Core Insights - The report from Gimme Credit highlights increasing pressures on U.S. health insurers due to regulatory scrutiny and funding risks in Medicare Advantage, Medicaid, and ACA exchange programs [1][2]. Regulatory Environment - The Centers for Medicare & Medicaid Services (CMS) is intensifying audits and expanding its medical coding team from 40 to 2,000 in response to increased medical utilization and concerns over risk upcoding in Medicare Advantage plans [2]. - Leading insurers like UnitedHealthcare and Humana are implementing internal controls to prepare for stricter regulations [2]. Medicaid and ACA Exchange Risks - Proposed changes in Medicaid, including work requirements and funding cuts, could potentially displace 8–10 million individuals from coverage, although full implementation of these proposals is deemed unlikely [3]. - The ACA exchanges, currently covering 21.4 million Americans, face significant risks if premium subsidies expire in late 2025, which could lead to a 75% increase in premiums and result in 3.8 million losing coverage [3]. Insurer Strategies - Insurers are focusing on rebuilding trust by committing to streamline prior authorizations and enhance patient communication by 2027, which may slightly increase costs but is expected to improve long-term member satisfaction and regulatory goodwill [4]. Market Outlook - The report anticipates that 2025 will be a transitional year for health insurers, particularly those reliant on government-funded plans, with Medicaid expected to experience the most significant cuts while Medicare Advantage and ACA exchanges remain relatively stable [5]. - Gimme Credit plans to monitor Q2 results closely and adjust credit ratings as necessary [5].