In this edition of AcademyHealth’s Situation Report, we celebrate our one-year anniversary of the Situation Report in which we brought you 88 editions spotlighting the latest health policy and federal policy changes impacting the field of health services research. Today’s update highlights federal workforce changes with implications for the interpretation and implementation of evidence as well as worker protection and nonpartisan expertise in decision-making, an update on concerns about TrumpRx and the direct-to-consumer model’s influence on drug prices and innovation, and CMS’ proposed plans to change how risk scores for Medicare Advantage plans are calculated. Read on for the latest news on these issues as well as tips for researchers to communicate their work to have real-world impact.
In today’s issue:
- The Situation Report is Now Available Via Substack
- Congress Discusses TrumpRx Drug Pricing Model
- New Federal Workforce Rules Raise Concern
- CMS Proposes Changes to Medicare Advantage Risk Adjustment to Curb Overpayments
- AcademyHealth Research Champion Miranda Yaver: Communicating Research for Real-World Impact
The Situation Report is Now Available Via Substack
AcademyHealth is excited to announce that starting in March 2026, the Situation Report will be transitioning exclusively to Substack. To facilitate this move, our current members will be automatically subscribed by the end of the month, ensuring they continue receiving these essential updates directly in their inbox. However, anyone can subscribe at any time, broadening access to our timely insights on health policy and research. As we look to Year Two of the Situation Report, expect more diverse content, including video updates and in-depth policy analysis, providing even more resources to support informed decision-making amidst an ever-evolving research landscape.
Congress Discusses TrumpRx Drug Pricing Model
In late January 2026, Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz met with Congress to influence members on strategies for codifying President Trump’s drug-pricing model, TrumpRx into law. TrumpRx is a direct-to-consumer platform that allows patients to purchase brand name medication directly from the pharmaceutical manufacturers. During the Capitol Hill visit, Dr. Oz, Medicare Director Chris Klomp, and special assistant to the president for domestic policy, Theo Merkel met with members from the Finance Committee to address their concerns and apprehensions about backlash from the pharmaceutical industry and its potential impact on drug manufacturing innovation. The meeting did not unveil new details about requiring drugmakers to offer: 1) Medicaid recipients the lowest prices available, and 2) having future drugs sold at low prices in the U.S. The January 2026 meeting appears to be a follow up from the December 2025, where nine pharmaceutical manufacturers-Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Genentech, Gilead, GSK, Merk, Novartis, and Sanofi- met with the Trump administration to lower the prices of some of their drugs. In addition to pledging to bring down the cost of their prescription drugs to make them comparable to the price of other countries, the manufactures also agreed to have some of their drugs have additional discounts through the TrumpRx platform.
The tone of the Capitol Hill meeting has been described as fairly neutral, despite some Republication Senators offering skepticism of the proposals, as there is concern that government price controls enacted by this direct-to-consumer drug platform could interfere with the free market. This concern has been raised historically, with Senator Bill Cassidy (R-LA) dissenting President Joe Biden’s 2022 reconciliation law (the Inflation Reduction Act of 2022) that gave Medicare the authority to negotiate prices for high-cost drugs for the first time.
New Federal Workforce Rules Raise Concern
The administration has finalized a rule reclassifying roughly 50,000 federal employees into a new “Policy/Career” category that makes them easier to dismiss and significantly weakens traditional civil service and whistleblower protections. The new designation shifts many policy-focused roles into a status similar to political appointees, removing longstanding guardrails that ensure continuity, nonpartisanship, and accountability in federal decision-making. Federal employee organizations warn the rule could increase politicization, reduce retention, limit protections for reporting misconduct, and diminish the government’s ability to rely on technical and scientific expertise across agencies.
For the health services research community, these changes could have substantial downstream implications. Many of the affected positions sit within agencies that generate, interpret, and implement evidence, roles central to health program administration, data stewardship, regulatory guidance, and evaluation. Increased turnover, weaker whistleblower pathways, and potential loss of nonpartisan expertise may affect the stability and reliability of federal health infrastructure, including how evidence is incorporated into program decisions and how research-informed policy is carried out over time. It is important to continue to monitor this situation as litigation proceeds and agencies begin implementing the new classification processes.
CMS Proposes Changes to Medicare Advantage Risk Adjustment to Curb Overpayments
The Centers for Medicare and Medicaid Services (CMS) is planning to change how risk scores for Medicare Advantage plans are calculated by relying more heavily on newer clinical data, according to a recent STAT report. Coming alongside the federal government’s recent proposal to keep payments to 2027’s Medicare Advantage plans essentially flat—averaging less than a 0.1 percent increase instead of anticipated 4-6 percent—this shift in risk score methodology signals a broader effort to rein in overpayments tied to coding intensity. CMS’s rationale is that the older data inflate estimates of enrollee illness severity, effectively allowing insurers to increase payments through upcoding, whereas newer data would better reflect actual spending patterns. The proposed adjustments including reducing payments for 98 of the 150 codes and variables that contribute to an individual’s risk score as well as reducing payments tied to enrollee’s ages and bonus payments plans receive if people have five or more chronic conditions.
Beyond being a part of a broader effort to enhance the accuracy and sustainability of the Medicare Advantage, this proposed change illustrates how risk adjustment can influence system-level incentives and ultimately patient care. While CMS seeks to curb overpayments, the proposed adjustments might inadvertently incentivize insurers and providers to intensify their diagnosis documentation efforts. Heightened focus on comprehensive coding can impact administrative burdens and shift what is prioritized in care delivery. It is important for health services researchers and policymakers to monitor these developments closely to ensure the adjusted risk scores achieve intended goals without adversely affecting provider behavior or patient care.
AcademyHealth Research Champion Miranda Yaver: Communicating Research for Real-World Impact
New research doesn’t change policy or lives if it stays locked in academic journals. In a new AcademyHealth blog post, Research Champion Miranda Yaver reflects on how she has worked to move her research on health insurance claim denials into the public conversation. Yaver shows how the accumulated burdens of navigating claim denials and appeals, which she calls “rationing by inconvenience” shapes access to care, particularly for patients already on the margins. She offers the following tips for getting your research in front of people who need it:
- Lead with stories
- Anchor your stories in data
- Keep your overall goal in mind
Yaver’s experience speaking with the media underscores the value of health services researchers taking responsibility not only for generating evidence, but for ensuring it reaches the people who can use it. As an AcademyHealth Research Champion, her work also shows our commitment to fostering connections between researchers and policymakers and translating evidence into action.
Read the full blog post for practical tips on communicating your research for impact and why leading with stories matters here.
Previous Editions
This is the latest in a series of Situation Report updates from AcademyHealth. You can find prior issues here.
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