House CR Unveiled With No Doc Fix
House Speaker Mike Johnson, R-LA, unveiled the FFY 2025 continuing resolution (CR) through the end of the fiscal year in September. If the bill passes the House, it goes to the Senate. At least one House GOP member has announced opposition, but the lack of a Medicare physician rate fix could mean others drop off. Passage in the Senate is unknown because 60 votes are needed and Democrats appear to be lining up against it. But moderate Democrats could have a change of heart. The bill also extends some critical healthcare programs that would expire on March 31. The House may vote on the bill Tuesday.
In other news, a bipartisan proposal to further extend telehealth, reform pharmacy benefits managers (PBMs), reverse Medicare physician pay cuts, and address the opioid crisis has failed to be called up in the Senate.
Additional articles: https://insidehealthpolicy.com/daily-news/providers-furious-house-continuing-resolution-omits-doc-pay-fix and https://www.modernhealthcare.com/politics-policy/spending-bill-medicare-doctor-pay and https://thehill.com/homenews/house/5184753-scott-perry-medicaid-coverage/ and https://www.fiercehealthcare.com/telehealth/senate-dems-push-long-shot-bill-pbm-reform-telehealth-extensions-and-35-doc-pay-fix
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#governmentshutdown #trump #congress #ffy2025 #medicare #physicians #cr
Trump Exchange Rule Would Crackdown On Fraudulent Enrollment
In its first healthcare rule, the Trump administration released a proposed rule to address the troubling amount of improper enrollments impacting Affordable Care Act (ACA) Health Insurance Marketplaces across the country.
The administration says the rule would reduce improper federal spending on advance payments of the premium tax credit by $11 billion to $14 billion in 2027. Among the many proposals, the rule would:
- End the availability of the monthly special enrollment period (SEP) for individuals with household incomes below 150% of the federal poverty level (FPL).
- Strengthen verifications of eligibility.
- Shorten the annual Open Enrollment Period by ending it on December 15.
Some of the changes I would not do and will lead to lower enrollment, which is unfortunate. But the Trump administration is not wrong on the issue of fraudulent enrollments. The Biden administration made some marketing changes, including cutting off agents and brokers who likely participated in fraudulent activities. But it likely was not enough.
CMS publications: https://www.cms.gov/newsroom/press-releases/cms-takes-aim-reduce-improper-enrollments-and-promote-more-affordable-health-insurance-marketplaces and https://www.cms.gov/newsroom/fact-sheets/2025-marketplace-integrity-and-affordability-proposed-rule
(Some articles may require a subscription.)
#aca #obamacare #exchanges
https://www.modernhealthcare.com/politics-policy/aca-enrollment-period-trump
Molina Settles Texas Suit
Texas Attorney General Ken Paxton’s Healthcare Program Enforcement Division obtained a $40 million settlement from Molina Healthcare under the Texas Health Care Program Fraud Prevention Act. Molina was accused of failing to assess beneficiaries on time and concealing its noncompliance from Texas in the Medicaid STAR+PLUS program.
#medicaid #fwa #molina
Democrats Want Details Of Big Pharma Meetings With Trump
Three Democratic senators have asked Health and Human Services Secretary Robert F. Kennedy, Jr. about private meetings with drugmakers held with President Trump at Mar-a-Lago in Florida.
#drugpricing #branddrugmakers
https://thehill.com/policy/healthcare/5186534-democrats-kennedy-trump-meetings-drugmakers/
— Marc S. Ryan
