The Land of Oz: Trump Nominates Mehmet Oz As CMS Administrator
President-elect Donald Trump has nominated television personality and surgeon Dr. Mehmet Oz to oversee the Centers for Medicare and Medicaid Services (CMS). Oz had a successful TV show for thirteen years, although has become controversial over supplements, alternative treatments, and COVID treatment. He lost to John Fetterman in a 2024 Senate race. He is a cardiothoracic surgeon and went to Harvard and Penn. He holds patents on a variety of devices related to heart surgery.
Additional articles: https://www.modernhealthcare.com/politics-policy/donald-trump-mehmet-oz-cms-administrator and https://www.healthcaredive.com/news/trump-dr-oz-nominate-medicare-medicaid-cms/733416/ and https://insidehealthpolicy.com/daily-news/oz-s-embrace-alternative-medicine-could-influence-cms-policy and https://www.beckershospitalreview.com/hospital-management-administration/president-elect-trump-taps-dr-oz-for-cms-administrator-10-things-to-know.html and https://thehill.com/policy/healthcare/4998738-trump-oz-cms-nomination/
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#cms #trump #healthcare #healthcarereform
AMA Study Says Health Insurance Is Highly Concentrated
A new study by the American Medical Association (AMA) finds that many regions are “stubbornly highly concentrated” when it comes to commercial health coverage. The AMA study found that 95% of metropolitan statistical area (MSA) markets were highly concentrated in both 2014 and 2023. The study examined 382 MSAs across all 50 states and the District of Columbia.
On Medicare Advantage (MA), the AMA found that competition among MA insurers has accelerated slightly on a local level over the past six years. But, at 97%, almost all MA markets were highly concentrated in 2023, the same percentage as in 2022. A single insurer held at least half of the market share in 30% of metropolitan areas in 2023.
Additional article: https://www.fiercehealthcare.com/payers/ama-study-insurance-markets-remain-stubbornly-highly-concentrated
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#insurers #coverage #commercial #employercoverage #medicareadvantage
https://www.modernhealthcare.com/insurance/medicare-advantage-markets-competition-2023-ama
GAO Finds HHS Facing Challenges With Cybersecurity
The congressional Government Accountability Office (GAO) finds that the Department of Health and Human Services (HHS) hasn’t implemented some policies recommended. This could mean a cybersecurity risk as attacks increase. The initiatives not implemented include tracking industry adoption of ransomware-specific cyber practices or assessing risks from the internet or technology devices. As I have stated often in these pages, the nation needs a true cybersecurity program and policy and HHS hasn’t a clue right now.
#cyberattack #cybersecurity
https://www.healthcaredive.com/news/hhs-healthcare-cybersecurity-policy-challenges-gao/732965
Urban Institute Finds That 4 Million Would Lose Coverage If Enhanced Subsidies Lapse
The Urban Institute finds that four million people could become uninsured if the enhanced premium subsidies in the Exchanges lapse at the end of 2025. It says almost 2.5 million would live in the 10 states that haven’t yet expanded Medicaid. The uninsured rate would rise by 16% and subsidized exchange coverage would drop by 42%.
The GOP generally opposes an extension due to cost, but a grand compromise could occur at the end of 2024 or in 2025. I have made the case that subsidy enhancements should be extended and the Affordable Care Act (ACA) protected. See my blog here: https://www.healthcarelabyrinth.com/the-gop-should-safeguard-the-aca/
#aca #obamacare #exchanges #trump
Paragon Weighs In On Healthcare Policy In End-Of-Year Bill
Congress must pass a stop-gap bill to keep the government running through FFY 2025. Some want to pass policy initiatives in the bill. The conservative healthcare think tank Paragon Institute is weighing in on possible policy inclusions. Paragon could be very influential on policy in the future.
Paragon says lawmakers should only partially offset CMS’ 2.83% cut to Medicare physician payments and then address permanent reform next year. It also says it should not delink pharmacy benefit manager (PBM) compensation from rebates right now. Last, it says Congress should limit additional funding for community health centers (CHCs).
For the record, I would fully restore the doc cut, increase rates and enact a permanent fix; delink PBM compensation from rebates; and fund CHCs well given our primary care issues.
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#healthcare #trump #pbms #physicians #providers #medicare
United Healthcare Filing Says Treated Unfairly In Star Ratings
UnitedHealthcare says in a court filing that the Centers for Medicare and Medicaid Services (CMS) treated its star ratings differently compared to Elevance Health in the prior year. It says the agency downgraded its Medicare Advantage (MA) star ratings “based upon a single phone call that lasted less than ten minutes.” It says the call never connected to its call center.
#cms #stars #medicareadvantage #unitedhealthcare
https://www.beckerspayer.com/payer/unitedhealth-alleges-unfair-treatment-in-star-ratings.html
Becker’s Gives Overview About Medicare Advantage Insurers in 2025
Becker’s clues us in on how six big insurers may fare in 2025 with Medicare Advantage (MA).
#medicareadvantage
— Marc S. Ryan
