December 1, 2023

Cigna-Humana Deal Could Pass Muster

While federal and state regulators will look closely and potentially oppose a combination, experts seem to think that the Cigna-Humana merger could eventually go through.  As I have indicated as well, the company profiles are quite different than earlier deals that fell through.

#cigna #humana #mergers #acquisitions

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Our Primary Care Problem

The article makes a couple key points.  It notes the vast difference between primary care and specialist compensation.  We are clearly over-specialized in the United States.  It also discusses an important bill sponsored by Sen. Bernie Sanders, I-VT, and Sen. Roger Marshall, R-KS, that would invest $26 billion to bolster primary care, increase training opportunities for doctors and nurses, and expand access to community health centers. We do need to invest in so many ways in primary care so we can pivot healthcare from utilization management to care management.

#utilizationmanagement #caremanagement #healthplans #providers #physicians

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Long-Term Fiscal Benefits Of Medicaid Coverage In Childhood

A Georgetown University assessment of a recent Congressional Budget Office (CB0) study finds that even one additional year of Medicaid will boost enrollees’ labor outcomes and earnings as well as reduce other forms of federal spending.


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Trump Gives Democrats A Winning Issue With ACA Repeal Talk

As the article notes, Donald Trump has given Joe Biden a winning issue to run on in the Affordable Care Act (ACA).  It likely had little life before Trump declared he is interested in repealing the ACA in favor of an alternative.  Senate Republicans are running away from the issue.  About the only ones praising Trump’s move are hard-right Republicans in the House. 

With 40 million benefiting from the ACA in one way or another, it hurts the GOP.  It may not look like that in a recent Kaiser Family Foundation poll (link here: https://www.kff.org/health-reform/poll-finding/kff-health-tracking-poll-november-2023/ ). About half (49%) of voters say it is a “very important” issue for the candidates to discuss. Seventy percent of Democrats say so and thirty-two percent of Republicans do. But, that a third of Republicans think it is a concern is nothing to sneeze at. And 45% of independents view the ACA as important as well. Still more Republicans and Independents treat other healthcare issues as important. (Some articles may require subscription.)

#aca #obamacare #medicaid #exchanges

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Hearing On An Entitlement Fiscal Commission

The fact that the House held a hearing on a possible budget commission to tackle entitlements is a good thing.  Republicans seem on board for one, while Democrats are split.  I would agree that Congress should do the job of righting entitlements before they are insolvent.  But in lieu of that, a bipartisan fiscal commission might do the dirty work of revenue raising, benefit changes, and other reforms.  This would ensure entitlements are actually around for future generations. Judging from recent polls, the American public are on board too. (Article may require a subscription.)

#entitlements #medicare #medicaid #fiscalcommission

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New Ways For Medicaid To Intervene On Social Determinants

The Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services (CMS) have announced additional ways that state Medicaid and children’s health insurance programs can support those with social determinant barriers to health.  The guidance outlines more health-related social needs policies states can adopt. The latest guidance also clarifies the difference between social determinants of health and health-related social needs. HHS and CMS are clearly moving in the same direction as they have in Medicare Advantage.(Article may require a subscription.)

#sdoh #socialneeds #medicaid #chip #medicareadvantage

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Prices On Drug Ads Are A Good Idea

Sens. Chuck Grassley (R-IA) and Dick Durbin (D-IL) sought unanimous consent for a floor vote on legislation requiring prescription drug advertisements include list prices of their drugs.  But Sen. Mike Crapo (R-ID) shot that request down. Crapo thinks the bill would further confuse consumers about the actual costs of drugs. Perhaps so, but it is not a bad idea.  The American public needs to begin to understand that brand drugs are obscenely priced, even if the actual cost-share someone pays is less. (Article may require a subscription.)


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Senators Ask For OIG Inquiry On Drug Pricing

Sens. Elizabeth Warren (D-MA) and Mike Braun (R-IN) want the Health and Human Services Office of Inspector General to investigate the extent to which Cigna, CVS Aetna and UnitedHealth Group are hiking up the prices of generic medications by utilizing entities they own.  They argue the plans are getting around the minimum medical loss ratio (MLR) requirement that they spend at least 80% or 85% of health care premium dollars on medical claims. This comes after a Wall Street Journal analysis compared the plans’ charges to those of the Mark Cuban Cost Plus Drug Company for the same selection of generic medications.

The minimum medical loss ratio requirement should not be abused by funneling dollars as medical expense to owned or closely-affiliated entities, such as PBMs, specialty pharmacies, or providers. It was only a matter of time before regulators began looking at such arrangements. (Article may require a subscription.)

#drugpricing #healthplans #minimummlr #mlr

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— Marc S. Ryan

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