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
(Some articles may require a subscription.)
#exchanges #healthcare #coverage
https://www.modernhealthcare.com/politics-regulation/mh-senate-healthcare-vote-aca-subsidies
Highmark and BCBS KC To Affiliate
As regional blues struggle to compete in a more competitive environment, Highmark and Blue Cross and Blue Shield Kansas City have announced plans to affiliate. Blue Cross KC will maintain its local brand and operations but will be able to tap into Highmark’s resources to accelerate innovation for its members. Highmark is the fifth-largest Blues plan in the U.S.
#healthplans
https://www.fiercehealthcare.com/payers/highmark-blue-cross-kc-announce-affiliation-plans
New MAHA Pilot
On the tail of the ACCESS Model announcement, the Centers for Medicare and Medicaid Services (CMS) has announced the creation of The Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence (MAHA ELEVATE) Model.
Like ACCESS, MAHA ELEVATE is meant to address the chronic disease epidemic. The model will provide approximately $100 million to fund 3-year cooperative agreements for up to 30 proposals that promote health and prevention for Original Medicare beneficiaries. The proposals will utilize evidence-based, whole-person care approaches — including functional or lifestyle medicine interventions — currently not covered by Original Medicare. These approaches are intended to support, not replace, the medical care received by people with Medicare.
MAHA ELEVATE will also gather and evaluate new data on cost and quality to inform future interventions promoting healthy lifestyle behaviors and ultimately reduce spending in Original Medicare. CMS will release a Notice of Funding Opportunity (NOFO) in early 2026 for the first cohort, and the voluntary model will launch on September 1, 2026.
Additional article: https://www.cms.gov/priorities/innovation/innovation-models/maha-elevate and https://www.fiercehealthcare.com/regulatory/cms-unveils-new-model-aimed-functional-lifestyle-medicine
(Some articles may require a subscription.)
#cms #maha #pilots #medicare
https://www.modernhealthcare.com/politics-regulation/mh-cmmi-model-nutrition-maha
Worker Healthcare Contributions Surge
Researchers from Rice University and Baylor College of Medicine have found that average worker contributions toward family insurance premiums surged by 308% between 1999 and 2024. Total premiums increased 342%, while average worker earnings increased by 119% and inflation increased by 64%.
#healthcare #inflation #affordability
Medicare FFS Could Have Saved $7B
A Berkeley Research Group report sponsored by Elevance Health found that traditional Medicare could have saved $7 billion from 2019 to 2023 across four services if it had mirrored Medicare Advantage’s (MA) utilization rates and fraud strategies. MA used prior authorization and step therapy, fraud programs, coverage policies, and capitation agreements to effectively manage the services.
Researchers found that traditional Medicare spent 1.5 to 6.5 times more on skin substitutes in this time frame, or more than $5.6 billion, compared to MA. From 2021 to 2022, curved tip catheter use increased 88% in traditional Medicare, versus just 3% in MA. More than $500 million in savings could have been realized. Medicare Advantage plans also had more guardrails to verify the necessity of certain genetic tests. Medicare Advantage users and spending per 1,000 enrollees were roughly 25% to 30% lower than traditional Medicare’s utilization of off-the-shelf braces. Savings could have amounted to nearly $400 million.
#medicare #medicareadvantage #fwa
https://www.beckerspayer.com/research-analysis/traditional-medicare-misses-7b-in-savings-report/
New KFF Polling On Affordability
A new healthcare policy group KFF poll has major findings on the ongoing affordability crisis in healthcare. Just under half of U.S. adults say it is difficult to afford healthcare costs, and about three in ten say they or a family member in their household had problems paying for healthcare in the past 12 months. Over a third put off care due to affordability. Over 20% do no fill prescriptions due to affordability.
Additional article: https://www.kff.org/public-opinion/kff-health-tracking-poll-health-care-costs-in-the-current-moment-of-economic-anxiety/
#healthcare #affordability
https://www.kff.org/health-costs/americans-challenges-with-health-care-costs/
— Marc S. Ryan
