The Trump administration recently revealed plans to significantly change the way H-1B work visas are awarded. These visas, reserved for foreign workers with specialized skills, are often a critical pathway for young international professionals, including journalists, to launch their careers.

Under the current system, most H-1B applicants must go through a lottery conducted by U.S. Citizenship and Immigration Services (USCIS) when the number of applications exceeds the annual cap: 65,000 for general applicants and an additional 20,000 for those with advanced degrees. But according to a recent filing from the Office of Information and Regulatory Affairs, the Department of Homeland Security (DHS) is now considering replacing the random lottery with a “weighted selection process” based on salary.

This idea echoes a final rule published by the DHS in 2021, in which USCIS proposed to rank and select applicants by wage level, starting with the highest (OES Wage Level IV) and working down to the lowest (Level I). Under this model, applicants offering higher salaries would be prioritized for selection.

It remains unclear how a salary-based selection process would account for disparities across occupations and regions, where prevailing wages can differ dramatically. For example, a Level 1 wage for a junior computer programmer in Silicon Valley is $102,877, significantly higher than the $98,613 salary of a Level 3 journalist, who is expected to have several years of experience. This discrepancy suggests that even highly qualified journalists could be ranked below entry-level peers in other, higher-compensated fields.

And what does a salary-based selection mean for young international journalists, if competition from other occupations is set aside?

Typically, recent international graduates started their careers with a Level I or Level II salary, as indicated on their labor condition applications. To qualify for a Level II Wage, young journalists working in New Jersey, New York, the District of Columbia, Maryland and Virginia, where most media job opportunities are concentrated, must earn salaries exceeding $100,000 annually, according to my analysis of U.S. Department of Labor OFLC Wage data. In contrast, journalists in states such as Kansas, Kentucky and West Virginia can meet the Level II threshold with salaries under $30,000.

With Donald Trump now sworn in as the 47th president and Republicans controlling both chambers of Congress, the future of Medicaid is uncertain.  

During his campaign, Trump promised to slash federal spending. And according to a document now circulating on Capitol Hill, House Republicans are considering several Medicaid policy changes that could reduce federal spending by $2.3 trillion, including imposing a per capita cap on federal Medicaid funding, reducing the funding match rate for the Medicaid expansion population, and lowering the federal medical assistance percentage (FMAP) floor from the current 50% level. 

As of January, more than 66.1 million people are enrolled in a managed Medicaid health plan, according to AIS’s Directory of Health Plans. The top 10 Medicaid MCO insurers by membership held about 60.9% of the national market. Centene Corp. alone accounted for 18.6% of the national market and covered Medicaid enrollees in 28 states across the nation. Elevance Health, Inc. and UnitedHealthcare ranked the second and the third largest, holding about 11.0% and 8.8% market share, respectively.

In 26 states, Centene is among the top three insurers by membership within the state’s Medicaid market. Molina Healthcare, Inc., the fourth-largest Medicaid MCO insurer, held 6.0% of the national market and ranked among the top three insurers in eight states. The company has more than 3.9 million Medicaid beneficiaries, accounting for almost 85.5% of its total membership. For more specific market share data, hover over the graphics below.

The Affordable Care Act expanded Medicaid coverage to people with incomes of up to 138% of the federal poverty level. The federal government covers 90% of the cost for ACA expansion enrollees and states pay 10% of the costs. As of 2025, 40 states and Washington, D.C., have adopted Medicaid expansion, as a Supreme Court decision made expansion optional. The FMAP for the non-expansion Medicaid population is based on states’ and U.S. territories’ per capita income and ranges from 50% to 83% for fiscal year 2025, according to KFF. 

The Paragon Health Institute, a right-leaning health care research firm, has proposed reducing the FMAP for Medicaid enrollees to the standard Medicaid match rate by 2034, which could shift a significant amount of Medicaid spending from the federal government to the states and lead to millions of people losing coverage. 

As of March 2024, more than 21 million people — 24% of total Medicaid enrollment — had coverage thanks to the ACA’s expansion provision, according to a KFF analysis. About 4.3 million expansion enrollees reside in 12 states that have “trigger laws” that would end expansion or require other changes if the match rate is below 90%. 

