January 15, 2025

Overall Record Enrollment in ACA Programs

As discussions are opening up in 2025 on whether enhanced premium subsidies are extended or not, the Kaiser Family Foundation (KFF) released a new analysis that said in 2024 Affordable Care Act (ACA) enrollment was 44 million. This includes federal and state Exchange Marketplaces, Medicaid expansions (ten states have not expanded), and the Basic Health Plan (in a small number of states). In 2024, Exchange Marketplace enrollment hit a record of 21.4 million people. Medicaid expansion enrollment was 21.3 million in 2024. Basic Health Plan enrollment in 2024 was 1.3 million.

Exchange enrollment in 2025 will hit at least 24 million, so those helped via the ACA will actually be about 47 million. These gains could be reduced over the next several years if the enhanced rebates expire at the end of 2025, if the Exchange benefits and subsidies are changed in other ways, and if the Medicaid expansion is rolled back or state matching funds are reduced.

KFF press release:https://www.kff.org/affordable-care-act/press-release/affordable-care-act-marketplace-and-medicaid-expansion-enrollment-reached-a-combined-44-million-in-2024/

#aca #medicaid #obamacare #exchanges #coverage

https://www.kff.org/affordable-care-act/issue-brief/a-look-at-aca-coverage-through-the-marketplaces-and-medicaid-expansion-ahead-of-potential-policy-changes/

HHS Releases Report On Impact Of Consolidation And Private Equity In Healthcare

The Department of Health and Human Services (HHS) released a report highlighting the impacts of increasing consolidation and private equity (PE) investment in healthcare. This comes after a public process solicited widespread input. Responses primarily addressed two major trends in the healthcare sector. Key themes from the comments included:

  • Provider consolidation leads to higher prices and less access for patients
  • M&A in healthcare services, especially in PE-backed transactions, results in process changes and quality reductions
  • Physicians that worked with PE firms offer mixed reviews
  • There is widespread desire for transparency on PE-led transactions
  • People are dissatisfied with private health insurers, especially vertically integrated insurers

Some case studies offered in the report highlight how PE firms loaded hospitals up with debt, sold the hospitals’ underlying assets, and paid investors through dividends and financially engineered sales. These led to bankruptcy, closure of facilities and service lines, staffing shortages, and patient safety and quality concerns.

#privateequityfirms #mergers #acquisitions #manda #antitrust #healthcare #consolidation

https://www.hhs.gov/about/news/2025/01/15/hhs-releases-report-consolidation-private-equity-health-care-markets.html

Business Group Sues FTC On Pre-Merger Disclosure Mandates

The U.S. Chamber of Commerce is suing the Federal Trade Commission’s (FTC) finalized changes to the filings parties must submit prior to a merger. The changes received unanimous approval on the commission so are not seen as partisan. They are slated to go into effect on Feb. 10 unless stopped by a court injunction.

The FTC says the additional information is necessary to spot potential antitrust mergers or acquisitions as well as deal with a huge volume. The business group says the regulation is onerous and exceeds the commission’s authority.

I am Teddy Roosevelt on mergers and acquisitions. Too much consolidation erodes the free market and government has a duty to scrutinize it.

#antitrust #ftc #healthcare #mergers #acquisitions #manda

https://www.fiercehealthcare.com/finance/us-chamber-commerce-sues-block-ftcs-premerger-requirement-overhaul

CMS Facing More Star Lawsuits

The Centers for Medicare and Medicaid Services (CMS) is facing at least seven lawsuits over its 2025 Medicare Advantage (MA) star ratings. 

Alignment Healthcare is the latest MA plan to sue CMS, alleging it acted wrongfully when assigning 2025 Star ratings. In part, Alignment challenges the Tukey outlier deletion rule. Florida Blue, Humana, United Healthcare, Elevance Health, Centene, and Blue Cross and Blue Shield of Louisiana have all sued as well. United Healthcare won relief in court and United and Centene have already seen Star rating increases.

#stars #cms #medicareadvantage #partd

https://www.beckerspayer.com/payer/lawsuits-over-medicare-advantage-star-ratings-pile-up.html

Americans Doubt Relief Will Come On Healthcare Costs

A new Gallup poll finds that nearly half of Americans don’t believe that the incoming Trump administration will lower health costs. About 48 percent of Americans are pessimistic about the new administration’s ability to lower healthcare costs, with 45 percent saying the same on prescription drug costs. 

There is a bit of a partisan divide. About 84 percent of Democrats said they think any future policy from the Trump administration on health costs is headed in the wrong direction, along with nearly half of independents. Nearly three-quarters of Republicans said they think the country is headed in the right direction on health costs. 

#healthcare #coverage #affordability

https://thehill.com/policy/healthcare/5085589-trump-administration-health-costs-poll

— Marc S. Ryan

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