Marc Ryan

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June 20, 2025

Budget Reconciliation In Senate Still In Limbo After going to bat for deeper healthcare cuts for conservatives, Senate Majority Leader John Thune, R-SD, is facing an uprising on the right and left. Three conservatives – Mike Lee, Rick Scott, and Ron Johnson, are threatening to be off the bill unless deeper cuts occur, including in healthcare. Rand Paul appears already against the bill due to a provision that increases the debt limit. This would sink the bill. At the same time, at least three moderates or pragmatists – Lisa Murkowski, Josh Hawley, and Susan Collins – remain very concerned about the depth of certain cuts, especially provider tax restrictions. Thune wants to vote on the bill next week. Rural providers, particularly hospitals, continue to argue the bill jeopardizes their livelihoods and that hospitals in under-served areas could shutter. An impasse over the state and local tax deduction threatens passage of

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80. Republicans Are In Stealth Mode On Healthcare Coverage Cuts, But The Impact Is Real

The GOP is not following the same overt repeal of healthcare coverage as it did in 2017, but the stealth approach still has real impact. About The Podcast: Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to

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June 19, 2025

Opposition To Healthcare Cuts In Budget Bill All of healthcare is lining up against the cuts to healthcare in the budget reconciliation bill. A new study from the Urban Institute and Robert Wood Johnson (RWJ) Foundation breaks down how providers (hospitals, physicians, and drugs) are impacted in each state by the reductions to Medicaid and the Exchanges. Over the next decade, the bill would decrease spending by $321 billion to hospitals, $81 billion to physicians and $191 billion for drugs. Spending for other healthcare services would decline by $205 billion. If the Exchange premium tax credits expire, spending would decline by an additional $262 billion — hospitals an additional $103 billion cut, physicians an additional $39 billion cut, and drugs an additional $50 billion cut. Spending on other healthcare services would drop an additional $70 billion. Now, I have little doubt on the math of what Urban and RWJ did.

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RADV Audit Methods And Instructions Published

RADV instructions show CMS is serious about attacking overpayments, but is the approach fair? The Centers for Medicare and Medicaid Services (CMS) is true to its word. Late Friday the agency published methods and instructions for Risk Adjustment Data Validation (RADV) audits for Payment Year (PY) 2019. In addition, a companion Frequently Asked Questions (FAQ) document was published. The agency announced on May 21 it will audit all eligible Medicare Advantage (MA) plans for each payment year in all newly initiated audits and invest additional resources to expedite the completion of audits for payment years (PYs) 2018 through 2024. Details of the announcement and some of my concerns are in this June 5 blog: https://www.healthcarelabyrinth.com/cms-to-audit-all-plans-on-risk-adjustment/ . On May 12, I also did a blog here ( https://www.healthcarelabyrinth.com/could-medicare-advantage-overpayments-be-considered-to-offset-deep-medicaid-cuts/ ) on the possibility that MA risk adjustment overpayments would be part of the budget reconciliation bill to increase savings and perhaps alleviate

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June 18, 2025

Budget Reconciliation Bill Flounders Senate Majority Leader John Thune, who won his position with backing from prominent conservatives, threw his weight behind budget-cutters in the reframing in the Senate of the House bill. But the move seems to have backfired on him. He has two conservative holdouts on the bill. He also has an uprising from moderates and pragmatic conservatives due to the Medicaid reductions, which are even deeper than the House had included. Thune essentially ignored a fundamental part of his caucus. The moderates are worried about impacts on states and providers as well as what will happen to the uninsured rate. At least three moderates or pragmatic conservatives – Josh Hawley, Susan Collins, and Lisa Murkowski – have been vocal on the cuts and expressed doubts about voting for the bill. But there are still others that could vote against them due to the Medicaid cuts. Right now,

