Affordability, payer-network disputes, and site-of-service pressure threaten margins

GAO reporting indicates high insurer concentration across many states, a factor in provider contracting leverage and consumer choice. The 2027 Medicare Physician Fee Schedule debate includes a reported potential 35% real-rate decline since 2016 if proposals are finalized; watch the final rule and actual practice effects. Medicaid work-requirement implementation adds state-specific risks to coverage, access, volume, and collections. FTC transparency warnings are not findings of violations, but leaders should ensure estimates cover full episodes and assign accountability for accuracy.