What If Exchange Premium Subsidy Enhancements Lapse?
A new Kaiser Family Foundation (KFF) analysis determines the potential effects of the lapsing of the enhanced premium subsidies in the Exchanges after 2025.
KFF concludes that enhanced subsidies have cut premium payments by an estimated 44%. It says if the enhancements lapse, individuals in twelve of the states that use HealthCare.gov would see their annual premium payments at least double on average. Enrollees with low incomes would see the greatest jump in their premium payments, but all income groups would be hurt (including middle-income earners).
The Congressional Budget Office (CBO) said that Exchange enrollment would drop from an estimated 22.8 million in 2025 to 18.9 million the following year if the subsidies lapse. It would drop to 15.4 million in 2030. This would send our uninsured rate up. I expect it to continue to increase now due to the Medicaid redeterminations and losses of coverage.
The lapse in the enhanced subsidies would be tragic for the nation. The problem is that an enhancement renewal would need to occur in 2024 to ensure no interruption to rate filings for 2026. Rates begin to be filed in the first half of 2025. With an election, that won’t happen.
#aca #exchanges #obamacare #premiumsubsidies
Bill Introduced To Heavily Regulate Private Equity Healthcare Investments
Massachusetts Sen. Ed Markey, D-MA, introduced legislation to regulate private equity (PE) firm ownership of healthcare facilities. This comes after the failure of Steward Health Care, which was owned by a PE firm that found numerous ways to cut costs and drain the enterprise. There is a companion bill in the House.
The Senate Health, Education, Labor, and Pensions (HELP) committee has also voted to launch an investigation into the now-bankrupt Steward Health Care with more than $9 billion in debt. A subpoena was also issued for Steward CEO Ralph de la Torre, M.D.
The bill would require PE firms to have enhanced reporting on spending and healthcare costs, any reductions in services, and pay or benefit reductions for staff. They also would be required to set up escrow accounts for facilities for five years of operational and capital expenses.
Some would argue that this would be regulatory overreach and might be struck in court. But I support this effort. The record shows that such investments generally have had a negative impact on the finances and quality of hospitals and other facilities.
#privateequityfirms #healthcare #hospitals
Centene Affirms Guidance And Beat The Street, With Some Warning Signs
Centene beat The Street in Q2 2024 and affirmed its annual guidance. But it has some major headwinds in the second half. Centene reported $1.1 billion in profit and $39.8 billion in revenue for Q2. That’s up from $1.05 billion in profit and $37.6 billion in revenue for the 2023 comparable quarter.
But some warning signs. Centene is down nearly three million Medicaid members as of June 30 due to redeterminations. That meant premium revenues falling 8% in Medicaid for Q2. Centene and others lobbied for good rate increases to solve for adverse selection setting in with the loss of membership. But there is now a major mismatch between costs/acuity and rates. Centene is pushing for greater hikes but the phaseout of enhanced state reimbursement and tougher state revenue times could hamper efforts over time.
Centene’s Exchange enrollment reached 4.4 million, up from 3.3 million in Q2 2023.
Centene will exit a handful of Medicare Advantage markets in 2025 due to rate issues in the program. Centene said it is realigning its Medicare footprint to its dominate Medicaid line.
Additional articles: https://www.modernhealthcare.com/insurance/centene-earnings-medicaid-exchanges-sarah-london and https://www.healthcaredive.com/news/centene-medicaid-redeterminations-aca-growth-q2-2024/722487/ and https://www.beckerspayer.com/payer/centene-to-exit-handful-of-medicare-advantage-markets-in-2025.html and https://www.beckerspayer.com/payer/centene-posts-1-1b-in-q2-profit.html
(Some articles may require a subscription.)
#centene #medicaid #managedcare #medicareadvantage #exchanges
https://www.fiercehealthcare.com/payers/centene-posts-11b-q2-profit-it-faces-down-medicaid-headwinds
Lawmakers Skeptical Of Need For New Infrastructure Post Chevron
Lawmakers at a House hearing on what to do post the striking of the Chevron precedent by the Supreme Court expressed skepticism that setting up new congressional infrastructure was a good idea or feasible. The Senate has a bill to do just that.
(Article may require a subscription.)
#chevrondeference #congress #regulations
Q2 Lobbying Big For Certain Healthcare Groups
A Fierce Healthcare analysis of Q2 lobbying spending shows hospitals, providers, health plans, and pharmacy benefits managers (PBMs) lobbying the most. I am a bit confused about where Big Pharma is. The article seems to imply they would be included, but they are not on the list. Surely, they would have made the list.
#lobbying #specialinterests #healthcare
https://www.fiercehealthcare.com/ai-and-machine-learning/top-35-healthcare-lobbying-spenders-q2
Huge CrowdStrike Outage Costs
Losses for the healthcare industry from the outage caused by cybersecurity firm CrowdStrike’s faulty update for Microsoft Windows may reach $1.9 billion according to Parametrix Solutions. The healthcare and banking sectors in the U.S. suffered the greatest losses. Its report states that 75% of firms in healthcare and banking had direct financial impacts.
#cybersecurity #healthcare #technology
Review Of New Book Covering Aggressive Provider Debt Collections
A good Health Affairs Forefront blog on a new book, Your Money or Your Life by Luke Messac. He chronicles the aggressive debt collection efforts and lawsuits of hospitals and providers over the outlandish bills issued by them to the uninsured, for out-of-network services, and even for in-network ones.
A Kaiser Family Foundation (KFF) briefer recounts the impact of medical debt in America on older individuals. More than one in five have medical debt. Large shares of the debt were from routine care. Three in ten have been contacted by a debt collector. Over 60% have skipped or delayed care due to affordability. Briefer: https://www.kff.org/medicare/issue-brief/what-are-the-consequences-of-health-care-debt-among-older-adults/
(Some articles may require a subscription.)
#medicaldebt #providers #surprisebilling #debt
https://www.healthaffairs.org/content/forefront/hospitals-hire-debt-collectors
— Marc S. Ryan
