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No Smooth Sailing: Agreement To Run Exchange Amendment Hits Rocks

An agreement between moderate Republicans and the House GOP leadership to allow a vote on an amendment to extend the expiring Exchange is in doubt as the two sides squabble over whether any extension will be paid for by spending offsets.

The amendment would extend the enhanced subsidies for two years but add certain eligibility reforms. But the House leadership is demanding spending offsets due to conservative objections. A full subsidy extension would cost about $35 billion a year.

Conservatives could derail the amendment in the Rules Committee even before it gets to the floor. GOP moderates could vote against the bill as a whole and sink it as Democrats will not support it. As an alternative, the GOP moderates could team up with Democrats to force a vote via one of several discharge petitions, which need 218 signatures to come to the floor without the Speaker’s permission. House Democrats say they’re looking for the green light from their leadership to band together with moderate Republicans.

A free-standing extension would have a better shot at passing the House. In the Senate, 13 Republicans would have to vote with Democrats to reach a 60-vote requirement to pass the bill.

Meanwhile, more is being released on the GOP master reform bill. The bill would approve association health plans, which have employers band together to purchase coverage. These plans have some but not all Affordable Care Act (ACA) protections. Individual coverage health reimbursement arrangements, or ICHRAs, would be expanded. These provide employer subsidies to allow employees to purchase Exchange coverage. Broadened access to stop-loss coverage for mid-size and small employers would be included, which would encourage additional self-insurance vs insurer risk arrangements.

Pharmacy benefits manager reform is also included. And cost-sharing subsidies in the Exchange would be reappropriated. This was defunded under Trump 45. The move would lower overall Silver premiums but have the adverse effect of lowering subsidies now, causing 300,000 to perhaps drop coverage.

The House bill does not endorse expansion of health savings accounts (HSAs), which is what the leading Senate bill proposed to do in lieu of an enhanced subsidy extension.

Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-house-aca-subsidies-association-health-plans/ and https://thehill.com/homenews/house/5650083-aobamacare-subsidies-amendment-vote/ and https://thehill.com/homenews/house/5647098-obamacare-subsidies-house-democrats/

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#exchanges #healthcare #coverage

https://www.fiercehealthcare.com/regulatory/house-gop-healthcare-bill-eschews-subsidy-extension-hsas

House GOP To Allow Vote On Exchanges But By Amending Major Reform Bill

Two major decisions from GOP leaders in the House today. First, it will allow a vote on an Obamacare extension to appease several dozen vulnerable Republicans in swing districts. Second, but this will come via an amendment on a broad reform bill from Republicans focused on more conservative reforms.

The main bill will feature the following reforms. Exchange cost-sharing subsidies would be funded to lower Silver premiums. This has positive and negative effects depending on subsidy status and income. Greater self-insurance provisions would be included, along with pressing for cheaper plan designs. Some pharmacy benefits manager reforms would be included.

Even if the amendment passed, the bill would ultimately not pass in all chambers because it would be viewed as a poison pill by Democrats, especially in the Senate.

Democrats are attempting to force a separate vote on a clean three-year extension. Moderates from both parties are looking at passing bills with a shorter extension and some reforms to the credits.

Meanwhile, President Donald Trump said he might be willing to work with Democrats on healthcare reform given affordability issues. Moderate GOPers in each chamber are putting pressure on their leaders to arrive at a real compromise instead of theatrics.

Additional article: https://thehill.com/homenews/house/5646341-gop-leaders-obamacare-vote/ and https://thehill.com/homenews/administration/5646004-donald-trump-democrats-health-care-aca-subsidies/?tbref=hp and https://thehill.com/homenews/senate/5645498-republicans-pressure-health-care-costs/

#exchanges #healthcare #coverage

https://thehill.com/homenews/house/5646973-house-gop-health-care-bill-obamacare

Dueling Healthcare Plans Fail In Senate

As expected, both the Democratic and GOP healthcare bills failed to get the 60 votes needed to pass in the Senate today. Democrats’ clean three-year extension of enhanced Exchange premium subsidies failed 51-48. Four Republicans, including Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, voted with Democrats. The GOP proposal from Republican Sens. Bill Cassidy, R-LA, and Mike Crapo, R-ID, also failed by a 51-48 vote.

