Big Beautiful Bill Signed
President Donald Trump signed Republicans’ One Big Beautiful Bill and touted it as a landmark major tax and domestic policy bill. The bill extends tax reductions ready to expire and enacts new ones. At the same time, it institutes massive cuts to Medicaid that could remove millions of people from Medicaid and the Exchanges.
The bill was months in the making and Donald Trump is being given considerable credit for its passage. Whatever you think of the bill itself, its passage can be described as a political master stroke given the tight vote count for the GOP in each chamber of Congress. Trump stayed engaged with lawmakers on each vote – the initial House draft, the Senate recrafted one, and the House adoption of the Senate version. He is credited with creating a full course press to pass the bill, including a mixture of cajoling, education, and even threats. Trump, Vice President JD Vance, Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz, Treasury Secretary Scott Bessent, other Cabinet officials, Speaker Mike Johnson (R-LA), Senate Majority Leader John Thune (R-SD), and other GOP leaders in each house all executed on final passage over several months.
Healthcare policy group KFF has already updated its bill comparison and it is well done as usual. The link is in the additional articles area. I will have a blog Monday that goes through the final language. At a high level, this is what is in the bill:
- Medicaid work requirements for the able-bodied.
- Medicaid eligibility checks every six months for some populations.
- Elimination of a Medicaid eligibility streamlining regulation.
- Medicaid Cost-sharing for some enrollees.
- Medicaid provider tax limitations in non-expansion states and a phasedown from 6% to 3.5% over time in expansion states.
- Limitations on state-directed payments in Medicaid.
- Affordable Care Act (ACA) Exchange subsidy verification and stricter eligibility rules.
- Limits on immigrant eligibility for Medicare, Medicaid, and ACA premium tax credits.
- A $50 billion fund for rural hospitals and health systems.
- Prohibition on enforcing a Biden-era nursing home staffing regulation.
Notwithstanding what Republicans say, millions will lose coverage as a result of social barriers, red tape, administrative hurdles, the great inefficiency and lack of infrastructure in state Medicaid agencies, and lower availability of revenue in states to match federal dollars.
The bill does include a temporary 2.5% increase to the Medicare Physician Fee Schedule for 2026.
Additional articles: https://thehill.com/homenews/house/5385546-trump-republicans-megabill/ and https://thehill.com/homenews/administration/5384512-trump-signs-big-beautiful-bill/ and https://www.beckershospitalreview.com/hospital-management-administration/senate-passes-gop-budget-bill-heads-to-house-8-things-to-know/ and https://thehill.com/policy/healthcare/5384707-how-trumps-megabill-will-impact-health-care/ and https://www.kff.org/tracking-the-health-savings-accounts-provisions-in-the-2025-budget-bill/
#budgetreconciliation #trump #congress #coverage #medicaid #exchanges #aca #obamacare #uninsured
https://www.healthcaredive.com/news/trump-signs-reconciliation-bill-medicaid-cuts/752259/
MA Commission Contraction
Medicare Advantage (MA) plans continue to rein in or stop commissions for 2025 enrollments due to major financial issues on the line of business. Even plans bullish on MA going into 2025 are doing so as well. Agents and brokers criticize the movement given the financial impact on them and the lack of services levels and robust choices to consumers.
The eliminations of commissions will clearly stop the growth in the balance of the year for many plans. United, Aetna, Cigna Medicare (now owned by HCSC), Elevance Health, and Blue Shield California are featured in the article.
#medicareadvantage #marketing #agents #brokers
https://www.beckerspayer.com/payer/the-latest-trend-changing-medicare-advantage
NEJM Highlights Corporate Influence In Healthcare
The “corporatization” of healthcare will be the subject of a new essay series from the New England Journal of Medicine (NEJM). NEJM says the series will define and untangle elements of the corporate takeover of healthcare and how the system can better move forward. Consolidations and concentration are clearly driving up healthcare costs and the series is certainly welcome.
#consolidations #mergers #acquisitions #healthcare #healthcarereform
https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/116368
— Marc S. Ryan