Of the 12 states with the trigger laws, eight voted for Trump as president and four voted for Kamala Harris. In Arkansas, Indiana, Iowa, Montana, New Hampshire, New Mexico and Virginia, more than 30% of Medicaid beneficiaries obtain their coverage through Medicaid expansion. 

This infographic was reprinted from AIS Health’s weekly publication Health Plan Weekly.

Chief executives of major publicly traded health insurance companies logged high pay in 2024 despite sometimes-disappointing financial performances, according to AIS Health’s analysis of proxy statements the companies submitted to the Securities and Exchange Commission.

The CEOs of the seven major national insurers — UnitedHealth Group, The Cigna Group, Molina Healthcare, Centene Corp., Elevance Health, Inc., CVS Health Corp. and Humana Inc., earned a combined $145,996,812 in total compensation in 2024.

UnitedHealth Group CEO Andrew Witty topped the list with $26.3 million in total compensation, an 11.9% increase year over year. The bulk of his payout came in stock awards, which totaled $17.2 million in 2024. His compensation has risen 42.9% since he took the role as president and CEO on Feb. 3, 2021.

The nation’s largest health care company, UnitedHealth brought in a record $400.3 billion in revenue in 2024 amid a year of crisis, including its Change Healthcare unit experiencing the largest health care data breach of all time and the shooting death of its top insurance executive. Analysts deemed UnitedHealth’s first-quarter 2024 earnings report “better than feared” amid heightened utilization in its Medicare Advantage business, and they gave its second-quarter results middling marks. But the disclosure of higher-than-expected medical loss ratios (MLRs) in both the fourth quarter of 2024 and the first quarter of 2025 caused UnitedHealth’s stock price to plummet.

Cigna CEO David Cordani saw his total compensation package rise more than 10.4% year over year, reaching $23.2 million in 2024. In its 2024 fourth-quarter earnings release, the company reported that it recorded a 27% year-over-year increase in revenue. But the insurer’s stock took an 11% tumble on news that it missed its fourth-quarter adjusted earnings per share (EPS) and MLR targets. 

Centene CEO Sarah London earned $20.6 million in total compensation in 2024, representing an 11.02% increase over 2023. Since she was appointed president and CEO in March 2022, her compensation has risen over 55.5%. Centene’s high first-quarter Medicaid MLR worried investors, and its overall MLR in the second quarter was higher than expected. But the firm beat Wall Street expectations in the third and fourth quarter.

Molina CEO Joseph M. Zubretsky saw a slight increase in his total compensation, earning $21.9 million in 2024. Molina, one of the largest managed Medicaid insurers in the U.S., beat expectations in its second and third-quarter earnings reports, yet it had a “disappointing” fourth-quarter performance driven by higher-than-anticipated care utilization among its members. 

Elevance Health CEO Gail Boudreaux saw her compensation drop by almost 6.5% in 2024 compared to 2023. That was largely due to a decline in her non-equity incentive plan compensation, which represents cash annual incentive plan awards earned as a percentage of their respective target awards, according to the company’s proxy statement. The insurer posted solid results in the first quarter and second quarter of 2024, but it struggled with rising MLRs in the third quarter and fourth quarter.

Meanwhile, after several disappointing quarters that were mostly due to challenges in its Aetna segment, CVS replaced its President and CEO Karen Lynch with David Joyner, president of CVS Caremark, in October 2024. Joyner earned $17.8 million in 2024, while Lynch logged $23.4 million.

Humana’s new CEO Jim Rechtin earned over $15.5 million since he assumed the role in July. In January 2024, the insurer surprised investors when it lowered its adjusted earnings per share guidance to about $16 for the year, down significantly from its previous estimate of about $25. Though still facing challenges in Medicare Advantage market, the insurer reported fourth-quarter earnings that slightly exceeded analyst expectations.

This infographic was reprinted from AIS Health’s weekly publication Health Plan Weekly.

In 2024, the health care sector reported 14 data breaches that involved more than 1 million patient records, representing almost 70% of the U.S. population, according to an AIS Health analysis of data from the HHS Office for Civil Rights (OCR).

