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January 16, 2024

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Congressional Leaders Agree on Extension of Funding

The four congressional leaders announced a deal to extend government funding to March 8 to avoid a government shutdown.  This is a concession by House Speaker Mike Johnson, R-LA, who originally said he would not extend government by a short-term continuing resolution (CR). A number of items are left out of the funding package. Conservatives in the House GOP caucus are not happy with Speaker Johnson’s (one of their own) endorsement of the extension.

Additional articles here: https://insidehealthpolicy.com/daily-news/short-term-cr-carries-extenders-through-march-8 and https://thehill.com/homenews/house/4410728-congress-shutdown-conservative-anger/

Additional article on status of healthcare bills, including hospitals’ opposition to site-neutral payments that is in a passed bill that would forestall disproportionate share hospital(DSH) funding cuts: https://www.modernhealthcare.com/politics-policy/congress-spending-deal-hospitals-dsh-medicare-site-neutral

(Some articles may require a subscription.)

#governmentshutdown #crs

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January 15, 2024

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Good Articles On Takeaways From JPM Healthcare Conference

Two good articles summarizing some major trends and topics at the JPM healthcare conference.  Highlights include:

  • Providers emphasizing creating payviders, where provider organizations set up their own insurance arm.
  • Hospital expansion of outpatient and ambulatory site investments given pressures on inpatient.
  • Medicare Advantage Star woes and risk adjustment changes.
  • PBM transparency reforms.

Additional article here: https://www.modernhealthcare.com/finance/jpm-2024-takeaways-commonspirit-mayo-clinic-centene-cvs-cigna-teladoc

(Some articles may require a subscription.)

#healthplans #providers #hospitals #stars #pbms

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January 12, 2024

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What Would A Nikki Haley Healthcare Agenda Look Like?

The Republican debates continue with Donald Trump bowing out and Ron DeSantis and Nikki Haley taking center stage.  A recent CNN debate saw the two sparring, sometimes on healthcare issues. Both Haley and DeSantis declared that they would like to replace the Affordable Care Act (ACA) with a block grant.  It is a horrible idea.

With Chris Christie’s departure from the race and Haley rising in the polls, Kaiser Health News (KHN) did a feature on what a Haley administration’s healthcare agenda may look like.

Additional article on Haley’s views on entitlement reform here: https://www.cnn.com/2023/12/05/politics/nikki-haley-social-security-medicare-reform/index.html

#gopprimary #haley #desantis #trump #healthcare #aca #obamacare

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January 11, 2024

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Dysfunction Junction Update:  Will Government Shutdown?

Faced with an upheaval by the rightists (his very own!) in the House GOP caucus and upended procedural votes, Speaker Mike Johnson, R-LA, met with the Freedom Caucus members to discuss a possible alternative spending bill.  This came as a surprise to other leaders.  But Johnson could face the same purge that former Speaker McCarthy saw when he tried to do the right thing and comprise to keep government operating.  While no one has explicitly said they would call a vote to vacate the speakership, the idea has again been put out there by prominent members of the right-wing fire-setting brigade. Meanwhile, Senate Majority Leader Chuck Schumer, D-NY, has begun drafting a continuing resolution (CR) that extends government while the agreed-upon deal is worked on.  Senate Minority Leader Mitch McConnel, R-KY, has said this is needed. Johnson may be softening, but previously ruled out additional short-term CRs.

Additional articles:

https://thehill.com/homenews/house/4401412-johnson-risks-same-fate-as-mccarthy-with-spending-deal/

https://thehill.com/homenews/senate/4402814-schumer-short-term-stopgap-cr/

#governmentshutdown #crs

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January 10, 2024

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Oscar Says It Can Be Profitable in 2024 And May Expand To Other Products

Insurtech Oscar says its enrollment will hit 1.3 million members in the Exchanges once open enrollment concludes, a 31% increase year-over-year. It also could see positive margins in 2024, as much as 5%. It could expand into individual coverage health reimbursement arrangements (ICHRA) and Medicare Advantage (MA) in the future.

Both Oscar CEO Mark Bertolini (former Aetna CEO) and Centene CEO Sarah London are right that the Affordable Care Act (ACA) is here to stay with over 20 million enrollees.  

ICHRA is a good Trump-era rule that allows employers to make tax-free contributions toward employees’ individual coverage.  Oscar would be well-placed to offer a total ICHRA administrative solution coupled with enrollment in individual Exchange enrollment. Bertolini is a genius on this issue.

In other news, Alignment Healthcare touted its Star scores.

