More Fallout From Budget Reconciliation
The saga over the House reconciliation bill and what the Senate will do continues.
Republicans in swing or moderate districts returned home to town halls with tough questions from their constituents about Medicaid and other social service cuts as well as the fact that deficits will increase under the bill.
A healthcare policy group KFF issue briefer allocates the Congressional Budget Office’s federal spending reductions and enrollment losses across the states. The CBO’s latest cost estimates say the bill would reduce federal Medicaid spending by $723 billion over the decade timeframe and that the number of uninsured would increase by 7.6 million due to those cuts.
KFF finds that the biggest reduction areas in Medicaid are:
- Mandating that adults who are eligible for Medicaid through the ACA expansion meet work and reporting requirements ($280 billion)
- Repealing the Biden Administration’s rule simplifying Medicaid eligibility and renewal processes ($167 billion)
- Establishing a moratorium on new or increased provider taxes ($89 billion)
- Revising the payment limit for state directed payments ($73 billion)
- Increasing the frequency of eligibility redeterminations for the ACA expansion group ($53 billion).
Federal cuts to states represent 11% of federal spending on Medicaid over the period. By state, the cuts range from 5% in Wyoming, Alabama, and Wisconsin to 15% in Washington, Louisiana, and Illinois. Great graphics show enrollment losses by states, but states could react differently.
A Health Affairs Forefront blog discusses the bill, especially impacts on dual eligibles and expiring enhanced premium subsidies.
A Modern Healthcare article about an Urban Institute and Robert Wood Johnson analysis says Medicaid is cut by over $700 billion and the Exchanges by over $100 billion (most of which is the expiring enhanced premium subsidies). About 4.2 million people will leave the Exchanges due to the enhanced subsidies expiring. The researchers say providers would be on the hook for $278 billion in uncompensated care for newly uninsured people.
Additional articles: https://www.kff.org/medicaid/issue-brief/allocating-cbos-estimates-of-federal-medicaid-spending-reductions-and-enrollment-loss-across-the-states/ and https://www.healthaffairs.org/content/forefront/big-republican-cost-shift-massive-cuts-medicaid-and-aca-increase-costs-older-adults-and and https://www.modernhealthcare.com/politics-policy/one-big-beautiful-bill-act-2025-obamacare-aca
(Some articles may require a subscription.)
#budgetreconciliation #trump #congress #medicaid #exchanges #spending #coverage
https://thehill.com/homenews/house/5325547-republicans-trump-big-beautiful-bill-town-halls
Medicare Doc Fix May Not Be Long-Term Solution
While many are championing the inclusion of a rate fix for Medicare doctors as a major win, the fact is it looks more like a short-term fix rather than long-term structural reform.
Healthcare policy consultants at McDermott say that long-standing structural flaws in the Medicare payment system could lead to yet another cut to doctor pay even in the upcoming 2026 year. This stems from budget neutrality constraints, coding forecasting errors, and under-valuation of digital tools.
McDermott says Congress must pass long-term reforms to ensure rates truly keep track with inflation.
(Article may require a subscription.)
#medicare #physicians #rates
NSA Report Shows Tilt To Providers
The Peterson-KFF Health System Tracker has updated an earlier study on the dispute resolution process. Almost 1.3 million disputes were adjudicated in 2023 and the first half of 2024. Providers and facilities initiated the vast majority of the disputes (90%) and won 80% of the time. This number is up from earlier reports.
The top ten initiating parties were all affiliated with private equity. In almost all cases where the provider prevailed (99.9%), this resulted in providers receiving the offer they proposed, which was, on average, well above the median in-network rate reported by insurers.
As the authors concluded, Americans are being protected but the law is not reducing prices or spending. I have argued the legislation was entirely tilted to providers and that Congress should reform the law. The law will clearly drive costs and prices over time.
#nsa #nosurprises #pricetransparency #transparency
— Marc S. Ryan
