Kennedy Has Subpar Performance Before Committee
While Health and Human Services (HHS) nominee Robert F. Kennedy, Jr., did not mortally wound himself before the Senate Finance Committee today at a confirmation hearing, he certainly did himself no favors, either. Kennedy was unable to articulate views on healthcare policy and reform or speak articulately on the Medicare and Medicaid programs. In fact, he confused the two programs at points and perhaps thought Medicaid looked more like the state children’s healthcare or Exchange programs. He even stated that Medicare Advantage (MA) is more expensive than the traditional one. The American public often confuses various healthcare programs, but you do not expect that from the future HHS leader. Just troubling.
The hearing likely means he gets no Democratic votes. What is more worrisome for the Trump team is that some Republicans are now worried about Kennedy’s capabilities. Betting odds are that Kennedy still wins confirmation, but four GOP senators could very well vote no. The day leads many to wonder if Kennedy is really up to the job, even setting aside controversial stands. Will tomorrow go any better?
Additional articles: https://www.fiercehealthcare.com/regulatory/live-updates-rfk-jr-senate-confirmation-meeting-kicks and https://www.modernhealthcare.com/politics-policy/rfk-confirmation-hearing-hhs and https://thehill.com/homenews/senate/5114271-fetterman-rfk-jr-nomination-hearing/ and https://www.healthcaredive.com/news/robert-f-kennedy-jr-confused-medicaid-hhs-secretary-confirmation-hearing/738690/
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#rfkjr #hhs #congress #trump #healthcare
https://apnews.com/article/rfk-jr-nomination-when-where-to-watch-dacfabb9a43efac93bab058ad6a327d9
Spending Freeze Rescinded – Or Not
The controversy over an Office of Management and Budget (OMB) memo continues to generate controversy and confusion. The budget agency pulled back on the memo today, which was meant to forestall further court action. But Democrats cried that the new Trump administration continues to violate law and the separation of powers by withholding funding. Both Trump and his press secretary seemingly confirmed that while the memo was rescinded, the administration continues to scrutinize funding within agencies based on issued executive orders. So, the federal funding freeze is not really off. And it appears agencies are expected to review most funding based on those orders.
A federal court will continue to hear the issue next week, signaling the controversy is not resolved. It will resolve whether any funding can be withheld. The controversy goes down as the first misstep of Trump 47 and the administration has done little to truly clarify what is going on. The memo was terribly drafted and Democrats continue to harp on the withholding of any funding.
Additional articles: https://www.fiercehealthcare.com/regulatory/trump-admin-orders-temporary-pause-most-federal-financial-assistance and https://www.modernhealthcare.com/politics-policy/trump-spending-freeze-reverse and https://www.healthcaredive.com/news/white-house-rescinds-federal-funding-freeze-healthcare/738667/ and https://insidehealthpolicy.com/daily-news/omb-rescinds-funding-freeze-memo-eo-remains-after-legal-challenges
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#trump #healthcare #spending #congress
https://thehill.com/homenews/administration/5113776-white-house-press-secretary-spending-freeze
CMS Issues Pro-Medicare Drug Negotiations Statement
While it is not a robust endorsement, the Centers for Medicare and Medicaid Services (CMS) issued a statement in support of continuing negotiations but soliciting more input and bringing more transparency to the process. This is a blow to Big Pharma, which had hoped to convince Trump to stall or abandon Round 2.
#ira #drugpricing #medicare #partd #branddrugmakers
https://www.cms.gov/newsroom/press-releases/cms-statement-lowering-cost-prescription-drugs
Business Group Makes Healthcare Database Available To Lower Costs
In a big public service, the Purchaser Business Group on Health is creating a database of hospital, insurer, and employer healthcare cost information to help companies negotiate the price of services and coverage for employees. It is one output of the efforts by both Trump and Biden to bring price transparency. The claims data will be from five large employers and analyze the cost and quality of care across 10 markets. Self-funded employers can then use the information to analyze provider networks, insurance contracts, and agreements with hospitals.
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#employercoverage #healthcare #healthplans #hospitals
https://www.modernhealthcare.com/insurance/pbgh-hospital-insurer-price-data
KFF Finds Major Prior Authorization In Medicare Advantage
The Kaiser Family Foundation (KFF) has found a high rate of the use of and denial of prior authorizations (PA) in Medicare Advantage. The KFF analysis finds that MA plans increased their use of PA by 7.8% to 49.8 million total requests in 2023. The analysis is based on Centers for Medicare and Medicaid Services (CMS) data. KFF finds that the increase ties to enrollment growth. MA plans also denied slightly fewer PAs requests in 2023, down to 6.8% from 7.4% in 2022.
Aetna, Centene and Kaiser Permanente denied at least one in 10 Medicare Advantage prior authorization requests in 2023.
KFF also finds that there were nearly two PA determinations on average per MA enrollee, similar to 2019. Only about 11.7% of PA denials were appealed in 2023, and 81.7% of them were partially or fully overturned.
On balance, the review is reasonable. But I find it a bit disturbing how KFF compares rates to traditional Medicare, which has very little PA requirements because it is an unfettered system. It can easily be taken out of context.
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#priorauthorization #medicareadvantage #healthplans #medicare
Public Option Pros and Cons
Interesting article on the pros and cons of a public option plan in two states with the option – Colorado and Washington. Progressives have argued that such options lower costs for consumers by taking out the margin and administrative costs of health plans. At the same time, the biggest reduction in overall costs comes from lower provider reimbursement. In public option programs, provider payments tend to be pegged closer to Medicare rather than two times or more Medicare as in most commercial contracts.
But providers complain that payments are not enough. I am not a fan of public options and would rather see incentives for private plans to offer plans in hard-to-serve areas. But I have argued that hospitals can survive at much lower rates if they economize. Unfettered hospital price masters and contracts that peg commercial rates obscenely serve as a disincentive for hospitals to be efficient. Check out my blog on the topic here:
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#publicoption #exchanges #aca #obamacare
— Marc S. Ryan