Additional articles:

https://www.fiercehealthcare.com/payers/jpm24-oscar-health-eyes-2024-profitability-and-ichra

https://www.fiercehealthcare.com/finance/jpm24-day-3-goodrx-expects-least-749m-revenue-2023

https://www.fiercehealthcare.com/payers/jpm24-centene-ceo-london-sees-growing-bipartisan-backing-acas-exchanges

(Some articles may require a subscription.)

#oscar #exchanges #alighnmenthealthcare #medicareadvantage #ichra

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January 9, 2024

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NY Wins Medicaid Waiver Approval

New York received an 1115 Medicaid waiver approval from the Centers for Medicare and Medicaid Services (CMS) covering a myriad of innovations, including recruitment and retention of Medicaid providers, eligibility to bill social needs spending, primary care investments, behavioral health investments, and health equity pilots. CMS press release here: https://www.cms.gov/newsroom/press-releases/cms-approves-new-yorks-groundbreaking-section-1115-demonstration-amendment-improve-primary-care

#medicaid #cms #waivers #socialneeds #healthequity

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January 8, 2024

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Aetna Turnaround On Stars And Enrollment Is Amazing

At the JP Morgan conference, CVS President and CEO Karen Lynch was taking a well-deserved victory lap.  With all that is going on at CVS, the Aetna turnaround on enrollment and Stars in Medicare Advantage (MA) is amazing.  It is no small feat given competitiveness in the MA world and the major changes in Star for 2024. 

#cvsaetna #cvshealth #aetna #medicareadvantage

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January 5, 2024

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FDA Approves Florida Drug Importation

The Food and Drug Administration (FDA) has approved Florida to import prescription drugs from Canada via bulk purchasing.  This would mean Florida residents would have access to Canadian wholesale prices, which are far lower than in the United States.  Brand drug makers immediately attacked the waiver as reckless and claimed it could endanger health.  Nonsense.  Canada is a developed country with a great safety record. The waiver also has strict quality control measures in it. This is yet another stunt by Big Pharma to maintain its high prices in the United States. It likely will sue to stop it. Canada, too, could disrupt the plan if it results in shortages there.  Although the targeted drugs right now look like they are in reasonable supply, look out for a “manufactured” crisis to emerge.

This is a feather in the cap of presidential candidate and Fl. Gov. Ron DeSantis, who has been pressing the Biden administration for the waiver. Biden will surely tout this during his run. Donald Trump too, as he passed the original rules to allow states to do this.  Florida sued the federal government when its application stalled.

Florida says residents could save $150 million annually, but Florida will start very slowly, with a few classes of drugs and government programs now. Other states have pending applications and others could submit as well. So, broad relief will take time and the program would have to grow in Florida and other states.  Many currently import drugs individually through Canadian pharmacies and it is technically illegal. But with Medicare drug price negotiations, this is yet another way to solve a huge affordability crisis in America over time.

Other articles here:

https://insidehealthpolicy.com/daily-news/florida-first-state-receive-fda-nod-rx-drug-importation

https://thehill.com/policy/healthcare/4390990-florida-drugs-canada-approval/

https://www.statnews.com/2024/01/05/ron-desantis-import-drugs-canada-biden-trump/

#drugpricing #drugimportation #fl #brandrugmakers

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January 4, 2024

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Hospitals, Payers Have Better Compliance With Transparency Requirements

Hospitals and payers seem to be complying more with required price transparency postings.  As well, the Centers for Medicare and Medicaid Services (CMS) has ramped up enforcement.  New rules went into effect 1/1 and Congress wants to codify the rules and enhance them. Additional article here: https://www.medpagetoday.com/special-reports/features/108126

#transparency #pricetransparency #healthplans #hospitals #cms

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January 3, 2024

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Aggressive Agenda for Healthcare on Capitol Hill

Good article on all the healthcare priorities for 2024.  This tracks very closely to my predictions for 2024 blog ( https://www.healthcarelabyrinth.com/channeling-nostradamus-the-healthcare-labyrinths-2024-predictions/ ).

As I noted, a continuing resolution (CR) or other funding bill must pass soon to keep healthcare agencies open. As well, the article says that price transparency reporting, PBM reforms, and site-neutral payments are on the agenda. Note the reference to the long shot possibility of Medicare Advantage (MA) payment reductions. Troubled by prior authorization and overpayment headlines, Congress could take a bite out of rates for MA plans. This was also a possibility I raised in my predictions. There is also the issue of physician fee cuts in Medicare.

(Article may require a subscription.)

#transparency #pricetransparency #governmentshutdown # crs #siteneutral #pbms #medicareadvantage #medicare #overpayments #providers #rates

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