Capitol Hill Abuzz With Exchange Negotiations
Washington, D.C is abuzz with at least some compromise talk on finding a way to extend the enhanced Exchange subsidies Dr. Mehmet Oz, administrator of the Centers for Medicare and Medicaid Services (CMS), said that the Trump administration is “willing to look at all options” regarding the subsidies. “But we have some major flaws with the way these COVID-era subsidies were added. And just so everyone’s on the same page in this issue, our goal is to get people covered,” he added.
At the same time, President Donald Trump wants to send payments to Americans directly instead of to insurers and allow them to purchase their own insurance. The president said he has been talking with Democrats about a direct health care payment plan as one way to tackle rising health insurance premiums. “The insurance companies are making a fortune,” he said. “Their stock is up over a thousand percent over a short period of time. They are taking in hundreds of billions of dollars, and they’re not really putting it back, certainly like they should.” Not quite, Mr. President.
Republicans on the House Ways and Means Committee are considering a bill that aligns with Trump’s pitch, yet they want to tackle what they see as huge fraud in the Exchange program.
Last, Sen. Chris Murphy, D-CT, said he believes it was a mistake for Democrats to reopen the government without a solution on the subsidies.
Additional article: https://thehill.com/policy/healthcare/5608268-dr-oz-comments-aca-flaws/ and https://www.beckerspayer.com/payer/aca/house-republicans-weigh-sending-aca-dollars-to-consumers/ and https://thehill.com/homenews/senate/5608324-murphy-criticizes-democrats-aca-government-funding/
#exchanges #healthcare #coverage
https://thehill.com/policy/healthcare/5608731-trump-democrats-direct-healthcare
Huge Surge In Part B Premiums in 2026
Medicare Part B premiums will rise by a whopping almost 10% in 2026 according to an announcement last week by the Centers for Medicare and Medicaid Services (CMS). The hike is 9.7%, or $17.90 higher than the 2025 standard premium rate of $185.00. This jump is almost twice the percentage increase seen in 2025, when the standard monthly Part B premium rate went up from $174.70 in 2024 to $185.
Additional articles: https://thehill.com/policy/healthcare/5609430-medicare-part-b-premiums-2026/ and https://www.beckerspayer.com/financial/medicare-part-b-premiums-to-rise-in-2026/
#medicare #premiums
Pence Group Attacks Trump On Drug Price Reform
Showing just how out of step some Republicans are on drug price reform, a conservative group led by former Vice President Mike Pence unveiled an ad attacking President Donald Trump’s drug pricing reforms, which include most-favored-nation pricing. It calls Trump’s plan “socialist price controls.”
Of course, Pence offers no definitive plan to bring relief to Americans other than to attack Trump. As usual, conservative groups tend to carry water for Big Pharma and Pence’s group is no exception. Whatever some issues with Trump’s plan, at least the president is attempting to change the paradigm.
#drugpricing #trump #branddrugmakers #mfn #irp
https://thehill.com/policy/healthcare/5609587-pence-group-targets-trump-drug-policy
Insurer News Aplenty
A great deal of insurer news today.
- Blue Cross and Blue Shield of Massachusetts reported a year-to-date net loss of $101.4 million on revenue of $7.7 billion (a -1.3% net margin). It expects to end the year with operating and net losses.
- Nonprofit health insurance company Medica has offered an undisclosed sum for rival UCare’s Medicaid and Exchange businesses. Medica, which has more than 1.4 million members across nine states, would gain nearly 262,300 covered lives from the acquisition.
- Provider groups owned by big insurers are struggling and they plan on demanding better payments and revenue from insurers. Because of vertical integration, that means UnitedHealth Group’s providers will demand more from UnitedHealthcare and Oak Street Health’s from CVS’ Aetna – not that the insurers can afford it right now. This is a result of major issues at the two entities from the v28 risk model in Medicare Advantage (MA). Humana appears to have weathered the storm on the issue better.
- Three major medical organizations are urging Anthem to withdraw a policy that would penalize hospitals and outpatient facilities that use out-of-network providers.
Additional articles: https://www.beckerspayer.com/financial/bcbs-massachusetts-expect-to-end-the-year-with-operating-net-losses/ and https://www.modernhealthcare.com/insurance/mh-medica-ucare-medicaid-aca-exchange-acquisition/ and https://www.fiercehealthcare.com/payers/anthem-may-penalize-facilities-use-out-network-providers-heres-why and https://www.beckerspayer.com/m-and-a/ucare-to-wind-down-operations-sell-assets-to-medica/
(Some articles may require a subscription.)
#healthcare #healthplans #margins #exchanges #medicaid #providers #medicareadvantage #elevancehealth
https://www.modernhealthcare.com/insurance/mh-unitedhealth-optum-cvs-oak-street-value-based-care
— Marc S. Ryan
