Matt dives into a specific healthcare topic to help those in the industry, and those outside of it, better understand the market drivers causing today’s healthcare challenges.

Two million children lost Medicaid or CHIP coverage since January 2025. CMS just signed the rules that do the rest. Georgetown counted the disenrollments. The tax law behind them strips close to a trillion dollars out of Medicaid. Every healthcare company that sells into covered lives owns a piece of what happens next, whether they planned for it or not.

Here is how the machine works. States must verify work compliance through automated digital systems. When the system flags an enrollee, the clock starts. That person gets 30 days to prove they worked, or prove they qualify for an exemption, or lose coverage. The exemptions decide who survives the clock. KFF found that 26 states will offer all four hardship exemptions, the carveouts that protect parents of children under 13, the medically frail, and people who are pregnant or postpartum. Indiana and Iowa will offer none. Same federal rule. Two different countries, sorted by zip code. A pregnant woman in one state keeps her coverage by default. A pregnant woman across the border has to fight an algorithm for it. We see the shape of this at ELAVAY before any dataset does. Advocacy organizations field the disenrollment calls weeks ahead of the official numbers. The parent who cannot upload a pay stub in time calls the patient group, not the state. That call is the earliest warning signal in the system, and most companies never hear it.

Walk into most commercial planning meetings right now and you will hear demand forecasts built on coverage that no longer exists. Teams model next year's covered lives off last year's enrollment, as if the trillion dollars never left the program. The brand plan assumes a stable denominator. The law already broke that denominator.

The managed care giants feel the squeeze first. States facing their own budget gaps lean on Centene, UnitedHealth, and Elevance, and those companies pass the churn straight downstream to patients and providers. Meanwhile the advocacy function shows up in the budget as a logo on a conference banner. They fund it like charity. They treat it like a tax write-off. They sponsor the patient group and call it a relationship. They bought a logo. They ignored the intelligence.

The companies that lead do the opposite, and they do it on purpose. They fund the advocacy function with real budget, real headcount, and real decision rights. The head of advocacy sits in the room where leaders build the brand plan, not in the hallway afterward. They treat field intelligence as an early-warning system. When the disenrollment calls spike, the data flows up, not into a quarterly report nobody reads.

They document the patient stories, the parent who lost coverage over a missed upload, the cancer patient stuck in a verification loop, and they carry those stories to state Medicaid directors while the exemption rules still sit in draft. Influence lands while the policy stays soft. The ELAVAY data shows the pattern plainly. The companies that improved their score year over year did it through real investment in the function. They bought headcount and authority. The ones that stalled bought logos.

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So do three things, starting this week.

The cliff is already here. Two million children went over the edge while the forecasts said the ground held firm. You can see the next drop coming if you choose to look.

Get the 2026 ELAVAY report to see if your reputation with the patient community will allow you to help, or run the Advocacy Influence Diagnostic to measure whether your advocacy function holds the internal influence to act on any of this. Reach me directly at [email protected].