By JULIE APPLEBY
Subsidies. Love ’em or hate them, they dominated the news during the Affordable Care Act’s sign-up season, and their reduction is now hitting many enrollees in the pocketbook.

While lawmakers continue to disagree on a way forward, and the politics of affordability keeps the issue front and center, it would be understandable to think these are the only taxpayer-funded health insurance subsidies in the U.S. system.

But that would be wrong.

“The vast majority of people with health insurance get some kind of federal subsidy for it, from Medicaid to Medicare to the ACA to employer-sponsored insurance,” said Larry Levitt, executive vice president for health policy at KFF, a health information nonprofit that includes KFF Health News.

These broad taxpayer supports are rarely discussed, though, as they apply to work-based coverage. So, let’s take a look.

Adding Up the Tax Breaks

Nearly half of the more than $1.1 trillion in annual spending on Medicare, the second-largest program in the federal budget behind Social Security, comes from general federal funds. The rest comes from payroll taxes and the monthly premiums paid by enrollees, who number more than 66 million.

Medicaid — the nation’s largest health insurer, covering more than 70 million low-income people — costs more than $918 billion annually. It’s jointly financed by the [Read More]

Facing a $1.8 billion budget hole going into Fiscal Year 2027, Gov. Gretchen Whitmer proposed last month an $88.1 billion spending plan based on roughly $800 million in tax increases, $630 million in cuts and $400 million from the rainy day fund.

The plan puts a premium on preventing cuts to Medicaid, the health program that roughly 1 in 4 Michiganders count on to cover their care. The One Big Beautiful Bill Act (OBBBA) pushed new eligibility requirements and costs for Medicaid and Supplemental Nutrition Assistance Program (SNAP) recipients onto the states.

“We can talk about efficiencies,” said Senate Appropriations Committee Chair Sarah Anthony (D-Lansing). “We can talk about tightening our belts and increasing revenues, but we also need to pause to think about the fact that there were decisions made at the federal level, and when I look at who is holding the bag, it’s people. Michigan families.”

Budget Director Jen Flood made it clear to a joint hearing of the House and Senate appropriations committees today that Whitmer is not going to throw people off their care, so a “responsible” funding plan was crafted to keep the program afloat amid an otherwise generally flat budget.

According to the Budget Office, Kentucky is proposing a $1 billion rainy-day fund withdrawal [Read More]

Nurses in Michigan would be guaranteed eight consecutive hours of time off after working a 12-hour shift, under legislation by Sens. Stephanie Chang (D-Detroit) and Ed McBroom (R-Waucedah Twp.).

“It pains me that after decades of nurses organizing and mobilizing for safer guardrails, so little has truly changed,” said Kimberly Rackley, a fourth-generation nurse working at Borgess Health in Kalamazoo.

Rackley testified in support of SB 296 and SB 297 in front of the Senate Regulatory Affairs Committee this morning, which heard testimony on the legislation. Rackley described working as part of an open-heart surgical team, and how the team must be available 24 hours daily in order for the hospital to maintain its Level II Trauma Center status.

“We are often scheduled long over our scheduled shifts, because we stack surgery after surgery, up to three, four or five surgeries a day sometimes,” Rackley said. “This will go on for days and weeks on end. This is not sustainable.”

She said that since joining her team in November 2023, it has lost nine nurses, while gaining one nurse and one surgical technician. She explained the reasons the nine left are consistent.

“We are overworked and exhausted, stretched beyond what is safe,” she said, adding that when she’s not on the clock, she’s caring [Read More]

By DANIEL AYYASH

Wachler & Associates, P.C.

On Dec. 31, 2025, the Drug Enforcement Administration (DEA) released a fourth temporary Rule extending certain controlled substance prescribing flexibilities through Dec. 31, 2026. The Rule maintains the DEA’s position on controlled substance prescribing via telehealth that has been in place since the beginning of the COVID-19 public health emergency (PHE). By extending these flexibilities, healthcare providers have extra time to make preparations in the event that pre-PHE telemedicine prescribing requirements are revived, and also gives the DEA time to evaluate whether a more permanent framework for telemedicine controlled substance prescribing can be implemented.

Background

Prior to the beginning of the COVID-19 PHE and the prescribing flexibilities that came with it, the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 (Ryan Haight Act) required a telemedicine provider to perform an in-person medical evaluation of a patient before a controlled substance could be prescribed, with certain limited exceptions. Once a provider had conducted at least one in-person medical evaluation of a particular patient, the specific requirements of the Ryan Haight Act related to remote prescribing of controlled substances no longer applied to that particular provider-patient relationship, and the provider could prescribe certain controlled substances via telemedicine indefinitely.

