Exchange Compromise Being Developed In Senate
A bipartisan group of senators is working on a compromise to extend the enhanced Exchange subsidies that expired on December 31. The draft compromise would extend the subsidies for two years but add reforms, including income caps for subsidies, minimum premium payments, and appropriations of cost-sharing subsidies. To combat fraud, the bill would penalize health plans that enroll phantom enrollees. The bill would also include expansion of health savings accounts (HSAs) by giving subsidized enrollees the choice of the current Exchange subsidy or having the money go to a pre-funded account beginning the second year of the extension.
The official draft may be released next week. Some Democrats say the caucus could agree to such changes. Others are upset by any minimum premium, even $5 or $10 a month. That seems like a ridiculous position.
But abortion could spell doom for the compromise. Republicans want a strict ban on abortion coverage in Exchange plans. Right now, under the Hyde amendment, a small amount more is charged each subscriber if the plan covers abortion. Democrats say any change is a non-starter.
The House of Representatives will vote Wednesday on a discharge petition to extend the subsidies by three years as they were in law. Four Republicans signed on and the bill is expected to pass the House. But a similar bill was voted down in the Senate because it failed to achieve the required 60 votes. Senate Majority Leader John Thune, R-SD, reiterated that a clean restoration of the subsidies without modifications is a nonstarter in the chamber.
In other news, President Trump will host leaders from 14 health plans to discuss ways to lower prices. Trump claimed that “with one talk,” he thinks costs can be reduced by “50(%), 60(%), or 70%.” But while some belt tightening can occur at big plans, costs are really governed by provider demands. He is talking to the wrong group.
Additional articles: https://www.fiercehealthcare.com/regulatory/legislators-revive-aca-debate-hill-trump-seeks-meeting-insurers and https://www.modernhealthcare.com/politics-regulation/mh-aca-subsidies-congress-2026/
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#healthcare #coverage #exchanges #healthplans #trump
https://thehill.com/policy/healthcare/5677676-obamacare-subsidies-health-care-premiums-abortion
UnitedHealthcare Tightens Claims Payments
Like some other big plans, UnitedHealthcare is making it tougher for certain providers to get paid. Starting in April, for commercial plans, United will require doctors like internists to submit a full written interpretation and report of radiology images in order to be reimbursed for their professional services. If the additional requirement is not submitted, the insurer will consider the radiology interpretation as not reimburseable and it will be deemed within the broader payment for an evaluation and management visit.
#healthplans #unitedhealthcare #claimsdenials
https://www.healthcaredive.com/news/unitedhealthcare-radiology-professional-billing-change/808950
— Marc S. Ryan
