Healthcare Media Reacting To Trump Win
A series of articles appeared today reacting to Donald Trump’s victory in the presidential election.
The articles predict as expected that the Exchanges and Medicaid will be reined in through a number of regulatory and statutory efforts. It notes that Trump may not again go after the Affordable Care Act (ACA), but that extension of the enhanced premium subsidies in the Exchanges are very much in doubt. At the same time, his incoming VP JD Vance outlined a potential change to premium setting in Exchanges.
On Medicare Advantage (MA), Trump is said to be much more enamored with the program as an alternative to the traditional system. I, however, feel Trump and lawmakers will still seek some reforms and savings in MA.
Pharmacy benefits manager (PBM) reform likely moves forward, given bipartisan congressional support and previous positions taken by the former president.
Trump is also seen as less antitrust focused than the current administration. But again, many GOP lawmakers in the Senate have grave concerns about consolidation.
An open question is what will happen to Medicare drug price negotiations. Trump took no real position on it during the campaign and he had policies that were in favor of drug price reform and reductions.
Health insurer stocks, especially those focused on MA, were up after Tuesday considerably.
Additional articles: https://www.fiercehealthcare.com/payers/insurers-prep-trump-admin-friendly-medicare-advantage-and-mergers-hostile-medicaid-and-aca and https://www.modernhealthcare.com/politics-policy/trump-healthcare-policy-medicare-aca-second-term and https://www.modernhealthcare.com/insurance/unitedhealth-humana-cvs-stocks-trump-election-win and https://insidehealthpolicy.com/daily-news/fate-ira-negotiations-uncertain-after-trump-election-victory
#election2024 #healthcare #healthcarereform #trump
(Some articles may require a subscription.)
CVS Reports Poor Financial News For Q3
While its stock was up after the election, CVS Health continued to report poor financial news. CVS did not release formal guidance for 2024 due to ongoing financial problems. Its medical loss ratio is about 95%. New CEO David Joyner says the company will continue to feel the sting from elevated utilization through the end of the year. Part of this was caused by a major misstep in pricing of Medicare Advantage (MA) by its insurer Aetna.
Revenue was $95.4 billion in Q3, up more than 6% year over year. However, CVS’ net income fell to $71 million, down from almost $2.3 billion the same time last year.
It announced the appointment of Steve Nelson, a former United Healthcare and Chen Med executive, as Aetna president. Veteran CVS executive Prem Shah will become group president over the pharmacy benefits manager, pharmacies, and health.
Additional articles: https://www.fiercehealthcare.com/payers/cvs-taps-former-unitedhealthcare-ceo-steve-nelson-lead-aetna and https://www.modernhealthcare.com/insurance/cvs-health-aetna-president-steve-nelson-unitedhealth-ceo-david-joyner-karen-lynch and https://www.healthcaredive.com/news/cvs-new-aetna-president-third-quarter-2024/732070/
(Some articles may require a subscription.)
#medicareadvantage #cvshealth #aetna
https://www.fiercehealthcare.com/payers/cvs-holds-back-guidance-it-outlines-plan-right-ship-aetna
Exchange Open Enrollment Outlined
A good article on what to expect from the Exchange open enrollment period for 2025. The average premium for benchmark silver plans is 3% higher than this year. Access and choice continue to grow with at least three health insurance companies offering plans in 2025 in 82% of counties, up from 78%.
(Article may require a subscription.)
#aca #exchanges #healthplans #coverage
https://www.modernhealthcare.com/insurance/marketplace-open-enrollment-aca-aetna-centene-elevance
MacPAC Questions Medicaid State Directed Payments
The Medicaid congressional policy arm, MacPAC, is questioning the proliferation of a widespread Medicaid funding mechanism known as state directed payments. While it admits these payments could help increase healthcare access for some of America’s most vulnerable patients, it too could serve as a windfall for hospitals and needs additional transparency. Is this another form of creative financing in states in Medicaid? The state share of Medicaid financing is often paid through provider assessments or taxes and some or all of the dollars are shuttled back with the federal reimbursement back.
MacPAC wants better assessment of the arrangements. These payments have increased dramatically the past few years and spending has skyrocketed to $110 billion a year — roughly four times larger than the $24.7 billion in projected spending from arrangements approved by the end of 2020.
#medicaid #spending
South Dakota Voters Approve Medicaid Work Requirements
South Dakota voters approved a ballot measure that allows state officials to consider work requirements for Medicaid expansion recipients if allowed by the federal government. South Dakota was a deep red state that approved Medicaid expansion in November 2022.
#medicaid #workrequirements #coverage
https://www.beckerspayer.com/payer/south-dakota-passes-medicaid-work-requirement-measure.html
— Marc S. Ryan
