Exchange Subsidy Debate Still Dominates Hill
The Exchange subsidy debate continues to dominate Capitol Hill.
Sen. Amy Klobuchar, D-MN, predicted Sunday that the Senate will hold a vote on extending Exchange subsidies. “That vote will happen. And whether it will pass is in the hands of Donald Trump and the Republicans,” Klobuchar told CNN. Senate Majority Leader John Thune, R-SD, has committed to a vote, while House Speaker Mike Johnson, R-LA, has not.
House Minority Leader Hakeen Jeffries, D-NY, is pressing centrist Republicans to help Democrats extend the tax credits before they expire at the end of the month by signing on to his discharge petition to force a vote in the House. Moderate Republicans in the House say they have their own discharge petition but are waiting to see what the Senate does.
Many are critical of President Trump’s equivocation on the subsidies – in one breath he is ready to present an extension and mini-reform plan and in another backing away and saying he does not want to extend subsidies. Centrists in the GOP want a clean extension perhaps with some small conservative tweaks on income caps, minimum premiums, and fraud protections. But conservatives want a fairly major remake of healthcare, migrating to individually controlled subsidies for coverage.
Former George W. Bush White House deputy chief of staff and GOP strategist Karl Rove said Republicans need to have a healthcare agenda ahead of the midterm elections or they’ll be in “deep trouble.”
Additional articles: https://thehill.com/policy/healthcare/5627171-klobuchar-predicts-aca-senate-vote/ and https://thehill.com/homenews/house/5628255-obamacare-tax-credits-extension/ and https://www.politico.com/news/2025/12/01/trump-health-care-subsidies-congress-00671172
#exchanges #healthcare #coverage
https://thehill.com/homenews/campaign/5627604-gop-health-care-agenda
Health Plans On Star Changes
Health plans and experts are weighing in on the proposed Star changes from the Centers for Medicare and Medicaid Services (CMS). The two main changes are retiring 12 measures, mostly operational ones, and stopping the Excellent Health Outcomes for All (EHO4all) reward that replaces the Reward Factor. The EHO4all reward is the former Health Equity Index (HEI).
Plans admit that the elimination of the 12 measures represents a sea change and could impact plans as they tend to perform well on them. But most are cheering the return of the Reward factor instead of putting EHO4all in place. Trade groups for plans are especially happy. Consistently high performers will benefit the most. But those who do not receive the Reward Factor and have high penetration of duals eligibles and low income subsidy individuals lose an opportunity.
The way I see it:
- The larger regional plans benefit the most from restoring the Reward Factor as they tended to be the most consistent high performers.
- Most of the big national players have had some benefit from the Reward Factor in the past but not as much as the larger regional players. At the same, they are making heavy investments in Special Needs Plan (SNPs) and attracting dual eligibles. Meaning, they could perhaps go either way on this. But given their woes, they are likely satisfied with no more upheaval in Stars right now if the Reward Factor stays.
- Certain poorer performing national plans likely would have done better under the EHO4all, but that assumes they can serve dual eligibles better than they do today.
- The losers may be some of the smaller plans with high concentrations of dual eligibles and SNPs who have not traditionally scored well but counted on the EHO4all to move them up the Star scale.
I continue to question whether what the Trump administration is doing actually meets the expectations of the Administrative Procedure Act. See my blog on this today: https://www.healthcarelabyrinth.com/is-the-trump-2027-ma-and-part-d-rule-eliminating-the-eho4all-reward-for-sy-2027-actually-legal/ . Given all the uncertainty in Stars right now, plans may be happy with the status quo. But there could be some that accept the challenge and sue because they invested heavily in planning for EHO4all.
(Article may require a subscription.)
#medicareadvantage #partd #stars #quality #cms
https://www.modernhealthcare.com/insurance/mh-cms-medicare-advantage-star-ratings-program
Tariff Threat Sends UK Increasing Drug Prices
You have to give Donald Trump credit. He has threatened major drug tariffs on foreign nations unless they reform pricing abroad and he is getting his way. The United States and the United Kingdom announced a high-level trade deal that exempts U.K. pharmaceuticals from tariffs in exchange for Britain paying more for medicines.
Under the agreement, the U.K.’s socialized medicine program will increase the net price it pays for new medicines by 25 percent. In addition, the U.K. will increase the tax that drug makers have to pay to the government when drug spending increases.
Now it does not close the gap between American prices and foreign nations, but it certainly begins to bring things somewhat closer with price concessions here.
In other news, Eli Lilly has unveiled additional savings for cash-paying users of its obesity and sleep apnea drug Zepbound.
As well, the American Hospital Association, the Maine Hospital Association and four safety-net hospitals filed a lawsuit against the Department of Health and Human Services to block the 340b pilot program that tests retrospective rebates instead of upfront discounts.
Last, a Wakely analysis of the proposal to cap GLP-1 drugs at a $50 co-pay in Medicare finds that approximately 72 percent of Part D members are enrolled in plans with a copay for relevant GLP-1 medications. These members will likely see either no change or higher annual cost sharing under the proposed policy because of the “greater of” maximum out of pocket accumulation logic.
Additional articles: https://thehill.com/policy/healthcare/5628347-trump-tariffs-uk-trade-deal-drugs/ and https://www.fiercepharma.com/marketing/lilly-joins-novo-glp-1-self-pay-price-cuts-lowering-costs-single-dose-zepbound-vials and https://www.modernhealthcare.com/politics-regulation/mh-aha-hhs-lawsuit-340b-rebate-pilot/
#drugpricing #tariffs #glp1s #weightlossdrugs #branddrugmakers #340b
https://www.wakely.com/blog/the-245-question-how-new-glp-1-pricing-could-transform-medicare-part-d/
Medicaid Provider Tax Overview
Healthcare policy group KFF issued a good briefer on the Medicaid provider tax landscape. It details which states have them, how they are used, and estimated impacts to the limitations on the One Big Beautiful Bill Act (OBBBA).
KFF says changes to federal rules for provider taxes are estimated to cut federal Medicaid spending by $226 billion over 10 years. About 31 states are expected to have to change their provider tax laws and policies.
#medicaid #providertaxes
https://www.kff.org/medicaid/5-key-facts-about-medicaid-and-provider-taxes/
— Marc S. Ryan
