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January 9, 2025

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Musk Calls Out Goals For DOGE

Tesla CEO Elon Musk, who is co-leader of Donald Trump’s proposed Department of Government Efficiency (DOGE) commission, said that the best-case scenario would be to put together $2 trillion in cuts to federal spending. He said that then DOGE would have a good shot at executing $1 trillion in reductions.

Whether the goal is a real $1 trillion or $2 trillion, it is clear that healthcare program cuts will play a big role in spending reductions.

#doge #government #spending #trump #congress #healthcare

https://thehill.com/homenews/administration/5076095-elon-musk-doge-2t-spending-cut-goal/?tbref=hp

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Exchange Enrollment Hits Record

With about a week left of enrollment, the Centers for Medicare and Medicaid Services (CMS) said that the Exchanges have reached yet another record enrollment number after mostly lagging during the enrollment season. More than 23 million people have selected coverage. There are 3.2 million new enrollees. Of the people who have signed up so far, 16.7 million found coverage on the federal Exchange, with 6.9 million on the state Exchanges. This is the fourth consecutive year of enrollment records.

Enhanced premium subsidies expire at the end of 2025, which could dramatically impact enrollment. Today congressional Republicans declined to say they would simply let the subsidies expire. Instead, they expect the issue to emerge during talks to extend the Trump tax cuts and the reconciliation process. I still see this as a long shot, but it is bolstered by Sen. Lisa Murkowski’s advocacy for continuation of the enhancements.

CMS press release and fact sheet: https://www.cms.gov/newsroom/press-releases/nearly-24-million-consumers-have-selected-affordable-health-coverage-aca-marketplace-time-left and https://www.cms.gov/newsroom/fact-sheets/marketplace-2025-open-enrollment-period-report-national-snapshot-1

Additional articles: https://www.healthcaredive.com/news/aca-enrollment-2025-record-high/736803/ and https://insidehealthpolicy.com/daily-news/admin-announces-24m-aca-sign-ups-so-far-urges-congress-keep-enhanced-credits and https://thehill.com/policy/healthcare/5072422-biden-administration-achieves-fourth-record-breaking-aca-enrollment-ahead-of-exit/ and https://apnews.com/article/obamacare-aca-health-care-coverage-biden-trump-0c73dcde4a19aea65cb83de01f2d5d2e and https://www.beckerspayer.com/payer/states-with-the-largest-aca-enrollment-increases-2025.html and https://www.modernhealthcare.com/politics-policy/aca-subsidies-trump-exchange-market

(Some articles may require a subscription.)

#aca #obamacare #exchanges #coverage

https://www.fiercehealthcare.com/regulatory/236m-people-have-signed-aca-coverage-during-open-enrollment-cms

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Biden Administration Finalizes Medical Debt Provision

The federal Consumer Financial Protection Bureau issued finalized regulations barring medical debts on credit reports. The rule bans credit agencies from including medical debts on consumers’ credit reports and prohibit lenders from considering medical information in assessing borrowers. To me, it is very unlikely the Trump administration will seek to overturn the regulation. I support the provision. Americans with and without insurance are unfairly saddled with huge provider bills that are exorbitant and have no basis in cost or fact.

Additional article: https://www.modernhealthcare.com/politics-policy/joe-biden-bans-medical-debt-credit-scores-cfpb-donald-trump

(Some articles may require a subscription.)

#medicaldebt #providers #healthcare

https://thehill.com/policy/healthcare/5070182-medical-debt-removed-credit-reports-cfpb

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Could Trump Bring Back International Reference Pricing

Interesting Forbes article alluding to a December dinner with President-elect Trump attended by Eli Lilly CEO David Ricks. Apparently, international reference pricing to set Medicare drug prices was discussed. Subsequently, Ricks has alluded to the need to increase prices abroad in developed countries, leading some to speculate Trump could re-issue his proposal for adopting the most favored nation prices for Part B medical drugs in Medicare. At the time, Trump said he might even make the proposal applicable to Part D retail drugs in Medicare.

During the campaign, he seemed to swear off the idea, but we know Trump changes his mind. He is also obsessed by being ripped off by other nations. Drug pricing is a great example. Drug makers agree to low prices in other developed countries because America pays for the vast majority of its profits (about three-quarters). The money earned in other countries is gravy.

#drugpricing #branddrugmakers #trump #medicare #partd #partb

https://www.forbes.com/sites/joshuacohen/2025/01/03/trump-may-revisit-most-favored-nation-model-for-prescription-drug-prices

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Murkowski Supports Exchange Premium Subsidy Extensions

Sen. Lisa Murkowski, R-AK, says she supports extending enhanced premium subsidies in the Exchanges because of the help it has provided people to afford coverage. Betting odds are still that the GOP-controlled Congress will allow the subsidies to expire at the end of 2025. But Murkowski’s statement leaves some hope for a long-shot, one-year extension some time in 2025.

#exchanges #aca #obamacare

https://thehill.com/policy/healthcare/5066188-murkowski-obamacare-premium-subsidies

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Laws And Rules That Went Into Effect as of January 1

A series of new healthcare federal and state laws and regulations went into effect on January 1.

A federal rule update requires new fields and data related to pricing that must be disclosed by hospitals related to the price transparency requirements. This will create greater compliance, consistency, and better comparisons of prices.

