Challenges with the Medicare Advantage quality rating system are colliding with a broader reckoning over how the federal government pays Medicare Advantage plans.

Why it matters: The five-star rating system, which governs billions of dollars in Medicare Advantage bonus payments, could be ripe for an overhaul as policymakers question how much the privatized Medicare program should cost taxpayers.

• There's growing interest in making sure plans are paid appropriately, said Jeannie Fuglesten Biniek, deputy director of KFF's program on Medicare policy.
• "I see continued conversations about how to make changes ... along a number of dimensions," she said. The star ratings system is "just one of them."

Driving the news: Last week, the Trump administration appealed a federal judge's decision that invalidated the quality rating for insurer Clover Health's contract.

• Clover Health sued the federal government over its 2026 rating in April, arguing that Medicare administrators used unlawful metrics that caused its rating to drop. The favorable court decision will win the company about $120 million, if it stands.

How it works: Medicare Advantage insurers get bonus payments for contracts that earn at least four stars from CMS, which they can use to offer extra benefits popular with seniors.

• The rating calculations involve dozens of metrics and have become increasingly complex. Insurers have been taking CMS to court to boost their star ratings for years.
• Clover's case goes further by challenging the administration's legal authority to consider certain metrics, said Erica Socker, co-director of the Medicare Policy Initiative at Georgetown's Center on Health Insurance Reforms.

Zoom out: Momentum has been building to reform the ratings system. There's mounting evidence that it hasn't improved plan quality, and experts say it doesn't provide the right information to seniors deciding where to enroll.

• Right-leaning think tank Paragon Health in 2024 proposed getting rid of quality bonuses and focusing star ratings on health outcomes and patient experience measures. Advocates and lawmakers on the left have also pushed to end the quality bonus program altogether.

The other side: Health insurers maintain that Medicare Advantage offers seniors better care for lower costs.

• "As health plans incorporate and navigate new Star Ratings policies, they will continue to focus on keeping coverage and care as affordable as possible during this time of sharply rising medical costs," Chris Bond, AHIP spokesperson, told Axios in a statement.

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The CDC made it official Friday that measles cases have passed last year's total (we told you about the Johns Hopkins University tracker that provided that warning earlier in the week).

• So let's take a closer look at where the cases are happening and which states are getting hit the hardest.

The big picture: Of the 2,318 confirmed measles cases, most — 2,302 — are spread across 45 "jurisdictions," per CDC. That's 44 states plus the District of Columbia.

• The other 16 cases were international visitors to the U.S.

Zoom in: The hardest-hit states, per CDC:

• South Carolina (670 cases)
• Utah (522 cases)
• Texas (188 cases)
• Virginia (176 cases)
• Florida (141 cases)
• Pennsylvania (134 cases)
• Arizona (108 cases)

Check out this piece by Axios' Herb Scribner for a deeper dive on what's driving the numbers in those states.

The bottom line: It's a tough time to be working in public health. The American Medical Association is practically begging Americans to get the measles vaccine.

✔ FDA advisers voted to recommend allowing pharmacists to compound six peptides. (Reuters)

⬆️ Cases of diarrhea-inducing parasite continue to rise in five states with outbreaks. (Axios)

🚛 Shipping and logistics companies are investing millions into temperature-controlled storage to keep up with the GLP-1 boom. (CNBC)

🍭 The Senate advanced a bipartisan bill to ban junk food ads targeted at kids and require warning labels on ultraprocessed food, in a win for MAHA. (Stat)