October 7, 2024

MA Fallout Much Greater Than CMS Indicates

The Centers for Medicare and Medicaid Services (CMS) has reported that all is fine in the Medicare Advantage (MA) and standalone Part D worlds. But we know that is just not the case. It is political spin in an election year. We featured some good analysis last week about why choice will drop and some premiums and out-of-pocket costs will go up in standalone Part D.

Now, an analysis of MA shows a similar thing. Insurers are exiting geographic markets, reducing benefits, increasing premiums, and imposing higher out-of-pocket costs. An ATI Advisory analysis says more than 7% of beneficiaries, or about two million people, will need to find new offerings. This is up from fewer than 100,000 in past years. This is major displacement right around the election and is the October Surprise I have been talking about.

(Article may require a subscription.)

#medicareadvantage #healthplans #cms

https://www.modernhealthcare.com/insurance/medicare-advantage-aetna-humana-elevance-2025

Site Neutral On Docket For 2025

Sens. Bill Cassidy, R-LA, and Maggie Hassan, D-NH, are teaming up on potential site-neutral legislation that could be ready for 2025. How extensive the payment reforms to hospitals would be is unknown, but both senators think they can address rural hospitals’ concerns as well as hospitals’ concerns more broadly. Cassidy and Hassan say some site-neutral savings could be used to fund emergency care in low-income areas and that rural hospitals could be exempted from site-neutral requirements. 

I do not think they can assuage the broader hospital lobby but could convince rural hospitals. Congrats to the senators for tackling the issue and the bill should be as broad as possible.

(Articel may require a subscription.)

#hospitals #siteneutral #healthcarereform #medicare

https://insidehealthpolicy.com/daily-news/cassidy-hassan-talks-site-neutral-potential-bill-aimed-assuaging-rural-hospitals-concerns

IV Fluids In Short Supply Due To Hurricane

U.S. hospitals are facing a shortage of IV fluid due to Baxter International’s North Carolina production plant being shut down in the wake of Hurricane Helene. Suppliers will reduce shipments to mitigate issues. In addition, hospitals will follow protocols to mitigate impacts as well.

Additional article: https://www.modernhealthcare.com/supply-chain/iv-fluid-shortage-baxter-plant-aha

#drugshortages #healthcare

https://www.fiercehealthcare.com/providers/us-hospitals-prep-supply-chain-constraints-wake-baxter-international-plant-closure

CBO Scores Various Drug Pricing Proposals

The Congressional Budget Office (CMO) scored a series of drug price reform proposals and found that most save just small amounts of money.  Taken together, broadening Medicare drug price negotiations could save up to 9% of overall drug spending. International reference pricing, recently abandoned by Donald Trump, could save up to 5%. But all of them would contribute to positive reform.

CBO report: https://insidehealthpolicy.com/sites/insidehealthpolicy.com/files/documents/2024/oct/he2024_2651.pdf

(Articles may require a subscription.)

#drugpricing #ira #branddrugmakers

https://insidehealthpolicy.com/daily-news/cbo-oft-debated-drug-policies-would-barely-cut-prices-except-reference-pricing

Medical Debt Targeted At State Level

This Kaiser Health News (KHN) article does a good job running through various initiatives at the state level to bar or rein in medical debt.

#medicaldebt #healthcare

https://kffhealthnews.org/news/article/medical-debt-bipartisan-issue-urgent/

PE Reform Bills Have Mixed Record In States

Legislation targeting private equity-linked healthcare transactions faltered in some states but succeeded in others. The mixed record could lead to more trouble passing bills in the future. This could spark additional PE-backed transactions in healthcare.

(Article may require a subsciption.)

#privateequityfirms #manda #mergers #acquisitions #healthcare

https://www.modernhealthcare.com/mergers-acquisitions/private-equity-bills-california-indiana-texas-2024

KFF Publishes Enrollment Season FAQs

The Kaiser Family Foundation has published a good web page on enrollment season questions.

#kff #coverage #medicare #medicareadvantage

https://www.kff.org/faqs/medicare-open-enrollment-faqs/?view=1

— Marc S. Ryan

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