House Budget Committee Advances Reconciliation Bill
After a high-profile defeat Friday, the House Budget Committee advanced the budget reconciliation bill with $625 billion in Medicaid reductions Sunday night. Four House Freedom conservatives in the GOP caucus voted present to advance the bill, apparently with commitments that changes will be made to the bill.
A prominent conservative, Chip Roy, said work requirements would be accelerated. He also mentioned the need for steeper provider tax cuts and a rollback of the enhanced reimbursement for the Medicaid expansion.
If all House moderates are on the bill now (a big if), they would likely jump off with steeper Medicaid cuts.
Providers and doctors are sounding the alarm on coverage losses, lower state dollars, administrative costs, and red tape.
Health policy group KFF published two briefs: one on the 15 states that would be impacted with lower reimbursement if they maintain undocumented immigrants and the impact on those with unpredictable incomes to proposed changes regarding tax penalties for Exchange subsidies.
Additional articles: https://insidehealthpolicy.com/daily-news/house-budget-moves-reconciliation-bill-rules-medicaid-changes-unclear and https://thehill.com/policy/healthcare/5305058-concerns-rise-over-medical-coverage-losses-from-big-beautiful-bill/?tbref=hp and https://www.kff.org/medicaid/issue-brief/proposed-medicaid-federal-match-penalty-for-states-that-cover-undocumented-immigrants-with-their-own-funds-state-by-state-estimates/ and https://www.kff.org/affordable-care-act/issue-brief/marketplace-enrollees-with-unpredictable-incomes-could-face-bigger-penalties-under-house-reconciliation-bill-provision/ and https://www.fiercehealthcare.com/payers/florida-blues-plan-rebuffed-cms-star-ratings-challenge
(Some articles may require a subscription.)
#trump #congress #budgetreconciliation #medicaid #coverage #spending
https://www.modernhealthcare.com/politics-policy/tax-bill-medicaid-house-budget-committee
Judge Rules For CMS And Against FL Blue On Star Rating
A federal judge ruled against Florida Blue and for the Centers for Medicare and Medicaid Services (CMS) on its Star ratings lawsuit. Florida Blue argued CMS did not account for the effects of natural disasters when it calculated the insurer’s star ratings.
Understanding the issue at play, I think FL Blue has a point here. If the president declares a state of emergency, surely the Department of Health and Human Services (HHS) should as well. The judge said it was a policy judgement. At the same time, CMS is broadening what constitutes a disaster.
Additional article: https://www.beckerspayer.com/payer/florida-blue-loses-medicare-advantage-star-ratings-challenge/
(Some articles may require a subscription.)
#cms #stars #medicareadvantage #flblue
https://www.modernhealthcare.com/legal/florida-blue-medicare-advantage-star-ratings-case
DOJ Accuses Plans Of Fraud With Broker Agreements
A good article on the Department of Justice (DOJ) suit against three big healthcare Medicare Advantage (MA) plans regarding allegations of fraud in paying brokers to steer Medicare beneficiaries to them. The Centers for Medicare and Medicaid Services (CMS) tried to fix this with a rule, only to be struck down by a judge. Congress and CMS should jointly fix this.
Plans of course argue they did nothing wrong and will fight. Whether they win or not, these financial arrangements are part of the ugly underbelly of MA that needs to go.
#medicareadvantage #marketing #fwa
Bloomberg Analyzes MFN Proposal
A Bloomberg article looks at all the complications of Donald Trump’s most-favored-nation drug price proposal. Some of the points are fair, but news outlets seem to be presenting pro-Big Pharma critics who feature only the potential legal and administrative implementation barriers. See my blog from last week on why Trump is right to push the limits on drug reform: https://www.healthcarelabyrinth.com/trump-goes-all-out-on-drug-price-reform/
As well, another study from RAND using 2022 data shows the real difference in drug prices. RAND says after applying rebates, U.S. net prices for brand originator drugs were still over three times as high as prices in other countries.
Interestingly, the U.S. has lower prices for unbranded generics than most countries. In the U.S., generics account for 90 percent of drug volume (compared with 41 percent in other developed countries) but are only 8 percent of U.S. drug spend. That is the killer.
Additional article: https://www.rand.org/pubs/research_reports/RRA788-3.html
#trump #drugpricing #branddrugmakers #irp #mfn
— Marc S. Ryan