Meanwhile, a growing number of centrist Democrats are joining forces with Republicans on bipartisan bills combining a shorter subsidy extension with policy reforms that could attract enough votes over time to past both chambers.

 Additional articles: https://www.fiercehealthcare.com/regulatory/dueling-democrat-republican-aca-subsidy-plans-fail-senate and https://www.beckerspayer.com/payer/aca/competing-bills-tackling-aca-subsidies-fail-in-senate/ and https://thehill.com/homenews/senate/5644661-republican-senators-democratic-obamacare-bill/ and https://thehill.com/homenews/house/5643381-obamacare-aca-subsidies-democrats-division/?tbref=hp

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#exchanges #healthcare #coverage

https://www.modernhealthcare.com/politics-regulation/mh-senate-healthcare-vote-aca-subsidies

Quick Recap Of House and Senate On Exchange Subsidies and Reform

The Senate is expected to vote Thursday on two proposals. The first is a Democratic proposal for a straight three-year extension of the enhanced Exchange subsidies. It is not expected to gain the 60 votes needed for passage as too few Republicans will join Democrats. But anything is possible right now.

The second is a GOP bill sponsored by Bill Cassidy, R-LA, and Mike Crapo, R-ID. It would not extend the enhanced subsidies, but fund health savings accounts (HSAs) for people who earn up to 700% of the federal poverty level. Those aged 18-49 would get $1,000 and those aged 50-64 would get $1,500. This bill is not expected to reach 60 votes, either, as few Democrats will vote with Republicans. Other compromise bills would extend the subsidy expansions for two years and make some reforms, including income caps, minimum premiums, and fraud protections. These do not appear on the docket, though.

 In the House, Republican leaders say they will vote on healthcare bills next week but not on enhanced subsidies. The caucus now seems to be on a mission to pass a broader reform package to impact affordability for all. The provisions could include site-neutral Medicare payments, pharmacy benefits manager reform, price transparency, expansion of alternative coverage, and health savings account initiatives. It also could fund cost-sharing reductions for the Exchanges.

In the meantime, some moderate Republicans are attempting to force a vote on subsidy extensions by filing a discharge petition. But the moderate GOP petition may be in competition with a Democratic one. Democrats in the House want a three-year extension.

Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-house-gop-vote-aca-subsidies-extension/ and https://thehill.com/homenews/house/5643481-republicans-obamacare-health-care-revolt/ and https://www.modernhealthcare.com/politics-regulation/mh-gop-aca-subsidies-extension-hsa-pbm/

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#exchanges #coverage #healthcare

https://thehill.com/homenews/house/5642438-house-gop-health-care-vote-subsidies

— Marc S. Ryan

Stars Health Equity Change Examined

A great Modern Healthcare article on the Trump administration’s proposal to expunge the Excellent Health Outcomes For All (EHO4all) health equity reward just a month before the second measurement year close. I am one of the Stars experts quoted. I make the argument that there are winners and losers when eliminating EHO4all and keeping the Reward Factor for high-performing plans. I think plans with major dual eligible populations and no near-term expectation of obtaining the Reward Factor could have a colorable argument that the rule does not give plans due process of a change. The switchback will cost Medicare billions.

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#cms #medicareadvantage #stars #quality

https://www.modernhealthcare.com/insurance/mh-medicare-advantage-star-ratings-centene-molina

Competing Senate Healthcare Bills

Senate Republicans launched competing proposals today to address the healthcare debate. Some want to preserve the enhanced subsidies, while others want the enhanced subsidies to expire and be replaced by direct cash to Americans. GOP Sens. Bernie Moreno, R-OH, and Susan Collins, R-ME, introduced a bill with a two-year extension of the enhancements with some conservative reforms – an income eligibility cap at $200,000, minimum premiums of $25 per month, and fraud reforms. The main competing proposal from HELP Chair Bill Cassidy, R-LA, and Mike Crapo, R-ID, doesn’t extend the subsidies at all. Instead, it would redirect that money into Health Savings Accounts paired with bronze or catastrophic plans on the Exchanges. Certain ACA enrollees earning less than 700 percent of the federal poverty level would receive $1,000 in an HSA if they’re 18 to 49 years old, and $1,500 if they’re 50 to 64.

