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March 11, 2024

March 12, 2024 No Comments

Biden Releases His FFY 2025 Budget The President announced his FFY 2025 budget even as all bills for the current FFY 2024 year have not been approved (including Health and Human Services spending).  Biden did sign into law the bill that funds some agencies for the current fiscal year, including a partial retreat on a major Medicare doc cut. Because of the split in Congress, most of his proposals are dead on arrival but serve as campaign differentiators against his GOP opponent, former President Donald Trump. In the FFY 2025 budget, Biden funds the commitments he made at the State of the Union and more: Additional articles: https://www.modernhealthcare.com/politics-policy/biden-budget-cybersecurity-insurance-subsidies and https://insidehealthpolicy.com/health-insider/admin-releases-budget-addresses-fallout-over-change-healthcare-attack and https://www.fiercehealthcare.com/providers/congress-reaches-spending-deal-doc-pay-bump-delayed-dsh-cuts-and-more (Some articles require a subscription.) #budget2025 #healthcare #healthcarereform Link to Article Change Healthcare Cyber-Attack Update The Department of Health and Human Services (HHS) urged UnitedHealth Group and other payers to provide financial assistance to providers impacted by the

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King Charles’ Cancer Diagnosis Shines A Light On Holes In The U.K.’s Healthcare System – And Ours

March 11, 2024 No Comments

In early February, Buckingham Palace announced that King Charles has been diagnosed with cancer. As is often the case for the royals’ personal lives, not a lot is always shared. But the King and his now deceased mother should be congratulated for some of their openness. Like his mother’s announcements when her health was in question, the King’s announcement was meant to encourage everyone to take care and get preventive care performed. At the same time, the King’s announcement has shined a light on some of the problems in the United Kingdom’s healthcare system. As I have covered a few times in my blogs, the U.K. just celebrated its National Health Services’ 75th anniversary of its founding a few years after World War II ended. The U.K. took the socialized medicine approach, where the government funds, directs, runs, and largely provides healthcare services to its citizens. Some other nations in

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March 8, 2024

March 8, 2024 No Comments

Biden SOTU Address Fiery And With Major Expansion Requests President Joe Biden gave a fiery campaign speech at the State of the Union Thursday.  He touched on policy changes he wants to see across government and society.  In the healthcare world, he asked for significant additions to what he thinks is his successful record: Additional articles: https://www.fiercehealthcare.com/payers/biden-call-drug-negotiation-expansions-stronger-reproductive-care-access-sotu and https://insidehealthpolicy.com/daily-news/biden-advocates-expansion-drug-price-controls-aca-state-union and https://www.modernhealthcare.com/politics-policy/joe-biden-state-union-sotu-2024 (Some articles may require a subscription.) #biden #sotu #healthcare #healthcarereform #aca #obamacare #exchanges #drugpricing #ira #coveragegap #insulin Link to Article Change Healthcare May Need Until Mid-March To Fully Restore All Services While some services have been restored, Change Healthcare says all services may not be restored until mid-March.  Meanwhile, class-action lawsuits are beginning to be contemplated.  Major parts of health plan and provider services have been impacted. Additional articles: https://www.fiercehealthcare.com/payers/optums-change-healthcare-responding-cybersecurity-issue and https://www.modernhealthcare.com/cybersecurity/change-healthcare-update-systems-online-march15 (Some articles may need a subscription.) #changehealthcare #cybertattacks Link to Article Sanders Asks Other Drug Makers To

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13. Medicare Advantage Compliance and Regulatory Trends in 2024

March 8, 2024 No Comments

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. 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. On this episode of the Healthcare Labyrinth Podcast, Marc explains the 2024 Regulatory and Compliance trends in Medicare Advantage. The most important change is a new 2024 prior authorisation rule. Marc gives his views

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March 7, 2024

March 7, 2024 No Comments

Almost 18 Million Initially Lost Medicaid Coverage During Redeterminations The Kaiser Family Foundation reports that almost 18 million initially lost coverage during Medicaid redeterminations.  Some regained eligibility later.  Most lost coverage on procedural grounds.  Enrollment has dropped by about 10M so far in Medicaid nationwide. #medicaid #redetermintations Link to Article Evernorth Continues Growth Cigna’s Evernorth service subsidiary continues its growth. It announced an expansion to its GLP-1 management solution as well as the launch of a new behavioral-health-focused medical group. #cigna #evernorth Link to Article Biden To Propose Major Expansion Of Healthcare Initiatives President Biden will propose major healthcare expansions in his State of the Union Address tonight.  Among other things, a Fact Sheet says he will propose an expansion of Medicare drug price negotiation (500 drugs negotiated over the next 10 years), permanent expansion of enhanced premium subsidies in the Exchanges, a special program for those in the coverage

