BOSTON — The building that houses the Brigham and Women’s Hospital emergency department opened in 2022. But by 2025, it was already too small. One early September evening, the emergency room had 59 patients — 152, if you counted everyone in the waiting room. 

“In terms of rooms for acute care, we have 61,” said Christopher Baugh, an emergency physician at the hospital. “You can’t see 152 patients in 61 rooms.” Patient beds lined every possible area, with a full circle of beds surrounding the staff workstations in the center of the bay. Figurines of Star Wars characters R2D2 and C3PO peered over beds 80H and 81H — where “H” stands for “hallway.”

To some, this may look like a scene from another country, Baugh said. But to him, it’s just Thursday.

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A cash parade for a top House Democrat

UnitedHealth Group’s top executives, including CEO Stephen Hemsley, and board members recently flooded the campaign coffers of Rep. Katherine Clark of Massachusetts, the No. 2 Democrat in the House who just beat two opponents in a closely watched primary.

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House Republicans canceled the last two weeks of their session in September, which means House lawmakers will have gotten at least 15 weeks off between Memorial Day and the midterms on Nov. 3. Send news tips and PTO requests to John.Wilkerson@statnews.com or John_Wilkerson.07 on Signal.

House Democrats’ agenda takes shape

In the week that the House was in town, a fuzzy outline of the health care agenda that Democrats are considering should they win back the House started to take form.

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RFK Jr. adviser Calley Means and Kennedy’s son Finn attended the Enhanced Games, the pro-doping athletic competition and biohacking extravaganza that took place over the weekend in Las Vegas, according to The Washington Post. Send news tips and personal bests to John.Wilkerson@statnews.com or John_Wilkerson.07 on Signal.

Ripple effects

For weeks, Republicans have been preoccupied with an immigration funding bill that they’re pushing through Congress, without support from Democrats. I’ve not been writing about that bill because it doesn’t include health care policies. But it’s now becoming relevant to health care, albeit indirectly.

Early last week, Republicans were expected to pass that budget reconciliation bill without much friction. By the end of the week, Senate Republicans adjourned for a week-long recess without voting on it due to an impasse over a new $1.8 billion settlement fund for Trump’s allies. They’d also butted heads with the president over his demands for $1 billion for a White House complex and ballroom.

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$775 billion

Centers for Medicare and Medicaid Services

Republicans’ recent tax law targets supplemental Medicaid funds that have increasingly propped up hospitals. The cuts are expected to be even bigger than originally forecast, which almost assuredly will provoke an opposition campaign from hospitals.

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Hospitals and other providers are bracing for an end to the extra money they’ve gotten for treating Medicaid patients, one of the many cuts contained in Republicans’ sweeping 2025 tax law.

But the Trump administration disclosed this week that it plans to take the cuts to state directed payments even further, setting up what’s likely to be a showdown with provider groups. 

Since 2024, some hospitals, doctors, nursing homes, and other types of providers have been reimbursed for Medicaid services at much higher commercial rates, thanks to a Biden-era change. The One Big Beautiful Bill Act, passed in July, directs the Centers for Medicare and Medicaid Services to gradually trim those payments beginning in 2028 until they’re close to or on par with Medicare rates. 

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Zac Jiwa, a federal Medicare official, delivered a eulogy of sorts at a Thursday Medicare event highlighting the successes of the Health Tech Ecosystem initiative. 

The eulogy’s subject? The clipboard. 

For the past eight months, hundreds of health tech companies have been working to meet goals set out by the federal government to make patient records more portable, create systems that import patients’ data into providers’ electronic health records systems, and stand up various patient apps. The idea is to make filling out a stack of paperwork at every doctor’s visit, on that ubiquitous clipboard, a thing of the past.

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In which RFK Jr. says the “government lies to us” while sitting in front of an HHS seal. Send news tips and podcast recommendations to John.Wilkerson@statnews.com or John_Wilkerson.07 on Signal.

First, control health care costs

Last month, a group of 12 Senate Democrats proposed a framework for rebuilding the health care system. The idea was to spur input from others ahead of when Democrats might get a chance to act on those plans.

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About 20 years ago, I stepped on stage at one of our Geisinger town halls and looked out upon a sea of people: thousands of full-time employees at an integrated health system charged with the health and well-being of millions of Pennsylvanians. 

Only a fraction of the people in that room were clinicians. 

That was the first time I fully visualized the problem: We employed more people in our revenue cycle department to process bills and reconcile data than we did doctors. And we weren’t alone. It’s the same story at every health system in America, large and small, and over the past two decades, the ratio has become dramatically more disparate. 

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Today’s the day

By law, the 2027 Medicare Advantage payment regulation must come out today. It will set the tone for how the Trump administration wants to work with the health insurance industry: as the “new sheriff in town” or just another friendly regulator.

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