use cases. Document your governance process. Be explicit about what clinical problems you are targeting. And pay attention to the equity dimension. If AI-enabled care becomes the standard in well-resourced systems and unavailable in safety-net systems, the quality gap between institutions will grow, not shrink. That is not a vendor problem. That is a leadership problem. Read the Healthcare IT News report
The Deep Dive
The 5 million: what the coverage collapse means for operators on the ground
The numbers released Friday are the most complete picture yet of what the expiration of enhanced ACA premium tax credits actually did to real people. About 4 million Americans who selected an ACA plan at open enrollment did not keep it. They either could not pay the premium after it jumped, or made the calculation that food or rent came first. KFF projects that by the end of 2026, average monthly enrollment could fall as low as 16.5 million, down from 22.3 million just one year ago. That is a potential loss of nearly 6 million people in a single year. The Congressional Budget Office estimated last year that Medicaid cuts in the One Big Beautiful Bill and the subsidy expiration combined would produce roughly 15 million more uninsured Americans by 2034. We are now five million into that number, and Medicaid work requirements do not take effect until January 2027.
For hospital operators, the math is not complicated. More uninsured patients means more uncompensated care. More uncompensated care means tighter margins. Tighter margins mean pressure on staffing, capital investment, and every other resource decision you make. This is the fiscal environment inside which you are also being asked to implement AI, meet new Joint Commission staffing standards, and hold your team together through a labor wave. These pressures are not separate stories. They are the same story. The leaders who treat coverage loss as a policy abstraction and not an operational reality will be caught flat-footed when the volume and acuity patterns in their EDs shift.
What can you do? Three things. First, pull your uncompensated care data from the last six months and project it forward using your service area's coverage loss rate. Have that number ready before your next finance meeting. Second, equip your front-line teams, especially in the ED and in primary care access, with language to help patients navigate what coverage options remain, including Medicaid, CHIP (the Children's Health Insurance Program), and community health centers. Third, make your voice heard. This is an advocacy moment. Your state hospital association, your congressional representatives, and your community partners need to hear from operating executives about what coverage loss looks like from the inside of a hospital. You have credibility in that conversation that no think tank does. Use it.
The Leadership Lever
The stay conversation: ask before they're already gone
The nursing strike data this week tells a story about what happens when leaders wait too long. By the time 99 percent of a nursing staff votes to authorize a strike, the relationship has been eroding for years. Stay conversations, direct one-on-one discussions with individual staff members about what keeps them engaged and what would cause them to leave, are the most effective early warning tool available to any leader. They are not surveys. They are not town halls. They are you sitting down with a person, asking a genuine question, and listening without defensiveness.
The research on stay conversations is clear: people who feel heard by their direct leader are significantly more likely to stay, even when conditions are imperfect. The conversation does not need to be complicated. Ask: what is working well for you right now? What is one thing that, if it changed, would make this job harder to stay in? What would make you want to stay here for the next three years? You do not need to promise a solution. You need to demonstrate that the answer matters to you. For physician leaders and new managers who have never been trained in this, it can feel awkward at first. That is normal. The discomfort of the conversation is nothing compared to the cost of the vacancy it prevents.
Try this week: This week, schedule three stay conversations with staff members you have not checked in with recently. Pick one high performer, one person you have sensed may be disengaged, and one newer team member still forming their attachment to the unit. Block 20 minutes each, go somewhere private, and ask the three questions above. Take notes. Follow up on at least one thing you hear within a week.