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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.

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

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

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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

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Trump Endorses House GOP One-Bill Approach

President Donald Trump came out today in favor of the House GOP’s one-bill approach, surprising the Senate which felt he was taking a wait-and-see, go-slow approach on the issue. The one bill approach has steep spending reduction targets in it. Still, the fate of the House bill is uncertain. Speaker Mike Johnson can afford to lose no more than one vote on the reconciliation bill. Several moderates have expressed concerns on healthcare cuts. Some conservatives are complaining cuts are not deep enough.

While leaders claim healthcare cuts to Medicaid and the Affordable Care Act (ACA) will not disrupt coverage, the savings targets could make that promise difficult to keep. Some conservatives are arguing that reductions in state reimbursement or even how much the federal government contributes should occur, which undoubtedly would impact coverage. Reining in provider taxes could also impact state financing schemes and require them to cover funding with more state budget dollars.

Additional articles: https://www.modernhealthcare.com/providers/medicaid-cuts-home-care-kff and https://insidehealthpolicy.com/daily-news/senate-democrats-blast-trump-endorsing-house-budget-plan-continue-warning-medicaid-cuts and https://kffhealthnews.org/news/article/republicans-medicaid-cuts-congress-state-federal-budgets-insurance-explainer/ and https://thehill.com/homenews/house/5154428-moderate-republicans-oppose-house-budget-resolution/ and https://thehill.com/homenews/senate/5153342-senate-gop-leader-reacts-trump-budget/?tbref=hp and https://www.medpagetoday.com/publichealthpolicy/medicaid/114286 and https://thehill.com/homenews/5153990-house-republicans-budget-resolution-trump-agenda/?tbref=hp

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#budgetreconciliation #congress #trump #healthcare #coverage #spending

https://www.fiercehealthcare.com/regulatory/medicaid-faces-severe-cuts-new-budget-framework

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Worried About House Vote, Senate Takes Different Path on Budget Reconciliation

On a 50-47 vote, the Senate GOP officially started the process of passing a budget reconciliation bill in a bid to enact a portion of President Trump’s agenda. 

The Senate is taking a two-bill approach to meet President Trump’s objectives, while the House is moving on one big bill. The Senate fears House Speaker Mike Johnson will not have enough votes on his plan because conservatives are demanding deep cuts and others want more moderate ones.

The Senate’s first bill would spend $325 billion to bolster border operations and allow Trump’s deportation plans to be executed as well as boost defense spending and greenlight Trump’s energy plans. The Senate Republicans are planning to use a second reconciliation bill to extend Trump’s 2017 tax cuts. The second bill would include offsetting spending cuts.

#budgetreconciliation #trump #congress #healthcare

https://thehill.com/homenews/senate/5152221-senate-gop-budget-resolution/?tbref=hp

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Study Shows How Obesity Impacts Employer Healthcare Costs

UnitedHealthcare and the Health Action Council have examined how the obesity epidemic has impacted the healthcare costs of employers and how it will continue to do so in the future.

About 75% of adults in the U.S. are either overweight or obese, up from 50% in 1990. Obesity rates have grown fastest among younger adults. The obese population accounts for 46% of the employers’ medical spend. Per member per month costs for obese employees are more than double ($973) than those who were not obese ($421).

Metabolic conditions are common among people with obesity. For workers in their ’50s, diabetes rates are 2.5 times higher among obese individuals. Hypertension rates were three times higher. Those who were obese also had greater rates of behavioral health illnesses.

Study: https://healthactioncouncil.org/media/i5qj3qah/2025-hac-white-paper.pdf

#obesity #glp1s #weightlossdrugs #healthcare #chronicconditions #employercoverage

https://www.fiercehealthcare.com/payers/unitedhealth-hac-study-examines-how-obesity-impacting-employer-health-costs

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Major Staff Cutbacks In Healthcare At Federal Government

The Trump administration has directed agencies to begin laying off probationary employees. The Department of Health and Human Services (HHS) and related agencies are firing up to 5,200 probationary employees as of today. About 1,300 are employed by the Centers for Disease Control and Prevention (CDC) and a sizeable number are with the National Institutes of Health (NIH). There are over 2 million federal employees.

Additional article: https://www.modernhealthcare.com/labor/cdc-layoffs-cuts-trump

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#hhs #nih #cdc #staffing #layoffs #trump #doge

https://www.fiercehealthcare.com/regulatory/mass-layoffs-hhs-cdc-cuts-1300-probationary-workers-reports-say

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RFK, Jr. Confirmed As Health Chief; Will Chair MAHA Commission

President Donald Trump’s nominee as secretary of Health and Human Services (HHS), Robert F. Kenndy, Jr., was confirmed by the Senate today on a 52-48 vote, with Mitch McConnell being the only GOP senator to not vote yes. All Democrats opposed Kennedy.

Trump also signed a new executive order to establish a Make America Healthy Again (MAHA) Commission. Kennedy will chair the task force, focused on investigating the “root causes of America’s escalating health crisis.” The commission first will address childhood chronic diseases.

