2024

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February 20, 2025

Trump Limits Public Benefits To Undocumented President Donald Trump issued an executive order that limits public benefits for undocumented immigrants. It directs each federal agency to identify programs that currently allow undocumented immigrants to receive federal benefits and to comply with the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, which generally prohibits such benefits. The order also mandates the enhancement of eligibility verification systems. It also seeks to limit or bar funding state and local programs that either subsidize illegal immigration or support sanctuary policies. Fourteen states plus D.C. provide state-funded healthcare coverage to children regardless of immigration status. California is the first state to offer Medicaid coverage to all eligible undocumented individuals. #trump #immigration #healthcare https://www.beckershospitalreview.com/legal-regulatory-issues/trump-signs-executive-order-to-end-federal-benefits-for-undocumented-immigrants.html Medicaid Cuts Consternation President Donald Trump’s endorsement runs smack into his public commitment that he will not take a meat axe to Medicaid benefits. Trump this week endorsed the one-bill approach to

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February 19, 2025

Trump Endorses House GOP One-Bill Approach President Donald Trump came out today in favor of the House GOP’s one-bill approach, surprising the Senate which felt he was taking a wait-and-see, go-slow approach on the issue. The one bill approach has steep spending reduction targets in it. Still, the fate of the House bill is uncertain. Speaker Mike Johnson can afford to lose no more than one vote on the reconciliation bill. Several moderates have expressed concerns on healthcare cuts. Some conservatives are complaining cuts are not deep enough. While leaders claim healthcare cuts to Medicaid and the Affordable Care Act (ACA) will not disrupt coverage, the savings targets could make that promise difficult to keep. Some conservatives are arguing that reductions in state reimbursement or even how much the federal government contributes should occur, which undoubtedly would impact coverage. Reining in provider taxes could also impact state financing schemes and

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February 18, 2025

Worried About House Vote, Senate Takes Different Path on Budget Reconciliation On a 50-47 vote, the Senate GOP officially started the process of passing a budget reconciliation bill in a bid to enact a portion of President Trump’s agenda.  The Senate is taking a two-bill approach to meet President Trump’s objectives, while the House is moving on one big bill. The Senate fears House Speaker Mike Johnson will not have enough votes on his plan because conservatives are demanding deep cuts and others want more moderate ones. The Senate’s first bill would spend $325 billion to bolster border operations and allow Trump’s deportation plans to be executed as well as boost defense spending and greenlight Trump’s energy plans. The Senate Republicans are planning to use a second reconciliation bill to extend Trump’s 2017 tax cuts. The second bill would include offsetting spending cuts. #budgetreconciliation #trump #congress #healthcare https://thehill.com/homenews/senate/5152221-senate-gop-budget-resolution/?tbref=hp Strange Bedfellows Against

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February 17, 2025

Study Shows How Obesity Impacts Employer Healthcare Costs UnitedHealthcare and the Health Action Council have examined how the obesity epidemic has impacted the healthcare costs of employers and how it will continue to do so in the future. About 75% of adults in the U.S. are either overweight or obese, up from 50% in 1990. Obesity rates have grown fastest among younger adults. The obese population accounts for 46% of the employers’ medical spend. Per member per month costs for obese employees are more than double ($973) than those who were not obese ($421). Metabolic conditions are common among people with obesity. For workers in their ’50s, diabetes rates are 2.5 times higher among obese individuals. Hypertension rates were three times higher. Those who were obese also had greater rates of behavioral health illnesses. Study: https://healthactioncouncil.org/media/i5qj3qah/2025-hac-white-paper.pdf #obesity #glp1s #weightlossdrugs #healthcare #chronicconditions #employercoverage https://www.fiercehealthcare.com/payers/unitedhealth-hac-study-examines-how-obesity-impacting-employer-health-costs Trump To Defend Brainwood Using Biden Arguments

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February 14, 2025

Major Staff Cutbacks In Healthcare At Federal Government The Trump administration has directed agencies to begin laying off probationary employees. The Department of Health and Human Services (HHS) and related agencies are firing up to 5,200 probationary employees as of today. About 1,300 are employed by the Centers for Disease Control and Prevention (CDC) and a sizeable number are with the National Institutes of Health (NIH). There are over 2 million federal employees. Additional article: https://www.modernhealthcare.com/labor/cdc-layoffs-cuts-trump (Some articles may require a subscription.) #hhs #nih #cdc #staffing #layoffs #trump #doge https://www.fiercehealthcare.com/regulatory/mass-layoffs-hhs-cdc-cuts-1300-probationary-workers-reports-say Trump Administration Cuts Exchange Navigator Funding Similar to what happened in its first term, the Trump administration axed Exchange Navigator funding by 90% to just $10 million. The navigator program received $98 million in the 2024 plan year but only enrolled 92,000 consumers, accounting for just 0.6% of selections through federally facilitated exchanges (FFEs) in the open enrollment period. Trump’s

