Senate Reconciliation Bill Sets Up Showdown
The Senate version of the House-passed budget reconciliation bill has been unveiled and will create a showdown within the Senate and eventually with the House.
The measure preserves the House reductions to Medicaid but goes further. Beginning in 2027, the legislation would lower healthcare provider taxes to 3.5% (from 6%) in states that chose to expand Medicaid. It also expands those who would be required to work as a condition of Medicaid eligibility. The Senate version says adults with dependent children older than 14 will also have to prove they work, attend school, or perform community service for 80 hours a month. The House-passed version would exempt all adults with dependent children.
A number of moderates and pragmatic conservatives could be off the bill, with Sen. Josh Hawley, R-MO, and Sen. Susan Collins, R-ME, already speaking out. Hawley dislikes the provider tax changes as well as cost-sharing on certain enrollees. At the same time, at least two conservatives appear to be signaling their opposition – Sen. Rand Paul, R-KY, and Sen. Ron Johnson, R-WI. Other conservatives also signaled their reservations earlier. The Senate GOP can afford to lose just three votes.
Thus far, no reductions to Medicare have been included in the draft. Further, the Senate bill rejects the increase in the state and local tax (SALT) deductions to $40,000 and keeps it at $10,000 a year. House moderates would not vote for a bill that does not considerably increase the SALT cap.
In other news, a study published in the Annals of Internal Medicine says the House reductions to Medicaid is projected to cause 16,642 premature deaths among adults each year as Americans lose coverage.
As well, Democrats have introduced new legislation that would establish a “Part E” for Medicare, which would allow people to opt into the program. The new Part E would supposedly sustain itself through premiums. But it would be costly as the bill makes subsidies available through the Affordable Care Act (ACA) plans applicable to Part E coverage as well.
Additional articles: https://www.beckershospitalreview.com/quality/patient-safety-outcomes/medicaid-cuts-will-cause-16500-deaths-annually-study/ and https://www.fiercehealthcare.com/regulatory/democrats-introduce-bill-establish-medicare-part-e-public-option and https://thehill.com/homenews/senate/5353226-senate-medicaid-house-bill/
#budgetreconciliation #spending #medicaid #medicare #coverage #trump #congress #aca #obamacare #exchanges
United To Stop Some Medicare Advantage Commissions
UnitedHealth Group will stop paying commissions to brokers who enroll new beneficiaries into nearly 200 Medicare Advantage (MA) products in 39 markets. The change is effective July 1. The list of products is dominated by expansive PPOs but also includes some HMOs and Special Needs Plans.
The change is more evidence of the major financial issues at the mega healthcare company. United had robust growth in 2025 in MA, but now is taking steps to rein in any further growth.
(Article may require a subscription.)
#medicareadvantage #unitedhealthcare #marketing
https://www.modernhealthcare.com/insurance/mh-unitedhealthcare-medicare-advantage-broker-commissions
Pros and Cons Outlined on Medicare Advantage
In a new report, MedPAC, the congressional policy arm, says Medicare Advantage (MA) enrollees receive fewer home health visits than those in traditional fee-for-service (FFS) Medicare.
In 2021, 8.3% of MA enrollees received home healthcare, a slightly lower number than the 8.6% of FFS enrollees that received this care. At the same time, MA enrollees were 3.2% more likely to receive home healthcare after an acute care hospitalization than FFS enrollees. MA enrollees were 13.7% less likely to use home healthcare without a prior hospital stay than FFS enrollees. Further they received 11% fewer visits annually. MedPAC thinks this could be related to MA plans’ use of prior authorization or indicate a preference of home health organizations to treat FFS beneficiaries.
I am having trouble understanding the significance of why MedPAC released what they even admit is preliminary information except to say it is more of MedPAC’s rising bias against MA.
At the same time, the Better Medicare Alliance (BMA) published a new study that finds that MA enrollees spent an average of $3,486 less on out-of-pocket costs and premiums than those enrolled in FFS in 2022. Savings were $2,541 in last year’s analysis.
Additional article: https://bettermedicarealliance.org/news/medicare-advantage-beneficiaries-spend-nearly-3500-less-per-year-than-fee-for-service-beneficiaries-on-out-of-pocket-health-care-costs/
#medicareadvantage #homecare
Opioid Settlement Agreed To By States
The attorneys general of all 50 states, Washington D.C., and four territories agreed to the new $7.4 billion settlement with Purdue Pharma and the Sackler family. The settlement compensates states for Purdue’s role in the epidemic that led to the deaths of hundreds of thousands.
I opposed the original settlement as it ruled out any further liability for the Sacklers. I continue to believe it is a crime that the Sacklers remain billionaires under the deal given the untold misery of so many. But states felt it was time to obtain relief.
#opioids #settlement
https://thehill.com/policy/healthcare/5352651-states-agree-settlement-purdue-sackler-opioid
— Marc S. Ryan
