Payers Expect Continuation of Enhanced Exchange Subsidies
Health plan executives say they expect continuation of enhanced premium subsidies in the Exchange in some form past 2025. Oscar Health CEO Mark Bertolini says both parties have an incentive to extend the subsidies. Executives think there will be a bipartisan solution to extend the subsidies.
Expiration of the subsidies could lead to surging premiums and destabilization of access and participation by insurers. At the same time, the price tag is big, especially as the GOP plans for its extension of the Trump tax credits.
I expressed in a recent blog that there could be an extension of the enhanced subsidies via a year-end stop-gap bill or during a 2025 master bill. But I am not as optimistic as the plan executives.
#aca #obamacare #exchanges
KFF Looks At 2025 Medicare Advantage Offerings
Just after Medicare Advantage (MA) benefits were released, the Kaiser Family Foundation (KFF) made a major misstep in my view when they put the same good spin on MA benefits for 2025 as the Centers for Medicare and Medicaid Services (CMS) did. In some ways, KFF is doing it again, but at least reporting some of the negatives.
KFF continues to report gross statistics on availability and premiums that put the best face on offerings. But at least in the latest analysis it adds some of the bad news. Here is some of that negative news: “About 5% of current Medicare Advantage enrollees in individual MA-PDs (or about 1.4 million people) are in a plan that has been terminated for 2025, while up to 7% of enrollees in MA-PDs (or as many as 1.8 million people) may be affected by a consolidation, meaning they are in a plan where some portion of the 2024 enrollment will be automatically assigned to a different plan in 2025.” KFF also notes a reduction in some supplemental benefits.
Still, other analyses have painted a much worse picture on changes to deductibles, benefits, and cost-sharing. I wish KFF would have gone deeper. The impacts are major for millions.
Additional article: https://www.kff.org/medicare/issue-brief/medicare-advantage-2025-spotlight-a-first-look-at-plan-premiums-and-benefits/
#kff #medicareadvantage
Lilly Now Sues Government Over 340B
Eli Lilly is now suing the government much like J & J over the 340B program, arguing the government cannot dictate how brand drug companies structure discounts to qualifying entities. The government has said discounts must be awarded upfront, while some would like to award a rebate later to bring more transparency and scrutiny to the program. I am not a big defender of the brand drug companies, but I agree with them here. The program is being abused by providers, especially hospitals.
Additional article: https://www.modernhealthcare.com/legal/340b-drug-pricing-program-johnson-johnson-lawsuit
(Articles may require a subscription.)
#340B #drugpricing #branddrugmakers #hospitals #providers
https://www.modernhealthcare.com/legal/eli-lilly-hhs-340b-drug-program-lawsuit
Debate Abounds On Whether Healthcare Policy Will Be in End-Of-Year Bill
Interesting article on whether any healthcare policy will be in the end-of-year bill to fund government in FFY 2025. There is a good chance that crafting a bill will be contentious, which likely means the appetite to include policy is fairly low. Some want PBM reform and critical extensions of programs in, but others argue the GOP will defer such issues until they control both chambers.
(Article may require a subscription)
#crs #governmentshutdown #congress
https://www.modernhealthcare.com/politics-policy/pbm-bills-telehealth-extension-congress
— Marc S. Ryan
