More Senate Budget News
The Congressional Budget Office (CBO) reaffirmed that the One Big Beautiful reconciliation bill will cost the healthcare sector a $1 trillion reduction over ten years. The Senate bill adds to limitations in the House bill on provider taxes (phasing them down and capping them to 3.5% over time for expansion states) and slightly tightens eligibility further. It also cuts certain existing state-directed payments to hospitals where the House just limited future payments.
Healthcare policy group has good summaries comparing the Senate and House versions for Medicaid and Affordable Care Act (ACA) cuts.
Additional articles: https://thehill.com/homenews/ap/ap-business/ap-trump-tax-bill-would-widen-deficits-by-2-8t-after-factoring-in-economic-impacts-cbo-says/?tbref=hp and https://thehill.com/homenews/senate/5353963-senate-medicaid-taxes-green-energy/ and https://www.kff.org/tracking-the-medicaid-provisions-in-the-2025-budget-bill/ and https://www.kff.org/tracking-the-affordable-care-act-provisions-in-the-2025-budget-bill/
(Article may require a subscription.)
#budgetreconciliation #congress #trump #spending #medicaid #coverage
https://www.modernhealthcare.com/politics-regulation/mh-gop-tax-plan-cost-cbo
Fitch Downgrades Health Insurers
Fitch Ratings has downgraded the health insurance industry’s outlook to deteriorating from neutral because of rising utilization and Medicaid and Exchange cuts in the budget reconciliation bill.
Additional article: https://www.beckerspayer.com/payer/gop-budget-bill-leaves-payers-with-deteriorating-outlook-fitch/
(Some articles may require a subscription.)
#healthplans #margins #medicaid #exchanges
https://www.modernhealthcare.com/insurance/mh-fitch-insurance-outlook-medicaid-cuts
Humana Defends MA But Admits Changes Needed
Humana CEO vigorously defended Medicare Advantage (MA) today in the face of rising criticism of how big plans run their plans. At the same time Jim Rechtin admitted that plans must act responsibly. He stated: “Risk adjustment and home assessments and prior authorizations have become dirty words. And they should not be dirty words,” Rechtin said. “These are great clinical tools. And we’re going to defend them all day long … But we need to do it responsibly.”
#medicareadvantage #healthplans #riskadjustment #overpayments
https://www.healthcaredive.com/news/humana-defends-medicare-advantage-investor-day/750872
Providers Continue To Win No Surprises Cases
As I have said all along, the No Surprises Act massively favors providers and is leading to increased costs in the healthcare system. A new study finds that a much higher volume of out-of-network pay disputes were being filed and processed through the first half of 2024. A small handful of larger providers drive the cases in a small number of states. Plans have a very low win rate: 14% of resolved cases in Q1 2024 and 18% of resolved cases in Q2 2024. When plans prevailed, the median prevailing offer amount was 105% of the qualifying payment amount (QPA, which is meant to be the median amount an insurer would pay for an in-network service).
The amounts providers win are escalating. Median prevailing provider offers ranged between 320% and 350% of QPA across 2023. They rose to 383% in Q1 2024 and to 447% in Q2 2024.
#nosurprisesact #providers #healthplans
— Marc S. Ryan
