Trump Wants To Preserve Medicaid By “Loving And Cherishing It”
On Friday, President Donald Trump promised to “love and cherish” Social Security, Medicare, and Medicaid. Notice Medicaid made it to the earlier list of protected programs. Trump continued: “We’re not going to do anything with that unless we can find some abuse or waste. The people won’t be affected. It will only be more effective and better.” A sea change for Trump? Perhaps. But let’s not get too hopeful from one press statement.
See my blog today on some interesting developments on the healthcare front. Trends suggest healthcare cuts may not be as deep as once suspected during the budget reconciliation process: https://www.healthcarelabyrinth.com/will-medicaid-and-the-affordable-care-act-see-huge-cuts/
#medicaid #aca #obamacare #exchanges #trump #congress #budgetreconciliation
https://www.politico.com/live-updates/2025/01/31/congress/trump-love-and-cherish-medicaid-00201893
Medicare Advantage Risk Adjustment Reform
While I disagree with some of the overpayment numbers quoted in this Health Affairs Forefront blog, I find interesting the authors’ position on tackling risk adjustment abuse and overpayments for those big Medicare Advantage (MA) plans and some others that have the highest levels of overpayment.
The article says MA plans were overpaid by $50 billion in 2024 related to upcoding in risk adjustment (it is a MedPAC figure and I disagree). The article also mentions total overpayment amounts in MA of over $100 billion (again MedPAC numbers and I disagree). But it does note that upcoding varies a great deal in MA. MedPAC estimated a 15-percentage-point variation in coding intensity among the eight largest MA plans and found 10 MA plans with coding intensity more than 20 percent higher than levels in traditional Medicare. As the article notes, about half of plans are getting a windfall while the other half get hurt.
The authors propose to increase the 5.9% coding intensity adjustment and apply it at varying levels to each MA plan based on its coding intensity compared with other MA plans. Those with lower coding would receive a rate increase, while those with higher rates of coding would have lower ones to make up for the robust upcoding.
The authors mention other reforms, such as barring codes only on health risk assessments, using two years of data in risk adjustment, and ensuring the v28 risk model is phased in for 2026.
I have endorsed eliminating both HRA-only and chart review-only coding. And I have said something should be done about the very aggressive coder plans as they give the whole program a bad name. Something like this could work. I, too, think getting a fair risk adjustment rule in place and executing is key. See my blog on this: https://www.healthcarelabyrinth.com/will-cms-rein-in-risk-adjustment-submissions/ . Of course, MA is in tough financial shape right now and changes need to be phased in over time.
(Article may require a subscription.)
#medicareadvantage #overpayments #riskadjustment #radv
Rating Agencies Downgrade Some Insurers
Moody’s has downgraded insurance ratings due to multiple reports of major increases in medical expenses. The rater notes that expected rate hikes will not offset the cost trends. Just one insurer, Elevance Health, received a positive outlook. Generally, Moody’s sees challenges in every line of business for health insurers.
So far, major insurers all have reported major drops in margins from 2023 to 2024.
Additional article: https://www.fiercehealthcare.com/payers/moodys-downgrades-insurers-credit-outlook-negative-amid-ongoing-cost-pressures
#healthplans #margins
https://www.beckerspayer.com/payer/moodys-negative-outlook-for-payers-amid-high-medical-costs.html
Two Judges Have Now Stopped Trump Spending Freeze Indefinitely
The Trump administration has now lost twice in court when it comes to its temporary pause and review of federal financial assistance. A second federal judge has now placed an indefinite temporary restraining order mandating release of frozen funds. The case now goes to hearings on the merits. Some complain that the administration review continues and the freeze is still on.
#trump #congress #spending
Healthcare Costs Could Increase Due To Tariffs
A survey of healthcare supply chain professionals, pharmaceutical executives, distributors, and medical equipment manufacturers say the tariffs being imposed by President Trump will increase costs for hospitals, physicians, payers, and patients. The respondents say costs would increase by at least 10 to 15%. Trump has placed 25% tariffs on Canada and Mexico due to drug and immigration issues. He placed a 10% additional tariff on China for similar reasons. A temporary hold on the Mexico and Canada tariffs was agreed to today.
#tariffs #trump #healthcare
Kennedy Flips On March-In Rights; Doesn’t Clearly Answer Drug Price Questions
In responses to questions from senators, Robert F. Kennedy, Jr. said he now does not favor patent march-in rights on drug patents. Earlier he was quoted as supporting them. One wonders if he understood the concept originally or was ordered by the White House to change his position. He answered most questions with the phrase “[I will] follow the law.” Kennedy did not answer clearly on many questions related to drug costs or negotiations. He did endorse pharmacy benefit manager reform, including Federal Trade Commission actions against the entities. Democrats are also calling for Kennedy to recuse himself from areas that his background and actions would create conflicts, including on vaccine approval processes.
Additional articles: https://insidehealthpolicy.com/daily-news/rfk-jr-skirts-around-senate-dems-questions-drug-pricing-reform and https://thehill.com/policy/healthcare/5122811-kennedy-vote-concerns/ and https://insidehealthpolicy.com/daily-news/wyden-warren-demand-rfk-jr-recuse-himself-vaccine-matters-blast-gardasil-fee-divestment
(Some articles may require a subscription.)
#rfkjr #hhs #drugpricing #patents #healthcarereform #ira #healthcare #branddrugmakers
https://insidehealthpolicy.com/daily-news/kennedy-rejects-use-march-rights-lower-drug-prices
Trump Inherits No Surprises Act Litigation Mess
The Trump administration has inherited the need to make major decisions on what to do with lawsuits over the No Surprises Act (NSA). While the law clearly favors providers, they continue to sue over various interpretations of the law and regulations. The Biden administration sought to make the process fairer and has defended its positions.
Arbitration decisions favored providers three-quarters of the time and awards were actually up compared with pre-NSA timeframes. Trump will need to determine whether it will defend the Biden administration’s direction to health plans on how to calculate the so-called qualify payment amount (QPA) in the arbitration process. As the court fights continue, Biden allowed the current QPA calculation practice to continue. Providers argue plans include ghost rates and rates for services not performed.
Trump should defend how Biden has approached the law and also encourage Congress to level the playing field by making the law not as friendly to providers. The status quo could further drive up already obscene provider costs.
(Article may require a subscription.)
#nsa #nosurprisesact #transparency #healthplans #providers
Molina Closes On ConnectiCare
Molina Healthcare has closed on its purchase of ConnectiCare, a subsidiary of New York City-based EmblemHealth. The plan has 140,000 individual, Medicare Advantage (MA), and commercial lives. Molina is a Medicaid-dominant insurer, but bought Bright Health’s MA lives a year ago.
#molinahealthcare #acqusitions #mergers #manda
https://www.beckerspayer.com/m-and-a/molina-closes-350m-connecticare-acquisition.html
KFF Shows Premium Hikes By Congressional District If Enhanced Premiums Expire
The Kaiser Family Foundation (KFF) has published an interactive map that shows the magnitude of premium hikes in the Exchange if enhanced premium subsidies expire. It is done by congressional district and not surprisingly GOP districts would see the highest hikes. This creates a cause for concern among GOP lawmakers in Congress.
Now we know that the enhancements were meant to aid folks during the COVID pandemic. But there is little question that they have driven coverage in America. While I might do things differently, I have endorsed at least the extension of the enhancements. See the blog I did here and why the GOP should be on board: https://www.healthcarelabyrinth.com/the-gop-should-safeguard-the-aca/ .
#aca #obamacare #exchanges #trump #congress
— Marc S. Ryan