In total, there were 734 health care data breaches that were large enough to report to OCR in 2024, a slight decrease compared to 747 breaches in 2023. However, 2024 was the worst-ever year in terms of the number of patients affected, as a data breach targeting UnitedHealth Group subsidiary Change Healthcare affected an estimated 190 million individuals.

In recent years, some of the biggest breaches targeted health care providers and business associates, such as third-party administrators that assist plans with claims processing or consultants that perform utilization reviews for hospitals. In 2024, more than 221 million health care records were exposed or stolen in data breaches at business associates compared to 40 million records in breaches at health care providers.

Breaches caused by hacking and IT incidents have skyrocketed since 2019, reaching 598 incidents in 2024 and becoming the leading cause of data breaches in the health care industry.

The largest health care data breach of 2024 — and of all time — occurred at Change Healthcare. In February, a hacking gang operating as ALPHV/BlackCat breached a server using stolen credentials and moved within the system for several days exfiltrating data before deploying ransomware. The attack then set off weeks of provider payment disruptions nationwide. UnitedHealth spent $3.1 billion responding to the attack in 2024, according to its financial results released in early January.

The second-largest health care data breach of 2024 involved Kaiser Foundation Health Plan, potentially affecting up to 13.4 million people’s protected health information. In May 2024, the health plan notified its members that certain online technologies on its websites and mobile apps may “have transmitted personal information to third-party vendors Google, Microsoft Bing, and X (Twitter),” according to the company.

In September 2024, CMS reported that the health information of almost 1 million individuals was potentially compromised in connection with a data breach affecting its contractor WPS, which handles Medicare Parts A and B claims for beneficiaries in multiple states. The notification came almost 16 months after a security vulnerability was discovered in MOVEit, a third-party file-transfer software used by the contractor. CMS later reported on HHS’s breach portal that the total number of affected people was 3,112,815.

This infographic was reprinted from AIS Health’s weekly publication Health Plan Weekly.

Premiums for many stand-alone Medicare Part D Prescription Drug Plans will go up moderately in 2025, while the number of PDP options for beneficiaries will drop significantly, according to AIS Health’s analysis of the recently released CMS Medicare Advantage and Part D landscape files.

The Inflation Reduction Act, passed in 2022, ushered in a host of policy changes to the Part D benefit that will take effect in 2025: Most notably, Medicare Part D beneficiaries’ out-of-pocket drug costs will be capped at $2,000 annually and Part D plan sponsors will be responsible for 60% (up from 20%) of any costs their enrollees incur beyond that cap. As a result, the Medicare Part D national average monthly bid amount (NAMBA) is projected to increase by $115, nearly 180%, to $179.45 in 2025.

At the same time that it released the 2025 NAMBA, the federal government unveiled the Part D Premium Stabilization Demonstration, which capped premium increases at $35 per month and applied a $15 reduction to the base beneficiary premium for all participating PDPs. In a fact sheet accompanying the release of the landscape files for 2025, CMS estimated that the Part D premium will decline by $7.45 to $46.50 next year, and the average PDP premium will drop by $1.63 to $40.00.

AIS Health’s analysis of CMS data showed that PDP premiums among the 12 national plans will range from $127.23 for Humana Premier Rx Plan to $2.55 for Centene Corp.’s Wellcare Value Script in 2025. The monthly premium for Wellcare Value Script — the largest PDP by enrollment in 2024 — will increase by $1.81 year over year. AARP Medicare Rx Preferred, offered by UnitedHealth Group, will see its premium drop by $15.75, from $104.94 in 2024 to $89.19 next year.

Meanwhile, the number of PDP options for beneficiaries will drop 26% year over year, from 709 in 2024 to 524 in 2025. That is the lowest number of PDPs available since Part D started in 2006.