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June 17, 2025

More Senate Budget News The Congressional Budget Office (CBO) reaffirmed that the One Big Beautiful reconciliation bill will cost the healthcare sector a $1 trillion reduction over ten years. The Senate bill adds to limitations in the House bill on provider taxes (phasing them down and capping them to 3.5% over time for expansion states) and slightly tightens eligibility further. It also cuts certain existing state-directed payments to hospitals where the House just limited future payments. Healthcare policy group has good summaries comparing the Senate and House versions for Medicaid and Affordable Care Act (ACA) cuts. Additional articles: https://thehill.com/homenews/ap/ap-business/ap-trump-tax-bill-would-widen-deficits-by-2-8t-after-factoring-in-economic-impacts-cbo-says/?tbref=hp and https://thehill.com/homenews/senate/5353963-senate-medicaid-taxes-green-energy/ and https://www.kff.org/tracking-the-medicaid-provisions-in-the-2025-budget-bill/ and https://www.kff.org/tracking-the-affordable-care-act-provisions-in-the-2025-budget-bill/ (Article may require a subscription.) #budgetreconciliation #congress #trump #spending #medicaid #coverage https://www.modernhealthcare.com/politics-regulation/mh-gop-tax-plan-cost-cbo Fitch Downgrades Health Insurers Fitch Ratings has downgraded the health insurance industry’s outlook to deteriorating from neutral because of rising utilization and Medicaid and Exchange cuts in the budget reconciliation bill. Additional article:

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June 16, 2025

Senate Reconciliation Bill Sets Up Showdown The Senate version of the House-passed budget reconciliation bill has been unveiled and will create a showdown within the Senate and eventually with the House. The measure preserves the House reductions to Medicaid but goes further. Beginning in 2027, the legislation would lower healthcare provider taxes to 3.5% (from 6%) in states that chose to expand Medicaid. It also expands those who would be required to work as a condition of Medicaid eligibility. The Senate version says adults with dependent children older than 14 will also have to prove they work, attend school, or perform community service for 80 hours a month. The House-passed version would exempt all adults with dependent children. A number of moderates and pragmatic conservatives could be off the bill, with Sen. Josh Hawley, R-MO, and Sen. Susan Collins, R-ME, already speaking out. Hawley dislikes the provider tax changes as

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Will Health Plan Pain Continue?

Health plans are in store for a few more rough years On June 12, I blogged about how mighty Big Healthcare has fallen ( https://www.healthcarelabyrinth.com/how-the-mighty-have-fallen/ ). I weighed in on the current pain many large health plans feel and the fact that their vertical integration has not really saved some of them during a downturn. On April 24, I discussed how Compound Annual Growth Rate EBITDA (CAGR EBITDA) dropped by 1.2% from 2019 to 2024 ( https://www.healthcarelabyrinth.com/big-healthcare-struggling/ ). So, will all these struggles continue for the foreseeable future, despite most big health insurers seemingly beginning to dig themselves out of their financial mess. My view – healthcare trends as well as government actions will most assuredly mean continuing bumpy times in all lines of business. Trends Let’s look at trends that we will see globally and by line of business. What will plans need to do? Thus, across the board,

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June 13, 2025

Democrats Propose Bills To Defend Medicaid Democratic senators have proposed as many as 13 bills regarding Medicaid as the GOP continues its debate over changes to the budget reconciliation bill cuts to the low-income healthcare program. Some of the bills tackle fraud, waste, and abuse (FWA), while others protect expansion of coverage and insulate providers. #budgetreconciliation #medicaid #trump #congress #coverage https://www.fiercehealthcare.com/regulatory/democrats-make-pitch-medicaid-improvements-big-beautiful-bill-debate-heats Trump Pushes Big Pharma To Lower Price With his deadline for brand drug makers to come forward with lower prices, the Trump administration is pushing pharmaceutical companies to begin negotiations to reduce prices. If they do not, the government will begin the process of implementing most-favored-nation (MFN) pricing. “Under President Trump’s direction, HHS is demanding that pharmaceutical companies end their obstruction and come to the table—just as they already do with nearly every other economically comparable nation—to negotiate fair, transparent pricing for Americans,” a Health and Human Services (HHS)

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79. Managed Care Enters New Cycle; Medicare Advantage Needs To Pivot To Thrive

Managed care is entering a new conversion cycle just as Medicare Advantage plans have to pivot to thrive. About The Podcast:Millions of Americans feel confused and frustrated in their search for quality healthcare coverage. Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change. Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare. Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name. Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare. Tune in every week as

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