Paragon Says DOGE Could Save $2.1 Trillion In Healthcare
Donald Trump has created the informal Department of Government Efficiency (DOGE) to reduce the size of government. He is also looking for budget cuts to help pay for extension of his 2017 tax cuts. As such, healthcare spending cuts are anticipated. Trump is chummy with certain conservative healthcare policy groups, including the Paragon Health Institute. Paragon has put together some possible healthcare cuts amounting to $2.1 trillion in savings over a decade. The possible reductions include the following. While Trump has said he will preserve Medicare, some Medicare cuts are below.
- Limiting state federal matching in Medicaid
- Eliminating the provider tax safe harbor in Medicaid
- Medicaid work requirements
- Rescinding certain Biden Medicaid rules
- Limiting Medigap cost-sharing amounts to reduce spending in Medicare
- Reducing the very high Medicaid admin cost reimbursement
- Passing site neutral policies for Medicare
- Expanding Medicare Advantage
- Eliminating Medicare bad debt reimbursement and reforming uncompensated care
- Reforming the 340B program
- Ending the enhanced Exchange premium subsidies
- Capping employer healthcare tax deductibility
The proposals are not a radical reform of current healthcare programs, but would remove a great deal of funding, shift costs to states and citizens, and mean reduced coverage overall. Some proposals, such as site neutral payments and certain Medicaid and Medicare abusive hospital funding practices, are tremendous ideas.
As well, the Kaiser Family Foundation (KFF) has issued a new brief discussing Affordable Care Act (ACA) and Medicaid issues. It finds that of the 41 states and the District of Columbia that expanded Medicaid under the ACA, 21 states went to Trump and 20 states went to Harris. The ten states that are holdouts on expansion are all red, except Wisconsin (which supported Trump as well). I have calculated that about three-quarters of the over 21 million Exchange enrollment are in states that are Red or Trump won in 2024.
KFF also notes that many are talking about reducing Medicaid expansion funding to regular reimbursement levels rather than repealing the ACA outright. There are 12 states that have a trigger law that rolls back Medicaid expansion if the 90% funding of the expansion population is removed at the federal level. That would impact 4.3 million of the 21 million nationwide covered under the expansion.
Additional article: https://www.kff.org/medicaid/issue-brief/medicaid-expansion-is-a-red-and-blue-state-issue/
(Some articles may require a subscription.)
#healthcare #trump #election2024 #healthcarereform #medicare #medicareadvantage #medicaid #aca #exchanges #obamacare
Regional MA Payers Stand To Gain Big In 2025 But Are Worried
A good article in Modern Healthcare explaining the dilemma of regional Medicare Advantage (MA) players. Due to major financial problems, many big MA national plans exited regions and sunset products in other places. They have also suspended commissions to some degree in MA and standalone PDP. In many regions, PDP premiums went up dramatically, cost-sharing increased and choice eroded as well due to the Inflation Reduction Act’s (IRA) misguided Part D cost-sharing reductions.
Regional players could see their enrollment go up dramatically as 1.8 million MA members and 500,000 PDP enrollees will need to change plans because their current policies will not be offered. Regional plans could struggle to serve huge growth and margin assumptions could be impacted too.
Despite financial woes, MA growth should still be robust given the value proposition compared with the traditional fee-for-service (FFS) program. There is some evidence that big plans are seeing larger growth than desired already despite their cutbacks. As such, some plans recently announced further commission elimination in areas.
(Article may require a subscription.)
#medicareadvantage #partd #pdp
https://www.modernhealthcare.com/insurance/medicare-advantage-2025-plans-part-d-market
Oz And Trump Could Fight Certain GOP Lawmakers On Medicare Advantage
A very good article on how future Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz may find Trump and himself fighting against certain GOP lawmakers on Medicare Advantage (MA). While Trump, Oz and some GOP lawmakers wish to reduce oversight of MA and even make it the default option for coverage, some anti-big-business GOP lawmakers and fiscal hawks are upset about allegations that MA plans are overpaid and abusing the system. They want MA more accountable and less costly. The Paragon Health Institute also wants to reduce MA funding.
I have stated that while the Trump administration will be very friendly to MA, don’t expect all scrutiny to go away. Reforms will occur and they will save money.