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February 13, 2025

RFK, Jr. Confirmed As Health Chief; Will Chair MAHA Commission President Donald Trump’s nominee as secretary of Health and Human Services (HHS), Robert F. Kenndy, Jr., was confirmed by the Senate today on a 52-48 vote, with Mitch McConnell being the only GOP senator to not vote yes. All Democrats opposed Kennedy. Trump also signed a new executive order to establish a Make America Healthy Again (MAHA) Commission. Kennedy will chair the task force, focused on investigating the “root causes of America’s escalating health crisis.” The commission first will address childhood chronic diseases. In other news, HHS assistant secretaries were also named by Trump. One of them is an anti-trust lawyer with deep background in healthcare mergers.  This could be a clue that the Biden administration’s healthcare anti-trust agenda may not totally go away. Additional articles: https://www.fiercehealthcare.com/regulatory/trump-creates-maha-commission-chronic-disease-chaired-rfk and https://insidehealthpolicy.com/daily-news/newly-confirmed-hhs-sec-rfk-jr-lead-maha-commission and https://www.modernhealthcare.com/politics-policy/rfk-jr-full-senate-vote-hhs and https://www.healthcaredive.com/news/rfk-jr-confirmed-hhs-secretary-robert-f-kennedy-jr/740054/ and https://insidehealthpolicy.com/daily-news/trump-nominates-two-hhs-asst-secretaries-general-counsel (Some articles may require a

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February 12, 2025

Healthcare Segments’ Top Priorities A good article in Fierce Healthcare on the priorities of the various healthcare segments for 2025. Here are the highlights and there will be some battles between the parties. Hospitals – extending Exchange premium subsidy enhancements, further health plan prior authorization (PA) and utilization management limits, fighting coverage reductions, and maintaining the 340b program substantially as is. Plans – relief on Medicare Advantage (MA), and PBM reform (most health plans support except those with sister company PBMs). Providers – a Medicare rate fix, reducing administrative burden, and workforce reform. Also on the agenda is extending telehealth flexibilities and the hospital-at-home program. #healthcare #healthplans #hospitals #providers #medicare #exchanges #medicaid https://www.fiercehealthcare.com/regulatory/healthcare-lobbying-2025-here-are-top-policy-issues-hospitals-payers-docs-and-tech Budget Reconciliation Progress But Showdown Looming The House announced it is moving forward with a one reconciliation bill approach and will mark up a budget resolution quickly. The resolution will allow the deficit to rise $4.5 billion

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February 11, 2025

Humana Continues Digging Out Of Its Financial Troubles Medicare Advantage (MA)-dominant Humana told investors today that it was prioritizing efficiency as it continues to dig out from financial woes due to the MA rate and regulatory landscape. Due to uncertainty, including on rates, it is not yet able to give guidance going into 2026 but affirmed its guidance for the current year. Humana is also suing the Centers for Medicare and Medicaid Services (CMS) over its 2025 Star ratings, accusing the agency of gross regulatory violations and incompetence in administering the quality bonus program. Humana posted a $693 million loss in Q4, an increase from a Q3 loss of $541 million. The company also halved its profits for the full year 2024 compared to 2023, posting $1.2 billion. Humana earned $2.5 billion in profit for 2023. Humana expects to lose up to 550,000 MA members this year. It lost 445,000

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February 10, 2025

Trump May Impose Tariffs On Drugs, But Calls Pricing Unfair And Wants Change In an exclusive Super Bowl interview on Fox News, President Donald Trump seemingly endorsed tariffs on drugs but said in the end drug costs would come down. Many are worried that tariffs on drugs and other medical devices will further drive up healthcare costs. But Trump seemed to signal he intends to try to end the fundamental unfairness of drug prices in America compared with other developed countries. Trump used the example of Ozempic costing $88 a month in the U.K., while it is $1,200 a month in America. Trump’s rough prices are entirely accurate and represents what he said was roughly ten times more in America. Trump said the U.S. has been too nice on the issue. In a recent blog, I predicted that the populist Trump would come around on the issue of drug pricing

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February 7, 2025

As DOGE Works, Evidence Of FWA Emerges Even as Democrats excoriate Elon Musk and the Department of Government Efficiency (DOGE) commission for its far-reach and tactics, more word is coming out about the depth of improper payments made through Medicare and Medicaid. While the estimate is down since the COVID pandemic, a new report says there was $88.5 billion in improper payments in 2024, more than 5% of outlays last year. A Centers for Medicare and Medicaid Services (CMS) fact sheet says improper payments from federal programs can include payment errors or fraudulent payments but most often involve insufficient or missing documentation in reporting by states, providers, or contractors. My view: fraud, waste, and abuse (FWA) is much higher. Latest estimates suggest FWA is more like 25% of all healthcare costs, up from a traditional 10% norm used before.  That would mean FWA accounts for over $1 trillion in the entire

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