MA Growth Down Markedly In Enrollment Season
The Centers for Medicare and Medicaid Services (CMS) finally published some data on the 2025 enrollment season and growth is down considerably. This is likely tied to the financial crisis in the industry. The January report still seems to have issues so many analysts are either comparing February 2024 to February 2025, January 2024 to February 2025, or a month in late 2024 to February 2025. I will have a comprehensive blog on this subject tomorrow.
Different outlets have ranges of numbers in their coverage. My calculation is that enrollment grew about 4.4% from January 2024 to February 2025. This is down from 8.7% in 2024 and 6.1% in 2022. Of the big nine national health plans, seven gained enrollment from January 2024 to February 2025. But just five of them gained from December 2024 to February 2025.
In other news, the Kaiser Family Foundation (KFF) published an analysis of the spending reductions related to a Medicaid per capita cap program – a possible revamp of Medicaid that stands in between the traditional program we have now and a strict block grant. KFF finds that capping per enrollee spending could reduce federal Medicaid expenditures by $532 billion to nearly $1 trillion over 10 years depending on how states respond. States could either fill the hole or reduce coverage, or a combination. KFF says as many as 15 million could lose coverage by 2034.
KFF also finds that eliminating the Medicaid expansion matching rate as well could push the federal Medicaid spending savings to as much as $2.1 trillion. As many as 30 million could lose coverage if both are done.
Additional articles: https://www.fiercehealthcare.com/payers/cms-data-medicare-advantage-enrollment-growth-hits-skids and https://www.beckerspayer.com/payer/which-medicare-advantage-insurers-gained-lost-members-for-2025.html and https://www.modernhealthcare.com/insurance/medicare-advantage-enrollment-2025 and https://www.kff.org/medicaid/press-release/capping-per-enrollee-spending-could-reduce-federal-medicaid-expenditures-by-532-billion-to-nearly-1-trillion-over-10-years-depending-on-how-states-respond-and-result-in-as-many-as-15-million-people/ and https://www.kff.org/medicaid/issue-brief/a-medicaid-per-capita-cap-state-by-state-estimates/
(Some articles may require a subscription.)
#medicareadvantage #enrollment #medicaid #budgetreconciliation
https://www.healthcaredive.com/news/medicare-advantage-enrollment-2025-unitedhealth-humana/738048/
Trump Orders More Layoffs And Restructuring
The White House Office of Management and Budget and Office of Personnel Management issued a letter to federal agencies ordering them to create a reorganization and downsizing plan for personnel. This goes beyond the probationary employee eliminations. The plans are due in April and would be implemented for the new fiscal year in October.
Additional article: https://thehill.com/homenews/5165117-federal-employee-layoffs-plans/
#trump #layoffs #spending
Bipartisan Group Wants PBM Reform Back on Table
A bipartisan group of lawmakers want a bill to pass tough rules on pharmacy benefit managers (PBMs). The House Energy and Commerce Committee’s Health Subcommittee relaunched the push for the legislation at a hearing Tuesday.
Additional article: https://www.modernhealthcare.com/politics-policy/pbm-legislation-bill-house-hearing
(Some articles may require a subscription.)
#pbms #drugpricing
https://thehill.com/policy/healthcare/5165851-pharmacy-benefit-manager-industry
Lawyers Unfired To Work Medicare Drug Price Negotiations Suits
Mor evidence that Donald Trump will keep the Medicare drug price negotiations. At least two litigation attorneys involved with defending Medicare’s drug price negotiations in court have been reinstated by the Trump administration after both were laid off.
(Article may require a subscription.)
#drugpricing #ira #branddrugmakers
Eli Lilly To Invest In Domestic Production
Drug maker Eli Lilly says it will invest $27 billion in four new pharmaceutical manufacturing facilities in the U.S. This comes after a meeting between Big Pharma and Donald Trump, where the drug makers promised to boost domestic production and tackle drug prices.
Three of the new sites will focus on producing active pharmaceutical ingredients, “reshoring” small-molecule chemical synthesis capabilities, and strengthening Eli Lilly’s supply chain. The fourth will focus on injectable therapies.
The expansion is expected to create more than 3,000 full-time jobs along with 10,000 construction jobs. Big Pharma also wants Trump to not levy tariffs on drug imports.
Additional article: https://thehill.com/policy/healthcare/5164970-eli-lilly-27-billion-new-domestic-plants/
#branddrugmakers #tariffs #drugpricing
https://www.beckershospitalreview.com/supply-chain/eli-lilly-to-invest-27b-in-manufacturing.html
Hospitals Could Face Increased Penalties On Transparency Violations
Louisiana Sen. John Kennedy has reintroduced legislation that would increase fines for hospitals violating federal price transparency rules. The bill would double current fines in law. A new Trump executive order seeks to tighten oversight and fines in the program.
Additional article: https://thehill.com/policy/healthcare/5165809-trump-executive-order-hospital-pricing/
#pricetransparency #hospitals
— Marc S. Ryan
