Tariff Costs Likely Passed Through On Drugs And Medical Devices
Drug and device makers abroad will be levied a tariff if their imported product origin is Mexico, Canada or China and the costs are likely to be passed through to consumers. This means various providers, including hospitals and physicians, will see cost increases. The costs, too, would be passed through in the drug channel, ultimately hitting employer groups, government programs, and consumers. Consumers could see higher premiums as well as cost-sharing hikes. Canada and Mexico will have 25% tariffs under the Trump administration’s announcement this week. China has total tariffs since September of 20% or more as well.
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#healthcare #drugpricing #tariffs #hospitals #physicians
https://www.modernhealthcare.com/digital-health/tariffs-mexico-canada-cardinal-intuitive
Healthcare Entities Could See Pressure On Margins If Medicaid Cuts Pass
While healthcare entities would not have major shifts in 2025, Medicaid cuts could mean pressure on margins according to Fitch, a ratings agency. This would apply to providers, payers, pharmaceutical companies, and medical device firms. Providers could be hit hard if states do not make up funding cuts by the federal government. Health plans, too, could be hit by rising rate demands from providers.
Additional articles: https://www.fiercehealthcare.com/payers/fitch-ratings-potential-medicaid-cuts-could-pressure-insurers and https://www.modernhealthcare.com/finance/tariffs-medicaid-credit-ratings-fitch
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#healthcare #healthplans #providers #medicaid
Impacts Of Expiration Of Enhanced Premium Subsidies
Researchers at the Commonwealth Fund and George Washington University’s (GWU’s) Milken Institute School of Public Health estimate that the end of the enhanced premium tax credits in the Exchanges would cost states $34 billion in gross domestic product (GDP), more than $2 billion in tax revenue, and 286,000 jobs.
In addition, Kaiser Family Foundation (KFF) profiles the types of Americans most impacted by the expiration of enhanced premium tax credits.
Additional articles: https://www.healthcaredive.com/news/loss-enhanced-aca-subsidies-batter-state-economies-job-losses-commonwealth-fund/741481/ and https://www.kff.org/policy-watch/who-might-lose-eligibility-for-affordable-care-act-marketplace-subsidies-if-enhanced-tax-credits-are-not-extended/
#aca #obamacare #exchanges #trump #budgetreconciliation
UnitedHealthcare Could Win Critical Fraud Suit
UnitedHealthcare is facing multiple government investigations, including one on its risk adjustment practices in Medicare Advantage (MA). But United just got a major win in a current case when a special master recommended that the federal court grant United a summary judgement.
The whistleblower suit dates back to 2011 and the Department of Justice (DOJ) joined the case in 2017 under fraud statutes. The special master found “that the government is lacking any evidence in support of two essential elements of its False Claim Act and related common law claims.”
The suit tried to make the case that United’s risk adjustment reviews of patients’ medical records identified underpayments but not overpayments. The special master also indicated that United did not try to conceal things, but actually sought to engage with its regulator.
Now, this is a good development for United. But a lot has changed in the industry since the filing of this lawsuit. There is no question in my mind that the government will continue to investigate and seek to make changes to risk adjustment and overpayments to save. Studies would indicate that the disproportionate amount of so-called risk adjustment overpayment dollars do go to a small number of larger plans, including United.
Additional articles: https://www.modernhealthcare.com/insurance/unitedhealth-medicare-advantage-billing-lawsuit and https://kffhealthnews.org/news/article/unitedhealth-special-master-ruling-medicare-advantage-overpayments/ and https://www.beckerspayer.com/payer/unitedhealth-medicare-advantage-fraud-case-should-be-thrown-out-special-master.html
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#riskadjustment #overpayments #fwa #unitedhealthcare #medicareadvantage
Makary Pledges To Resign From Healthcare Roles And Divest To Avoid Conflicts
Food and Drug Administration (FDA) commissioner nominee Dr. Marty Makary pledged to resign from advisory roles at several healthcare entities and divest related stock holdings if approved for the healthcare regulatory position. At the same time, some Democrats, including Sen. Elizabeth Warren, D-MA, are seeking that he goes further. They want Makary to make additional conflict of interest commitments as well recuse himself from GLP-1 compounding issues.
Makary is almost certainly slated to be confirmed, although advocacy groups and Democrats are turning up the heat on Makary to explain his positions and how they reconcile with the administration’s.
Opponents are seeking to feature Makary has a healthcare contrarian. But if you look at his record, Makary has always taken responsible positions on various issues. His record and ethics are beyond reproach. He is indeed a responsible healthcare reformist and one of the best things that could happen to government and healthcare.
In other news, Kaiser Health News notes that, while President Donald Trump has promised to end surprise billing, key staff of an agency overseeing the initiative is being gutted via layoffs. The No Surprises Act (NSA) implementation has been very much a debacle, in part because the law certainly favors providers over health plans.
Additional articles: https://www.medpagetoday.com/publichealthpolicy/fdageneral/114494 and https://kffhealthnews.org/news/article/trump-surprise-medical-bills-agency-responsible-job-cuts-doge/
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#martymakary #fda #healthcare #surprisebilling #pricetransparency #nsa #nosurprisesact
— Marc S. Ryan
