Say This Three Times: Healthcare Cut Consternation
Republican senators are weighing in with leadership regarding concerns with the “Big Beautiful Bill.” Moderates are concerned about spending cuts to Medicaid and the Supplemental Nutrition Assistance Program (SNAP). Budget hawks are demanding more deficit and debt reduction and want the House compromise on state and local tax (SALT) deductions undone. The conservatives also want $200 billion in reductions to Medicare in the area of fraud, waste, and abuse (FWA).
There are at least two hard “No’s” on the conservative side. There are other conservatives very concerned and looking for more reductions. On the moderate and pragmatic conservative side, there are a number of senators very concerned about reductions. The House version of the bill would not be able to pass in the Senate as written based on probable numbers of negative votes on either side of the ideological divide.
At least 4 in 10 Republicans are worried about the consequences of Medicaid cuts, a new healthcare policy group KFF survey finds. Further, of the Republican respondents, the poll found that 75% are worried that sweeping changes to the program would hurt their family’s ability to get and pay for care. About 70% are concerned that the cuts would lead to an increase in the uninsured and negatively impact providers.
KFF also published an update of the breakout of the uninsured by state if the budget reconciliation bill passes. The budget bill’s healthcare cuts and the expiration of enhanced Exchange subsidies mean 15 million will lose coverage, with 16 million losing coverage by 2034 when you include Trump’s proposed Exchnage regulation changes.
In other news, the Paragon Health Institute, which has great influence in the Trump administration, is touting its analysis of incentives for people to misestimate income to qualify for larger subsidies in the Exchanges. The analysis shows the number of people claiming income between 100 percent to 150 percent of the federal poverty limit (FPL) who sign up for coverage with the likely number of people who are eligible for this coverage within that income grouping. It also discusses the incentives facing brokers and insurers for improper enrollment.
Paragon says 4 to 5 million people improperly enrolled for subsidized health coverage on the Exchanges in 2024, with a cost of upwards of $15 to $20 billion in 2025.
While I support the Exchanges and even continuing enhanced subsidies in some form, Paragon’s analysis is compelling. We should not tolerate fraud and should be able to better monitor such enrollments and misestimation.
Paragon recommends reforms, including the following. Some of the recommendations are in the budget reconciliation bill.
- Allowing enhanced subsidies to expire after 2025.
- Raise subsidy recapture limits to reduce incentives for people to misestimate their income.
- Limit automatic re-enrollment into Exchange plans and end it for people moving from or into fully-taxpayer subsidized plans.
- Appropriate cost-sharing reduction payments and prohibit silver-loading.
- Aggressive oversight of HealthCare.gov, enhanced direct enrollment, and insurer and broker actions to take advantage of misestimating income.
- Reverse Biden policies that enabled such widespread fraudulent enrollment, particularly the continuous open-enrollment period for people who report they have income below 150 percent FPL.
Additional articles: https://thehill.com/policy/healthcare/5336641-republicans-worried-medicaid-cuts-impact-kff-survey/ and https://www.kff.org/medicaid/poll-finding/kff-health-tracking-poll-the-publics-views-of-funding-reductions-to-medicaid/ and https://www.kff.org/affordable-care-act/issue-brief/how-will-the-2025-reconciliation-bill-affect-the-uninsured-rate-in-each-state-allocating-cbos-estimates-of-coverage-loss/ and https://paragoninstitute.org/private-health/the-great-obamacare-enrollment-fraud/
#budgetreconciliation #congress #trump #medicaid #aca #obamacare #exchanges #coverage #fwa
https://thehill.com/homenews/senate/5335866-senate-bill-medicaid-ai-snap-negotiations
United Now Backs Similar Risk Adjustment Reform As Humana
Just after Humana unveiled its proposal to reform risk adjustment coding, UnitedHealth Group says it wants Congress to adopt changes as well. United’s push is likely tied to the fact that it has been signaled out as one of the biggest offenders of coding abuse as well as fraud suits and the dire fiscal situation it is in. Take all the pain now, so to speak.
Similar to Humana, United says that non-home-based providers should confirm new patient conditions uncovered during home visits. If this is not possible within 18 months, CMS should not pay for diagnoses tied only to the health risk assessment (HRA). Humana endorsed all new diagnoses identified during home visits being confirmed by providers over time. I think a diagnosis should be on file from a provider tfor plans to get credit for the diagnosis, but the reform would be a good step.
The proposals increase the likelihood that risk adjustment reform will be put in the budget reconciliation bill as the Senate grapples with moderate concerns over Medicaid cuts and conservatives wanting more cuts due to debt and deficit issues.
Additional article: https://www.modernhealthcare.com/politics-policy/unitedhealth-presses-congress-cut-pay-medicare-home-visits
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#radv #riskadjustment #medicareadvantage #unitedhealthcare #humana #fwa
— Marc S. Ryan
