Budget Reconciliation Could Slip Into The Summer
A prominent GOP lawmaker told hospital stakeholders today that action on budget reconciliation spending cuts could slip into the summer. Rep. Buddy Carter, R-GA, who chairs a key health subcommittee, indicated the possible slowdown. In addition, hospital leaders exhorted lawmakers to avoid sweeping cuts, which could include work requirements, reduced state matches for the expansion population, fraud reduction, and a per capita cap funding mechanism. They also want the Exchange enhanced subsidies to continue.
Insiders say Medicaid per-capita caps and other major structural reforms to the program were being put on the back burner due to moderates’ concerns, but budget hawk conservatives revolted. The committee was readying about $621 billion in Medicaid cuts over ten years. The package included numerous eligibility reforms and restrictions, a reduction in Medicaid expansion match, work requirements, and reducing provider tax allowable rates to 5%. Medicaid spread pricing was also being banned.
In other news, Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz said that he supports reduction of the enhanced match in Medicaid for expansion populations. This shows the power of the Paragon Health Institute within the administration. Paragon has been campaigning on reducing the expansion population match rates for some time now.
Additional articles: https://www.modernhealthcare.com/politics-policy/cms-mehmet-oz-medicaid-expansion and https://www.modernhealthcare.com/politics-policy/medicaid-cuts-budget-buddy-carter and https://insidehealthpolicy.com/health-insider/providers-patient-advocates-continue-medicaid-lobbying-blitz-house-gop-crossroads and https://insidehealthpolicy.com/inside-drug-pricing-daily-news/carter-medicaid-pbm-spread-pricing-ban-expected-reconciliation
(Articles may require a subscription.)
#budgetreconciliation #trump #congress #spending #medicaid #exchanges
https://www.modernhealthcare.com/politics-policy/aha-annual-meeting-medicaid-cuts
Prior Authorization’s Status On Capitol Hill
Rep Greg Murphy, R-NC, an MD and co-chair of the House Doctors’ Caucus, describes his recent medical events and all he went through to get vial medicine approved by his health plan. So far, prior authorization (PA) bills have failed to move but lawmakers are more hopeful now. In addition, Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mehmet Oz is rumored to be delivering on part of his promise to tackle Medicare Advantage (MA) reforms by crafting new PA restrictions in the program. These would streamline and make more uniform allowable utilization policies across plans. Plans have been reducing reliance on PA across lines of business.
(Article may require a subscription.)
#priorauthorization #medicareadvantage
https://www.modernhealthcare.com/politics-policy/prior-authorization-bills-legislation-greg-murphy
A Look At Big Healthcare Entities’ Q1 Financials
A great article summarizing Q1 financials of the big integrated health entities. Each reported quarterly profitability, but medical expense and trends continued to be issues. Government programs continued to be fragile financially. We are now in the third year of financial challenges for the companies, especially in terms of government programs.
Additional article: https://www.modernhealthcare.com/finance/what-unitedhealth-humana-elevance-navigated-during-q1
(Some articles may require a subscription.)
#healthplans #margins
— Marc S. Ryan
