Budget Bill Stalled In House
The House is in flux right now as Speaker Mike Johnson, R-LA, and President Donald Trump are seeking to cajole moderates and conservatives in the GOP caucus to support the Senate version of the Big Beautiful Bill. Conservatives criticize the massive additional overall deficit and debt the Senate bill generates against the House version. They issued a memo criticizing both the Speaker and Senate Majority Leader John Thune, R-SD, for moving away from the House framework. At the same time, moderates are criticizing the fact that Medicaid cuts are actually higher than in the House bill, especially as it relates to greater limitations on the provider tax and its phasedown to 3%.
Trump and Johnson are having some impact. Between six and 20 GOP votes might have been in the “no” column today, but some are now coming around and saying they will vote for the bill or now are open to doing so. Interestingly, one of two no votes on the initial passage of the House bill, Warren Davidson, R-OH, has now said he will support final passage.
A lack of sufficient support from both moderates and conservatives who visited the White House today so far has stalled a series of procedural votes on the floor. The House likely will be in all night in an attempt to move forward to debate and eventually to pass the bill. I have always argued there is an inevitability associated with passage of the bill, whatever healthcare cuts are in or the impact on the deficit. The GOP sees the Big Beautiful Bill as a seminal event for the party and a movement. But right now there are many to convince before final passage.
In other news, Health Affairs Forefront Blog looks at the major administrative costs of carrying out work requirements in six states.
7/3/2024 1:00 PM UPDATE: The House GOP did get a successful vote early Thursday morning to pass a rule governing debate. The vote was 219-212. Debate has happened and now Minority Leader Hakeem Jeffries, D-NY, has all the time he wants as a leader under House rules to give a speech on the bill. At just after 1:00 PM Thursday, Jeffries was still discussing his opposition to the bill and set the record for longest House floor speech, which was about 8.75 hours. A final vote now can occur to adopt the bill.
7/3/2024 3:30 PM UPDATE: The House has passed the Senate version of the Big Beautiful Bill. The vote was 218-214, with just two Republicans voting with all of the Democrats against the measure. The vote caps a saga in the House, then the Senate, and then the House again to ensure enough conservatives and moderates in the GOP caucuses were on the bill.
Additional articles: https://thehill.com/homenews/administration/trump-the-next-100-days/5380399-live-updates-house-gop-trump-bill/ and https://thehill.com/homenews/house/5381728-gop-deficit-hawks-trump-megabill-memo/?tbref=hp and https://thehill.com/homenews/house/5381441-white-house-gop-holdouts-trump-megabill/?tbref=hp and https://kffhealthnews.org/news/article/one-big-beautiful-bill-medicaid-work-requirements-affordable-care-act-immigrants/ and https://thehill.com/homenews/house/5382760-warren-davidson-trump-big-beautiful-bill/ and https://thehill.com/homenews/house/5382215-house-republicans-delay-vote-gop-opposition/ and https://www.healthaffairs.org/content/forefront/recent-experience-shows-national-medicaid-work-requirements-would-create-enormous
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#budgetreconciliation #trump #congress #spending #coverage #medicaid
Providers, Cities Sue Trump Over Exchange Rule
Groups of providers and cities are suing the Trump administration over a proposed rule reining in eligibility in the Exchanges. Republicans argue the rule closes down inappropriate enrollment and fraud. The plaintiffs argue the rule will lead to massive premium hikes and disruption for both enrollees and providers.
The budget bill and rule make major changes to restrict eligibility. In addition, enhanced premium subsidies will expire at the end of the year as no extension will be enacted. This is leading to massive consternation from insurers and insurance regulators. All of the factors likely lead to enrollment losses, higher risk, and higher premiums.
Additional article: https://www.medpagetoday.com/publichealthpolicy/healthpolicy/116354 and https://www.fiercehealthcare.com/payers/cms-sued-over-trump-administrations-aca-final-rule and https://thehill.com/policy/healthcare/5381566-mayors-sue-over-trump-administration-rules-restricting-obamacare-enrollment/
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#exchanges #regulations #hhs #cms #trump #providers #coverage
https://www.modernhealthcare.com/insurance/mh-highmark-unitedhealthcare-aca-market-premiums
340B In The Spotlight
The Department of Health and Human Services (HHS) wants to move oversight of the 340B drug discount program from the Health Resources and Services Administration (HRSA) to the Centers for Medicare and Medicaid Services (CMS). The move is meant to create greater accountability and reform of the program. Of course, hospitals and other providers hate the proposal. They had it good under HRSA. The program is badly in need of reform. Hospitals and other entities receive discounts but do little to pass on savings to those in need. There is evidence that drug prices at 340B hospitals are actually higher than at those without program eligibility.
#340B #hospitals #drugpricing #cms
https://www.healthcaredive.com/news/340b-move-cms-hrsa-hhs-restructuring-hospitals/751204
Tariffs Could Increase Generic Drug Prices
Interesting Health Affairs Forefront Blog on the impact of tariffs on drug prices, President Trump’s proposals on lowering costs, and how other countries set price.
(Article may require a subscription.)
#drugpricing #mfn #irp #tariffs #generics #brands
— Marc S. Ryan
