Centene Reports Decent Financial News With Some Uncertainty
Centene reported relatively sound financial news, but did raise policy issues that could impact the company over time. The uncertainty ties to what will happen in Congress in the next year on Medicaid and the Exchanges.
Centene says it believes sweeping Medicaid cuts will not occur and are still pushing hard for extending the premium enhancements in the Exchanges, focusing on swing states and general support for government programs. They do admit some changes, such as work requirements, could occur.
The medical loss ratio (MLR) was 87.5%, about the same as the prior year’s same quarter. But expenses could rise.
Centene posted $1.3 billion in net income in the first quarter. Total revenues in the first quarter were $46.6 billion, up 15.4% year over year. The company reaffirmed its year-end adjusted guidance.
A few complications for Centene could occur. Even modest Medicaid changes could mean shedding more enrollment. If the subsidies do expire, that would mean major enrollment losses on the Exchange front. That would also change the Exchanges’ risk, which could drive up premiums.
Centene said it has reached agreements with more than half of state insurance regulators to submit two sets of rates for 2026 – with and without extension of the enhanced premiums.
Additional articles: https://www.beckerspayer.com/payer/centene-posts-1-3b-profit-in-q1/ and https://www.healthcarefinancenews.com/news/centene-pulls-13-billion-q1-earnings and https://www.healthcaredive.com/news/centene-raises-2025-revenue-medical-cost-guidance-q1/746349/ and https://www.modernhealthcare.com/finance/centene-medicare-advantage-marketplace-drew-asher
(Some articles may require a subscription.)
#medicaid #aca #obamacare #exchanges #medicareadvantage #centene #fwa #budgetreconciliation #spending #congress #trump
https://www.fiercehealthcare.com/payers/centene-boosts-revenue-guidance-2025-it-brings-466b-q1
Trump Says He Would Veto Healthcare Cuts
President Donald Trump said he would veto legislation that calls for cuts to Social Security or federal health coverage for the elderly or low income. “If it cuts it, I would not approve,” the president said in an interview with TIME magazine. But Trump seemingly left open his support for reductions in the budget reconciliation bill that would still impact coverage, including fraud, waste, and abuse (FWA).
Congressional moderates are battling conservatives and budget hawks with regard to how deep Medicaid cuts will be. With tight vote counts for the GOP in each chamber, there is no certainty about what will happen on Medicaid.
In other news, a group of experts at a virtual panel sponsored by healthcare policy group KFF pushed back on allegations that state provider taxes amount to money laundering. The panel was on fraud and waste and panelists emphasized that taxes are a legitimate policy tool permitted under federal law and approved by the Centers for Medicare and Medicaid Services (CMS).
Influential healthcare policy group Paragon Health Institute, with huge influence on Congress and former staffers and fellows in the administration, is pushing to rein in provider taxes as part of the FWA focus. About 30% of all state match is from provider taxes. The debate will hinge on how extreme taxes are. Even a panelist admitted some states may “push the envelope” in how they structure provider taxes.
Additional article: https://insidehealthpolicy.com/daily-news/medicaid-experts-reject-claims-provider-taxes-constitute-fraud-congress-eyes-cuts
(Articles may require a subscription.)
#medicaid #providertaxes #fwa #budgetreconciliation #spending #congress #trump
https://www.modernhealthcare.com/politics-policy/trump-veto-medicaid-cuts
KFF Explores Per Capita Caps On Expansion Population
As I have said, what will occur in terms of Medicaid cuts is unknown. The president and GOP leaders in Congress have pretty much taken radical funding changes to Medicaid off the table. But one option still on the table is to reduce the 90% reimbursement for the Medicaid expansion under the Affordable Care Act (ACA). Some have proposed to limit reimbursement to the usual reimbursement rate, which is a range of 50% to almost 80%. In an alternative, the current funding would stay for base Medicaid, but there would be a per capita cap placed on the expansion population reimbursement. Healthcare policy group KFF finds that such a proposal essentially reduces reimbursement from 90% to 69% over ten years.
Another KFF briefer discusses the profile of the Medicaid expansion populations.
Additional article: https://www.kff.org/medicaid/issue-brief/5-key-facts-about-medicaid-expansion/
#medicaid #aca #obamacare #budgetreconciliation #spending #coverage #healthcare
Blue Cross and Blue Shield Facts
With one in three Americans obtaining healthcare coverage from one of 33 independent Blue Cross Blue Shield companies, Becker’s has published 101 things to know about such plans and their history.
My book, The Healthcare Labyrinth (available at this site at https://www.healthcarelabyrinth.com/book/ ), has a neat history of U.S. healthcare that covers the Blues’ history.)
#bcbsa #healthcare #coverage
https://www.beckerspayer.com/payer/100-things-to-know-about-blue-cross-blue-shield
— Marc S. Ryan
