Uninsured Rate Remains Steady
Despite major erosion in Medicaid coverage, the census bureau announced that the uninsured rate remained steady in 2023 at about 8%. Experts say that it appears that most of those disenrolled either regained coverage in Medicaid or enrolled in other coverage. The rate also benefited from a generally good economy and strong private coverage.
At the same time, the Biden administration announced that 50 million have taken advantage of the Affordable Care Act (ACA) since its passage in 2010. I am surprised that the numbers have not increased, but I do expect them to do so in the future.
Further, Democrats are pushing for a vote this year to make permanent the enhanced premium subsidies that are set to expire Dec. 31, 2025. The Congressional Budget Office (CBO) says the cost would be $335 billion over 10 years, plus $48 billion in net interest outlays.
Additional articles: https://insidehealthpolicy.com/daily-news/uninsurance-rate-sticks-record-low-admin-says-50m-have-used-exchanges and https://insidehealthpolicy.com/health-insider/congress-returns-facing-cr-uncertainty-harris-trump-debate-deck and https://www.nytimes.com/2024/09/10/us/politics/affordable-care-act-marketplaces-enrollment.html
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#aca #obamacare #exchanges #medicaid
https://kffhealthnews.org/news/article/uninsured-rate-stable-2023-medicaid-unwinding-census/
OptumRx To Move To Humira Biosimilar
Consistent with the trends, OptumRx, UnitedHealth Group’s pharmacy benefits manager, will begin moving to a biosimilar to replace brand Humira. This is yet another sign that biosimilars are gaining traction in a win for consumers and their pocketbooks.
#biosimilars #drugpricing #fda
https://www.fiercehealthcare.com/payers/optum-rx-pull-humira-some-its-preferred-formularies-report
Providers See Increasing Compensation
A new provider survey finds a number of specialties are seeing increases in compensation — 3.6% for primary care; 5.1% for medical; 5.5% for surgical and 5.8% for radiology, anesthesiology, and pathology. The primary care increase is lower than the average recently.
#providers #compensation
Healthcare Somewhat Important To Voters
Voters in a new Kaiser Family Foundation (KFF) survey finds that more than 40% of voters say the cost of care, prescription drugs and insurance premiums are important healthcare concerns. However, only 5% say the cost of care is the single most important issue.
Additional articles: https://www.kff.org/womens-health-policy/poll-finding/kff-health-tracking-poll-september-2024-harris-v-trump-on-key-health-care-issues/ and https://www.kff.org/womens-health-policy/press-release/a-growing-share-of-voters-see-the-election-as-a-referendum-on-abortion-access-vice-president-harris-holds-a-strong-advantage-on-the-issue/
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#election2024 #healthcare #trump #harris
AMA Unveils CPT Code Updates
The American Medical Association (AMA) released its updated list of Current Procedural Terminology codes for 2025. There are 420 updates, including adding 270 new codes.
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#providers #healthplans #coding
https://www.modernhealthcare.com/providers/ama-american-medical-association-cpt-codes-2025
Plans And Providers In Conflict As Medicare Advantage Realigns
Even before Medicare Advantage (MA) plan struggles there were growing conflicts between MA plans and providers. Providers complained that MA plans had restrictive prior authorization policies and had aggressive claims denials. MA plans complained that hospitals were terming contracts to stop MA from growing vs. traditional Medicare and have adopted an out-of-network strategy. With a realignment of MA due to financial problems in the program, more contention is expected.
In other news, an American Hospital Association briefer says that administrative costs now account for more than 40% of hospitals’ total expenses for delivering patient care. It says a good portion is tied to increasing claims denials generated by artificial intelligence tools.
Additional article: https://www.beckershospitalreview.com/finance/ai-linked-to-surge-in-medicare-advantage-commercial-claims-denials-aha.html
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#medicareadvantage #healthplans #providers #claimsdenials
Republicans Send Pointed Questions To CMS On Part D Demonstration Program
House Republicans are asking some pointed questions about the costs and legality of the standalone Part D premium stabilization created by the Centers for Medicare and Medicaid Services. CMS announced the program in late July after it saw huge spikes in premiums for 2025, which would become public right before the November election. Republicans said the program would cost $15 billion over three years. Others pegged it at $10 billion over three years.
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#partd #pdp #medicareadvantage #cms
More Details On Enrollment Brokers Cut Off From Exchange Platform
In a lawsuit, two broker entities are arguing the Centers for Medicare and Medicaid Services (CMS) acted arbitrarily and capriciously in suspending them from enrollments in the Exchanges. CMS says there was evidence that information would be accessed abroad and compromise personal information. In addition, CMS says they were undertaking fraudulent enrollments.
#exchanges #fwa #cms
— Marc S. Ryan