In other news, a new poll says 57% of Americans approve of the Affordable Care Act (ACA) while 35% oppose. In addition to potentially going without coverage, healthcare policy group finds that many Americans may turn to short-term duration plans. And finally, Democrats are taking on water for a budding Medicaid scandal in Minnesota, under the leadership of Gov. and former Democratic VP candidate Tim Walz.

Additional articles: https://thehill.com/policy/healthcare/5638360-aca-affordable-care-act-obama-care-approval/?tbref=hp and https://www.kff.org/quick-take/as-aca-deadline-approaches-some-price-sensitive-consumers-may-consider-switching-to-short-term-plans/ and https://www.foxnews.com/politics/dr-oz-warns-walz-address-alleged-somali-medicaid-fraud-lose-federal-funding-stop-paying

#exchanges #congress #trump #healthcare #coverage

https://thehill.com/policy/healthcare/5638878-senate-republicans-health-care-proposals

Moderate GOPers Frustrated On Exchange Impasse

Frustration is mounting for moderate GOP lawmakers as the GOP has no defined healthcare plan, and Democrats are capitalizing on the lack of affordability in healthcare and the expiration of enhanced subsidies in the Exchange. Millions will see surging premiums as of January 1 with no action to extend the subsidies. Dozens in the GOP caucus in the House from swing districts face an uncertain future. A few GOP senators are also vulnerable. But so far, House Speaker Mike Johnson, R-LA, bolstered by opposition from conservatives, refuses to guarantee a vote in the House. In the Senate, Majority Leader John Thune, R-SD, did agree to hold a vote and Democrats are pushing a three-year extension. Sixty votes are needed to pass the bill. Democrats would need thirteen GOP defectors. It is a near impossibility.

In other news, MedPage Today talks about the irony that tax-free Health Savings Accounts (HSAs) can pay for parenting workshops, bassinets, and even saunas, but cannot use the funds to pay for premiums under current law. Some Republicans want to send the enhanced subsidies in favor of funding HSAs, but many even among Republicans doubt the federal government can pull off such a swift implementation.

Additional article: https://www.medpagetoday.com/publichealthpolicy/washington-watch/118862 and https://www.fiercehealthcare.com/payers/ahip-presses-aca-subsidy-extension-further-program-integrity-measures

#exchanges #healthcare #coverage #hsas

https://thehill.com/policy/healthcare/5634256-gop-health-care-plans-frustration

Schumer Unveils Three-Year Subsidy Extension

Senate Minority Leader Chuck Schumer, D-NY, unveiled a clean three-year extension of enhanced premium subsidies for a vote next week in the upper chamber. This came after a group of Senate Democrats gained a commitment from Senate Majority Leader John Thine, R-SD, for a subsidy vote when the group agreed to support a bill to reopen the government.

Some Democrats have held talks with centrist Republicans to seek a compromise that would temporarily extend the enhanced subsidies while adding policies such as income eligibility caps, minimum premiums, and anti-fraud measures. This could mean the bill is amended to attract GOP votes to get to 60 votes. Some GOP senators are open to doing so, frustrated with the lack of any real GOP alternative. There are some GOP bills being developed which focus on Health Savings Account support but are not expected to be ready in the Senate next week.

In the House, Reps. Jen Kiggans (R-Va.) and Josh Gottheimer (D-N.J.) led a bipartisan group of 35 House members who released an alternative plan. This proposal would extend enhanced subsidies for two years, lengthen the 2026 open enrollment period until March 19, phase in income caps, and institute anti-fraud policies. The bill also reforms pharmacy benefits managers (PBMs).

House Speaker Mike Johnson, R-LA, and Steve Scalise, R-LA, are working with more conservative members and say they will have a bill in that chamber next week. They say it does not do what Kiggans and Gottheimer have planned.

A poll from healthcare policy group KFF finds that one in three enrollees in the Exchange say they would very likely shop for a cheaper plan if their premiums doubled and one in four would very likely go without insurance. KFF found that 84% want Congress to extend the credits.

In other news, Modern Healthcare reports that healthcare lobbying expenditures spiked 16% to $653 million during the first three quarters of 2025 compared with the same period last year.

