What if Congress bans spread pricing by Medicaid drug middlemen?
A Medicaid PBM spread-pricing ban compresses CVS/Cigna/UNH pharmacy-benefit profit pools — short the three PBM-integrated payers, a managed-care-specific hit. Rhymes with the late-2023 PBM-reform scare and UNH's 2024-25 MLR-driven drawdowns, contained to healthcare. The generic crypto cascade is irrelevant; no meaningful macro transmission.
how we built this number — every step
The class rate is measured from our dated, sourced event library (decade-normalized Poisson — the full table is public at base_rates.json). The variant’s share within its class is the analyst’s editorial call, published so you can audit it. A wider range means thinner precedent. Full recipe: methodology · scored at Reality Check.
The butterfly cascade
How this trigger trickles across markets, left → right — the root shock, its first‑order moves, then the ripple effects. Drag any node; tap a market for its real price history.
Resolution timeline — how this probability is moving
Our model's odds (gold) over time vs the crowd's (Polymarket, blue), from the past toward the 1–3 years horizon. Each dot is a real macro event that nudged the probability — green pushed it up, red pushed it down. Tap a dot for the source. The gold path is an illustrative reconstruction anchored to today's estimate — real dated events, not a live re-estimate history.
What it would mean
If this plays out, it is a mixed shock. Congress enacts the dropped Medicaid spread-pricing ban, extending de-linking to managed-care plans and further compressing CVS/Cigna/UNH pharmacy-benefit profit pools. The trigger decomposes into signed root‑shocks — Risk appetite ▼ — which propagate through our causal graph to the markets below.
If it happens — the markets it would move
Biggest moves first. Projected moves are cascade-model priors; hist A–B% = what comparable past events actually did (measured abnormal returns), and model prior · unmeasured marks markets with no analogue backing yet. Tap any market for its price history.
| Market | Class | Projected move |
|---|
Historical precedent — what analogous events actually did
Across 40 analogous events (overlap‑weighted), as abnormal returns — market beta stripped, so it's the event's own effect, not the market backdrop. Shown at 20 days (persistent) and 5 days (immediate); ↺ fades = the two horizons disagree. Confidence = consistency × sample × significance.
| Asset | History says | Abnormal (20d · 5d) | Hit | n | Confidence | vs cascade |
|---|---|---|---|---|---|---|
| Bitcoin BTC | SHORT | -4.5% · 5d -3.4% | 60% | 40 | 0.15 | · |
| Gold XAU | LONG | +0.2% · 5d -0.3% ↺ fades | 57% | 40 | 0.13 | · |
| High-yield credit HYG | SHORT | -0.0% · 5d +0.2% ↺ fades | 55% | 40 | 0.07 | · |
| US dollar DXY | SHORT | -0.0% · 5d -0.1% | 53% | 40 | 0.05 | · |
| Volatility VIX | SHORT | -0.8% · 5d +0.1% ↺ fades | 53% | 40 | 0.04 | · |
| 10y yield DGS10 | LONG | +2bp · 5d +1bp | 53% | 40 | 0.04 | · |
Why this probability
Medicaid spread-pricing ban dropped before; PBM reform stalls in Congress, modest odds over 1-3y. A base‑rate‑anchored prior, continuously scored against what actually happens — not a forecast.