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Federal spending on the Medicare Advantage quality bonus program has more than quadrupled since 2015, rising to at least $12.7 billion in 2025. Most Medicare Advantage enrollees are in a plan that receives a bonus payment in 2025, with employer- and union-sponsored plans receiving the highest bonus payments and special needs plans receiving the lowest bonus payments, on average.

On May 22, 2025, the U.S. House of Representatives passed a budget reconciliation bill that includes significant reductions in federal Medicaid spending to help offset the cost of tax cuts, along with changes to the Affordable Care Act (ACA), immigration reforms and other provisions. This issue brief discusses the potential implications of the bill for hospitals and explains how some hospitals (such as rural hospitals as well as urban hospitals that serve a large share of Medicaid patients) may be less well positioned than others (such as hospitals that serve a large share of commercial patients) to absorb revenue losses given their current financial status.

This volume highlights how a report criticized for flawed methodology is influencing renewed efforts to restrict access to mifepristone; a federal plan to study the causes of autism that could be contributing to stigma by over-emphasizing environmental toxins; and the resurgence of false claims about fetal tissue in vaccines.