The Lobby · November 4, 2026
Who Controls American Hospital Policy
The American Hospital Association seats a new board on January 1 under a new CEO. Thirty-two people, their pay, their lobbying and their red flags, sourced to public filings.
Read the AHA dossiers →Every fight over the rules, one table
As of November 6, 2026
Site-neutral pay: drug administration at off-campus hospital departments
In effectJan. 1, 2026 · Final rule. Paid at the physician-office rate.
Site-neutral pay: imaging without contrast
FinalNov. 4, 2026 · CY2027 Medicare outpatient final rule. Physician-office rates from Jan. 1, 2027; rural sole community hospitals exempt.
Hospital price transparency
EnforcedApr. 1, 2026 · Hospitals must post actual allowed amounts; a senior official attests.
340B program: Medicare payment cut
FinalNov. 4, 2026 · 340B drugs paid at ASP minus 28% from Jan. 1, 2027, down from ASP plus 6%. CMS had proposed minus 33.4%.
340B program: rebate model
In courtOct. 9, 2026 · AHA sued to stop the revised pilot set to start Jan. 1, 2027.
Physician-owned hospital ban
UnchangedNov. 2026 · Physician-led competitors stay locked out.
Medicaid provider taxes and state-directed payments
EnactedJuly 4, 2025 · New provider-tax cap began Oct. 1, 2026; payment cuts start 2028.
Certificate of need
State by state2026 sessions · Where repeal and reform stand in every CON state.
Gold: the hospital lobby held the line. Green: the reform happened. White: still being fought.
Intelligence, by desk
Washington
Who writes the rules
Ways & Means
Every member's healthcare record, votes and money.
Healthcare Advisory Committee
Who advises HHS and CMS, and what they stand to gain.
18
members, none for physician ownership
Coming: Energy & Commerce · Senate HELP · Senate Finance · GOP Doctors Caucus · Machine Score
The Lobby
Who buys the outcome
American Hospital Association
The 2027 board and executive team: pay, lobbying, red flags.
$25.5M
federal lobbying, 2025
Federation of American Hospitals
The for-profit hospital lobby: board, lobbying, PAC, eight fights.
Coming: Lobbying firms · Hospital PACs · State hospital associations
The Systems
Who gets paid
Coming: Every nonprofit health system · Executive pay
The Fights
How the game is rigged, and who's trying to change it
Certificate of need
Rankings, case law and reform status in every CON state.
35
jurisdictions require permission to compete
Physician-owned hospitals
The 2010 ban on physician-owned hospitals, state by state.
Coming: 340B program reform · Site-neutral payment · Price transparency · Single payer · Stark and Anti-Kickback
The States
Where it costs you
Coming: State dossiers · AG oversight of nonprofit systems
From The Rojas Report
- He Meant Every WordNov 4, 2026
- Who Holds the Contract?Nov 3, 2026
- Who Buys Your Care?Nov 1, 2026
- You Are the SupplyOct 31, 2026
What you can do about it
For independent physicians: own what you build, contract directly, and stop financing the systems that compete with you.