Senate Conservatives Want Deep Cuts
Conservative senators are arguing that huge new spending cuts need to be added to the budget reconciliation bill if they are to vote for the package. One lawmaker called the bill a “debt bomb.” At least four senators on the right have raised issues with the long-term implications of more debt and deficits. Deficits will grow from $2.2 trillion a year in FFY 2025 to more than $2.5 trillion in FFY 2035. Many want a return to pre-pandemic levels of spending. The Senate problem is a group of moderates who could sink the bill want fewer Medicaid cuts.
Also, a good article on the provider tax reductions and impacts on states and providers. And a good article talking about impacts to younger Americans of losing Medicaid.
Additional article: https://stateline.org/2025/05/27/republicans-target-a-tax-that-keeps-state-medicaid-programs-running/ and https://www.healthcaredive.com/news/medicaid-cuts-impact-young-adults-urban-institute/749030/
#budgetreconciliation #trump #congress #medicaid #coverage
https://thehill.com/homenews/senate/5316940-trump-bill-fiscal-concerns-republicans
CMS To Investigate Illegals On Medicaid Rolls
The Centers for Medicare & Medicaid Services (CMS) announced increased federal oversight to investigate states misusing federal Medicaid dollars to cover healthcare for individuals who are in the country illegally. Under federal law, federal Medicaid funding is generally only available for emergency medical services for noncitizens. Fourteen states and D.C. use state dollars to cover non-citizens. But conservative policymakers argue that liberal tax schemes essentially have the federal government contributing funds.
Additional article: https://www.cms.gov/newsroom/press-releases/cms-increasing-oversight-states-illegally-using-federal-medicaid-funding-health-care-illegal
(Some articles may require a subscription.)
#medicaid #coverage
Examining Default Medicare Advantage Enrollment
A good Health Affairs Forefront blog that looks at the pros and cons of Medicare Advantage (MA) default enrollment for new Medicare beneficiaries. Reasonably balanced. Perhaps a little antagonistic to MA. On the pro side, supplemental benefits in MA are discussed. On the negative side, costs, access, Medigap, and access are mentioned.
(Article may require a subscription.)
#medicareadvantage #enrollment #medicare
Study Shows IRA Changes Not Helping Consumers
A new study from the Pioneer Institute finds little benefit so far from the Inflation Reduction Act’s Medicare Part D changes, including drug price negotiations that will first go into effect in 2026. Pioneer concluded that many patients will continue facing substantial out-of-pocket (OOP) costs. It looked at enrollees covered by the four largest pharmacy benefits managers (PBMs) and looked at drug data for 2024 and 2025.
The study found:
- The OOP average cost increased in total for all of the Maximum Fair Price (MFP) medicines that were included in the analysis.
- The average OOP cost across all nine MFP drugs increased by $23.91, from $74.51 to $98.42.
- The average OOP cost for all nine MFP medicines increased by 32%.
- The OOP costs increased specifically for seven of the nine medicines with a negotiated MFP.
- Cost increases ranged from $10.56 to $316.81.
- Of the two medicines that did not have OOP increases, one faced new competition from biosimilars that only became available in 2025. All four of the largest PBMs increased OOP costs for six of the seven medicines with cost increases; one medication had OOP increases from only three of these PBMs.
A lot contributes to the trends. The law reduced and limited OOP costs for beneficiaries without the government paying for it. Therefore, PBMs and health plans saw costs shifted to them. They had to change benefit designs, increase cost-sharing, and move some drugs to more expensive tiers to “pay” for the significant reductions in OOP costs. At least part of what is mentioned above was caused by the massive cost-shift to PBMs and plans.
As well, many predicted that PBMs would use various schemes to preserve rebates by discriminating against the negotiated drugs in favor of others in similar classes.
#ira #drugpricing #pbms #branddrugmakers #medicareadvantage #pdp #partd
https://pioneerinstitute.org/the-inflation-reduction-act-ira-overview/
— Marc S. Ryan
