Budget Reconciliation In Senate Still In Limbo
After going to bat for deeper healthcare cuts for conservatives, Senate Majority Leader John Thune, R-SD, is facing an uprising on the right and left. Three conservatives – Mike Lee, Rick Scott, and Ron Johnson, are threatening to be off the bill unless deeper cuts occur, including in healthcare. Rand Paul appears already against the bill due to a provision that increases the debt limit. This would sink the bill.
At the same time, at least three moderates or pragmatists – Lisa Murkowski, Josh Hawley, and Susan Collins – remain very concerned about the depth of certain cuts, especially provider tax restrictions.
Thune wants to vote on the bill next week.
Rural providers, particularly hospitals, continue to argue the bill jeopardizes their livelihoods and that hospitals in under-served areas could shutter.
An impasse over the state and local tax deduction threatens passage of the budget bill in the House even if it passes the upper chamber. The Senate put no increase in the bill, while House moderates have demanded a $40,000 cap, up from $10,000. They say that is what they can live with.
In other news, the Trump administration finalized an Exchange integrity bill that removes special enrollment periods, shortens the open enrollment period, and strengthens eligibility requirements. The change is expected to mean 900,000 people lose enrollment. The administration argues the rule lowers premiums, but insurance regulators are looking at huge rate hikes for consumers due to the likely expiration of the enhanced premium subsidies and cost increases.
As well, the Senate parliamentarian said today that certain portions of the House-passed bill did not meet Byrd rules in the Senate, which would mean the bill as is could not pass on a majority vote. These provisions will most likely be cut as the GOP is not expected to overrule the parliamentarian on a majority vote. The struck provisions have little or no impact on the healthcare reductions, but the provision to have states take on some nutrition program costs has been tagged as violating Byrd rules.
Additional articles: https://thehill.com/homenews/senate/5360488-parliamentarian-rules-bill-trump-agenda/ and https://thehill.com/homenews/house/5360071-impasse-over-salt-cap-deepens-as-house-moderates-stand-firm/?tbref=hp and https://www.modernhealthcare.com/politics-regulation/mh-one-big-beautlfil-bill-rural-healthcare/ and https://www.cms.gov/newsroom/press-releases/cms-finalizes-major-rule-lower-individual-health-insurance-premiums-americans and https://www.cms.gov/newsroom/fact-sheets/2025-marketplace-integrity-and-affordability-final-rule
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#budgetreconciliation #congress #trump #spending #medicaid #exchanges #hospitals #coverage
https://thehill.com/homenews/senate/5360058-conservatives-demand-deeper-spending-cuts
Plans Ready To Rein In Prior Authorization
Just as regulators appear to be ready to further ratchet down prior authorization (PA), health plans are expected to announce major initiatives to rein in PA. Aetna has already done so. Plans are collaborating on common standards as well as an 80% electronic submission rate.
The new Centers for Medicare and Medicaid Services (CMS) Administrator, Dr. Mehmet Oz, told Congress at his confirmation hearing that he wanted to standardize and streamline PA in Medicare Advantage (MA). A federal announcement may come as early as June 23, which would have Oz endorsing the plans’ proposal and giving them a chance to implement the PA changes. CMS is said to be continuing to fashion its own proposal if needed.
#priorauthoriziation #cms #oz #healthplans #medicareadvantage
Medicare Trustees Say Part A Can’t Support Benefits As Of 2033
The Medicare Trustees report that the Part A Medicare Trust fund, supporting largely hospital care, will not be able to cover current estimated expenses as of 2033 vs. 2036 in its last report. The trustees say growth in spending outpaces income. Part A expenditures will nearly double between 2024 and 2034.
This prediction is vastly different than one from the Congressional Budget Office (CBO) in April, which said the trust fund would live on until 2052 — 17 years later than what CBO analysts predicted last year.
No one seems too alarmed based on no reasonable proposals to reform Medicare.
Additional article: https://www.beckerspayer.com/financial/medicare-faces-2033-cliff-5-things-to-know/
#medicare #coverage
ICHRA Growth Strong
With individual health reimbursement “ICHRA” arrangements potentially getting a boost from Congress, adoption is growing among employers. While the vast majority of individual coverage health reimbursement arrangements (HRAs) remain among small employers, large employers are beginning to adopt them in a big way as well. Adoption rose 34% from 2024 to 2025 among employers of 50 or more.
#ichra #hra #coverage #employers
https://www.healthcaredive.com/news/ichra-adoption-growing-employers-congress-aca/750988
Health Plans Tackle Big Issues
At the health plan lobby AHIP conference, driving discussions centered on care navigation, artificial intelligence to identify gaps in care, provider experience, interoperability, and Medicaid and Exchange reductions.
(Article may require a subscription.)
#healthplans #coverage #medicaid #exchanges
https://www.modernhealthcare.com/insurance/mh-ahip-2025-conference-takeaways
— Marc S. Ryan
