Trump May Veto Subsidy Bill If Passes; Exchange Enrollment Down About 1.5M So Far
With days left before open enrollment ends for the season, the Centers for Medicare & Medicaid Services (CMS) reports that about 22.8 million consumers have signed up for 2026 individual market Exchange coverage thus far. This is surprisingly robust. About 21.4 million enrolled in 2024 and about 24.3 million enrolled in 2025. The 1.5 million drop is less than the 2.2 million people the Congressional Budget Office (CBO) said would lose coverage in 2026. The CBO said an average of 3.8 million more uninsured people annually would result from 2026-2034.
The results so far include 15.6 million Exchange selections in the 30 states using the HealthCare.gov platform for the 2026 plan year and 7.2 million plan selections in the 20 states and the District of Columbia with state-based Exchanges (SBEs) that are using their own eligibility and enrollment platforms. Total nationwide plan selections include 2.8 million new consumers and 20 million consumers who had active 2025 coverage.
Meanwhile, President Trump says he may veto any subsidy extension that passes Congress.
In other news, interesting Politico coverage on Sen. Bernie Moreno, a MAGA Republican who is leading the fight for some sort of compromise on Exchange subsidies. He says reviving Obamacare subsidies would be “putting America first.”
Further, three states have extended open enrollment – Connecticut, Illinois, and Pennsylvania. Pennsylvania says it is shedding a thousand people daily due to premium hikes, which could lower the 22.8 million reported by CMS.
Additional articles: https://www.reuters.com/business/healthcare-pharmaceuticals/trump-says-he-may-veto-extension-obamacare-subsidies-2026-01-12/ and https://www.politico.com/news/2026/01/12/bernie-moreno-obamacare-talks-00719585 and https://www.beckerspayer.com/payer/aca/3-states-extending-open-enrollment/ and https://www.beckerspayer.com/payer/aca/pennsylvania-aca-exchange-losing-1000-enrollees-daily-after-subsidies-expire/ and https://www.cms.gov/newsroom/fact-sheets/marketplace-2026-open-enrollment-period-report-national-snapshot-0
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#exchanges #coverage #healthcare
Senate Report Trashes United’s Risk Adjustment Empire
A new Senate report says UnitedHealth Group (UHG) uses “aggressive strategies” to maximize diagnoses and inflate risk adjustment payments in Medicare Advantage (MA). The report says the process of identifying patient diagnoses “has become a business in itself” and gaming by the biggest healthcare vertically integrated behemoth.
The report says United uses a combination of staff, technology, and provider incentives, which has “turned risk adjustment into a major profit centered strategy, which was not the original intent.”
“UHG has identified opportunities and strategies to increase its capture of untapped risk score garnering diagnoses and has used its robust provider workforce to implement those strategies,” per the report. “Bloated federal spending to UnitedHealth Group is not only hurting the Medicare Advantage program, it’s harming the American taxpayer,” Sen. Chuck Grassley, R-IA, said.
The report also notes that when CMS excluded some 8,000 codes from risk adjustment, United identified new opportunities to expand revenue.
The report compounds United’s problems, which include a financial meltdown and numerous federal investigations alleging fraud and impropriety. The report is backed up by numerous studies, which have concluded that the vast majority of risk adjustment overpayments go to the nation’s biggest plans.
At the same time as the report was released, UnitedHealth Group announced two independent studies from actuarial firm Milliman it commissioned that highlight MA savings for both the federal government and beneficiaries. The reports say estimated federal payments for MA plans were about 9% less than what the government spent on traditional Medicare. Savings amounted to more than $1,400 per member each year. Further, MA brings $63 billion in further annual value to enrollees through reduced cost sharing, lower premiums, and more robust supplemental benefits.
Additional articles: https://www.modernhealthcare.com/insurance/mh-unitedhealth-medicare-senate-report/ and https://www.healthcaredive.com/news/unitedhealth-grassley-medicare-advantage-investigation/809377/ and https://www.beckerspayer.com/payer/medicare-advantage/senate-finds-unitedhealth-used-aggressive-strategies-in-medicare-advantage/ and https://thehill.com/policy/healthcare/5685132-grassley-investigation-unitedhealth-billing/ and https://www.beckerspayer.com/payer/medicare-advantage/medicare-advantage-savings-for-federal-government-beneficiaries-unitedhealth-research/
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#medicareadvantage #riskadjusment #overpayments #unitedhealthcare
Many Skeptical Of Trump’s Strong-Arming Of Health Plans
Experts doubt anything will come from Donald Trump’s plan to bully and chastise health plan executives for healthcare reductions. Experts say voluntary reductions are unlikely to be significant or lasting. As I have been saying, the experts tell us why — the biggest culprit in rising healthcare costs is the rates charged by hospitals and doctors’ offices. As healthcare policy group KFF found, the higher prices for care that Americans pay hospitals and doctors account for 80% of the difference in spending in the U.S. vs. other countries. What health plans add to overall costs is tiny. Of course, hospitals blame insurers for red tape and rogue practices, but costs will not come down without price reform.
#healthplans #margins #trump #providers #hospitals
— Marc S. Ryan
