Government Funding Deal Now More Remote
While bipartisan talks continue, today saw the two parties argue over a government funding bill and the parties appear further apart. Senate Minority Leader Chuck Schumer, D-NY, proposed a bill that would fund some parts of government for the year and others partially, enact some additional funding being negotiated between the parties, and provide a one-year extension of enhanced Exchange premium studies. Republicans rejected the Democratic proposal.
Instead, the Republicans will challenge Democrats to reject a bill based on the same bipartisan negotiations to fund some parts of government for the year and extend other funding to January. There would be no deal on subsidies. Senate Majority Leader John Thune, R-SD, has committed to a vote on subsidies later, but House Speaker Mike Johnson, R-LA, has refused to do so, and Democrats believe President Trump will also refuse a subsidy extension and continue his campaign to downsize government and lay off workers.
Additional articles: https://www.medpagetoday.com/washington-watch/washington-watch/118374 and https://thehill.com/homenews/senate/5595759-senate-gop-democratic-offer-shutdown/ and https://thehill.com/homenews/senate/5595545-schumer-plan-government-shutdown/ and https://thehill.com/homenews/senate/5594333-government-shutdown-deal-democrats-trump/
#governmentshutdown #congress #trump #exchanges #healthcare #coverage
Divisions Over ACA
A contentious Senate hearing on the future of Obamacare found policy and political lines drawn. Republicans generally indicated that the Affordable Care Act (ACA) failed to live up to its promise to make healthcare more affordable and reduce costs. Democrats called it a godsend for tens of millions of Americans. Some Republicans advocated for tired, old, and failed mechanisms for health insurance like high-risk pools. My party had little constructive to add for healthcare reform.
#aca #obamacare #exchanges #medicaid #healthcare #coverage
https://www.medpagetoday.com/publichealthpolicy/healthpolicy/118375
Big Health Plan Financials Poor
A good Fierce Healthcare article that discusses the lackluster financial situations at most health plans. Plans are struggling in multiple lines of business and have very high medical loss ratios. The prognosis is mixed given challenges with the One Big Beautiful Bill (OBBBA) and utilization. I had a blog this week covering the issue here: https://www.healthcarelabyrinth.com/recap-of-big-plan-q3-financial-news-mlrs-big-concern/ .
#healthplans #margins
Medicare Demonstrations – One Under Attack
Democrats in Congress are seeking to block a new prior authorization process in traditional Medicare that would in part rely on artificial intelligence. The pilot will be in six states as of Jan. 1 and have six companies conducting prior authorizations.
In other news, the Centers for Medicare and Medicaid Services (CMS) has finalized a new payment model that will be mandatory for select specialty care providers. CMS is establishing the Ambulatory Specialty Model, a five-year payment demonstration with a two-sided risk model geared toward improving identification and management of chronic conditions.
Additional article: https://www.modernhealthcare.com/politics-regulation/mh-cms-ambulatory-specialty-model-explained/
(Articles may require a subscription.)
#medicare #priorauthorization
Grocery Care Benefit Increases Office Visits
A study from the Elevance Health Public Policy Institute finds that use of a grocery card benefit by Medicare Advantage (MA) dual-eligible enrollees resulted in increased office visits. The study, published in the American Journal of Managed Care, reviewed eligible adults with continuous enrollment in Elevance Health-affiliated plans from 2021 through 2022. The study found that those who leveraged the benefit were more likely to have annual wellness, primary care, and specialist visits, with increases ranging from 4.9% to 6.6%.
#supplementalbenefits #medicareadvantage
— Marc S. Ryan
