Budget Reconciliation And DOGE Updates
Two key developments on the spending reduction front. Republican senators met with Elon Musk on his Department of Government Efficiency (DOGE) commission reductions. Many senators, rightists and moderates, told him that Congress must sign off on the reductions. On one hand, the senators were asserting their branch’s constitutional authority. On the other, they said it insulates the DOGE cuts from court attacks. Musk was open to Senate approval but indicated he did not think some of the reductions had to come back to Congress.
He also was surprised that a rescission package can be passed by just a majority vote. Rescission is authorized by the Impoundment Act of 1974. Some House Republicans want to repeal the rescission process to allow the president to exercise what they see as the president’s inherent impoundment authority. It is ironic that the same act could be used to validate DOGE reductions.
GOP senators have expressed frustration with the lack of consultation and Musk’s operating style.
In a second development, the Congressional Budget Office (CBO) said that the House Energy and Commerce Committee cannot reach its $880 billion reduction goal without cutting Medicaid, Medicare, and children’s insurance. GOP leaders say they want to reduce fraud, waste, and abuse (FWA) vs. making major reductions to the Medicaid program.
Additional article: https://thehill.com/homenews/house/5178944-republicans-medicaid-trump-tax-cuts-cbo-finds/?tbref=hp
#doge #budgetreconciliation #congress #trump #spending
https://thehill.com/homenews/senate/5178899-musk-chaired-meeting-restricts-government
Trump’s Anti-DEI Agenda Now Hits Health Equity
The Trump administration has extended its anti-Diversity, Equity, and Inclusion (DEI) campaign to the Biden administration’s push on health equity and social determinants of health (SDOH). The Centers for Medicare & Medicaid Services (CMS) pulled information on health equity for the Medicaid and Children’s Health Insurance Program (CHIP) through Section 1115 waivers. CMS says it will only consider state waiver applications on a rolling basis and then determine whether the applications meet federal requirements.
In Medicare Advantage (MA), a health equity index (HEI) goes into effect for SY 2027, with the measurement years in 2024 and 2025. Could this now be in jeopardy?
Additional article: https://insidehealthpolicy.com/daily-news/cms-scraps-guidance-medicaid-health-related-social-needs and https://www.modernhealthcare.com/politics-policy/medicaid-waivers-house-cms
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#sdoh #healthequity #medicareadvantage #medicaid #schip #chip
https://www.fiercehealthcare.com/payers/cms-rescinds-medicaid-health-related-social-needs-guidance
Judge Halts NIH Grant Reductions
A federal judge has enjoined the Trump administration from reducing National Institutes of Health grants, including the change to the indirect cost rate of 15%.
As well, Trump’s nominee to lead the agency took questions on vaccine research, ideas for pushing down drug prices, and recent firings and funding cuts. He largely toed the line.
Additional article: https://thehill.com/policy/healthcare/5178897-5-takeaways-as-trumps-contrarian-nih-pick-faces-senators/
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#nih #doge
https://www.modernhealthcare.com/politics-policy/nih-funding-cuts-judgment
Providers Opt Out Of BCBSA Settlement
After settlements on antitrust allegations in 2020 and 2024, providers are now seeking to opt out of the settlements, arguing they do not do enough to address allegations that the Blues plans are anti-competitive in their markets and little has changed in terms of suppressed payments. Some employers argue not enough has changed as well.
A group of 25 health systems encompassing more than 80 hospitals have filed an antitrust lawsuit against the Blue Cross Blue Shield Association and its 33 independent entities, alleging anticompetitive practices that led to suppressed payments to providers.
In other news:
- Centene pharmacy benefits manager (PBM) continues to settle lawsuits that it overcharged states in the Medicaid program. There remain two state holdouts in terms of settlement.
- The Trump administration is defending the Biden administration’s Medicare Advantage (MA) lawsuits. The cases in question involve Star Ratings quality assessment program, marketing rules and the risk-adjustment system. It is a sign that all will not be smooth sailing for MA plans despite Trump’s greater friendliness to the industry.
- Becker’s recaps a Commonwealth Fund report that finds that most MA enrollees rate supplemental benefits as important, but less than half report using dental or vision benefits each year.
Additional articles: https://www.modernhealthcare.com/legal/bcbsa-antitrust-commonspirit-bon-secours and https://www.modernhealthcare.com/insurance/centene-pbm-medicaid-settlements-georgia-florida and https://kffhealthnews.org/news/article/centene-settlements-pbms-medicaid-silence-holdouts-georgia-florida/ and https://www.modernhealthcare.com/legal/trump-medicare-advantage-lawsuits and https://www.beckerspayer.com/payer/some-medicare-advantage-enrollees-arent-using-supplemental-benefits-5-stats-to-know.html
(Some articles may require a subscription.)
#pbms #centene #medicareadvantage #star #riskadjustment #marketing #supplementalbenefits #bcbsa #antitrust #employercoverage
Novo Nordisk Sets Up Direct Discounted Access To GLP-1s
Mimicking Eli Lilly, Novo Nordisk has created a direct access, discount pharmacy for the uninsured and those without access to obesity drugs. Here is the catch, while the regular price of Wegovy is $1,350 per month, the discount price is still nearly $500 per month – hardly affordable.
#glp1s #weightlossdrugs #branddrugmakers #drugpricing
https://thehill.com/policy/healthcare/5178180-novo-nordisk-slashes-wegovy-prices
Survey Finds Massive Borrowing For Healthcare
More than 31 million Americans borrowed $74 billion last year to pay for healthcare, a new survey found. What’s more, most of them had health insurance. It is hard to find better statistics for the underinsured problem in America.
#medicaldebt #healthcare #healthcarereform #uninsured #underinsured
https://thehill.com/policy/healthcare/5177771-americans-loans-health-care-survey
— Marc S. Ryan
