Praise For And Panning Of Trump Proposals
Insurers and hospitals are largely together in criticizing the Trump administration proposed rule to allow non-network benefit plans to become qualified health plans under the Affordable Care Act (ACA) and in the Exchanges. The groups say individuals won’t be able to grasp the differences between network and non-network plans and this would expose them to higher-than-expected out-of-pocket costs. Trump officials argue premiums have gone up so much over the years that alternatives must be tested.
At the same time, in an unlikely event, billionaire entrepreneur Mark Cuban praised the federal government’s TrumpRx drug platform, saying the initiative is saving Americans money. “Everyone wants me to rip on TrumpRx,” Cuban wrote on X. “Reality is, it’s saving patients money on IVF and a few other drugs. A lot of money. IMO, anything that saves patients money is a win.”
Cuban is right. While TrumpRx does not always save the most, the president deserves credit for a number of initiatives he has worked on to reduce drug pricing. He has done far more than any other president in recent years.
Additional article: https://www.fiercehealthcare.com/payers/payers-hospitals-pan-cms-plan-bring-non-network-plans-aca-exchanges
#exchanges #trump #regulations #coverage #trumprx #drugpricing
https://thehill.com/policy/healthcare/5790314-mark-cuban-praises-trump-rx
Health Plan News
Highmark Health and Blue Cross and Blue Shield of Kansas City are set to finalize an affiliation agreement, making Highmark the third largest Blues insurer in the nation. The deal was approved by the Missouri Commerce and Insurance Department. The affiliation is expected to close March 31. Together, the plans will serve nearly 8 million members across six states.
John Kao of Alignment Healthcare spoke with Healthcare Dive. He discussed the state of Medicare Advantage (MA), why Alignment is winning with enrollment and bucking the poor financial results trends, and comments on 2027 MA rates.
The Health and Human Services’ Office of Inspector General (HHS OIG) estimates in a March audit that Blue Cross and Blue Shield Alabama received at least $7 million in MA overpayments.
A Moden Healthcare article discusses recent health plans shuttering in 2025. The numbers are up but the total remained below historical trends.
Additional articles: https://www.modernhealthcare.com/mergers-acquisitions/mh-highmark-health-bcbs-kansas-city-approved/ and https://www.fiercehealthcare.com/payers/highmark-blue-cross-kc-announce-affiliation-plans and https://www.healthcaredive.com/news/alignment-healthcare-john-kao-medicare-advantage/814907/ and https://www.beckerspayer.com/payer/medicare-advantage/bcbs-alabama-estimated-to-have-received-at-least-7m-in-ma-overpayments-oig/
(Some articles may require a subscription.)
#healthplans #medicareadvantage #riskadjustment #overpayments
https://www.modernhealthcare.com/insurance/mh-health-insurance-bankruptcies-2025
Certain LTC Providers Worried About Medicaid Cuts
Healthcare providers are worried that Medicaid cuts could disproportionately impact home- and community-based services in Medicaid because the services are voluntary under federal law. Nursing home coverage is not. There is already evidence that several states are cutting back in these areas and more states could do so.
(Article may require a subscription.)
#medicaid #obbba #homecare #ltc
https://www.modernhealthcare.com/politics-regulation/mh-medicaid-cuts-home-communitiy-based-services
Provider Consolidation Dominates Hill Hearing
Provider consolidation was top of mind for many at a House Energy and Commerce Subcommittee on Health hearing involving both hospital and physician representatives. Many lawmakers felt such consolidation is helping drive healthcare costs. A number of studies have shown that hospital acquisitions and mergers as well as physician acquisition by health systems have driven costs and changed practice patterns to more expensive settings.
The committee also covered physician reimbursement, price transparency, and the 340B program, Democrats also attacked Medicaid cuts. Many espoused increasing physician reimbursement to ensure independent practices remain viable. This is indeed a must for primary care.
#providers #hospitals #healthsystems
— Marc S. Ryan