Further, the Government Accountability Office (GAO) did find fraud in the Exchanges enrollment system. The analysis found that misused Social Security numbers is a notable source of the fraud risk to monitor. It fraudulently signed up for and renewed coverage. The vast majority of applications were approved. The GAO found that more than 29,000 numbers in 2023 and 68,000 numbers in 2024 were used to receive more than a single year’s worth of coverage, including the tax credits. The agency also identified at least 30,000 applications submitted in plan year 2023 and at least 160,000 applications for 2024 that likely included changes made by brokers or agents that were not authorized. It earlier said that thousands have reported they were fraudulently enrolled or their information changed.

Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-aca-subsidies-extension-senate-democrats-proposal/ and https://www.modernhealthcare.com/politics-regulation/mh-healthcare-lobbying-2025-phrma-aha/ and https://thehill.com/policy/healthcare/5633501-schumer-to-force-senate-gop-to-vote-on-three-year-extension-of-health-insurance-subsidies/?tbref=hp and https://www.kff.org/public-opinion/poll-1-in-3-aca-marketplace-enrollees-say-they-would-very-likely-shop-for-a-cheaper-plan-if-their-premium-payments-doubled-1-in-4-say-they-very-likely-would-go-without-insurance/ and https://www.modernhealthcare.com/insurance/mh-aca-premiums-blue-cross-michigan/ and https://www.kff.org/public-opinion/2025-kff-marketplace-enrollees-survey/ and https://thehill.com/policy/healthcare/5633353-obamacare-subsidies-aca-kff/ and https://thehill.com/policy/healthcare/5633614-republican-health-bill-johnson-scalise/

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#exchanges #healthcare #coverage

https://www.fiercehealthcare.com/regulatory/gao-report-highlights-fraud-risk-around-enhanced-aca-subsidies

Will Subsidy Extension Pass?

A Senate vote on a clean, three-year enhanced Exchange subsidy extension is scheduled for next week. And many Republicans are frustrated that their party is divided and no consensus can be reached on any compromise legislation. Any Republican bill would not be ready until after next week. That opens up the possibility that enough Republicans cross the aisle and vote with Democrats to extend the subsidies as is. House Speaker Mike Johnson, R-LA, has not yet committed to bring up the bill, but Democrats and some moderate Republicans could force a vote through a discharge petition.

Given the lack of a real Republican bill, GOP lawmakers in both chambers are coming around to a temporary extension of enhanced Exchange subsidies. Conservative House and Senate Republicans either want fundamental reform or no action to extend the enhanced subsidies. Moderate Republicans in the House want either a clean extension or small changes to address conservative concerns regarding uncapped subsidies, no premiums for some, and fraud.

In the Senate, Republicans favor a variety of Health Saving Account expansions, including a proposal from HELP Committee Chair Bill Cassidy that would send the difference between base and enhanced subsidies to certain Americans to buy insurance on their own or use for costs. Sen. Josh Hawley, R-MO, pitched a plan to allow taxpayers to deduct all out-of-pocket medical expenses up to $25,000 per individual or dependent. 

The HELP Committee held an affordability hearing today that looked very much like one held in Senate Finance recently. Fireworks flew between the parties.

Moderate voices in the GOP, especially from swing districts, worry that affordability of healthcare will dominate midterm elections in 2026.

Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-aca-subsidy-extension-republicans-congress/ and https://thehill.com/newsletters/health-care/5632682-bipartisan-obamacare-deal-remains-out-of-reach-in-senate-hearing/

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#exchanges #healthcare #coverage

https://thehill.com/policy/healthcare/5632583-republicans-divided-aca-subsidies

Nursing Home Staffing Rule In Dustbin

The controversial rule seeking to impose nursing home staffing requirements has been officially repealed by the federal government after a judge struck down the Biden administration provision. The rule would have meant huge costs for the industry and actually either forced the shutter of smaller firms or led them to sell out to massive consolidators in the industry. The rule was a political sop to the unions as well.

Additional article: https://www.modernhealthcare.com/politics-regulation/mh-cms-nursing-home-staffing-mandate-repealed/

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#nursinghomes #staffing #medicaid #medicare

https://www.fiercehealthcare.com/regulatory/hhs-closes-book-controversial-nursing-home-staffing-mandate