Paragon Urges Hospital Payment Reform
The influential Paragon Institute, which influenced the One Big Beautiful Bill Act (OBBBA) and no extension of Exchange enhanced subsidies, has issued a new report challenging hospitals’ views on their finances and advocating payment reform.
About one third of over $5 trillion each year is spent on hospital care and Paragon notes that hospitals are a key factor in driving premiums given major cost hikes annually. It notes that since 2000 hospital prices have risen three times faster than inflation and double wage growth. It says government policies inflate and distort hospital prices as well as encourage consolidations and physician acquisition. It argues hospitals can make money at Medicare rates and hospitals have had strong positive margins. It calls attention to the success of some hospitals with large government program patient loads.
Paragon proposes a number of reforms below. Hospital groups took issue with the financial characterizations as well as proposals. But reform appears to be fermenting in Congress.
The proposed reforms include:
- Site-neutral payments in Medicare
- Medicare rate setting based on Medicare Advantage price transparency data
- Further Medicaid provider tax and state-directed payment restrictions
- Oversight of hospital supplemental payments
- Development of a comprehensive inventory of federal hospital payments
- Better targeting of 340B net savings to in-need entities or individual patients directly
- Repeal of state’s certificate of need laws
- Repeal of restriction on reimbursement to new physician-owned hospitals
- Increased oversight of hospitals’ compliance with tax rules
- Increased enforcement of hospital and insurer price transparency
- Removal of uncompensated care payments from Medicare and moving to targeted payments based on share of charity care and non-Medicare bad debt
- Elimination of the current graduate medical education (GME) funding formula in favor of discretionary grants
Additional article: https://paragoninstitute.org/private-health/the-hospital-cost-crisis-how-government-policies-drive-consolidation-undermine-competition-and-fuel-soaring-prices/?nab=0
#hospitals #siteneutral #payments
Molina Reports Q1 Results
Molina Healthcare reaffirmed its 2026 projections and $14 million in profit for Q1 2026, a significant drop from the $298 million in Q1 2025. Revenues were $10.8 billion, down year over year from $11.1 billion. Its medical loss ratio (MLR) was 91.1% overall, with a 92% MLR in Medicaid. Membership fell 12.5% to 5 million, driven primarily by lower enrollment in the Exchanges.
Additional articles: https://www.fiercehealthcare.com/payers/molina-strikes-prudent-tone-2026-outlook-amid-positive-signs-medicaid-spending and https://www.healthcaredive.com/news/molina-moh-q1-2026-cost-control-medicaid-doubt/818236/
(Some articles may require a subscription.)
#molinahealthcare #healthplans #margins
https://www.modernhealthcare.com/insurance/mh-molina-healthcare-earnings-medicaid-aca-membership
Bad Polls For GOP
Two bad polls for GOP prospects in the midterms.
A new Fox News poll found Democrats have the edge over Republicans on economic issues for the first time since 2010 – 52 to 48%.
Democrats hold a 6-percentage point advantage on the generic congressional ballot, leading Republicans 50 percent to 44 percent in a survey of the 36 districts most likely to determine the outcome of the November midterms.
Kalshi says Democrats have an 86% chance of taking the House and a 49% chance of taking the Senate. Polymarket says Democrats have an 85% chance of taking the House and a 53% chance in the Senate.
Additional article: https://thehill.com/business/5845645-gop-democrats-economy-poll/?tbref=hp
#midterms #congress #trump
https://thehill.com/homenews/campaign/5845751-democrats-battleground-districts-poll/?tbref=hp
Regeneron Strikes Deal With Trump
President Trump announced a deal with drug maker Regeneron. The brand drug company will cut prices along the lines of other deals. The White House says 86% of brand drugs will now see reductions due to the negotiations thus far.
#drugpricing #branddrugmakers
https://thehill.com/policy/healthcare/5845958-trump-regeneron-drug-price-deal
RAPID Reform Announced
The Centers for Medicare & Medicaid Services (CMS) and the U.S. Food and Drug Administration (FDA) announced the Regulatory Alignment for Predictable and Immediate Device (RAPID) coverage pathway. The new pathway is designed to expedite access to certain FDA-designated Class II and Class III Breakthrough Devices for people with Medicare.
#cms #fda #innovation
— Marc S. Ryan
