Given the holidays, we are going to be brief this week. Just a few ruminations from me today about recent healthcare events. We will do a quick blog on Friday regarding a great analysis by Wakely Consulting regarding the importance of wellness visits and prevention in Medicare. Next week, we will have my 2025 Healthcare Year in Review on Monday and my Healthcare Predictions for the 2026 Year Ahead later in the week.
Here is wishing everyone a Merry Christmas, Happy Hanukkah (today is the last day), and Happy New Year.
The courage of the moderates
I have to give great credit to four GOP House moderates who have signed on to a Democratic discharge petition to force a vote in the House on extending the enhanced Exchange premium subsidies. They did so only after House Seaker Mike Johnson, R-LA, broke his promise to allow an amendment vote on extending the premium tax credits. Johnson’s move was clearly underhanded. He caved to conservatives who want to see the enhanced subsidies die.
The four Republicans from swing districts — Reps. Rob Bresnahan (Pa.), Brian Fitzpatrick (Pa.), Mike Lawler (N.Y.), and Ryan Mackenzie (Pa.) – may very much be ostracized in their party and get weak backing for re-election. Indeed, Johnson’s move could almost assuredly mean the GOP is relegated to the minority after the 2026 midterms. Polls show affordability, especially on healthcare, as resonating with voters – very much so in several dozen swing districts.
I have issues with the richness of the Exchange benefits, including the minimum essential mandate and subsidies as they are now. But there is little doubt that some sort of compromise should have been reached by now. The GOP clearly has no plan for affordability. The GOP measure that was passed in the House — with almost no chance in the Senate — plays around with the concept of cheaper benefits and policies and expanding employer subsidies to buy coverage in the individual marketplace. But this is by no means a coherent agenda or anything that will drive affordability in the enar or long term. The Senate GOP wants to expand Health Savings Accounts (HSAs) as an answer. The two caucuses are not on the same page and it is almost as if the GOP does not care about the immediate plight of millions who will see the doubling of premiums on January 1 or will abandon coverage because they simply cannot afford it.
There is some hope that moderates on both sides of the aisle could still force a compromise on the enhanced subsidies sometime in January. Talks are occurring between the chambers to fashion something that could get 60 votes in the Senate. But that no compromise was reached weeks ago is a stain on the GOP (my party), which looks more and more like a party with no compassion.
Meanwhile, showing how out of touch the president is, he is ready to chastise health plans for driving costs and the lack of affordability. There is no talk about real healthcare reform or uncontrolled price in the healthcare world. It is all Truth Social thearics at this point. He, too, has been insenstive to the looming surge in premiums in the Exchanges and what is occurring in the employer sector.
Trump’s drug game plan
If I think the president has little foresight on healthcare reform in general, I have to give him great credit for his work on drug price reform. So far, he has issued a series of executive orders to reform drug pricing and bring transparency to the system. He has struck more than a dozen deals with brand drug makers that lower costs in Medicaid and introduce lower prices for self-pay Americans. He has introduced the concept of most-favored-nation (MFN) pricing throughout the system.
Last week, the Centers for Medicare and Medicaid Services (CMS) announced two new models that would tie the prices Medicare Part B and Part D pay for medicines to what is paid in foreign countries. The Global Benchmark for Efficient Drug Pricing Model, or GLOBE, would cover Part B drugs. A second mandatory initiative called Guarding U.S. Medicare Against Rising Drug Costs Model, or GUARD, would cover Part D drugs. The models would run from 2027 through 2031, with rebate invoicing and reconciliation continuing into 2033. While retrospective rebates would be assessed, the program would lead to ongoing price reductions and lower out-of-pocket costs for seniors and the disabled in Medicare.
I hope the president continues down this course and implements all the far-reaching reforms he has proposed. We desperately need reform in all lines of business, including the employer world. Here is hoping the president puts together a coherent agenda for healthcare generally as well.
#exchanges #drugpricing #coverage #healthcare #healthcarereform
— Marc S. Ryan