In other news, HHS assistant secretaries were also named by Trump. One of them is an anti-trust lawyer with deep background in healthcare mergers.  This could be a clue that the Biden administration’s healthcare anti-trust agenda may not totally go away.

Additional articles: https://www.fiercehealthcare.com/regulatory/trump-creates-maha-commission-chronic-disease-chaired-rfk and https://insidehealthpolicy.com/daily-news/newly-confirmed-hhs-sec-rfk-jr-lead-maha-commission and https://www.modernhealthcare.com/politics-policy/rfk-jr-full-senate-vote-hhs and https://www.healthcaredive.com/news/rfk-jr-confirmed-hhs-secretary-robert-f-kennedy-jr/740054/ and https://insidehealthpolicy.com/daily-news/trump-nominates-two-hhs-asst-secretaries-general-counsel

(Some articles may require a subscription.)

#rfkjr #healthcare #hhs #maha

https://www.fiercehealthcare.com/regulatory/senate-confirms-rfk-jr-head-hhs-52-48-vote

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Healthcare Segments’ Top Priorities

A good article in Fierce Healthcare on the priorities of the various healthcare segments for 2025. Here are the highlights and there will be some battles between the parties.

Hospitals – extending Exchange premium subsidy enhancements, further health plan prior authorization (PA) and utilization management limits, fighting coverage reductions, and maintaining the 340b program substantially as is.

Plans – relief on Medicare Advantage (MA), and PBM reform (most health plans support except those with sister company PBMs).

Providers – a Medicare rate fix, reducing administrative burden, and workforce reform.

Also on the agenda is extending telehealth flexibilities and the hospital-at-home program.

#healthcare #healthplans #hospitals #providers #medicare #exchanges #medicaid

https://www.fiercehealthcare.com/regulatory/healthcare-lobbying-2025-here-are-top-policy-issues-hospitals-payers-docs-and-tech

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Humana Continues Digging Out Of Its Financial Troubles

Medicare Advantage (MA)-dominant Humana told investors today that it was prioritizing efficiency as it continues to dig out from financial woes due to the MA rate and regulatory landscape. Due to uncertainty, including on rates, it is not yet able to give guidance going into 2026 but affirmed its guidance for the current year. Humana is also suing the Centers for Medicare and Medicaid Services (CMS) over its 2025 Star ratings, accusing the agency of gross regulatory violations and incompetence in administering the quality bonus program.

Humana posted a $693 million loss in Q4, an increase from a Q3 loss of $541 million. The company also halved its profits for the full year 2024 compared to 2023, posting $1.2 billion. Humana earned $2.5 billion in profit for 2023.

Humana expects to lose up to 550,000 MA members this year. It lost 445,000 during the recent open enrollment. Medicaid struggled as well from a cost and enrollment standpoint. In MA, Humana has lost a great number of high-revenue and usually highly profitable Dual Eligible Special Needs Plan (D-SNP) members. Overall medical loss ratio (MLR) was 91.9% in Q4.

Overall, the financial performance was better than expected and investors seem to think Humana is turning a corner financially. Humana appears to be shedding unprofitable products and enrollment around the country to improve margins. It is also expanding in Medicaid, which could boost its attractiveness in SNPs in the future.

Additional articles: https://www.modernhealthcare.com/finance/humana-medicare-advantage-investment-2025 and https://www.modernhealthcare.com/insurance/humana-medicare-earnings-outlook and https://www.healthcaredive.com/news/humanas-2024-profit-halved-medicare-advantage-losses/739761/ and https://www.beckerspayer.com/payer/humanas-no-1-medicare-advantage-priority-5-notes.html and https://www.beckerspayer.com/payer/humana-posts-693m-loss-in-q4.html

(Some articles may require a subscription.)

#humana #medicareadvantage #medicaid #margins

https://www.fiercehealthcare.com/payers/humana-posts-693m-loss-q4-it-continues-weather-elevated-utilization

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Trump May Impose Tariffs On Drugs, But Calls Pricing Unfair And Wants Change

In an exclusive Super Bowl interview on Fox News, President Donald Trump seemingly endorsed tariffs on drugs but said in the end drug costs would come down. Many are worried that tariffs on drugs and other medical devices will further drive up healthcare costs. But Trump seemed to signal he intends to try to end the fundamental unfairness of drug prices in America compared with other developed countries.

Trump used the example of Ozempic costing $88 a month in the U.K., while it is $1,200 a month in America. Trump’s rough prices are entirely accurate and represents what he said was roughly ten times more in America. Trump said the U.S. has been too nice on the issue.

In a recent blog, I predicted that the populist Trump would come around on the issue of drug pricing and may press for real reform. See the blog here: https://www.healthcarelabyrinth.com/2027-drug-negotiations-off-and-running/ .

#trump #branddrugmakers #drugpricing #glp1s #weightlossdrugs

https://www.foxnews.com/video/6368624897112

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