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MA Growth Down Markedly In Enrollment Season

The Centers for Medicare and Medicaid Services (CMS) finally published some data on the 2025 enrollment season and growth is down considerably. This is likely tied to the financial crisis in the industry. The January report still seems to have issues so many analysts are either comparing February 2024 to February 2025, January 2024 to February 2025, or a month in late 2024 to February 2025. I will have a comprehensive blog on this subject tomorrow.

Different outlets have ranges of numbers in their coverage. My calculation is that enrollment grew about 4.4% from January 2024 to February 2025. This is down from 8.7% in 2024 and 6.1% in 2022. Of the big nine national health plans, seven gained enrollment from January 2024 to February 2025. But just five of them gained from December 2024 to February 2025.

In other news, the Kaiser Family Foundation (KFF) published an analysis of the spending reductions related to a Medicaid per capita cap program – a possible revamp of Medicaid that stands in between the traditional program we have now and a strict block grant. KFF finds that capping per enrollee spending could reduce federal Medicaid expenditures by $532 billion to nearly $1 trillion over 10 years depending on how states respond. States could either fill the hole or reduce coverage, or a combination. KFF says as many as 15 million could lose coverage by 2034.

KFF also finds that eliminating the Medicaid expansion matching rate as well could push the federal Medicaid spending savings to as much as $2.1 trillion. As many as 30 million could lose coverage if both are done.

Additional articles: https://www.fiercehealthcare.com/payers/cms-data-medicare-advantage-enrollment-growth-hits-skids and https://www.beckerspayer.com/payer/which-medicare-advantage-insurers-gained-lost-members-for-2025.html and https://www.modernhealthcare.com/insurance/medicare-advantage-enrollment-2025 and https://www.kff.org/medicaid/press-release/capping-per-enrollee-spending-could-reduce-federal-medicaid-expenditures-by-532-billion-to-nearly-1-trillion-over-10-years-depending-on-how-states-respond-and-result-in-as-many-as-15-million-people/ and https://www.kff.org/medicaid/issue-brief/a-medicaid-per-capita-cap-state-by-state-estimates/

(Some articles may require a subscription.)

#medicareadvantage #enrollment #medicaid #budgetreconciliation

https://www.healthcaredive.com/news/medicare-advantage-enrollment-2025-unitedhealth-humana/738048/

House Passes Budget Framework; Healthcare Cuts Heat Up

The House adopted a budget reconciliation bill today with just one GOP defection. House Speaker Mike Johnson and President Donald Trump got three other doubters to convert to “yes.” The vote was 217 to 215. The bill paves the way for final passage down the road but a great deal of work has to occur, with committees now meeting on spending cut targets. This includes $880 billion in healthcare spending cut targets. Johnson and perhaps Trump convinced holdouts that Medicaid rolls will not be cut except for work requirements and if someone is illegally on the program. It may be hard to keep the commitment with a large reduction bogey. The victory was major for Johnson but he now needs to hold all these folks in place as spending cuts are debated in committees.

Meanwhile, healthcare news is heating up due to the possible spending cuts:

• The Blue Cross and Blue Shield Association (BSCSA) issued a report today that has $1 trillion in healthcare cost reductions over a decade — federal savings of $524 billion, lower private insurance premiums of $389 billion, patient savings of $180 billion. The largest potential area for savings is to adopt site-neutral payments in Medicare, which would save $484 billion over 10 years. I will do a blog on the report next week.
• A Modern Healthcare article explains work requirements and their history in Medicaid.
• The Health and Human Services (HHS) Office of Inspector General (OIG) said that Medicare costs of ten common diabetes medications, including GLP-1s, went up by 364% between 2019 and 2023. In 2019, Medicare spent roughly $7.7 billion. In 2023, the cost reached $35.8 billion.
• Trump plans to sign an executive order to reinforce rules to make healthcare prices more transparent for patients. The order will update agency enforcement policies to make sure healthcare providers and insurers are complying with the rules.
• Insurers overall had a poor 2024 due to various issues, including poor Medicare Advantage (MA) rates. There were a few exceptions.
• A Kaiser Family Foundation (KFF) poll finds that Medicaid is viewed favorably by a large majority (77%) of the public and an even larger share of those on the program (84%). Another poll from Hart Research conducted for the nonprofit Families Over Billionaires finds that 71% percent of voters who backed Trump said cutting Medicaid would be unacceptable. 
• A compound pharmacy trade group has filed a lawsuit against the Food and Drug Administration (FDA) for removing semaglutide, the active ingredient in Ozempic, from its drug shortage list. Many Americans use these generic compounds for weight loss due to the $1,000 plus cost of brands. Still, the generic drug costs can be $200 plus a month.

