Opposition To Healthcare Cuts In Budget Bill
All of healthcare is lining up against the cuts to healthcare in the budget reconciliation bill. A new study from the Urban Institute and Robert Wood Johnson (RWJ) Foundation breaks down how providers (hospitals, physicians, and drugs) are impacted in each state by the reductions to Medicaid and the Exchanges. Over the next decade, the bill would decrease spending by $321 billion to hospitals, $81 billion to physicians and $191 billion for drugs. Spending for other healthcare services would decline by $205 billion.
If the Exchange premium tax credits expire, spending would decline by an additional $262 billion — hospitals an additional $103 billion cut, physicians an additional $39 billion cut, and drugs an additional $50 billion cut. Spending on other healthcare services would drop an additional $70 billion.
Now, I have little doubt on the math of what Urban and RWJ did. If you cut a trillion out of healthcare over ten years, it is technically true that it flows through the system down to providers rendering care. What the researchers miss is that we do need real price reform in the system. Done right, money could be taken out of the system without impacting coverage. Those hospitals at risk could even be stabilized under the new paradigm.
In other news, health plan trade and lobbying group AHIP said it will mount an opposition effort to the bill in concert with other healthcare groups. It wants the budget bill reductions reversed and premium credit enhancements extended.
AHIP and health insurers are worried about the massive financial fallout from the Exchange and Medicaid cuts as well as the impact of the recent risk adjustment data validation (RADV) audit announcement for Medicare Advantage (MA).
Additional article: https://www.fiercehealthcare.com/payers/ahip-2025-insurer-coalition-vows-fight-trump-budget-bill-final-hour
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#budgetreconciliation #congress #trump #medicare #exchanges #medicareadvantage #coverage #healthplans #providers
https://www.modernhealthcare.com/latest-news/mh-one-big-beautiful-bill-cuts-states/
GLP-1 Drug Shortage End Upheld
A federal judge found that the Food and Drug Administration (FDA) lawfully and correctly removed certain brand name GLP-1 weight-loss drugs from its drug shortage list, a federal judge ruled this week. The order impacts Wegovy and Ozempic.
The ruling impacts compounding pharmacies who sought to overturn the FDA ruling on the end to the shortage. The compounders will seek to continue creating the generic knockoffs by arguing another federal law allows individual customization of dosages and drugs. Brand makers will now seek to bar this as well.
(Article may require a subscription.)
#glp1s #weightlossdrugs #drugpricing #branddrugmakers #fda
https://www.modernhealthcare.com/legal/mh-glp-1s-fda-shortage-list-lawsuit
Aetna Eliminating Some PAs, Investing In Automation
Aetna said it has big initiatives to eliminate some prior authorization (PA) requirements, automate pre-certification approvals, and partner with health systems in hopes of smoothing over often-contentious relationships. Part of the drive was created by government requirements for electronic PA.
(Article may require a subscription.)
#priorauthorization #healthplans
https://www.modernhealthcare.com/insurance/mh-aetna-prior-authorization-steve-nelson-ahip-2025
— Marc S. Ryan
