Schumer Unveils Three-Year Subsidy Extension
Senate Minority Leader Chuck Schumer, D-NY, unveiled a clean three-year extension of enhanced premium subsidies for a vote next week in the upper chamber. This came after a group of Senate Democrats gained a commitment from Senate Majority Leader John Thine, R-SD, for a subsidy vote when the group agreed to support a bill to reopen the government.
Some Democrats have held talks with centrist Republicans to seek a compromise that would temporarily extend the enhanced subsidies while adding policies such as income eligibility caps, minimum premiums, and anti-fraud measures. This could mean the bill is amended to attract GOP votes to get to 60 votes. Some GOP senators are open to doing so, frustrated with the lack of any real GOP alternative. There are some GOP bills being developed which focus on Health Savings Account support but are not expected to be ready in the Senate next week.
In the House, Reps. Jen Kiggans (R-Va.) and Josh Gottheimer (D-N.J.) led a bipartisan group of 35 House members who released an alternative plan. This proposal would extend enhanced subsidies for two years, lengthen the 2026 open enrollment period until March 19, phase in income caps, and institute anti-fraud policies. The bill also reforms pharmacy benefits managers (PBMs).
House Speaker Mike Johnson, R-LA, and Steve Scalise, R-LA, are working with more conservative members and say they will have a bill in that chamber next week. They say it does not do what Kiggans and Gottheimer have planned.
A poll from healthcare policy group KFF finds that one in three enrollees in the Exchange say they would very likely shop for a cheaper plan if their premiums doubled and one in four would very likely go without insurance. KFF found that 84% want Congress to extend the credits.
In other news, Modern Healthcare reports that healthcare lobbying expenditures spiked 16% to $653 million during the first three quarters of 2025 compared with the same period last year.
Further, the Government Accountability Office (GAO) did find fraud in the Exchanges enrollment system. The analysis found that misused Social Security numbers is a notable source of the fraud risk to monitor. It fraudulently signed up for and renewed coverage. The vast majority of applications were approved. The GAO found that more than 29,000 numbers in 2023 and 68,000 numbers in 2024 were used to receive more than a single year’s worth of coverage, including the tax credits. The agency also identified at least 30,000 applications submitted in plan year 2023 and at least 160,000 applications for 2024 that likely included changes made by brokers or agents that were not authorized. It earlier said that thousands have reported they were fraudulently enrolled or their information changed.
Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-aca-subsidies-extension-senate-democrats-proposal/ and https://www.modernhealthcare.com/politics-regulation/mh-healthcare-lobbying-2025-phrma-aha/ and https://thehill.com/policy/healthcare/5633501-schumer-to-force-senate-gop-to-vote-on-three-year-extension-of-health-insurance-subsidies/?tbref=hp and https://www.kff.org/public-opinion/poll-1-in-3-aca-marketplace-enrollees-say-they-would-very-likely-shop-for-a-cheaper-plan-if-their-premium-payments-doubled-1-in-4-say-they-very-likely-would-go-without-insurance/ and https://www.modernhealthcare.com/insurance/mh-aca-premiums-blue-cross-michigan/ and https://www.kff.org/public-opinion/2025-kff-marketplace-enrollees-survey/ and https://thehill.com/policy/healthcare/5633353-obamacare-subsidies-aca-kff/ and https://thehill.com/policy/healthcare/5633614-republican-health-bill-johnson-scalise/
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#exchanges #healthcare #coverage
Humana Working With Cuban On Lowering Drug Prices
Humana Inc. is working with billionaire Mark Cuban on a potential pharmacy partnership. The move is aimed at cutting out drug channel middlemen, such as wholesalers and pharmacy benefits managers, by direct-to-employer programs.
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#drugpricing #pbms
https://www.modernhealthcare.com/insurance/mh-humana-mark-cuban-pharmacy-partnership
— Marc S. Ryan
