A Second Budget Bill Coming?
Capitol Hill was abuzz today when the budget chairs of each house signaled that they both would like to see a second bill. While budget reconciliation rules allow for only one bill per year, the GOP had FFY 2025 and FFY 2026 budget years they could use for the process. And technically, after October 1, 2025, FFY 2027’s budget could also be acted on with a budget reconciliation bill.
Budget Chairs Mike Crapo, R-ID, and Rep. Jodey Arrington, R-TX, each confirmed a desire for a second bill later this year but did not specify what might be included. Separately, Ron Johnson, R-WI, said that he has a commitment from the White House and Senate GOP leadership to get another chance to repeal part of the Affordable Care Act’s (ACA) expansion of Medicaid. Johnson’s proposal would end the 90 percent federal cost-share at the end of 2030. Afterwards, states would return to regular matching rates for expansion populations. A group of conservatives sponsored such an amendment during the recent Vote-a-Rama, but it failed to receive sufficient support to be acted on. Crapo was one of the sponsors. So, this idea could get into any second bill.
Separately, Democrats are seeking to hang the blame on expiring subsidy enhancements for the Exchanges on the GOP. The enhanced subsidies expire at the end of the year because they have not been extended. Part of the political gameplan of Democrats is to tie the subsidy expiration to the GOP and argue more displacement is coming after the election. The Democrats could also point to a new Trump rule that tightens enrollment processes. About 5 million fewer people are forecasted to be on the Exchanges due to the subsidy expiration and the new rule. Overall, about 17 million would lose coverage when including the full rollout of the budget reconciliation cuts.
Drew Altman of healthcare policy group KFF has a good article on this issue and whether the Democrats will be successful. I will opine on this in an upcoming blog.
Additional articles: https://www.politico.com/live-updates/2025/07/08/congress/senate-finance-chair-endorses-a-second-megabill-this-fall-00443261 and https://www.politico.com/live-updates/2025/07/08/congress/ron-johnson-believes-he-will-get-second-bite-of-the-apple-on-medicaid-cuts-00443331 and https://www.kff.org/from-drew-altman/can-democrats-make-the-medicaid-and-aca-cuts-their-winning-political-issue-before-people-feel-the-cuts/
#budgetreconciliation #trump #congress #medicaid #exchanges #coverage
https://thehill.com/policy/healthcare/5390885-republicans-obamacare-subsidies-expiration
FIDE SNPs Have Lowest Disenrollment Rates
The Centers for Medicare and Medicaid Servies (CMS) is pushing hard for the highest integration in the Medicare Advantage (MA) Special Needs Plan (SNP) world and a new JAMA Network study boosts the CMS policy. The study looked at one-year disenrollment rates (from 2021 to 2022) across various MA and SNP plan types. It found that Fully Integrated Dual Eligible (FIDE) SNPs had the lowest disenrollment rates. The disenrollment rates were as follows:
FIDE SNPs – 8.1%
Coordination-only SNPs – 18.3%
Standard MA plans – 28.2%
D-SNP look-alikes – 30.5%
Th study also looks at disenrollment across various demographic and clinical factors. A tremendous study and read.
#medicareadvantage
https://jamanetwork.com/journals/jama-health-forum/fullarticle/2835812#google_vignette
Children’s Hospitals Could Be Hit Hard
An excellent article in Modern Healthcare about the bad financial plight of children’s hospitals when Medicaid cuts hit. Leaders at these hospitals are especially worried about the limits on provider taxes as well as state directed payments.
As a former board member of a children’s hospital, these leaders are right to be concerned as they heavily rely on state Medicaid supplemental aid. Children’s hospitals take care of a disproportionate share of the most vulnerable. While a rural hospital fund was created to lessen impacts, nothing was done for children’s hospitals. Children’s hospitals also play a big role in graduate medical education, and that funding could also be at risk.
(Article may require a subscription.)
#medicaid #hospitals #budgetreconciliation
https://www.modernhealthcare.com/providers/mh-medicaid-cuts-lurie-phoenix-childrens-hospitals
Cotton To Lead United Medicaid
Mike Cotton, a seasoned health plan executive has been promoted by UnitedHealthcare to serve as CEO of the Medicaid product nationally. I have known Mike for years and he is an incredibly talented guy. Congratulations, Mike.
(Some articles may require a subscription.)
Additional article: https://www.modernhealthcare.com/insurance/mh-unitedhealth-group-mike-cotton-medicaid/
#unitedhealthcare #medicaid
https://www.beckerspayer.com/executive-moves/unitedhealth-group-names-new-medicaid-ceo
Health Insurers’ Woes
A good Modern Healthcare article from Nona Tepper describing the major challenges of health insurers right now. In particular a good deal of attention is paid to those insurers heavily focused on Medicaid the Exchanges. Both programs are hit hard by the budget reconciliation bill. The expiration of the enhanced Exchange subsidies and a new enrollment rule further hurts enrollment.
Risk is increasing in both programs. Rates are coming in very high for 2026 in the Exchanges. Risk adjustment redistribution has also hurt many plans. Some national players are pulling out and others could follow due to the major changes and rising risk.
(Article may require a subscription.)
#medicaid #exchanges #aca #obamacare #healthplans
https://www.modernhealthcare.com/insurance/mh-centene-molina-elevance-aca-market
Study Shows Small But Growing Health Plan Ownership Of PCPs
A new study published in Health Affairs Scholar finds that health insurers are steadily expanding their control over the primary care physicians (PCPs), driven by Medicare Advantage (MA) growth opportunities.
The study said that payer-operated practices accounted for 4.2% of the national Medicare primary care market by service volume, in 2023, up from 0.8% in 2016. Control over PCPs varies a great deal by region.
Another study from the Brookings Institution and Cornell Medical College’s Health Policy Center found that of the more than 381,000 primary care doctors billing Medicare in 2023, 6.4% worked for a payer-operated practice.
The number is still small compared with the percentage of physicians now employed by health systems and hospitals.
Additional article: https://www.healthcaredive.com/news/insurer-ownership-primary-care-doctors-medicare/752420/
#providers #medicareadvantage #hospitals #healthplans
Onshoring Drug Manufacturing
The Trump administration’s threat of drug and other product tariffs is focusing many on the idea of reshoring drug manufacturing. This article does a great job explaining the complexity of reshoring initiatives.
#drugpricing #tariffs
States Try To Tackle Ground Ambulance Surprise Billing
States are attempting to pass laws and otherwise regulate surprise billing for ground ambulances. Ground ambulance firms flexed their muscles and got exempted from being included in the No Surprises Act at the federal level. State efforts to protect citizens from excessive out-of-network ambulance bills are hampered by the fact that some insurance products are pre-empted by federal law (e.g., ERISA self-insured and Medicare).
#nsa #nosurprisesact #surprisebilling #pricetransparency #transparency
— Marc S. Ryan
