The Regulator

The Affordable Care Act subsidy verification proposal publishes in the Federal Register October 27, starting a 30-day comment clock. The Centers for Medicare & Medicaid Services (CMS) announced the rule (CMS-9873-P) October 23, and the Federal Register’s public inspection list now shows it scheduled for publication tomorrow. Under it, Exchanges would verify income, family size, citizenship or immigration status, other coverage and residence before paying advance premium tax credits or cost-sharing reductions, though people could still enroll without help while verification is pending. Current enrollees would keep subsidies at renewal only if they return and re-verify, and everyone else would be re-enrolled without them. The first verification window would open August 1, 2027, for 2028 coverage. Who it hits: Exchange enrollees, brokers and insurers whose enrollment depends on subsidies. So what: if the 30 days run from October 27, comments would be due around November 26, Thanksgiving Day, so the published notice’s own date controls. CMS gives no estimate of coverage loss or federal savings. Confidence: High on the provisions; Med on the deadline. Sources: CMS fact sheet on the proposed rule, Federal Register public inspection listing.

California Proposition 40 would send 90% of a one-time billionaire wealth tax to health care, and voters decide November 3. The state’s nonpartisan Legislative Analyst says the 5% tax on the net worth of billionaires who lived in California on January 1, 2026 would probably raise tens of billions of dollars over several years, with payments due in 2027 and an option to spread them over five years at a higher cost. Ninety percent of the money must go to health care services for the public, and the rest to education, food assistance and administering the tax. The same analysis warns of a possible ongoing loss of less than $1 billion a year in income tax revenue if billionaires leave or shift income, and administration costs of tens of millions of dollars a year. Who it hits: Medi-Cal (the state Medicaid program), the hospitals and clinics that depend on it, and the state General Fund. So what: the yield is hard to predict because it depends on stock prices and on what billionaires do, and the Analyst says exactly that. Confidence: High on the terms and the Analyst’s ranges; Low on actual collections. Sources: Legislative Analyst’s Office analysis of Proposition 40, California Secretary of State voter guide.

Four states vote November 3 on abortion measures that would change who regulates care. Missouri’s legislatively referred Amendment 3 would repeal the 2024 abortion-rights amendment and ban abortion except for medical emergencies, fatal fetal anomalies, and rape or incest at 12 weeks or less. Nevada votes a second time on a constitutional right to abortion until viability. Virginia’s amendment would protect abortion until the third trimester along with contraception and fertility care, and early voting there began September 18. Idaho’s Proposition One would create a statutory right before viability, which the legislature could later amend or repeal, after the state Supreme Court ordered rewritten ballot language September 4. Who it hits: patients, clinicians and hospitals in four states, plus the insurers and employers that cover reproductive care. So what: constitutional amendments are far harder to reverse than statutes. Confidence: Med, because this summary rests on the KFF tracker and we did not review the four states’ official ballot texts. Sources: KFF tracker of 2026 abortion ballot initiatives.

Illinois: a laboratory owner is charged in a $66.2 million scheme billing for COVID-19 tests that were never performed. Rajesh Patel, 52, of Schaumburg, was indicted by a federal grand jury in the Northern District of Illinois, according to a listing the Department of Health and Human Services Office of Inspector General dated October 20. The listing says he billed for hundreds of thousands of tests that were never performed. Who it hits: Medicare and other payers that reimbursed the claims, and legitimate labs that compete against inflated billing. So what: $66.2 million is the amount prosecutors allege in fraudulent billing, not a proven loss, and Patel is presumed innocent until convicted. The listing does not state the counts or maximum penalties, and we could not retrieve the Justice Department’s release. Confidence: High that he was indicted; Low on the charges and final loss. Sources: HHS Office of Inspector General enforcement listing.