Passage Of Stop Gap Measure In Limbo
The passage of a government shutdown bill is now in limbo after a group of House Republicans as well as President-elect Donald Trump, VP-elect JD Vance, Elon Musk, and Vivek Ramaswamy came out against the measure, arguing it is irresponsible and not a straight government-funding extension.
The bill includes provisions to bolster the accuracy and reliability of Medicare Advantage (MA) provider directories and cost-sharing protections for those who receive care from out-of-network providers due to inaccuracies in those directories.
The bill also includes reform of pharmacy benefit managers’ practices in Medicare, Medicaid and the commercial market and reforming so-called patent thickets to delay generic competition.
Trump and Vance also argue the debt ceiling should be raised under Biden’s watch to avoid issues with Democratic support in 2025.
In other news, the final health piece of the bill left out site-neutral payments and prior authorization reforms.
House Democrats have said they will not support a clean CR to keep government operating.
Additional articles: https://www.fiercehealthcare.com/payers/how-healthcare-orgs-are-reacting-proposed-government-funding-bill and https://www.modernhealthcare.com/politics-policy/donald-trump-government-spending-bill-debt-ceiling and https://insidehealthpolicy.com/daily-news/congress-moves-forward-25-physician-pay-fix-omits-site-neutral-prior-auth-reforms and https://insidehealthpolicy.com/daily-news/trump-jeopardizes-two-year-telehealth-extension-broader-health-deal and https://insidehealthpolicy.com/daily-news/medicare-advantage-ghost-network-reforms-risk-trump-urges-lawmakers-oppose-cr and https://insidehealthpolicy.com/inside-drug-pricing-daily-news/cr-flux-pbm-generic-drug-transparency-drug-patent-reforms-uncertain and https://thehill.com/homenews/administration/5047382-trump-government-spending-deal/ and https://thehill.com/homenews/house/5047510-hakeem-jeffries-democrats-government-funding/
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#governmentshutdown #crs #healthcare
https://thehill.com/homenews/house/5047285-mike-johnson-spending-plan-b
Healthcare Expenditures In 2023 Soared
The Centers for Medicare and Medicaid Services’ (CMS) Office of the Actuary released healthcare spending for 2023. It reached $4.9 trillion, growing by 7.5% from the prior year. Healthcare took up 17.6% of the nation’s gross domestic product (GDP). Spending in private insurance as well as Medicare grew at a faster rate than in 2022, while spending and enrollment growth in Medicaid slowed.
In other news, the Business Group on Health says employers are bracing for healthcare costs to spike yet again in 2025 and businesses will be forced to make significant changes.
Additional articles: https://www.fiercehealthcare.com/finance/cms-health-spending-grew-75-2023-amid-increase-insurance-coverage-care-utilization and https://www.modernhealthcare.com/policy/2023-national-health-spending-cms-actuaries and https://www.fiercehealthcare.com/payers/2025-outlook-employers-face-yet-another-year-healthcare-cost-increases
(Some articles may require a subscription.)
#healthcare #cms
https://www.medpagetoday.com/publichealthpolicy/healthpolicy/113461
House Issues AI Report With Recommendations
The House Bipartisan Task Force on Artificial Intelligence has issued a comprehensive report outlining policy recommendations for AI’s in healthcare. The report says AI can reduce administrative burden, speed drug development, and improve clinical diagnosis. But the report warned that it could reduce the quality of care, break down patient privacy protections, perpetuate biases and create unnecessary denials of care.
(Article may require a subscription.)
#ai #regulations #healthcare
https://www.modernhealthcare.com/digital-health/house-bipartisan-task-force-ai-healthcare
DOJ, Whistleblower Say CVS Illegally Dispensed Controlled Substances
Fresh off a New York Times expose accusing pharmacy benefits managers of taking payments to not limit opioid prescriptions, the Department of Justice and a whistleblower are accusing the company in an unsealed lawsuit of illegally dispensing controlled substances including opioids. It says CVS helped fuel an overdose crisis as short-staffed stores ignored red flags.
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#opioids #cvshealth
https://www.modernhealthcare.com/legal/cvs-health-pharmacy-opioid-dispensing-whistleblower-lawsuit
Warren Pushes For Biden To Tackle MA Overpayments
Senator Elizabeth Warren, D-MA, is urging the Biden administration to advance a proposed rule now to address Medicare Advantage (MA) overpayments of more than $80 billion. I disagree with opponents’ calculations of overpayments. I am also unclear on what rule is open and could be finalized before President-elect Trump takes office.
(Article may require a subscription.)
#cms #medicareadvantage #riskadjustment #overpayments
Employers Battling MA Wrap Cost Hikes
Employers are battling soaring costs in Medicare Advantage (MA) wrap program costs for retirees, known as EGWPs, given the major rate and other issues MA plans are having. A majority of employers have exclusively or partially relied on MA to preserve retirees benefits and to control costs in the past. But some are now reevaluating whether MA EGWPs are better or should they migrate back to Medigap wrap coverage in concert with the traditional Medicare program. Another alternative could be moving to a wrap voucher for individual MA. They are also battling concerns about shrinking networks in some areas.
(Article may require a subscription.)
#medicareadvantage #egwps #employers
https://www.modernhealthcare.com/insurance/group-medicare-advantage-costs-public-sector-plans
CBS News Coverage On Possible ACA and Medicaid Cuts
While healthcare media have covered the issue for weeks, CBS News is finally covering the possible cuts in the Affordable Care Act (ACA) and Medicaid by the incoming Trump administration. As CBS notes, a full ACA repeal is unlikely, but the program could be changed in favor of savings. Enhanced premium subsidies could simply lapse. Medicaid could be cut in several ways. Much of this is tied to interest in spending cuts to pay for tax cut extensions. Of course, cuts could send the uninsured rate up and premiums soaring in the Exchanges.
#medicaid #aca #exchanges #obamacare #coverage #trump
https://www.cbsnews.com/news/trump-medicaid-aca-obamacare-affordable-care-act-tax-cuts/
— Marc S. Ryan
