Medicaid Reimbursement Back On Budget Table
House Republicans are still considering a proposal that would reduce the 90% federal match for the Medicaid expansion population down to normal state match rates. In addition, both work requirements and provider tax changes are being considered.
The House could be influenced by the powerful Paragon Health Institute, a Trump-leaning think tank whose staffers and fellows have been in Trump 45 and 47. Paragon recently unveiled a Medicaid landing page that talks provider taxes, enhanced federal matches, fraud and waste, and more.
Meanwhile, Axios reports that a Trump pollster reveals that Medicaid is popular among America, even with Trump voters. About 78% of Trump supporters support Medicaid. And an analysis from the Center for American Progress (CAP) found that about 34,200 more people would die annually if the federal government reduced its current 90 percent match for the expansion costs and states dropping their Medicaid expansions.
Last, a proposed regulation has landed at the Office of Management and Budget that could seek to rein in provider taxes as well as directed payments.
How deep any of these cuts go is unknown. House rightists want deep Medicaid cuts, while moderates in each chamber have vowed to oppose the budget reconciliation bill if coverage is impacted.
Additional articles: https://www.axios.com/2025/04/23/maga-trump-medicaid-cuts-congress and https://thehill.com/policy/healthcare/5261905-medicaid-cuts-house-republican-budget-plan/ and https://paragoninstitute.org/newsletter/medicaid-reform-goals-paragons-latest-on-reducing-medicaid-and-exchange-waste/ and https://paragoninstitute.org/issue-library/medicaid-reform/ and https://www.healthcaredive.com/news/cms-medicaid-directed-payments-rule-omb/746096/
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#medicaid #aca #obamacare #trump #congress #budgetreconciliation
Eli Lilly Suing Compounders
Eli Lilly is suing four telehealth companies that prescribe compounded versions of the drug maker’s weight loss medications. Lily claims telehealth companies were misleading consumers and illegally prescribing compounded versions of its GLP-1 drugs Mounjaro and Zepbound.
Additional article: https://www.modernhealthcare.com/digital-health/eli-lilly-mochi-health-glp1-lawsuits
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#glp1s #weightlossdrugs #drugpricing #branddrugmakers
https://thehill.com/policy/healthcare/5263827-eli-lilly-lawsuits-telemedicine
United Sees Major Trends in MA EGWPs
UnitedHealth Group reports that premiums have increased dramatically among some public sector retiree groups in its Medicare Advantage (MA) plans. These are known as EGWPs. It appears that the increase is driven by ongoing utilization by these members and that members continue to engage in services even with hiked premiums. United has seen this phenomenon more broadly across all its EGWPs.
The trend is not surprising. These wrap programs in MA represent some of the most generous plans in America and generous plans tend to be the most expensive from a premium standpoint and annual growth one as well.
#medicareadvantage #egwps
https://www.beckerspayer.com/payer/do-higher-premiums-drive-more-healthcare-usage
— Marc S. Ryan
