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
Republican Conundrum On Budget Reconciliation
While many rightist GOP lawmakers want as many spending cuts as possible to offset tax cut extensions, some in the GOP are considering telling the Congressional Budget Office (CBO) to score on a “current policy” basis vs. “current law” basis.
Under the current law approach, impacts to the budget deficit over a ten-year period are tied to whether spending (increases or decreases) or revenues (increases or decreases) would stay in place over a budget horizon. Under current policy, there is a presumption that current spending or revenues would stay in place regardless of underlying law.
Some Republicans want a current policy approach so as to limit spending cuts and still extend tax cuts. Otherwise, spending cuts would have to be adopted to keep the deficit neutral under the current law approach (perhaps $4 trillion over the ten-year horizon). However, the move could also mean some spending to be sunset in law would suddenly cost nothing under the current policy basis to extend. Many Republicans attack the enhanced Exchange premium subsidies as wasteful and too costly ($335 billion if made permanent over ten years). But under the current policy approach, Democrats could argue extending the enhanced subsidies and much more are free.
Of course, all of this is just a budget gimmick. The federal budget is massively out of whack due to excessive spending and tax cuts. It simply is an accounting game and more and more debt will be taken on regardless.
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#budgetreconciliation #trump #congress #aca #exchanges #obamacare
MA Plans And Organizations Lobby Trump For Relief
In comments on the Biden administration’s proposed 2026 Medicare Advantage (MA) and Part D rule, MA health plans are encouraging the Trump administration to grant some relief to the industry and limit regulatory changes enacted.
Regarding the major changes to the proposed rule, it asks that coverage for GLP-1 weight-loss drugs not be finalized and that the Health Equity Index (HEI) component of the Stars quality bonus program either be scaled back or eliminated entirely. It also wants the Value Base Insurance Design (VBID) for a while. See my blog today on VBID: https://www.healthcarelabyrinth.com/if-vbid-is-to-go-ensure-flexibilities-remain-for-plans/ . Separately it wants a better rate hike in 2026 after two years of cuts.
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#medicareadvantage #cms #regulations #rates #vbid #hei #stars
https://www.modernhealthcare.com/policy/medicare-advantage-policies-trump-oz
More Court Actions On Spending Freezes
The daily spending freeze soap opera continues, with states and community organizations arguing that funds are not flowing freely since the presidency changed. Several courts have stopped the so-called funding freeze initially put in place by Trump. But a federal judge took an extraordinary action today, saying his decision is being ignored and immediately directed the White House to immediately restore funding. He went as far as to say that the administration could risk criminal contempt regardless of the ultimate decision on the case.
A different federal judge also stopped the administration from capping indirect costs paid for by the National Institutes of Health (NIH) at 15%. As well, two Republican senators, Susan Collins and Katie Britt, have raised concerns about the NIH indirect cost reductions.
Additional articles: https://www.modernhealthcare.com/politics-policy/trump-release-federal-funds-restraining-order and https://www.modernhealthcare.com/legal/democrat-ag-sue-trump-nih-hhs-research-funding-cuts and https://thehill.com/policy/healthcare/5136846-collins-britt-nih-indirect-cost-cuts/ and https://insidehealthpolicy.com/daily-news/judge-says-omb-defying-funding-order-demands-nih-funds-released and https://thehill.com/policy/healthcare/5137047-federal-judge-restrains-nih-research/
(Some articles may require a subscription.)
#trump #spending #healthcare
Kaiser Permanente Reports Financial Progress
Integrated non-profit health system Kaiser Permanente achieved its highest annual revenues ever, bolstered by its acquisition of several health systems through its subsidiary Risant Health. Kaiser brought in $115.8 billion in operating revenues in 2024, up 14.9%. Operating expenses increased 14.6% to $115.2 billion. Operating income was $569 million, a 0.3% operating margin for the year. Net income more than tripled to $12.9 billion.
Kaiser said that 2024 was impacted by significant financial pressures due to high prescription drug prices, high costs of goods and services, and increased care volumes, especially in ambulatory care settings. It has put in place operational efficiencies and streamlining.
Additional article: https://www.modernhealthcare.com/finance/kaiser-permanente-risant-health-earnings
(Some articles may require a subscription.)
#kaiser #healthplans #margins
NC DOI Fines UnitedHealthcare
North Carolina has fined UnitedHealthcare $3.4 million following a four-year investigation into the company’s claims handling practices involving balance billing.
#balancebilling #surprisebilling #transparency #nosurprisesact
Health Affairs Forefront Blog Backs MA Reinsurance
My problem with Health Affairs Forefront Blog sometimes is that it allows its authors to repeat many falsehoods. Once again, the blog allowed its authors to argue that Medicare Advantage (MA) is over-reimbursed by $83 billion or 22%. The authors break down the MedPAC estimates into two categories: $49 billion in risk adjustment coding and $34 billion in favorable selection. The MedPAC numbers are quite dubious, especially the favorable selection figure. There is plenty of other research that questions the conclusion.
Nonetheless, the authors conclude that the way to tackle supposed favorable selection in MA would be introducing a reinsurance program, which would take away incentives to engage in marketing and other activities that supposedly cherry pick enrollees and leave the more adverse in the fee-for-service (FFS) system.
A reinsurance program likely would be funded by assessments on plans and perhaps some dollars from Medicare. Those that have outlier costs would be reimbursed above a certain threshold. The problem is that reinsurance has had a mixed record at the Centers for Medicare and Medicaid Services (CMS). The Exchange program had a reinsurance program in the first three years of the law. But the program was underfunded and CMS did not pay those plans who had excessive costs.
(Article may require a subscription.)
#riskadjustment #overpayments #medicareadvantage
Republicans In States Moving To Restrict Medicaid
With the change in the White House, Republican lawmakers in several states have begun moving to rollback Medicaid expansion and threats that federal funding could be restricted. In Idaho, a bill would repeal the voter-approved expansion. In Montana, a bill could allow its expanded program to expire. In South Dakota, lawmakers want to ask voters to let the state end expansion if federal aid declines.
There are nine states with trigger laws that go into effect. If the federal government reduces the 90% reimbursement, their expansions are rolled back, impacting more than 3 million now on the Medicaid rolls. There are ten states that have not yet expanded Medicaid under the affordable Care Act (ACA). Due to the change in the White House, expansion talks have all but ceased.
#medicaid #aca #obamacare #coverage
— Marc S. Ryan