Additional articles: https://www.fiercehealthcare.com/regulatory/bcbsa-report-addressing-hospital-pharma-costs-could-save-1t-over-next-decade and https://www.modernhealthcare.com/policy/medicaid-work-requirements-gop-budget and https://www.beckerspayer.com/payer/medicare-part-d-spending-on-weight-loss-drugs-surges-364-oig.html and https://www.modernhealthcare.com/policy/trump-healthcare-cost-transparency and https://www.healthcaredive.com/news/health-insurer-medical-costs-climbing-ma-medicaid/740611/ and https://www.kff.org/medicaid/report/the-debate-over-federal-medicaid-cuts-perspectives-of-medicaid-enrollees-who-voted-for-president-trump-and-vice-president-harris/ and https://thehill.com/policy/healthcare/5161953-obamacare-medicare-budget-entanglement/ and https://thehill.com/homenews/house/5163381-democrats-medicaid-gop-budget/ and https://thehill.com/policy/healthcare/5163193-trump-voters-oppose-medicaid-cuts-poll/\ and https://thehill.com/policy/healthcare/5163570-weight-loss-drugs-fda-shortage-list-ozempic-wegovy/

(Some articles may require a subscription.)

#healthcare #trump #congress #budgetreconciliation #medicare #medicaid #coverage #siteneutral #glp1s #weightlossdrugs #drugpricing #branddrugmakers #healthplans #hospitals #pricetransparency

https://www.cbsnews.com/news/budget-resolution-house-vote-mike-johnson-trump-agenda

More Surprises From Trump On Drug Pricing

Donald Trump’s Centers for Medicare and Medicaid Services (CMS) in late January said it would continue Medicare drug price negotiations. Then, in a Super Bowl interview, Trump bemoaned the cost of GLP-1 weight-loss drugs in America compared with other developed nations. Now, the Trump administration has chosen to defend the Medicare drug price reform law in court.

In a filing Feb. 19, the government agreed with the legal arguments used by the Biden administration and by a lower court.

Trump so far is not what Big Pharma hoped.

#ira #medicare #partd #drugpricing #branddrugmakers

https://www.fiercehealthcare.com/payers/trump-admin-defends-ira-drug-price-negotiation-program-novartis-lawsuit

Centene and Molina Could Be Hurt By Medicaid Cuts

Medicaid managed care-dominant insurers Centene and Molina could be hurt by Republicans’ plans for cuts to Medicaid. The House GOP has a target of $800 billion in healthcare spending reductions. While President Trump and GOP leaders have promised no dramatic changes to Medicaid, the targets would clearly mean deep reductions. While work requirements and fraud cuts are certain, other impacts could be reimbursement changes at the state level.

Centene is the largest Medicaid managed care insurer with 13 million Medicaid beneficiaries as of Dec. 31. The membership generates 62% of the company’s revenue. Medicaid represents 88% of Molina’s membership and nearly 80% of its revenue for 2024.

(Article may require a subscription.)

#medicaid #managedcare #budgetreconciliation #trump #congress #molina #centene

https://www.modernhealthcare.com/insurance/medicaid-cuts-centene-molina-healthcare

Trump Limits Public Benefits To Undocumented

President Donald Trump issued an executive order that limits public benefits for undocumented immigrants. It directs each federal agency to identify programs that currently allow undocumented immigrants to receive federal benefits and to comply with the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, which generally prohibits such benefits. The order also mandates the enhancement of eligibility verification systems. It also seeks to limit or bar funding state and local programs that either subsidize illegal immigration or support sanctuary policies.

Fourteen states plus D.C. provide state-funded healthcare coverage to children regardless of immigration status. California is the first state to offer Medicaid coverage to all eligible undocumented individuals.

#trump #immigration #healthcare

https://www.beckershospitalreview.com/legal-regulatory-issues/trump-signs-executive-order-to-end-federal-benefits-for-undocumented-immigrants.html