Healthcare Segments’ Top Priorities
A good article in Fierce Healthcare on the priorities of the various healthcare segments for 2025. Here are the highlights and there will be some battles between the parties.
Hospitals – extending Exchange premium subsidy enhancements, further health plan prior authorization (PA) and utilization management limits, fighting coverage reductions, and maintaining the 340b program substantially as is.
Plans – relief on Medicare Advantage (MA), and PBM reform (most health plans support except those with sister company PBMs).
Providers – a Medicare rate fix, reducing administrative burden, and workforce reform.
Also on the agenda is extending telehealth flexibilities and the hospital-at-home program.
#healthcare #healthplans #hospitals #providers #medicare #exchanges #medicaid
Budget Reconciliation Progress But Showdown Looming
The House announced it is moving forward with a one reconciliation bill approach and will mark up a budget resolution quickly. The resolution will allow the deficit to rise $4.5 billion over the budget horizon to make way for most of Trump’s cuts. It also includes cuts of up to $2 trillion over the horizon. The national debt ceiling would be increased by $4 trillion.
The House could have almost no lost votes and there are already critics of the framework. Meanwhile, the Senate continues to prefer a quick first bill with wins followed by a more complex one. It is proceeding this way for now, in part anticipating a blow up in the House.
With $2 trillion in targeted cuts, many would likely fall on healthcare. This is notwithstanding House leaders’ declaration that Medicaid will not be fundamentally impacted. They say the focus will be on work requirements and fraud, waste, and abuse (FWA).
There are numerous forces pushing back on deep cuts and forces within the Congress that do not want to see major healthcare impacts. Some even want to spend more, such as on a Medicare physician rate fix. Site neutral payments could save tens of billions if not hundreds of billions over time, but hospitals are opposed. See my blog on the complications of deep cuts: https://www.healthcarelabyrinth.com/will-medicaid-and-the-affordable-care-act-see-huge-cuts/ .
Additional articles: https://www.fiercehealthcare.com/regulatory/medicaid-faces-severe-cuts-new-budget-framework and https://insidehealthpolicy.com/daily-news/medicaid-work-requirements-gain-steam-gop-seeks-unite-financing-reforms and https://www.modernhealthcare.com/politics-policy/house-budget-healthcare-cuts-2025
(Some articles may require a subscription.)
#budgetreconciliation #spending #congress #trump
https://thehill.com/homenews/house/5140539-house-republicans-budget-resolution-trump-agenda
CVS On Road To Recovery
CVS Health reported some better financial news and investors are characterizing it as on a road to recovery, especially for its insurance arm Aetna. Its major cost-cutting efforts are bearing fruit.
CVS Health reported $1.6 billion in profit for the fourth quarter, down from a $2 billion haul a year ago. Full-year 2024 profits were $4.6 billion, down significantly from the $8.3 billion that the company earned in 2023. But revenue was up year-over-year: $97.7 billion in revenue from Q4 vs. $93.8 billion in Q3 and $372.8 billion in 2024 vs. $357.8 billion in 2023.
Medical expense continued to hurt Aetna. It reported a medical loss ratio (MLR) of 94.8% in Q4, growing from 88.5% in Q4 2023. The MLR for the full year was 92.1%, up from 86.2% in 2023.
New CEO David Joyner went on an impassioned speech on the investor call about the value pharmacy benefits managers (PBMs) bring and how they save the healthcare system from huge brand drug costs. He also championed the integrated nature of CVS Health, which also puts to bed the idea that the company would break up its units.
CVS pulled back on its products and footprint in Medicare Advantage and expects its 2024 to 2025 enrollment to shrink in a high single-digit percentage. The individual business line will contract as well.
In other news, Becker’s Payer reports on margins of health plan companies in 2024. Four of the seven saw lower margins in 2024 than in 2023.
Additional articles: https://www.modernhealthcare.com/finance/aetna-medicare-advantage-enrollment and https://www.modernhealthcare.com/providers/cvs-earnings-medical-costs and https://www.healthcaredive.com/news/cvs-q4-2024-earnings-medical-costs-profit-slashed/739959/ and https://www.beckerspayer.com/payer/cvs-working-tirelessly-to-improve-aetna-7-notes.html and https://www.beckerspayer.com/payer/payers-ranked-by-2024-profits.html
(Some articles may require a subscription.)
#cvshealth #aetna #medicareadvantage #margins #healthplans
States Continue Efforts To Rein In Private Equity In Healthcare
States continue their efforts to rein in private equity deals in healthcare. While bills failed last year, in 2025 state legislatures are looking at various new initiatives. Requirements being proposed include notice requirements and reporting as well as proposed operational models. Many want national standards.
Of course, private equity firms say the requirements are onerous and could chill transactions.
(Article may require a subscription.)
#healthcare #privateequityfirms
https://www.modernhealthcare.com/finance/private-equity-bills-washington-oregon
Speculation About Exchange Marketing Fraud
Interesting speculation about the reasons for the high complaints and fraud allegations related to Exchange enrollment. The Centers for Medicare and Medicaid Services (CMS) recently put in reforms on enrollment. What are the thoughts on the sharp rise? Some speculate the Exchange fraud came after CMS cracked down on similar concerns in the Medicare Advantage (MA) world.
(Article may require a subscription.)
#exchanges #fwa #medicareadvantage #marketing
https://www.modernhealthcare.com/insurance/medicare-advantage-marketing-aca-fraud
Trump Will Massively Downsize The Federal Workforce
In addition to the cost-cutting efforts impacting programs, President Donald Trump signed an executive order that will massively downsize the federal workforce. Reportedly, federal agencies will be directed to “undertake plans for large-scale reductions in force,” with the ability to hire one position for every four eliminated. The Department of Government Efficiency commission will oversee the effort.
Additional article: https://insidehealthpolicy.com/daily-news/trump-signs-eo-mandating-further-staff-cuts-fed-agencies
(Some articles may require a subscription.)
#doge #trump #spending #staffing
— Marc S. Ryan
