February 13, 2024

Showing Strain In MA, PE Deals Dropped Significantly

Private equity firms’ investment in the Medicare Advantage (MA) space are way down from a peak in 2021. This is a sign that rising medical expense and regulation is impacting the industry. Just 4 deals occurred in 2023, down from 19 in 2021.

Additional article here: https://www.modernhealthcare.com/finance/private-equity-medicare-advantage-pesp-report

(Some articles may require a subscription.)

#medicareadvantage #privatequityfirms

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Site-Neutral Payment Fight

Great Kaiser Health News article on the fight over site-neutral payments.  Advocates want site neutral and won passage in a small way on Part B drug infusion in the House.  Hospitals are using their weight and dollars to keep it out of any bill. 

In a related move, advocates are proposing a possible rural exception to a site neutrality to get the reform passed. See here: https://insidehealthpolicy.com/daily-news/site-neutral-proponents-float-rural-exemption-hospitals-flag-risks

(Some articles may require a subscription.)

#siteneutral #medicare

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Texas Federal Judge Dismisses Drug Price Lawsuit

A Texas federal judge dismissed a lawsuit challenging the  Medicare drug price negotiations filed by the pharmaceutical industry lobbying group, Pharmaceutical Research and Manufacturers of America (PhRMA), and some other plaintiffs. The judge said the groups lacked standing. Not an end to the fight, but so far Big Pharma is losing.

#ira #drugpricing

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Washington State Bill Would Regulate Hospital Mergers

Just as the Federal Trade Commission (FTC) is ramping up anti-trust scrutiny, Washington could pass a state regulatory bill on hospital mergers.  This could mean other states do so as well. The bill would grant authority to the state attorney general to deny mergers that may limit healthcare access.

#ftc #mandas #mergers #consolidations #hospitals

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Two Million Lose Medicaid Coverage In Texas

Axios reports that new data from the state shows that two million have lost Medicaid coverage since redeterminations began again in April 2023. The latest Kaiser Family Foundation (KFF) trackers says almost 17 million have lost coverage nationally.  See here: https://www.kff.org/report-section/medicaid-enrollment-and-unwinding-tracker-overview/ .  Since some eventually gain coverage back, the latest KFF estimate of the actual Medicaid and children’s coverage enrollment reduction is about 9.5 million.  This is about halfway through Medicaid redeterminations and will go up.  See here: https://kffhealthnews.org/news/article/health-202-medicaid-unwinding-enrollment-data-states/

#medicaid #redeterminations

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Elevance Health Lays Off More

Showing the impact of Medicare Advantage regulation and other negative trends on utilization and medical expense, Elevance Health has laid off thousands of employees on a rolling basis since September. Other insurers have done so and we should expect more.

#layoffs #healthplans

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— Marc S. Ryan

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