In response to the COVID-19 PHE, [Read More]

By DAVID J. DAVIDSON
Dickinson Wright

2025 was a busy year for federal health law, with several major laws, regulations, and policy changes. Many of these will still be relevant in 2026. The following is a brief overview of the most significant developments and what they may mean going forward.

1. The “One Big Beautiful Bill Act” (OBBBA)

The OBBBA was a comprehensive reconciliation bill enacted in mid-2025.  The law includes noteworthy changes to federal health policy, including changes to Medicaid, Medicare, and the Affordable Care Act (ACA). The law addresses health coverage and federal program integrity, along with new eligibility and verification requirements for ACA marketplace enrollment.  The phasing out of enhanced ACA premium tax credits could raise enrollees’ costs unless there is further legislative action.

2. Inflation Reduction Act

Pursuant to the Inflation Reduction Act of 2022, effective January 1, 2026, Medicare began implementing drug pricing negotiated between the government and drug manufacturers.  These “final maximum fair price” amounts can only be adjusted for inflation (tied to the CPI), or through subsequent negotiation. Under this program, in 2026, drug costs are capped for ten Medicare Part D drugs.  Up to fifteen more drugs will be added per year in 2027 and 2028, with up to [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

A Little Fire Smoldering Over Surgical Smoke

The House Health Policy Committee watched a demonstration last month showing how quickly surgical smoke can accumulate when a cautery device is used without a smoke evacuation system.

The presentation accompanied testimony on HB 4779 , which would require health facilities performing smoke-producing procedures to develop and implement a policy to clear the air of these surgical areas.

During the demonstration, a representative from the medical device company Stryker used a Bovie cautery device inside a sealed container to simulate what occurs in an operating room when tissue is cut or blood vessels are cauterized. Within moments, smoke filled the enclosure. When the smoke evacuation unit was switched on, the plume was captured at the source.

Rep. Pauline Wendzel (R-Watervliet), the bill sponsor, told the committee members that the surgical smoke plume contains 16 EPA priority pollutants and more than 150 identified chemicals. Her testifier, (former Rep.) Ben Frederick, from Stryker, compared the amount of smoke generated over the course of a typical operating room shift to the equivalent of 27 to 30 cigarettes.

Frederick added that research indicates standard surgical masks do not adequately filter microscopic particles found in surgical [Read More]

The Michigan Democratic Party (MDP) blasted Republican candidate for U.S. Senate Mike Rogers for his perceived position on healthcare Tuesday, framing it as supportive of the insurance premium hikes that thousands of Americans are encountering early this year.

In a virtual press conference, Michigan Democrats deployed what’s proved to be a salient line of attack for the party as it approaches the 2026 midterms, saying rising health insurance costs are now factoring into a broader “affordability crisis.” Furthermore, speakers took a populist tone, accusing Rogers of being “out of touch” with such economic hardships, given his wealth.

“He’s someone who supports Medicaid cuts while he lives up in his Florida mansion,” said MDP Chair Curtis Hertel.

He and other speakers pointed to Rogers’ several votes as he represented Michigan’s 8th House district from 2001 to 2015 to reduce federal spending on health insurance, including his vote against former President Barack Obama’s landmark 2010 healthcare legislation, the Affordable Care Act (ACA).

They also claimed Rogers has previously said he would vote against any compromise to extend ACA subsidies, which expired at the start of this year.

Asked about the basis of that characterization, MDP spokesperson Joey Hannum pointed to a December 2025 POLITICO report, in which Rogers was quoted  saying “we can’t just put another Band-Aid” on a [Read More]

The flu, COVID-19 and other seasonal viruses have smashed into state residents, and outbreaks of vaccine-preventable diseases have surged as vaccination rates continue to plummet in the state.

The Michigan Department of Health and Human Services (MDHHS) reported the end of December saw very high activity of influenza cases that were among the nation’s highest. The state saw an 11.3% increase with a total of 13,568 patients going to the hospital with flu-like symptoms.

“Flu is not a mild illness for many children. Every year, children become seriously ill from flu complications that really could have been prevented by vaccination. Some of these children require intensive care, and children and adolescents who die from the flu were not vaccinated,” said University of Michigan Medicine Pediatrics Professor Dr. Aarti Raheja.

