Preliminary Reports Show Major Exchange Premium Hikes
Exchange rate filings are beginning to filter in for 2026 and the news is not good. Many insurers are asking for double-digit rate increases in the individual and small group Exchange markets. This is occurring due to the likely expiration of enhanced premium tax credits and rising costs. Reports from various states say rate hikes could be as much as 23%. Average increases seem to be well into the teens.
#exchanges #aca #obamacare #coverage
https://www.beckerspayer.com/payer/payers-seek-double-digit-exchange-rate-hikes-for-2026
Big PBMs Suing Over State Regulatory Laws
Many states have passed pharmacy benefits manager (PBM) regulation bills and at least two big PBMs, CVS Caremark and Express Scripts, are suing to overturn the state laws.
The PBMs argue that state regulation of PBMs is preempted by the Commerce Clause and federal regulation. The problem is that the feds have been very lenient over the years, which states say forced them to step in. Rising drug costs, concerns about vertical integration, and anger over how PBMs operate spurred state legislation.
PBMs are in store for tougher federal regulation if the budget reconciliation bill becomes law.
(Article may require a subscription.)
#pbms #drugpricing
https://www.modernhealthcare.com/politics-policy/cvs-health-cigna-pbm-laws-reaction
GOP Defends Healthcare Cuts
GOP lawmakers are on a campaign to defend the significant $1 trillion healthcare cuts in the budget reconciliation bill. Their message is that reductions are only occurring for those who do not deserve coverage. Many, including a group of GOP moderates and compassionate conservatives, know the truth is much more complicated. People will fall through the cracks and millions will lose coverage. See my blog today which discusses the controversy: https://www.healthcarelabyrinth.com/republicans-in-stealth-mode-on-coverage-cuts-but-they-are-real/
Senate Majority Leader John Thune, R-SD, is setting up small workgroups to hash out changes, including Medicaid and nutrition cuts. The July 4th deadline looks to be in jeopardy as numerous moderates have issues on healthcare and other policy changes.
Medicare Advantage upcoding reform and perhaps other Medicare cuts appear to be on the table now to add to spending reductions and to perhaps relieve Medicaid cuts.
Additional article: https://thehill.com/policy/healthcare/5335867-senate-gop-medicaid-cuts/?tbref=hp
#budgetreconciliation #trump #congress #healthcare #coverage #medicaid #aca #exchanges #obamacare #medicareadvantage #medicare
https://thehill.com/homenews/senate/5337997-republicans-thune-trump-bill
Health Affairs Forefront Discusses Supplemental Benefits
An excellent overall blog in Health Affairs Forefront on the need for more data to determine the value of supplemental benefits and to clear up enrollee confusion. I disagree with the idea of adding such benefits to traditional Medicare and the article’s overpayment calculation, but the blog shows the various penetration of supplemental benefits, discusses the paucity of data, reforms to fix it, and says missing data means the federal government can do little evaluation.
As it notes, these basic questions cannot be answered:
Which supplemental benefits are used most often?
Does the use of supplemental benefits vary by enrollee characteristics, or across plans?
How much does each Medicare Advantage insurer and plan spend on specific supplemental benefits, and what do enrollees pay out of their own pockets when they use these benefits?
How much is the federal government paying to reduce cost sharing for Medicare Advantage enrollees?
(Article may require a subscription.)
#medicareadvantage #medicare #supplementalbenefits #overpayments
— Marc S. Ryan
