Insurers Backing Away From Medicaid
Given the looming budget cuts to hit Medicaid over the next decade, there are signs that some health plans are backing out of certain Medicaid managed care contracts. Insurers such as Centene and Elevance Health have walked away from Medicaid managed care contracts as costs rise. This has led to other plans picking up the slack in affected states. Providers complain that successors may not have enough providers in their network.
Plans have said there are some good signs coming from certain states who are increasing rates to deal with financial problems in managed care. Louisiana increased rates. It appears that Arkansas and D.C. may have done so as well.
#medicaid #managedcare #obbba
https://www.modernhealthcare.com/insurance/mh-centene-elevance-medicaid-states-providers/
Optum and Express Scripts Grow
Pharmacy benefits managers (PBMs) Optum Rx and Express Scripts each hold 23% of the PBM market, up from 21% and 17%, respectively. CVS Caremark fell from market leader to third-largest PBM, with 18% market share.
The four largest PBMs now control 75% of the market, rising from 70% in 2022. Notwithstanding all this, transparent or alternative PBMs seem to be growing.
#pbms #drugpricing #employercoverage
https://www.modernhealthcare.com/insurance/mh-optum-rx-express-scripts-pbm-ama/
Lawmakers Want RPM Changes Tossed
A bipartisan group of House lawmakers wants the Centers for Medicare and Medicaid Services (CMS) to roll back proposed Medicare payment changes that would bar remote patient monitoring programs by third-party clinical staff.
Lawmakers argue that could significantly reduce access to remote monitoring for Medicare beneficiaries, particularly rural patients and those served by small, independent physician practices and hospitals.
CMS argues the changes are needed for program integrity and that many vendors have low-quality care. Payments for remote patient monitoring jumped 31% from $408 million in 2023 to $536 million in 2024. In 2024, nearly 1 million enrollees received these services, up 27% from 2023.
#medicare #remotemonitoring
Medicare For All In Vogue Again
Support for Medicare for All is in vogue again. Support jumped to 66% among U.S. adults in 2026, the highest since 2016. Health research group KFF found that 32% strongly favored “having a national health plan … in which all Americans would get their insurance from a single government plan.” That is 13 points up from 2020. Medicare for All support hit 76% when those polled heard that the policy may guarantee health insurance as a right for all Americans.
But 64% opposed the plan if it caused tax hikes, while 61% said they would be against a national health program if it threatened the current Medicare system. Only 52% backed such a program if it eliminates health insurance premiums.
#medicareforall #healthinsurance #coverage
https://thehill.com/policy/healthcare/6132204-medicare-for-all-support-jumped-poll/?tbref=hp
— Marc S. Ryan