A KFF analysis of monthly premiums for PDPs in California also painted a mixed picture: Enrollees in eight of the 16 national PDPs offered in 2024 will see their premiums increase by $35 if they do not switch to a different plan in 2025, while enrollees in six other national PDPs will see a premium reduction. SilverScript SmartSaver, offered by CVS Health Corp.’s Aetna, will no longer be available in 2025 and its enrollees will be switched into Aetna’s sole PDP offering for 2025, SilverScript Choice, unless they choose another plan. Because of the switch, those customers’ monthly premium will see a $35 increase, from $18.60 to $53.60. Without the implementation of the Part D Premium Stabilization Demonstration, premium growth would be even more significant, according to KFF.

Rising premiums and fewer options in the PDP market may lead to substantial enrollment shifts, with more enrollees switching from traditional Medicare to Medicare Advantage Prescription Drug plans, the study suggested.

According to AIS’s Directory of Health Plans, the four largest PDP insurers by market share — Centene, Aetna (under the name SilverScript Insurance Company), UnitedHealth Group and Cigna Healthcare — accounted for almost 80% of enrollment as of September 2024. Centene reported year-over-year membership growth of nearly 49.2%, while Aetna saw a double-digit loss at 19.7%. Both UnitedHealthcare and Aetna reduced their PDP offerings in 2025.

This infographic was reprinted from AIS Health’s biweekly publication Radar on Drug Benefits.

Privately insured enrollees are generally satisfied with their health plan selection process and benefits, according to recently released data from the Employee Benefit Research Institute (EBRI) and Greenwald Research.

The Consumer Engagement in Health Care Survey found that the majority of adults surveyed obtained their health insurance coverage through their job or a spouse’s job. Most individuals said they were satisfied with various aspects of their health plan coverage. Over half of enrollees were extremely or very satisfied with their open enrollment process.

When selecting plans, good provider networks was the factor valued by the highest share of enrollees (78%), followed by low out-of-pocket costs (73%) and low premiums (72%).

About two-thirds of individuals said they have a choice of health plan. Adults with high-deductible health plans (HDHPs) were more likely to have three or more health plans to choose from, compared with adults with traditional health plans.

Enrollment in health savings account (HSA)-eligible health plans and health reimbursement arrangements (both of which are known as consumer-driven health plans) leveled off in recent years, bouncing between 18% and 19% between 2020 and 2023. Enrollment in HDHPs that were not eligible to be paired with a health savings account (HSA) fell from 12% in 2022 to 9% in 2023.

Among enrollees who opened HSAs, the top reason was to take advantage of employer contributions (60%), followed by saving for future health care expenses (58%) and on taxes (52%). Over 60% of people saw their HSA as a savings account, while 31% viewed it as an investment account, according to the survey.

“Employers have an opportunity to educate their employees on HSAs. Many accountholders feel having more information would make them more likely to invest their unused funds. For non-accountholders, interest remains high when shown important product features,” Greenwald Research CEO Lisa Greenwald said in a statement.

However, employee satisfaction surveys do not always tell the whole story, according to the 2024 State of Employee Health Benefits Report, produced by SureCo, a platform that offers large and medium-sized companies’ personalized health coverage through Individual Coverage Health Reimbursement Arrangements (ICHRAs). The report was based on responses from 1,637 employees, human resources and finance leaders, and benefits consultants.

While about 84% of employees surveyed said they were satisfied with their health care benefits, about 59% said they would leave their current company for another one with better health benefits. Seventy-nine percent of employees said their plan is sufficient to cover medical problems that may come up in the future, however, almost half of them said they’ve considered alternative health coverage outside of their employers’ offerings, according to the report.

Employees’ main concerns included high out-of-pocket costs, limited coverage and accessibility to the services that they need. Eight out of 10 employees said they would prefer to select their own plan from all available options rather than pick from the options their company offered.

The report also noted that to better control the rising health care costs, only 35% of employers were using traditional, fully insured health plans, while another 33% have already moved to self- or level-funded plans.

This infographic was reprinted from AIS Health’s weekly publication Health Plan Weekly.

The average annual premium for employer-sponsored health insurance in 2024 hit $8,951 for single coverage and $25,572 for family coverage, according to the KFF 2024 Employer Health Benefits Survey. This is the second year in a row that family premiums went up 7%, compared to a 4.5% year-over-year increase in workers’ wages and a 3.2% rise in inflation. Over the past 10 years, growth of the average premium for family coverage outpaced the rate of inflation (52% vs. 32%), while the average family premium and average wages grew at comparable rates (52% vs. 45%).

