Oscar Worried About Sunset of Exchange Premium Subsidy Enhancement
Insurtech Oscar Health is worried about the potential sunset of the enhanced premium subsidies in the Exchanges. Exchange enrollment has reached 21.3 million with the enhanced subsidies, the loss of Medicaid eligibility through the reintroduction of redeterminations, and general pro-coverage policies of the Biden administration.
Oscar could lose 15% to 20% of its enrollment. Oscar is focused on Exchange enrollment. The nation’s uninsured rate has increased already due to Medicaid coverage losses. The increase in the number of uninsured could worsen with the sunset of the enhanced premium subsidies.
The Urban Institute found that the enhanced subsidies will lead to 7.2 million more people receiving subsidized Marketplace coverage and 4.0 million fewer people being uninsured in 2025. It also found that the 7.2 million in added enrollment also will reduce insurer premium rates by 5 percent on average. The sunset of the subsidies would reduce all of this. Not extending the subsidies in 2024 will upend the preparation process for the 2026 benefit year.
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Additional article: https://www.healthaffairs.org/content/forefront/delays-extending-enhanced-marketplace-subsidies-would-raise-premiums-and-reduce
#exchanges #aca #obamacare #oscarhealth
Audit Blames PA Medicaid And PBMs In Part For Overpayments
An audit of Pennsylvania Medicaid found an extra $7 million was spent for prescription drug benefits in 2022 because of pharmacy benefit managers (PBMs) and lack of oversight from the state’s Medicaid agency.
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#pbms #medicaid #drugpricing
Eli Lilly Valuation Could Hit $1 Trillion
Pharmaceutical company Eli Lilly could become the first healthcare company to hit a market value of $1 trillion. It is riding high on its GLP-1 weight-loss drugs Zepbound and Mounjaro, which cost $12,000 to $14,000 per year for treatment. Talk about building a company on the backs of Americans. Americans pay many folds more for drugs than those in other developed countries.
#weightlossdrugs #glp1s #branddrugmakers
MHK Reviews Recent Medicare Advantage Audits
Good review of what happened in 2024 Medicare Advantage (MA) program audits in 2024 from software technology vendor MHK. I gave my take in the following blog as well: https://www.healthcarelabyrinth.com/2023-medicare-advantage-and-part-d-program-audit-enforcement-report-out-what-does-it-tell-us/
#medicareadvantage #audits #cms
KFF Reviews Healthcare Policy Positions Of Candidates
The Kaiser Family Foundation (KFF) reviews the healthcare positions of both Kamala Harris and Donald Trump in a recent briefer analysis. It tells a story of pro-coverage Democrats vs. previous efforts by Republicans to rein in healthcare costs and coverage.
My view is that Trump will be less radical on Medicaid and the Affordable Care Act (ACA) than before. I doubt he will again push to repeal the ACA or radically change Medicaid. But on Medicaid he will seek to save due to his commitments on tax reduction extensions and not to touch Medicare.
The briefer does not give enough credit on what he proposed on drug price reform. Harris and Trump are much closer on these issues. I doubt Trump would seek to repeal Medicare drug price negotiations.
Further, a VP Vance could temper more radical views on healthcare from any Trump administration.
Additional article: https://www.kff.org/medicaid/issue-brief/medicaid-waiver-priorities-under-the-trump-and-biden-harris-administrations/
#medicaid #aca #obamacare #exchanges #medicare #healthcare
https://www.kff.org/medicaid/issue-brief/what-the-outcome-of-the-election-could-mean-for-medicaid/
Peterson-KFF Discuss How Many Adults Might Be Eligible For GLP-1s
A new Peterson-Kaiser Family Foundation (KFF) study finds about 42% or 57.4 million adults under 65 with private insurance could be eligible for GLP-1s as they would meet clinical criteria for GLP-1 drugs to treat type 2 diabetes, cardiovascular diseases, obesity or excess weight, and weight-related health issues. Other studies show that the high-cost of such weight-loss drugs threatens to jeopardize government programs and the healthcare system in general.
#weightlossdrugs #glp1s #drugpricing #healthcare
— Marc S. Ryan
