How the showdown over ACA subsidies has spurred debate on broader healthcare reforms.
Aetna delaying new inpatient payment policy.
Applications for the 2026 cohort of the Healthcare Leadership Academy.
Showdown over ACA subsidies spurs debate on broader healthcare reforms
Negotiations over the Affordable Care Act’s (ACA) enhanced premium tax credits remain highly inflamed as the Dec. 31, 2025 expiration date quickly approaches.
While Senate Majority Leader John Thune committed to hold a vote on extending the subsidies by mid-December, too few GOP lawmakers have publicly come on board for a straight extension to pass.
Democrat leadership is so far continuing to hold firm on a clean extension of the subsidies, but many moderate Democrats have signaled a willingness to negotiate modifications as part of an extension.
Although vulnerable GOP moderates prefer to extend the tax credits, President Trump's opposition makes an extension increasingly unlikely.
The President has expressed support only for "sending the money directly back to the people” and directed Congress not to “waste your time and energy on anything else.”
It is unclear exactly how a GOP alternative would work. Senate Finance Committee Chairman Bill Cassidy outlined a plan on Monday that would redirect the enhanced subsidies to Health Savings Accounts to help some enrollees pay out-of-pocket costs.
The Senate Finance Committee held a hearing on Wednesday to discuss not only the ACA tax credits but also ideas for broader healthcare reforms.
Republicans are reportedly eying a second reconciliation bill for next year aimed at addressing healthcare affordability in particular.
Without an extension of the enhanced ACA subsidies by the end of the year, millions of Americans could see their monthly premiums more than double. According to the Bipartsian Policy Center, about 92% of enrollees in ACA marketplace plans — about 22.4 million Americans — have received advance payments of the enhanced tax credits in 2025.
Aetna delays new inpatient payment policy
Aetna is postponing its “level of severity” inpatient payment policy to Jan. 1, 2026, after initially planning a Saturday, Nov. 15, 2025 rollout.
The insurer also narrowed the scope. The new policy applies to Medicare Advantage and Dual-Eligible Special Needs Plans.
Why it matters: The original policy could have resulted in inpatient denials and observation downgrades.
The revised version ensures inpatient approval but adjusts payment based on severity. Aetna states this approach complies with Center for Medicare and Medicaid Services guidance while aiming to reduce administrative burden.
Updated details:
Applies only to urgent/emergent stays of one to four midnights.
Stays of five or more midnights remain at full inpatient DRG rates.
Providers can request a severity review if criteria aren’t met.
Members will continue to receive inpatient benefits regardless of severity determination.
While Aetna argues that this policy will speed up reimbursement, hospitals have raised concerns about reimbursement levels and clarity of severity determinations.
What’s next: AzHHA is soliciting feedback from our members on this revised policy. Please submit feedback to Amy Upston, director of financial policy and reimbursement.
Apply now: Healthcare Leadership Academy
Applications are currently being accepted for the 2026 cohort of the Healthcare Leadership Academy (HLA).
The AzHHA Foundation partners with Creighton University’s College of Professional and Continuing Education to provide healthcare leadership and management education to rising leaders within AzHHA member hospitals.
Nine months of learning begins in March 2026 and culminates in November 2026 which includes three in-person and six virtual sessions.
The HLA is geared toward mid-level managers and early-stage executives to prepare them for C-suite positions.
This is third cohort of the HLA. Learn more about the program here.
What’s next: To apply, submit your resume, letter of support and statement of purpose in one PDF to memberservices@azhha.org by 5 p.m. on Friday, Nov. 28, 2025.
If you have any questions, please contact Laura Dickscheid, vice president of member services and 2024 HLA participant, at memberservices@azhha.org.
Be the voice for Arizona hospitals
The AzHHA Political Action Committee (PAC) aims to ensure that hospitals have a strong and coordinated presence in the policy decisions shaping our industry.
Why it matters: The legislative and regulatory decisions made at the Arizona Capitol and on Capitol Hill directly impact funding, workforce development, reimbursement policies, operational flexibility and patient access. These choices significantly affect hospitals, and your involvement is crucial to ensure that our sector is represented clearly and effectively.
How your support drives impact
Protect access: Your support helps protect vital services in rural and underserved areas where stability is most fragile.
Shape policy: It provides hospitals with a unified voice in discussions that impact everything from payment models to emergency preparedness, licensure and oversight.
Strengthen communities: Hospitals play a crucial role in supporting Arizona's families, economy and workforce. A strong advocacy effort is essential to continue meeting the state’s needs.
The bottom line: Supporting the AzHHA PAC is an investment in the long-term strength of Arizona's healthcare system.
Whether through a one-time gift or a recurring contribution, you help ensure hospitals remain involved in critical decisions.
Member spotlight: Onvida Health partners with SAVAHCS to unveil a brand new Veteran’s medical facility
Onvida Health announces, in partnership with Southern Arizona VA Health Care System (SAVAHCS), the construction of a brand new, state-of-the-art medical facility (rendering above) dedicated to serving the Yuma Veteran community.
Set to break ground in December 2025, the 30,000-square-foot, free-standing facility will be located on the Onvida Health Foothills Medical Plaza.
Why it matters: The facility will offer primary care, women’s health, physical and occupational therapy, audiology, optometry, and laboratory and imaging services.
With an estimated completion in summer 2027, the project marks SAVAHCS and Onvida Health’s long-term investment in the health, dignity and well-being of Yuma Veterans.
Friday, Nov. 28 - Healthcare Leadership Academy application deadline Applications are currently being accepted for the 2026 cohort of the Healthcare Leadership Academy. The AzHHA Foundation partners with Creighton University’s College of Professional and Continuing Education to provide healthcare leadership and management education to rising leaders within AzHHA member hospitals. To apply, submit your resume, letter of support and statement of purpose in one PDF to memberservices@azhha.org by 5 p.m. on Friday, Nov. 28, 2025.