While employers have seen their total premiums rise steadily, the amount that employees, on average, paid toward their annual premiums has changed little over the past five years. In 2024, employees contributed 16% of the premium for single coverage and 25% of the premium for family coverage, and both were lower than the average contribution levels last year. Employees with single coverage at small firms (under 200 workers) were more likely to enroll in plans with no premium contribution (37%), compared with only 5% of workers at large firms.

The average annual deductible for workers with single coverage was $1,787 in 2024, similar to last year’s $1,735. On average, workers at small firms faced much larger deductibles than workers at larger firms ($2,575 vs. $1,538).

“Employers are shelling out the equivalent of buying an economy car for every worker every year to pay for family coverage,” KFF President and CEO Drew Altman said in a press release. “In the tight labor market in recent years, they have not been able to continue offloading costs onto workers who are already struggling with health care bills.”

To assist their lower-wage employees, some firms offered programs to reduce cost sharing (6%) or to reduce premium contributions (14%) in 2024. Among firms with 200 or more workers, 14% offered a plan with reduced benefits and a low premium contribution to make it more affordable for lower-wage workers.

The growing interest in weight-loss drugs, GLP-1 agonists, along with their hefty price tags, has posed a major challenge for employers. In 2024, only 18% of firms with 200 or more workers covered GLP-1s when used primarily for weight loss. And when they provided such coverage, over half of the polled firms required certain steps before the coverage was approved. Most commonly, the firms asked employees to meet with a professional, such as a dietitian, psychologist, case worker or therapist, before approving a GLP-1 drug prescription.

Among firms with 200 or more workers that did not cover GLP-1s primarily for weight loss, 62% said that they were “not likely” to begin covering these medications for weight loss within the next 12 months, and only 3% say that they were “very likely” to do so.

This infographic was reprinted from AIS Health’s weekly publication Health Plan Weekly.

Kaiser Permanente unveiled plans to acquire Geisinger Health and make it the first member of a new value-based nonprofit health organization called Risant Health, if the deal gains regulatory approval.

Kaiser Permanente’s health insurance products cover more than 11 million people in eight states and the District of Columbia, according to AIS’s Directory of Health Plans. Combined, Kaiser’s seven regional managed care plans form the largest provider-sponsored insurer, enrolling 28.1% of all provider-sponsored lives. It is the largest insurer in the commercial risk market, with over 9 million members. It also ranks as the fifth-largest Medicare Advantage health plan in the nation.

Geisinger Health operates the ninth-largest insurer in Pennsylvania, Geisinger Health Plan, which currently serves 615,147 members. Under the deal, Geisinger will keep its brand identity and its mission.

As one of the largest nonprofit health systems in the U.S., California-based Kaiser Permanente operates 39 hospitals and 737 medical clinics across eight states and the District of Columbia. In 2022, the organization reported $95.4 billion in operating revenue, a $1.3 billion operating loss and a $4.5 billion net loss. The nonprofit Geisinger Health owns 10 hospital campuses in Pennsylvania, with service areas mainly covering the northeast and central regions of the state. It reported $6.9 billion in operating revenue during 2022 but swallowed a $239 million operating loss and a $842 million net loss.

The Kaiser Permanente-Geisinger deal reflects the rebounding trend in health care merger and acquisition activity post-pandemic. A Kaufman Hall report showed that 2022 logged a total of 53 announced transactions, with a combined revenue of transacted hospitals over $45 billion. Fifteen percent of the announced transactions were a “mega merger,” in which the smaller party has annual revenues in excess of $1 billion, just below 2021’s historic high of 16.3%.

The report also highlighted the trend of cross-market transactions, which connect health systems located in different geographic areas with little or no overlap between markets. In 2022, Advocate Health in the Midwest and Atrium Health in North Carolina closed their mega merger to create a 67-hospital health system. UnityPoint Health in Iowa and Presbyterian Healthcare Services in New Mexico just proposed merging last month.

This infographic was reprinted from AIS Health’s weekly publication Health Plan Weekly.