Health Policy, Reform and Pricing Transparency

In US healthcare, Congress and CMS are the largest market makers. Medicare and Medicaid (1965) created the modern hospital and physician business. The HMO Act (1973) seeded managed care. Prospective payment (1983) changed how hospitals behave. Medicare Part D and Medicare Advantage (1997–2003) created two of the largest profit pools in the industry. The Affordable Care Act (2010) created the exchanges, expanded Medicaid and rewrote insurance rules. The No Surprises Act (2020), the price-transparency rules (2019–20) and the Inflation Reduction Act (2022) went after prices directly. The 2025 reconciliation law and the expiry of enhanced ACA subsidies at the end of 2025 started to reverse some coverage gains (CBO projects ~10m more uninsured by 2034 from the law alone). This section explains the main reforms, how they changed who gets paid what, and how operators and investors should read policy.