States enacted laws that restrict prior authorization, expand mandated benefits, expand Medicaid, require bias training, require cybersecurity audits, reform pharmacy benefit managers (PBMs), restrict cost-sharing for drugs, and undertake medical-debt reform.

Additional: article: https://www.modernhealthcare.com/government/state-healthcare-laws-2025-california-illinois-minnesota-arkansas

(Some articles may require a subscription.)

#2025 #healthcarereform #regulations

https://www.statnews.com/2025/01/02/hospital-price-transparency-rules-2025-cms/

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Hospitals In Better Financial Shape Going Into 2025

Hospitals and health systems are on better financial footing than a year ago. Operating margins, cash flows, outpatient revenue, average inpatient length of stay, and outpatient revenue improved from 2023. For many providers (in particular health systems), volumes have rebounded to above pre-pandemic levels.

In October 2024, the mean operating margin for hospitals was 4.4%, up from 2.5% in November 2023 and 2.7% in December 2023, says consulting firm Kaufman Hall.

Labor expenses have dropped and inflationary pressures have subsided. But there has been continued growth in supplies, drug expenses, and purchased service expenses.

On the policy front, hospital groups are worried about budget cuts under the incoming Trump administration that could lead to the expiration of Exchange enhanced subsidies, rate cuts in Medicare and Medicaid, and a pullback on coverage overall. As well, smaller entities could struggle on the cybersecurity preparedness front.

#hospitals #providers #cybersecurity #coverage #medicare #medicaid #costs #rates #drugpricing #exchanges

https://www.fiercehealthcare.com/hospitals/2025-outlook-hospital-finance-show-signs-stability-rising-costs-will-be-headwind

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Kennedy And Oz At Odds On GLP-1s

Department of Health and Human Services (HHS) Secretary-nominee Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services (CMS) Administrator-nominee Dr. Mehmet Oz are at odds over support for GLP-1 weight-loss drugs.

Oz has opined that the drugs could have a positive effect on weight loss and reducing disease prevalence. Kennedy sees them as a scam and insists that the American public simply needs to eat better.

The Biden administration has proposed in a draft rule to provide Medicare Part D coverage for obesity alone. Trump will need to finalize the rule or remove the provision. This will be the first test of who will win the GLP-1 coverage war.

The drugs are expensive at $1,000 or greater per month at list price.

#glp1s #weightlossdrugs #drugpricing #branddrugmakers

https://thehill.com/policy/healthcare/5055607-rfk-jr-vs-oz-sets-up-clash-on-weight-loss-drug-coverage

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Some Hope For Medicaid Hikes

Medicaid managed care plans have argued that risk in the program has gone up with the Medicaid unwinding (redeterminations) and rates have become inadequate to serve remaining enrollees. A number of state Medicaid directors are now saying mid-year rate hikes could address the financial woes of plans.

The Alliance of Community Health Plans is urging the current administration to urge states to re-evaluate current rates.

Notwithstanding the positive signs, states will have a hard time affording major hikes given the drying up of extraordinary federal revenue given to states during the COVID pandemic.

(Article may require a subscription.)

#medicaid #redeterminations #rates #healthplans #managedcare

https://insidehealthpolicy.com/daily-news/states-promote-mid-year-rate-adjustments-mcos-struggling-post-covid

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HHS Issues Cybersecurity Rule

The U.S. Department of Health and Human Services (HHS), through its Office for Civil Rights (OCR), issued a proposed rule to improve cybersecurity and better protect the healthcare system from cyberattacks.

The proposed rule modifies the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule. It requires health plans, healthcare clearinghouses, most healthcare providers, and most business associates, to strengthen cybersecurity protections against external and internal threats. It requires updates to existing cybersecurity safeguards, using modern best practices, to reflect advances in technology and cybersecurity. It provides greater detail on what covered entities and business associates need to do to protect the security of electronic protected health information (PHI). Policies and procedures would have to be in writing, reviewed, tested, and updated on a regular basis.

Specifically, HHS says the rule reacts to:

Changes in the environment in which healthcare is provided.
Significant increases in breaches and cyberattacks.
Common deficiencies OCR has observed in investigations into Security Rule compliance by covered entities and their business associates.
Other cybersecurity guidelines, best practices, methodologies, procedures, and processes.
Court decisions that affect enforcement of the Security Rule.

The rule is in response to growing cybersecurity incidents, including the Change Healthcare attack earlier this year that made much of healthcare come to a standstill.

Th fact sheet is well written and explains many of the details of the rule. I am surprisingly impressed with the proposal and its details. I think it is a good start to protecting the nation from emerging cyberattacks. The problem, though is the readiness of health plans and providers, especially many who have limited expertise and knowledge. They do not have the dollars or know-how to implement protections. As such, I think we need a true national cyber plan with a strong budget and implementation strategy. The rule is a start but is not enough.

Rule at Federal Register: https://www.federalregister.gov/public-inspection/2024-30983/health-insurance-portability-and-accountability-act-security-rule-to-strengthen-the-cybersecurity-of .

Fact Sheet: https://www.hhs.gov/hipaa/for-professionals/security/hipaa-security-rule-nprm/factsheet .

#cybersecurity #healthplans #providers #cms #hhs

https://www.hhs.gov/about/news/2024/12/27/hhs-office-civil-rights-proposes-measures-strengthen-cybersecurity-health-care-under-hipaa.html