Budget Reconciliation Saga
House Freedom Caucus members could sink the budget reconciliation bill coming out of the Budget Committee for lack of enough reductions and weak Medicaid policy changes. Conservatives are pushing for an acceleration of work requirements from the current plan targeted for 2029.
At the same time, moderates are upset with the scope of Medicaid reductions.
House Speaker Mike Johnson also said that the proposed bill would be changed to enhance state and local tax deductions as well as increase Medicaid savings. But the latter could further upset moderates.
The current reductions fall disproportionately on states, which will have to make up hundreds of millions of reimbursement reductions, as well as enrollees, who could lose coverage.
Another controversy is ambiguous language regarding provider taxes. While new provider taxes are barred, it is unclear how long existing taxes would be grandfathered or whether renewing current provider taxes would be permissible.
To refresh on major Medicaid reductions in the bill, the following are in the current proposal:
- Work requirements (starting in 2029)
- Repealing Biden eligibility rules
- Eligibility checks twice a year
- Cost-sharing for Medicaid beneficiaries above 100% of poverty
- Reimbursement penalties for states that provide coverage for undocumented immigrants
- Limits on new provider taxes
- Codify Program Integrity Rule
Affordable Care Act (ACA) changes include:
- Barring most legal immigrants from premium tax credits
- Rescission of the cap on premium repayment
On the positive side, Medicare docs get a rate fix.
Not talked about much is the budget reconciliation bill’s efforts to rebrand Trump’s earlier push to promote individual coverage subsidies known as IHCRA, and expand Health Savings Accounts (HSAs) and High Deductible Health Plans (HDHPs).
In other news, a good Health Affairs blog explains the rationale behind the Trump administration’s proposed rule to reform the provider tax. I have to say, after reading through it, I do think some reform is needed.
Additional articles: https://www.modernhealthcare.com/politics-policy/medicaid-cuts-provider-taxes-state-budgets and https://www.healthaffairs.org/content/forefront/cms-proposes-limit-provider-taxes and https://thehill.com/homenews/house/5302339-trump-mega-bill-changes/ and https://thehill.com/homenews/5302765-gop-medicaid-work-requirements/?tbref=hp and https://www.beckerspayer.com/policy-updates/an-ichra-rebrand-3-things-to-know/ and https://www.beckerspayer.com/policy-updates/house-gop-pushes-for-big-changes-to-hdhps-hsas/
(Some articles may require a subscription.)
#budgetreconciliation #trump #congress #spending #medicaid #aca #obamacare #medicare
https://thehill.com/homenews/house/5302554-trump-gop-tax-thin-ice-budget-committee
Three States To Limit Or Sunset Non-Citizen Healthcare Coverage
Illinois, California, and Minnesota offer health coverage to undocumented immigrants but are sunsetting or limiting those benefits following expenses that were greater than anticipated.
In other news, California may cut Medicaid coverage for GLP-1s for weight loss.
Additional articles: https://www.beckerspayer.com/policy-updates/california-may-have-to-roll-back-medi-cal-coverage-for-undocumented-immigrants-5-notes/ and https://www.beckerspayer.com/policy-updates/california-could-cut-medicaid-coverage-of-glp-1s-for-weight-loss/
#immigrants #medicaid #coverage #glp1s #weightlossdrugs #drugpricing
RFK Jr. And Sanders Will Work On MFN Drug Pricing
Health and Human Services Secretary Robert F. Kennedy Jr. told Senate health committee ranking member Bernie Sanders, I-VT, he’s willing to work with him on legislation Sanders will introduce on most favored nation drug pricing. President Trump just proposed the concept. As well, Republican Josh Hawley and Democrat Peter Welch have proposed a similar bill.
In other news, there is a good Health Affairs Forefront blog on the recent draft guidance on year three of Medicare drug negotiations.
(Articles may require a subscription.)
Additional article: https://www.healthaffairs.org/content/forefront/administration-releases-medicare-drug-price-negotiation-program-draft-guidance-2028
#drugpricing #mfn #irp #branddrugmakers #ira
ACOs Want Formula Fix
Over 100 accountable care organizations (ACOs) are urging the federal government to fix a benchmark issue some say could cost them tens of thousands in average annual revenue. They want the Centers for Medicare and Medicaid Services (CMS) to zero out a factor in their financial calculations for contract years 2024 and 2025.
Medicare pilots have been criticized for saving little or even costing dollars.
(Article may require a subscription.)
#acos #medicare
https://www.modernhealthcare.com/policy/medicare-shared-savings-aco-mehmet-oz
United Faces Federal Probe
The Wall Street Journal reports UnitedHealthcare is facing yet another criminal investigation for possible Medicare fraud. Several probes or lawsuits have already been reported on risk adjustment practices. The probe began last summer.
In other news, due to its Medicare woes, United is stopping commissions next month to brokers and sales agents who sell new Medicare Part D prescription drug plans.
Additional articles:
https://www.modernhealthcare.com/legal/unitedhealth-group-medicare-advantage-fraud and https://www.beckerspayer.com/payer/unitedhealth-under-criminal-investigation-for-alleged-medicare-advantage-fraud-wsj/ and https://www.modernhealthcare.com/insurance/unitedhealth-group-medicare-drug-plan-commissions
(Some articles may require a subscription.)
#medicareadvantage #partd #unitedhealthcare
https://www.fiercehealthcare.com/payers/wsj-feds-investigating-unitedhealth-criminal-medicare-fraud
— Marc S. Ryan
