New Poll Finds Unaffordability Having Consequences
As we enter the midterms, healthcare affordability remains a significant challenge. A new poll finds that one in three Americans had to cut back on daily living expenses to afford care. A new West Health/Gallup survey says about a third of those surveyed cut back on at least one daily expense to afford healthcare last year. That is the equivalent of about 82 million Americans. For those that did not have insurance, about 62% said they made a cutback. For those with income of $24,000 or less, the tradeoff rate was about 55%. About 48% of those earning between $24,000 and $48,000 in annual household income said the same.
In other news, a Modern Healthcare analysis finds that healthcare revenue rose faster than all other services categories in 2025. Increased prices and growing demand from an aging population drove much of this. Revenue tied to the delivery of healthcare services increased 8.6% year-over-year – higher than the 6.1% increase for all other categories in the services sector. This is down from 10.1% and 11.2%, in 2024 and 2023, respectively for healthcare.
In Monday’s blog here I gave you my views on the midterm congressional races: https://www.healthcarelabyrinth.com/a-look-at-the-status-of-congressional-midterm-elections/ .
Additional articles: https://www.fiercehealthcare.com/finance/gallup-poll-one-three-americans-cutting-back-daily-expenses-pay-healthcare and https://www.modernhealthcare.com/providers/mh-healthcare-revenue-services-2025-census-bureau/
(Some articles may require a subscription.)
#healthcare #coverage #affordability
https://thehill.com/policy/healthcare/5780428-americans-cutting-expenses-healthcare
Elevance Says It Was Disappointed With Sanction
Elevance Health said it was “surprised and disappointed” by a recent Medicare Advantage sanction involving risk adjustment. Its enrollment will be suspended as of April 1. Elevance says it flagged provider-submitted diagnosis codes and shared information with CMS “in good faith.” It additionally said any issues have been updated. Elevance also says this is a legitimate difference in policy interpretation in the timeframe.
#medicareadvantage #overpayments #riskadjustment #elevancehealth
MedPAC Still Touting Erroneous Data
In its latest report, congressional policy arm Medicare Payment Advisory Commission (MedPAC) continues to tout dubious data on overpayments in Medicare Advantage (MA). It continues to peg them at 14% greater than traditional Medicare. This includes 4% for actual risk adjustment and 10% for favorable selection. MedPAC says the 14% is an extra $76 billion for MA. A separate analysis by Trump administration officials says the risk adjustment overpayment is just 2%, and that could go down further with proposed model changes for 2027.
See my recent blogs on why MedPAC and other opponents are wrong. The Healthcare Leadership Council (HLC) did a fantastic job on all this last year. I will have a follow-up blog on the HLC findings.
Recent MA blog covering risk adjustment: https://www.healthcarelabyrinth.com/reports-of-mas-death-are-greatly-exaggerated/ and https://www.healthcarelabyrinth.com/ma-overpayments-remain-controversial-but-could-part-of-the-argument-be-going-way/ .
“MedPAC estimates do not accurately reflect Medicare Advantage spending, nor do they even attempt to capture the superior value of the program to beneficiaries and taxpayers. That is a problem,” a statement from the Better Medicare Alliance said before MedPAC’s report was issued.
Additional article: https://www.beckerspayer.com/payer/medicare-advantage/7-medicare-advantage-numbers-to-know-in-2026/
#medicareadvantage #riskadjutstment
MN May End Medicaid Managed Care
Gov. Tim Walz, D-MN, says he wants to end Medicaid managed care in Minnesota in favor of an administrative services organization (ASO) approach. He says the proposal reflects the need to modernize systems built decades ago. Some say it also could very well be aimed at diverting attention from massive fraud in the state in part involving Medicaid.
#medicaid #managedcare
https://www.yahoo.com/news/articles/walz-proposes-overhaul-minnesota-medicaid-181700158.html
Lilly Says Compounds GLP-1 May Be Dangerous
Brand drug maker Eli Lilly says that compounded versions of tirzepatide (the ingredient in Mounjaro, and Zepbound, containing vitamin B12 pose a potential safety risk to the public. Following laboratory testing, the drugmaker says it uncovered “significant levels” of an impurity in the compounded products, which results from a chemical reaction between tirzepatide and B12. The chemicals created are listed on product labels as methylcobalamin, hydroxocobalamin, or cyanocobalamin. It says that dangers include potential toxicity, immune reactions, and interactions with GLP-1 and GIP receptors.
Lilly wants the FDA to initiate a recall and patients should contact their doctors.
While the information has not been released and should be for analysis, this sounds like more scare tactics from Big Pharma trying to preserve their market share and stop the further reduction in their obscene prices.
Additional article: https://www.medpagetoday.com/publichealthpolicy/productalert/120277
#weightlossdrugs #glp1s #branddrugmakers #compounding
— Marc S. Ryan
