February 26, 2024

Not All Is Rosy In Hospital Finance

While the hospital industry is recovering overall from the COVID slump, recovery is not universal in the hospital industry. And there are still some bad barometers of financial performance overall.


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PBM Reform and Site-Neutral Policy May Not Be Included In Health Bill

Due to the major threat of a government shutdown and no consensus yet on the issue, time is running out on passing substantive policy reforms.  Congress is looking at a very skinny health bill and that could mean the death of PBM reform and site-neutral policies this year. A partial or full prospective Medicare doc payment fix will likely still be included.

I don’t like the tone and tenor of the PBM reform measures, but would like the site neutral reforms to begin.

At the same time, Sen. Chuck Grassley wants a PBM reform vote given the slow pace of a Federal Trade Commission (FTC) inquiry. Article here: https://insidehealthpolicy.com/inside-drug-pricing-daily-news/grassley-slams-ftc-slow-pbm-probe-urges-senate-vote-pbm-bills

Additional articles here: https://thehill.com/policy/healthcare/4490034-congrescongress-exclude-pbms-health-priorities-spending-package/ and https://insidehealthpolicy.com/health-insider/doc-pay-patch-could-emerge-scaled-back-health-package-budget-talks-continue #siteneutral #pbms

(Some articles may require a subscription.)

#governmentshutdown #healthcare

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Top Insurers Did Well On Investments In 2023

Investment earnings helped sustain insurers last year, but by and large stock performance for the industry was below 2022.

(Article may require a subscription.)

#insurers #managedcare

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1.5 Million In Coverage Gap

A new Kaiser Family Foundation analysis finds that there are 1.5 million people still in the coverage gap.  The coverage gap is found in states that have not expanded Medicaid.  People find themselves too rich to be in Medicaid but too poor to be on the Exchanges with a premium subsidy because they have income below 100% of the federal poverty limit (FPL). This is a no man’s land for healthcare coverage and is tragic.  Two states did expand Medicaid to the Affordable Care Act (ACA) levels in 2023 – South Dakota (via a ballot initiative) and North Carolina (via legislation).  Some southern states ate looking at expansion, but so far not Texas and Florida.  These two states account for about 60% of the coverage gap population. As troubling, KFF finds that there are another 1.4 million in these states who may be eligible for subsidized coverage in the Exchanges but have not enrolled.  This is likely do in part to the lack of Medicaid expansion.

#aca #obamacare #medicaid #coveragegap #coverage

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— Marc S. Ryan

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