Senate Budget Bill Could Be in Trouble
Both sides of the House caucus declared that they could oppose the current Senate version of the budget reconciliation bill if it passes the upper chamber and returns to the House. Senate Majority Leader John Thune, R-SD, has an uprising in his own chamber between moderates and conservatives, but both sides of the House have already declared their concerns.
More than a dozen House Republicans warned they won’t support the Senate’s version because the proposed Medicaid cuts are too steep. The Senate added more reductions in the area of provider taxes, state directed payments, and work requirements. This moderate opposition does not even fully take into account those who oppose the bill if the state and local tax deduction does not come back over with a generous increase. Right now, the Senate has no changes from the low $10,000 limit.
On the conservative side, House Freedom Caucus Chairman Andy Harris, R-MD, said he would oppose the Senate version because it waters down critical savings in the House version, does not do enough on deficit reduction, has insufficient Medicaid reductions, and eliminates major provisions of the Green New Deal. Harris voted present when the bill passed the House but would now vote no. This could lead other conservatives to bail on the bill. Speaker Mike Johnson, R-LA, had no votes to spare the last time.
The House conservatives also want the Health Savings Account (HSA) expansion and related individual premium (ICHRA) provision put back in the bill. They were stripped by the Senate. The House conservatives favor a strengthening of indvidual health insurance options.
In other news, the Congressional Budget Office (CBO) said states would be forced to reduce provider reimbursements to cope with the Medicaid cuts. This is similar to a private study released recently.
Another study from The Third Way think tank finds that the healthcare cuts could push medical debt up by $50 billion. The number of people in families facing medical debt could increase by 5.4 million, with debts increasing by up to $22,800.
As well, a bipartisan group of lawmakers is introducing legislation that would allow the Department of Veterans Affairs to bill Medicare Advantage (MA) plans for care provided to members. They say the current law pays twice for care furnished veterans. MA plans netted $1 billion by pocketing rates without paying back the government agency. The agency can bill Medicare Supplement plans but not MA plans right now.
Additional articles: https://thehill.com/policy/healthcare/5367133-house-gop-moderates-senate-tax-bill-medicaid-cuts/ and https://www.modernhealthcare.com/politics-regulation/mh-medicaid-cuts-tax-bill-provider-pay-cbo/ and https://www.beckerspayer.com/policy-updates/lawmakers-target-medicare-advantage-va-loophole-wsj/ and https://www.cnbc.com/2025/06/23/big-beautiful-bill-health-care-cuts-may-add-to-medical-debts-report.html
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#budgetreconciliation #trump #congress #medicaid #exchanges #medicareadvantage #medicaldebt #coverage
https://thehill.com/homenews/house/5366809-harris-freedom-caucus-senate-trump-bill/?tbref=hp
Providers Take Wait-And-See Approach On PA Reform
Major provider organizations welcomed insurers’ pledge to reform prior authorization (PA), but they generally kept their powder dry to see what actually happens. They note that health plans have promised changes before (including a similar 2018 commitment) only to not deliver on promises. They also say many PAs will remain. At the same time, they admitted that if plans follow through it could mean major relief for providers.
Another analysis suggests that the real impact on plans may be minimal as any increased costs from the loss of PA use would be passed on as higher premiums. However, the tech investment promised by plans in electronic PA would be meaningful.
The health plan changes were very much like ones Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz backed earlier. CMS promises to track the changes to ensure they are being implemented. If not, regulations will be implemented.
Additional articles: https://www.fiercehealthcare.com/providers/insurers-have-promised-ease-prior-authorization-providers-expect-them-deliver and https://kffhealthnews.org/news/article/5-takeaways-from-insurers-pledge-to-improve-prior-authorization/
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#priorauthorization #healthplans #providers
https://www.modernhealthcare.com/insurance/mh-prior-authorization-initiative-cms
Oz Now Wants Drug Rebates To End
Fresh from an agreement with health plans to move forward on major prior authorization reform, Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz said he wants pharmacy benefits managers to end the complicated system of drug rebates or the government will step in to change it. Oz said regulators and lawmakers could revamp the system “fairly expeditiously” because there is widespread support.
Under Trump 45, the administration did propose to eliminate the safe harbor that allows the paying of rebates in Medicare.
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#pbms #drugpricing #rebates
https://www.modernhealthcare.com/politics-regulation/mh-mehmet-oz-pbm-rebates
— Marc S. Ryan
