Exchange Enrollment Hits Record
With about a week left of enrollment, the Centers for Medicare and Medicaid Services (CMS) said that the Exchanges have reached yet another record enrollment number after mostly lagging during the enrollment season. More than 23 million people have selected coverage. There are 3.2 million new enrollees. Of the people who have signed up so far, 16.7 million found coverage on the federal Exchange, with 6.9 million on the state Exchanges. This is the fourth consecutive year of enrollment records.
Enhanced premium subsidies expire at the end of 2025, which could dramatically impact enrollment. Today congressional Republicans declined to say they would simply let the subsidies expire. Instead, they expect the issue to emerge during talks to extend the Trump tax cuts and the reconciliation process. I still see this as a long shot, but it is bolstered by Sen. Lisa Murkowski’s advocacy for continuation of the enhancements.
CMS press release and fact sheet: https://www.cms.gov/newsroom/press-releases/nearly-24-million-consumers-have-selected-affordable-health-coverage-aca-marketplace-time-left and https://www.cms.gov/newsroom/fact-sheets/marketplace-2025-open-enrollment-period-report-national-snapshot-1
Additional articles: https://www.healthcaredive.com/news/aca-enrollment-2025-record-high/736803/ and https://insidehealthpolicy.com/daily-news/admin-announces-24m-aca-sign-ups-so-far-urges-congress-keep-enhanced-credits and https://thehill.com/policy/healthcare/5072422-biden-administration-achieves-fourth-record-breaking-aca-enrollment-ahead-of-exit/ and https://apnews.com/article/obamacare-aca-health-care-coverage-biden-trump-0c73dcde4a19aea65cb83de01f2d5d2e and https://www.beckerspayer.com/payer/states-with-the-largest-aca-enrollment-increases-2025.html and https://www.modernhealthcare.com/politics-policy/aca-subsidies-trump-exchange-market
(Some articles may require a subscription.)
#aca #obamacare #exchanges #coverage
Johnson Takes Social Security And Medicare Cuts Off Table
House Speaker Mike Johnson, R-LA, clearly declared today that the GOP would not cut Social Security and Medicare in a budget and tax cut package. The Speaker also discussed the possibility of one or two reconciliation bills and how the debt limit may be handled.
Exactly how Medicare will be treated is anyone’s guess. There may not be cuts to benefits, but I still say lawmakers will make changes to Medicare and Medicare Advantage (MA) that could save overall expenditures. We shall see. Social Security cannot be addressed in a reconciliation package anyway.
#socialsecurity #medicare #speakerjohnson #trump #budgetreconciliation
Crapo Outlines Priorities
Incoming Senate Finance Chair Mike Crapo, R-ID, outlined his priorities as he takes over the key committee of cognizance over healthcare. Priorities include pushing for pharmacy benefit manager (PBM) reform, telehealth extensions, a long-term physician payment fix schedule, and mental healthcare.
On drug pricing, Crapo said the committee will have aggressive oversight of the Inflation Reduction Act (IRA) and Medicare drug price negotiations.
The Medicare doc fix is good news for physicians. That he did not signal repealing the IRA drug provisions is of note as well.
(Article may require a subscription.)
#pbms #drugpricing #medicare #physicians #rates #ira #branddrugmakers #mentalhealth #telehealth
Bipartisan Senate Report Attacks Private Equity Investment In Healthcare
Members of the Senate Budget Committee issued a scathing investigatory report on private equity firms’ role in healthcare, arguing such investments make the healthcare system worse. Sens. Sheldon Whitehouse, D-RI, and Chuck Grassley, R-IA, issued the report. The title says it all: “Profits Over Patients: The Harmful Effects of Private Equity on the U.S. Health System.”
The report was instigated by high-profile impacts and bankruptcies of major healthcare entities after private equity investment. The report focused on two case studies of failure.
In other news, a new law in Massachusetts went into effect that regulates private equity investments in healthcare, which was spurred by the Steward bankruptcy.
Additional articles: https://insidehealthpolicy.com/daily-news/bipartisan-senate-budget-report-calls-action-rein-private-equity and https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/113700 and https://www.modernhealthcare.com/policy/massachusetts-law-private-equity-healthcare-maura-healey-steward-health-care-reit
(Some articles may require a subscription.)
#privateequityfirms #healthcare #antitrust
https://www.modernhealthcare.com/politics-policy/private-equity-senate-report-grassley-whitehouse
Predictions Health Insurers Will Rebound In 2025
After a battering in 2024, predictions are that insurers will rebound in 2025, bolstered by a more health plan-friendly president. While Medicare Advantage’s outlook will be better, there is the possibility of cuts in Medicaid and the Exchanges. Some predictions are also made:
- The tragedy in New York will lead insurers to reassess prior authorization and claims denials.
- MA will get more profitable but benefits could still be cut in 2026.
- Medicaid and the Affordable Care Act (ACA) could be cut in budget reconciliation.
- GLP-1s will continue to drive drug costs.
Separately, shareholders of UnitedHealth Group (UHG) are calling on the company’s board of directors to release a report on how its policy of limiting or delaying access to healthcare may be impacting the company’s brand, the economy, and patients.
Additional article: https://thehill.com/policy/healthcare/5074769-unitedhealth-denied-care-uhg-brian-thompson/
#priorauthorization #claimsdenials #healthplans #medicare #medicaid #exchanges #aca #obamacare #drugpricing #glp1s #weightlossdrugs #unitedhealthcare
https://www.healthcaredive.com/news/health-insurer-2025-predictions/735966
BSC Restructures Company And Names New CEO
Blue Shield of California has restructured its corporate operations and named a new CEO and COO.
Lois Quam will be the new CEO, replacing Paul Markovich. Susan Mullaney becomes COO. Markovich will continue to play a role at the company.
Additional articles: https://www.modernhealthcare.com/insurance/blue-shield-california-restructure-lois-quam-ceo and https://www.beckerspayer.com/executive-moves/blue-shield-of-california-restructures-names-ceo-5-things-to-know.html
(Some articles may require a subscription.)
#bsc #healthplans #healthcare
— Marc S. Ryan