Raheja said 14 Michigan children died of the flu last year. So far in 2026, nine have died nationally, but none from Michigan. Overall, 2,110 flu cases resulted in hospitalizations with 306 being ages 4 and under.

“The best way to prevent flu is to get your flu vaccine. It’s not too late at all to go in and get your flu vaccine, because flu has not peaked yet,” Raheja said.

She said people with the flu should stay home and stay [Read More]

By MARTHA BEBINGER

Inside a cancer research laboratory on the campus of Harvard Medical School, two dozen small jars with pink plastic lids sat on a metal counter. Inside these humble-looking jars is the core of Joan Brugge’s current multiyear research project.

Brugge lifted up one of the jars and gazed at it with reverence. Each jar holds samples of breast tissue donated by patients after they underwent a tissue biopsy or breast surgery — samples that may reveal a new way to prevent breast cancer.

Brugge and her research team have analyzed the cell structure of more than 100 samples.

Using high-powered microscopes and complex computer algorithms, they diagram each stage in the development of breast cancer: from the first sign of cell mutation to the formation of tiny clusters, well before they are large enough to be considered tumors.

Their quest is to prevent breast cancer, a disease that afflicts roughly 1 in 8 U.S. women over their lifetimes, as well as some men. Their ultimate goal is to relieve the pain, suffering, and risk of death that accompany this disease. And their painstaking work, unspooling across six years of a seven-year, $7 million federal grant, has yielded results.

In late 2024, Brugge and her colleagues identified specific cells in [Read More]

By KATHLEEN CAMPBELL WALKER
Dickinson Wright

In fiscal year 2024, approximately 8,492 H-1B visas were approved for workers in medicine and health occupations.1 The American Medical Association and over 50 national specialty societies and state medical associations expressed serious concerns over the $100,000 H-1B fee imposed by the Presidential Proclamation, warning that it could worsen the U.S. physician shortage, projected to reach 86,000 by 2036, including a shortage of 50,440 psychiatrists.2 The groups urged the Department of Homeland Security to exempt foreign physicians from this fee. Educators are also a major group using H-1B visas, with nearly 30,000 petitions approved in 2024, often for positions in rural areas.3

The H-1B Presidential Proclamation, effective at 12:01 am eastern daylight time on September 21, 2025 (Proclamation Effective Date), requires a $100,000 payment or National Interest Exception (NIE) waiver for new I-129 petitions filed with U.S. Citizenship and Immigration Services (USCIS) for nonimmigrant H-1B workers outside the U.S. without a valid H-1B visa or an approved H-1B I-129 petition on or before the Proclamation Effective Date.4 The Proclamation is set to expire on September 21, 2026, unless extended.

Importantly, cap-exempt employers, such as nonprofit colleges, universities, affiliated organizations, and research institutions, still must pay the $100,000 fee, unless an NIW waiver is [Read More]

Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.

AG Argues It Should Decide Venue In Medicaid Fraud Case

As the Republican-led House moved this week to curb the Michigan Attorney General’s authority — including where cases may be filed—the Attorney General’s office was simultaneously defending its venue powers before the Michigan Supreme Court.

At issue is whether the Attorney General properly brought a Medicaid fraud enforcement case in Ingham County instead of Oakland County, where the defendants argue the alleged misconduct occurred.

Appearing before the court on Wednesday, Assistant Attorney General Stephanie Seery said the state should prevail because the injury caused by the alleged fraud occurred in Ingham County, where the state government is based.

“The injury is that the state was deprived of its funds, and that occurred in Ingham County where the state is located,” Seery told the justices. She urged the court to overturn a November 2024 lower-court ruling that held the venue must be tied to where the alleged wrongdoing occurred.

Seery warned that the ruling would allow defendants to dictate venue by choosing where to commit alleged misconduct. “What this means is that wrongdoers get to choose venue by choosing where to commit their bad acts,” she said, “this leaves [Read More]

By ARTHUR ALLEN & JACKIE FORTIER

The federal government has drastically scaled back the number of recommended childhood immunizations, sidelining six routine vaccines that have safeguarded millions from serious diseases, long-term disability, and death.

Just three of the six immunizations the Centers for Disease Control and Prevention says it will no longer routinely recommend — against hepatitis A, hepatitis B, and rotavirus — have prevented nearly 2 million hospitalizations and more than 90,000 deaths in the past 30 years, according to the CDC’s own publications.

