Senate Passes One Big Beautiful Bill
It was another wild all-nighter for the Senate GOP caucus Monday in its efforts to pass the One Big Beautiful Bill. But early afternoon Tuesday, the bill was finally passed and now goes back to the House.
A conservative amendment to lower the federal matching percentage in expansion states did not have enough votes to pass. But in the end the conservatives except Rand Paul voted for the measure. Despite helping get a rural hospital fund to $50 billion, moderate Susan Collins voted against the bill along with Thom Tillis.
All eyes Monday were on moderate Lisa Murkowski. She won some SNAP nutrition and Medicaid funding concessions in the bill for Alaska and, with the rural hospital fund increase, voted yes. That gave the bill 50 votes, allowing Vice President JD Vance to cast the tie-breaking vote for approval.
Healthcare providers and health plans universally panned the bill, which is being described by Democrats as the largest rollback of Medicaid ever. The GOP notes that the program grew tremendously since the COVID pandemic and has become unaccountable.
I will inventory all the healthcare reductions soon in an upcoming blog when the House acts. But the big major reductions generating both savings and the vast majority of the lower projected insured are work requirements, limitations on provider taxes, caps on state-directed payments, and tighter eligibility requirements, which in the Senate version phases the allowable rate down over time from 6% to 3.5%. Medicaid is slashed by $940 billion over ten years. More than $200 billion is cut from the Exchanges through various eligibility restrictions and bars on illegal immigrant participation and subsidies. Tighter access restrictions for immigrants apply to Medicare as well.
A limited Medicare physician fix was included, which will not repair the reduced rates in 2025 but boost them by 2.5% in 2026. No structural changes were adopted for the future.
The bill could also trigger mandatory reductions in Medicare due to outyear deficit increases unless the law is overridden later. Medicare cuts could hit at least $45 billion in 2026 and a total of $490 billion in the remainder of the ten-year horizon.
The bill could struggle in the House. Some moderates are not happy with the five-year sunset on the state and local tax deduction increase. Other moderates are upset about increased Medicaid cuts. And conservatives are upset about the increase in deficits and debt. Conservatives could protest at the rules committee level and on the House floor. At least six House members have said they will vote against the bill as of now, which would sink the bill. But let’s see what arm-twisting occurs.
Additional articles: https://www.modernhealthcare.com/politics-regulation/mh-senate-tax-bill-medicaid/ and https://www.modernhealthcare.com/politics-regulation/mh-tax-bill-senate-one-big-beautiful-bill/ and https://www.healthcaredive.com/news/senate-passes-reconciliation-bill-medicaid-cuts/752018/ and https://www.beckerspayer.com/policy-updates/insurers-urge-house-to-reverse-course-on-budget-bill/ and https://thehill.com/homenews/senate/5379770-senate-trump-bill-tax-cuts-medicaid-snap-student-loans/ and https://thehill.com/policy/healthcare/5378970-medicaid-cuts-senate-republicans/?tbref=hp and https://www.kff.org/medicaid/issue-brief/allocating-cbos-estimates-of-federal-medicaid-spending-reductions-across-the-states-senate-reconciliation-bill/ and https://thehill.com/homenews/senate/5380186-trumps-tax-bill-heads-house/ and https://thehill.com/homenews/house/5380166-house-conservatives-threaten-senate-bill/
(Some articles may require a subscription.)
#budgetreconciliation #trump #congress #spending #medicaid #exchanges #coverage
https://www.fiercehealthcare.com/providers/senate-passes-reconciliation-bill-51-50-vote
Centene Pulls Guidance
Centene pulled its guidance for the year after Wakely actuaries reported the health insurance company will receive more than $1.8 billion less than expected through the Exchange risk-adjustment program. Centene did not issue updated earnings guidance for 2025. CMS will finalize payments for this plan year in June 2026. Centene has the most exchange lives nationwide and will work with state regulators to refile bids for next year to reflect higher-than-projected morbidity. The lower risk revenue ties to lower enrollment.
Centene said rising Medicaid costs were driven by behavioral health, home health services and high-cost drugs. Medicare Advantage and Medicare Part D prescription drug plan costs were better than Centene expected.
(Article may require a subscription.)
#centene #margins #exchanges #riskadjustment #medicareadvantage #medicaid
https://www.modernhealthcare.com/insurance/mh-centene-guidance-aca-risk-adjustment
Federal Judge Block HHS Layoffs
A federal judge ruled that the mass layoffs carried out at the Department of Health and Human Services (HHS) likely went against the law and there is sufficient evidence to support claims of irreparable harm as a result. The Biden appointee granted a request by plaintiffs to block the far-reaching terminations at HHS as well as the planned restructuring of the agency. The ruling will be appealed by the Trump administration.
#hhs #cms #layoffs
https://thehill.com/policy/healthcare/5379630-federal-judge-finds-hhs-mass-layoffs-likely-unlawful
— Marc S Ryan