#medicareadvantage #trump #oz #overpayments
https://www.axios.com/2024/11/27/mehmet-oz-medicare-republicans-tension
Trump Picks Bhattacharya To Head NIH
President-elect Donald Trump has chosen health policy researcher, economist and Stamford professor and surgeon Jay Bhattacharya to head the National Institutes of Health. He is best known recently for his criticism of COVID lockdowns. Also, he has been a frequent critic of how NIH operates and is committed to reform.
Bhattacharya is clearly well-credentialed and qualified. He is not outside the mainstream of science despite critics’ attacks. The NIH, like the FDA and CDC, needs critical restructuring and reform.
Trump has also chosen Jim O’Neill, an investor and former healthcare official under George W. Bush, to be deputy secretary of Health and Human Services (HHS). He has been a frequent critic of the Food and Drug Administration (FDA). O’Neil wants to remove efficacy as a tenet of drug approval and limit reviews to safety. I happen to think that safety and efficacy should remain as key factors and we should consider cost-effectiveness and comparative effectiveness as well.
A Hill article discusses the status of all of the healthcare nominees. In general, despite some misgivings about some, the GOP seems content to support Trump here. This likely includes Kennedy as well.
Additional articles: https://www.modernhealthcare.com/politics-policy/donald-trump-jay-bhattacharya-nih-national-institute-health-stanford and https://insidehealthpolicy.com/daily-news/trump-picks-frequent-nih-critic-bhattacharya-next-director and https://www.politico.com/news/2024/11/26/trump-picks-jim-oneill-for-no-2-spot-at-hhs-00191827 and https://insidehealthpolicy.com/daily-news/trump-s-hhs-deputy-pick-previously-urged-drug-approval-reform-opposed-fda-reg-ldts and https://thehill.com/homenews/administration/5011492-jim-oneill-selected-to-lead-hhs-alongside-rfk-jr-as-deputy/ and https://thehill.com/policy/healthcare/5011226-trump-nominees-health-agencies/
(Some articles may require a subscription.)
#nih #healthcare #trump
Fallout Over Biden Announcement On GLP-1 Coverage In Medicare And Medicaid
Major concerns and fallout over the Biden administration’s proposal to expand coverage of GLP-1 weight-loss drugs to people who are obese but do not have underlying disease states. Yesterday I characterized the move as a potential budget buster and one that could further destabilize Medicare Advantage (MA) but more importantly the standalone Part D PDP plans. Both MA and PDP plans are already shouldering huge new costs from the Inflation Reduction Act’s (IRA) Part D cost-sharing reductions, which were unfunded.
The announced rule appears to permit coverage of GLP-1s for obesity in Medicare but may require it in Medicaid.
Medicare costs could increase by $35 billion over roughly a decade. Medicaid would see an increase of $3.8 billion over the next 10 years (this seems very low to me). Only 12 Medicaid states now cover GLP-1s for obesity alone right now.
The national medical directors are raising alarm bells on affordability.
Senator Bernie Sanders, I-VT, is also raising concerns, arguing the move is a giveaway and cash cow to Big Pharma. He argues prices must come down. Without price reductions, coverage could impact the Medicare and Medicaid budgets a great deal.
Insurers and their lobby groups are very concerned. One association president called the move irresponsible without further analysis.
Studies show that a majority of people discontinue treatment before seeing meaningful health impacts.
Additional articles: https://insidehealthpolicy.com/daily-news/new-cms-obesity-drug-coverage-could-cost-states-billions and https://insidehealthpolicy.com/daily-news/sanders-others-raise-cost-concerns-obesity-drug-coverage-plan
(Some articles may require a subscription.)
#glp1s #weightlossdrugs #medicare #medicaid #partd #medicareadvantage #pdp
United Under Attack For Denying Mental Health Coverage
An interesting study and article from ProPublica alleging that United Healthcare and its service subsidiary Optum have been unfairly and perhaps illegally targeting and denying needed mental healthcare in various lines of business. ProPublica says the practice continues today with arbitrary thresholds and cost-driven targets. United may be in violation of mental health parity laws as well. ProPublica said it reviewed what amounts to the company’s internal playbook to save on mental health costs.
(Article may require a subscription.)
#mentalhealth #unitedhealthcare #optum #priorauthorization
— Marc S. Ryan
