Senate GOP Looking To Change House Budget Reconciliation Bill
Senate Republicans say they’re going to rewrite the 1,116-page budget reconciliation bill the House passed on a tight vote. House Speaker Mike Johnson, R-LA, says the Senate needs to be judicious and make minimal changes to avoid another showdown in the House that could sink the bill. But Senate Majority Leader John Thune, R-SD, said his body will definitely have an imprint on the bill. The Senate is generally far more independent than the House.
The ideological split we saw in the House is now emerging in the Senate. Rightist Rand Paul, R-KY, will vote against the bill given the provision that increases the debt limit dramatically. Conservatives Ron Johnson, R-WI, Rick Scott, R-FL, and Mike Lee, R-UT, argue much deeper cuts need to occur. Johnson says the bill has a $2.2 trillion deficit on average each year and the bill should target greater reductions. This is an increase from a projected deficit in federal fiscal year 2025 of $1.9 trillion. They also want deeper Medicaid cuts and structural changes, such as state matching fund reductions.
On the other hand, moderates and pragmatic conservatives Josh Hawley, R-MO, Susan Collins, R-ME, Lisa Murkowski, R-AK, and Jerry Moran, R-KS, are threatening to oppose Medicaid reforms that would cut benefits. They worry, too, about impacts on state budgets and providers.
As you can see there are at least four votes on each side of the ideological spectrum that could sink the House bill as is in the Senate. At the same time, making changes that all can get on will be a struggle. Last, the Senate may target removal of the state and local taxes (SALT) deduction increase. That would sink any revised bill in the House.
Health Affairs Forefront blog has a good summary of all healthcare provisions in the House version that passed. One area not discussed is the restoration of appropriations for the cost-sharing reductions (CSR) subsidies in the Exchanges. These ended under Trump 45 and actually cost the federal government more in premium subsidies because plans have to offer the CSR plans and must increase base Silver plan premiums dramatically. But those above 250% of federal poverty could see some negative impacts.
Additional articles: https://thehill.com/homenews/senate/5315185-trump-big-beautiful-bill-senate-gop/ and https://www.healthaffairs.org/content/forefront/house-republicans-pass-budget-reconciliation-legislation-s-new-coverage-provisions and https://thehill.com/homenews/senate/5315019-senate-republicans-salt-cap-big-beautiful-bill/?tbref=hp
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#budgetreconciliation #spending #trump #congress #medicaid #coverage
Initial Claims Denials Up At Insurers
A new report from consultant Kodiak Solutions finds that health insurers initially declined to pay more than one of every ten dollars providers submitted in claims in 2024, an increase from 2023.
Payers initially denied 11.8% of dollars from hospitals. Insurers often overturned their initial denials and paid about 97% of dollars requested.
In Medicare Advantage (MA), a major decline in rejections over prior authorization (PA) requirements was tied to the implementation of the two-midnight rule.
(Article may require a subscription.)
#priorauthorizations #claimsdenials #healthplans
https://www.modernhealthcare.com/insurance/claim-denials-prior-authorization-2024
— Marc S. Ryan
