Houses Passes GOP Healthcare Reform Bill
The House passed its healthcare reform today with no vote or provisions to extend the enhanced Exchange premium subsidies. The vote was 216-211, with one Republican defecting. By and large, the bill does little to solve the affordability problem:
- Expands association health plans.
- Expands individual coverage health reimbursement arrangements (ICHRAs).
- Expands catastrophic stop-loss coverage for more employers.
- Funds cost-sharing subsidies that were removed under Trump 45.
- Implements pharmacy benefit manager (PBM) reforms.
The vote comes after Speaker Mike Johnson, R-LA, broke his promise to hold a vote on a subsidy amendment. Johnson broke his word after conservatives objected. The GOP leadership blames the backtrack on no plan from moderates to pay for the major cost of the extension. But the caucus recently passed the One Big Beautiful Bill Act (OBBBA) without major offsets, increasing budget deficits by $4.1 trillion with interest over 10 years. And conservatives on the Rules Committee turned down moderate amendments and simply did not want to allow a subsidy vote.
Given the duplicity of the speaker, GOP Reps. Rob Bresnahan (Pa.), Brian Fitzpatrick (Pa.), Mike Lawler (N.Y.) and Ryan Mackenzie (Pa.), have signed onto a Democratic discharge petition to pass a three-year extension. This is a stunning rebuke of the Speaker. The subsidy vote would not take place now until January, though. As is, even if the bill passed the House, a similar bill failed to get 60 votes in the Senate.
Due to that, some moderate Republicans are now meeting with moderates in the Senate to come to an agreement on a version that could get 60 votes in the Senate, which would require 13 GOP senators to votes with Democrats.
Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-house-passes-healthcare-bill-aca-subsidies/ and https://www.medpagetoday.com/publichealthpolicy/washington-watch/119070 and https://www.fiercehealthcare.com/regulatory/house-gop-healthcare-bill-eschews-subsidy-extension-hsas and https://thehill.com/homenews/house/5653462-moderate-gop-obamacare-senators/ and https://thehill.com/homenews/house/5652673-gop-centrists-democratic-obamacare-discharge-petition/ and https://thehill.com/homenews/house/5652894-house-republicans-aca-subsidies-lawler-fitzpatrick-bresnahan-mackenzie/ and https://thehill.com/homenews/house/5653238-fitzpatrick-gop-leaders-obamacare/?tbref=hp
(Some articles may require a subscription.)
#exchange #congress #healthcare #coverage
https://thehill.com/homenews/house/5653811-house-gop-health-care-bill
Insurers Pitching Cheaper Plans To Employers
Health insurance companies and startups are striving to win over employers with new and lower cost plan designs. Alternative health plans such as variable copayment plans that favor certain in-network providers as well as individual coverage health reimbursement arrangements (ICHRAs) are leading options being pitched.
(Article may require a subscription.)
#healthplans #employergroups #coverage
https://www.modernhealthcare.com/insurance/mh-variable-copay-health-plans-employer-costs
Audit Shows MA Overpayments
A Health and Human Services Office of Inspector General (HHS OIG) audit found that Humana’s Louisiana business received at least $10.5 million in Medicare Advantage (MA) overpayments in 2017 and 2018. The OIG found $553,049 in overpayments in its sample of 240 enrollee-years. Medical records did not support the submitted diagnosis codes for 218 of the 240 sampled cases. The extrapolated overpayment would be $10.5 million.
#medicareadvantage #overpayments #riskadjustment #radv
— Marc S. Ryan