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Joe Biden Goes On The Offensive With Healthcare Reforms

March 7, 2024 No Comments

Looking for any angle to take the focus off his age and the economy overall, President Joe Biden and Democrats are now focusing on healthcare in the presidential election. In my mind, it is a very good strategy. As I have said in previous blogs, my Republican Party has a compassion gap when it comes to healthcare. Republicans have not formulated any real agenda on healthcare reform. Most tend to distance themselves from any talk of reform. More right-wing elements talk actively of repealing the Affordable Care Act (ACA), which has helped in the neighborhood of forty million Americans (not counting those with pre-existing conditions and on their parents’ policies until age 26.) Whatever you think of some of the Democrats’ ideas, the party has actively embraced healthcare reform. Some ideas I clearly hate, such as Medicare for All. But others, like drug price reform and anti-trust activities, make a

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March 6, 2024

March 6, 2024 No Comments

Walgreens Will Have Long Road To Recovery Walgreens says that its road to financial recovery will be long – not a 12-month plan.  It is undertaking a strategic review of its business. It plans to cut $1 billion in expenses this year.  Additional article: https://www.modernhealthcare.com/providers/walgreens-tim-wentworth-villagemd-shields-health-ownership (Some articles may require a subscription.) #walgreens Link to Article Major Claims Reductions Reported In Light of Change Healthcare Cyber Attack While UnitedHealth Group remains mum, Humana and Elevance Health say they are seeing a 15% to 20% reduction in data from providers since the Change Healthcare cyber attack. The rate of reduction is now down to 10% as providers and plans adapt to the outage from Change. Plans are adopting a reserve strategy to ensure a set aside for such claims in the future. Change Healthcare/Optum will likely lose a great deal of business as providers and plans lose faith in Change and migrate to other

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March 5, 2024

March 5, 2024 No Comments

Cuban Recommends Radical Change In Drug World To Reduce Costs I am a big fan of Mark Cuban and what he and his Cost Plus Drugs are doing to reform the drug price system.  So when he speaks, I listen.  At a White House round table, Cuban proposed that federal programs cut off all ties to traditional pharmacy benefits managers (PBMs) and embrace full transparency.  He has a direct-to-consumer firm and various transparent PBMs are all in on this idea.   The White House liked the transparency idea but knows it is easier said than done and there are many barriers to unravel what we have now. I note that the transparency model emerging right now works well for generic drugs, but it will be harder and take more time for brand drugs, especially until we get prices lower and solve for the shadowy rebate system. But Cuban’s transparency and

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March 4, 2024

March 4, 2024 No Comments

FFY 2024 Spending Package Agreed To By Key Lawmakers A bipartisan spending bill has been agreed to by key lawmakers and will need to be voted on in each House.  The package basically cuts in half the Medicare doc fix cut of 3.4%, pushes back scheduled disproportionate share hospital (DSH) payment cuts, and increases annual funding for community health centers. Accountable Care Organizations’ (ACOs) bonus program was also protected. Absent from the bill are major healthcare reforms. Docs are not very happy with the partial fix and no total overhaul of their rates. Additional articles here: https://www.fiercehealthcare.com/providers/congress-reaches-spending-deal-doc-pay-bump-delayed-dsh-cuts-and-more and https://insidehealthpolicy.com/health-insider/lame-duck-battle-looms-health-wins-skinny-bill-expiring-december and https://insidehealthpolicy.com/daily-news/skinny-health-package-scales-back-doc-fix-adds-chc-funding and https://www.medpagetoday.com/practicemanagement/reimbursement/109008 and https://thehill.com/policy/healthcare/4507164-government-funding-bills-leave-out-phamacy-benefit-manager-industry-changes-as-white-house-mulls-reforms/ (Some articles may require a subscription.) #governmentshutdown #healthcare Link to Article All Drug Makers Submit Counter Offers In Medicare Drug Price Negotiations The White House announced that all ten companies involved in the initial Medicare drug price negotiations have sent in counter proposals to what

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Part 4: My Courageous Daughter Is Having Brain Surgery!

March 4, 2024 No Comments

This is one of a number of blogs that will appear on my daughter. I call her Kitty. She is a wonderfully talented, bright, and empathetic individual in her late ‘20s. She and I agreed I would write this series to impart how important health coverage is. Not only is her decision to have surgery courageous, but so is her decision to share her journey through me. The principal reason to share the journey is because we both want to explain what many average Americans go through financially when they have major operations and do not have the best insurance or no insurance at all. My daughter is privileged to come from a well-off family and to have consistent and robust insurance. This will mean that she will pay a tiny amount for a surgery with a sticker price in the hundreds of thousands of dollars. But for uninsured and

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