Vaccines against the three diseases, as well as those against respiratory syncytial virus, meningococcal disease, flu, and covid, are now recommended only for children at high risk of serious illness or after “shared clinical decision-making,” or consultation between doctors and parents.

The CDC maintained its recommendations for 11 childhood vaccines: measles, mumps, and rubella; whooping cough, tetanus, and diphtheria; the bacterial disease known as Hib; pneumonia; polio; chickenpox; and human papillomavirus, or HPV.

Federal and private insurance will still cover vaccines for the diseases the CDC no longer recommends universally, according to a Department of Health and Human Services fact sheet; parents who want to vaccinate their children against those diseases will not have to pay out-of-pocket.

Experts on childhood disease were baffled by the change in [Read More]

By PAULA SPAN

Year after year, Mary Bucklew strategized with a nurse practitioner about losing weight. “We tried exercise,” like walking 35 minutes a day, she recalled. “And 39,000 different diets.”

But 5 pounds would come off and then invariably reappear, said Bucklew, 75, a public transit retiree in Ocean View, Delaware. Nothing seemed to make much difference — until 2023, when her body mass index slightly exceeded 40, the threshold for severe obesity.

“There’s this new drug I’d like you to try, if your insurance will pay for it,” the nurse practitioner advised. She was talking about Ozempic.

Medicare covered it for treating Type 2 diabetes but not for weight loss, and it cost more than $1,000 a month out-of-pocket. But to Bucklew’s surprise, her Medicare Advantage plan covered it even though she wasn’t diabetic, charging just a $25 monthly copay.

Pizza, pasta, and red wine suddenly became unappealing. The drug “changed what I wanted to eat,” she said. As 25 pounds slid away over six months, she felt less tired and found herself walking and biking more.

Then her Medicare plan notified her that it would no longer cover the drug. Calls and letters from her health care team, arguing that Ozempic was necessary for her health, had no [Read More]

The WISeR Model: CMS’ New Venture into AI‑Driven Reviews and Its Implications for Providers

By JENNI COLAGIOVANNI & SHANIYA RAHEJA
Wachler & Associates, P.C.

On June 27, 2025, CMS announced its plan to implement the Wasteful and Inappropriate Service Reduction (WISeR) Model, purportedly designed to introduce enhanced oversight into the Medicare payment process and to ensure timely and appropriate Medicare payment for select items and services. Incorporating advanced technologies such as artificial intelligence (AI) and machine learning (ML), together with human clinical review, WISeR will involve prepayment assessments of certain items and services. Beginning January 1, 2026, WISeR will be implemented in six states—Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington—for an initial six‑year performance period.

The stated objective of the initiative is to promote accuracy and timeliness in Medicare reimbursement, while reducing expenditures on services deemed unnecessary or inappropriate. To do so, WISeR will be implemented through “model participants,” which CMS describes as “companies with expertise providing recommendations on medical necessity of coverage for payers using enhanced technology like AI.” The companies selected as model participants will each operate in one of the six states and will be responsible for applying Medicare coverage criteria in National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). WISeR will initially [Read More]

Telehealth’s Weight-Loss Boom and the Corporate Practice of Medicine

By ALLISON TUOHY DOLSON
Dickinson Wright

Telehealth weight-loss platforms offering rapid GLP-1 prescriptions have become one of the fastest-growing segments in healthcare. These platforms connect consumers with clinicians via virtual consultations to assess eligibility for drugs like semaglutide or tirzepatide. This model has attracted significant venture capital as demand surges. Yet, behind the glossy marketing and rapid expansion lies a longstanding legal principle that many companies are confronting anew: the corporate practice of medicine (CPOM).

The Old Doctrine Meets the New Model

The CPOM doctrine prohibits corporations and other non-physicians from practicing medicine, owning medical practices, or controlling physicians. Its core purpose is to ensure that licensed clinicians make medical decisions free from corporate influence, safeguarding the physician–patient relationship from conflicts of interest. Despite decades of healthcare consolidation and reform, CPOM remains a resilient guardrail.

To effectively navigate the CPOM laws, which vary significantly from state to state, most telehealth companies rely on a two-entity model. In this compliant MSO-PC model, a physician-owned professional corporation delivers medical services, while a separate management services organization (MSO) handles non-clinical functions such as marketing, technology, and administration. The professional entity must maintain full authority over medical decisions, including prescriptions. MSOs typically charge a flat management [Read More]