Exchange Compromise Appears To Be Fizzling
Prospects for a compromise bill in the Senate on an enhanced Exchange subsidy extension compromise appear to be fizzling. I have said the chance is at best 50-50 and now those odds are even dwindling. The negotiating group has failed to reach agreement on two of the biggest sticking points – allowing some or all of the dollars to move to health savings accounts (HSAs) and stricter “Hyde amendment” abortion restriction language. Meanwhile, some Democrats are also arguing the minimum premium of $5 or $10 per family per month is unaffordable for those who are low income. The GOP argues zero premiums have led to fraudulent enrollment.
On the home front, states and plans are waiting to see what the fallout of an average 26% premium hike and 114% hike for subsidized individuals will mean. The latest statistics say that enrollment is only down 800,000 from his time last year. But states are seeing drop-offs happening as people were required to pay their first premium before their January or February effective date. We will see what the real fallout is.
Meanwhile, Donald Trump is touting the $50 billion rural health fund as one solution to the affordability crisis. The funding was not the president’s idea but a last-minute add to get certain senators to vote yes. Vulnerable Republicans in 2026 joined him at a White House event.
Additional articles: https://www.nbcnews.com/politics/congress/senate-aca-funding-talks-fizzle-higher-premiums-take-effect-millions-rcna254227 and https://www.cbsnews.com/news/senators-aca-premium-tax-credits-extension-bipartisan-deal-stalled/ and https://www.politico.com/live-updates/2026/01/15/congress/the-senates-bipartisan-health-care-talks-are-on-shaky-ground-00732678 and https://www.politico.com/news/2026/01/15/democrats-make-pitch-to-keep-no-premium-obamacare-plans-00729669 and https://kffhealthnews.org/news/article/aca-obamacare-premium-payments-prices-marketplace-plans-hard-choices/ and https://www.modernhealthcare.com/insurance/mh-aca-enrollment-premium-payments/ and https://thehill.com/policy/healthcare/5692996-trump-rural-health-fund-affordability/
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#exchanges #healthcare #coverage #affordability
https://thehill.com/homenews/administration/5692760-trump-rural-health-roundtable
MedPAC Does Not Weigh In On Doc Pay Inflation Tie; Details MA Overpayments
Congressional Medicare policy arm MedPAC voted to recommend that Medicare increase physician reimbursement next year but didn’t recommend that annual payment updates should be linked to inflation. This was an important reform sought by physicians.
In other news, MedPAC also reported that it estimates Medicare Advantage (MA) was overpaid by $76 billion in 2025. But this is down from the previous estimate of $84 billion due to the roll out of the v28 risk adjustment model. MA spending will be 114% of spending in fee-for-service Medicare this year.
MedPAC says MA is also more expensive than traditional Medicare because of favorable selection and risk adjustment overpayments. Without those two factors, MA and traditional Medicare spending would be comparable, MedPAC says. It says favorable selection adds 11 percentage points and increased coding intensity adds another 4.
I have criticized MedPAC for its ongoing arguments that favorable selection exists at all or at such levels. Other studies counter this. As well, the amount of overpayments due to risk adjustment is suspect as well. And where overpayments in risk adjustment exist, the lion’s share goes to the biggest health plan players who are abusing the system.
Additional article: https://www.healthcaredive.com/news/medpac-medicare-physician-pay-2027-recommendations/809813/
#medicareadvantage #riskadjustment #overpayments #medicare #physicians #rates
https://www.healthcaredive.com/news/medicare-advantage-overpayments-76b-2026-medpac/809859
GLP-1 Study Says Long-Term Savings Exist
A new study from Aon finds that sustained GLP-1 use sows medical cost growth. The firm analyzed 192,000 GLP-1 users from July 2022 to March 2025 and compared outcomes to non-users. The study says pairing GLP-1 strategies with programs that encourage adherence and total well-being can improve outcomes for workforces. Medical cost growth for users of GLP-1s for diabetes was down 6 percentage points from 12 to 30 months and 9 points for people with at least 80% adherence. Medical cost growth for GLP-1 users for weight loss was down 3 percentage points from 12 to 18 months and 7 points for people with at least 80% adherence.
In other news, healthcare policy group KFF issued a nice briefer on GLP-1 coverage in Medicaid. While states cover GLP-1s for disease states like diabetes and heart disease, only 13 cover the drugs for obesity alone. Costs for GLP-1s continue to rise in Medicaid.
Additional article: https://www.kff.org/medicaid/medicaid-coverage-of-and-spending-on-glp-1s/
#glp1s #weightlossdrugs #drugpricing
https://www.beckerspayer.com/research-analysis/long-term-glp-1-use-trims-medical-cost-growth-aon/
Four M&A Transactions Already For Health Plans
A number of health plan mergers have been either finalized or announced so far. Worcester-based Fallon Health will merge with Boston-based Mass General Brigham Health Plan. Blue Cross Blue Shield licensee Hawaii Medical Service Association and Honolulu-based Hawaii Pacific Health — which includes ACO Hawaii Health Partners — will affiliate under a new nonprofit parent organization, One Health Hawaii. Priority Health became the sole governing group of Wisconsin’s Health Cooperative of Eau Claire, a community-based health plan with more than 61,000 members.
#healthplans #manda #mergers #acquisitions
https://www.beckerspayer.com/m-and-a/4-payer-ma-deals-2026/
— Marc S. Ryan
