Elon Musk Targeting CMS and Medicare
Elon Musk and his Department of Government Efficiency (DOGE) commission is now targeting the Centers for Medicare & Medicaid Services (CMS) as part of efforts to reduce spending and waste. In particular, Musk is targeting Medicare for fraud, waste, and abuse (FWA).
The DOGE representatives have gained access to payment and contracting systems.
In other news, the hospital lobby is petitioning President Donald Trump to grant carveouts for medical devices and pharmaceutical products for tariffs. China is a large exporter of such products.
As well, Democratic lawmakers are asking the Trump administration why some federal financial assistance recipients still aren’t receiving funds after two judges froze the spending freeze.
Additional article: https://www.modernhealthcare.com/politics-policy/elon-musk-doge-fraud-medicare-medicaid and https://www.beckershospitalreview.com/legal-regulatory-issues/doge-probes-cms-for-medicare-medicaid-fraud-wsj.html and https://www.fiercehealthcare.com/providers/hospitals-ask-trump-exempt-medical-pharma-products-tariffs and https://www.fiercehealthcare.com/regulatory/trump-admin-orders-temporary-pause-most-federal-financial-assistance
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#doge #fwa #cms #medicare #spending #tariffs #healthcare
Coalition Asks Trump To Revive PBM Reform
A broad coalition of healthcare companies, health plans, employers, labor unions, and trade associations is calling for President Trump and the GOP Congress to resurrect pharmacy benefits manager (PBM) reforms that failed to pass last year. Some insurers own big PBMs while others do not.
Healthcare policy analysts also see Trump as being sympathetic to generics and drug price reform.
Additional article: https://insidehealthpolicy.com/daily-news/policy-experts-forecast-potential-trump-admin-sympathy-generics
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#pbms #drugpricing #generics
https://www.modernhealthcare.com/politics-policy/pbm-legislation-spending-bill-congress
KFF Says Just Small Number Would Be Eligible For Work Requirements
President Donald Trump wants to push work requirements again in Medicaid. A Kaiser Family Foundation (KFF) analysis finds that most adults in Medicaid are already working – 64%. Most of the remaining population would likely qualify for work exemptions.
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#medicaid #workrequirements #coverage
https://www.modernhealthcare.com/medicaid/medicaid-work-requirements-trump
Coalition Pushing For Extension Of Exchange Subsidies
A broad coalition of advocates, plans, and providers are pushing for extension of the Exchange premium subsidy enhancements and are seeking to educate the public and lawmakers on the benefits. They see opportunities to pass the extension in the continuing resolution for FFY2025 due in March or the budget reconciliation bill targeted for May. But the latter bill will largely include spending cuts to fund extension of the 2017 tax cuts.
The House GOP is looking at ways to get around existing scoring of budget bills related to the deficit and necessary reductions. At the same time, rightist Republicans are arguing they want a large amount of budget reductions. Moderates are known to oppose sweeping healthcare changes and this is where a good deal of spending is. See my blog on Monday on this: https://www.healthcarelabyrinth.com/will-medicaid-and-the-affordable-care-act-see-huge-cuts/ .
Additional articles: https://thehill.com/homenews/house/5127330-house-republicans-trump-agenda-scramble/?tbref=hp and https://thehill.com/homenews/house/5128657-tensions-house-gop-trump-agenda/ and https://thehill.com/business/5126025-republicans-congressional-budget-tax-bill/
(Some articles may require a subscription.)
#aca #obamacare #exchanges #coverage #budgetreconciliation #healthcare #coverage #medicaid #medicare
https://www.modernhealthcare.com/politics-policy/aca-insurance-exchange-subsidies-expire-fight-back
Providers Continue To Push Prior Authorization Reforms
Provider groups continue to push for additional prior authorization (PA) reforms at both the federal and state levels. One priority is passage of the Improving Seniors’ Timely Access to Care Act, which would implement additional Medicare Advantage (MA) PA changes in law. Most are already in regulation. Plans, too, are investigating changes on their own.
In other news, for the third year in a row, Colorado lawmakers have advanced a bill that would explore the feasibility of a statewide universal healthcare system.
Additional article: https://www.beckerspayer.com/payer/colorados-single-payer-bill-advances.html
#priorauthorization #providers #healthplans
https://www.beckerspayer.com/payer/the-prior-authorization-reform-push-continues.html
— Marc S. Ryan
