House GOP Abandons Budget Reconciliation Vote Tonight
House Speaker Mike Johnson, R-LA, abandoned a vote on Senate reconciliation bill framework after rebellion by conservatives would have sunk the vote. Conservatives are upset by the Senate framework that has almost no spending reductions. In addition, the bill adopts a current-policy vs. current-law scoring of spending and taxes.
The conservatives say the budget gimmick is disingenuous and would set a horrible precedent and drive up deficits and the national debt. The conservatives said they couldn’t move forward as they do not believe the Senate will agree to deep cuts if they pass the framework. The House GOP will now regroup on the issue and see if they can gather votes later in the week to pass the framework.
Additional article: https://www.modernhealthcare.com/politics-policy/house-budget-resolution-medicaid-tax-cuts
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#budgetreconciliation #congress #trump #spending #medicaid #healthcare
Study Pushes Back On MedPAC Assertions
A new study by Inovalon pushes back on congressional policy arm MedPAC’s conclusion that Medicare Advantage (MA) plans have beneficial selection. MedPAC and some researchers have continually argued this and I have always called their findings suspect.
Inovalon found that individuals who enroll directly into MA when first eligible for Medicare are less healthy than those who enroll into fee-for-service (FFS) Medicare based on their pre-enrollment characteristics. The research also performed a detailed claims analysis comparing people with similar demographic, clinical, and social risk factors to show that MA plans significantly reduce costs for the Medicare program for enrollees with similar risks.
Inovalon concluded these enrollees are less healthy, have higher risk scores, have more chronic conditions, and have more social barriers.
#medicareadvantage #medicare #medpac #riskadjustment
CareSource Buys CCA
Ohio-based CareSource has completed its acquisition of Commonwealth Care Alliance (CCA). The move ensures the ongoing operations of CCA, which is a non-profit entity that serves about 50,000 medically complex Medicare and Medicaid members.
Additional article: https://www.fiercehealthcare.com/payers/caresource-closes-acquisition-massachusetts-based-commonwealth-care-alliance
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#medicare #medicaid #healthplans
MA Plans Cautiously Optimistic
In light of the recent announcement of enhanced 2026 rates, Medicare Advantage (MA) executives have expressed cautious optimism for the future of the program. The industry has been in turmoil and the healthier hike will help insurers hit their turnaround plans. It also helps with 2026 benefit designs and bids.
(Article may require a subscription.)
#medicareadvantage #cms #rates #healthplans
https://www.modernhealthcare.com/insurance/medicare-advantage-pay-rate-reaction
Drugs Could Be Tariffed
President Donald Trump said he is planning to announce “a major tariff on pharmaceuticals,” which were exempted recently. Medical devices and supplies are currently subject to his tariff plans. Trump has put a 90-day moratorium on most tariffs in light of bond and stock market falls.
#tariffs #healthcare #drugpricing
https://www.healthcaredive.com/news/trump-major-tariffs-pharmaceuticals-coming-europe/744880
Judge Dismisses MultiPlan Lawsuit
A New York federal judge dismissed an antitrust lawsuit brought by a provider group against UnitedHealthcare and MultiPlan. The suit alleged the companies conspired to reduce reimbursement rates for an anesthesia services provider.
#multiplan #unitedhealthcare #fwa #rates #providers
https://www.beckerspayer.com/payer/judge-tosses-multiplan-unitedhealthcare-antitrust-suit
Fetterman Wants GLP-1s Covered In Medicare
In a heartfelt editorial in The New York Times, Sen. John Fetterman, D-PA, disclosed he is on a GLP-1 drug for cardiac issues and his health has improved dramatically. He believes the Trump administration should finalize the Biden administration’s proposal to cover the drugs for obesity, arguing the government can negotiate discounted pricing for the expensive drugs.
My view is that the drugs have to be brought down in price before considering expansion to obesity in Medicare. Huge price and utilization costs for the drugs could undermine benefits in other areas if prematurely adopted.
#glp1s #weightlossdrugs #drugpricing #branddrugmakers #partd #medicare
— Marc S. Ryan
