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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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February 6, 2025

Molina Reports Mixed Financial News Medicaid-dominant insurer Molina Healthcare had its net income grow 8.1% to $1.2 billion in 2024 as revenue spiked 19.3% to $40.7 billion. For the fourth quarter, net income rose 16.2% to $251 million as revenue increased 16% to $10.5 billion. But like other insurers, Molina struggled with medical expenses and had an 89.1% medical loss ratio (MLR) in 2024, one percentage point higher than in 2023. Membership expanded by 10.8%. Molina expects Medicaid spending to increase by 4.5% in 2025, but thinks cost pressures will ease. Molina sees growth and financial success in 2026 and beyond with new state Medicaid awards and success on bidding in existing states. Molina Healthcare CEO Joe Zubretsky downplayed attempts by Republicans to gut or limit Medicaid in upcoming reconciliation bills. He thinks any cuts will be marginal. See my blog this week on the topic: https://www.healthcarelabyrinth.com/will-medicaid-and-the-affordable-care-act-see-huge-cuts/ . Additional articles: https://www.healthcaredive.com/news/molina-earnings-q4-2024-medicaid/739391/ and https://www.fiercehealthcare.com/payers/medicaid-cuts-washington-will-be-marginal-says-molina-healthcare-ceo (Some

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February 5, 2025

Elon Musk Targeting CMS and Medicare Elon Musk and his Department of Government Efficiency (DOGE) commission is now targeting the Centers for Medicare & Medicaid Services (CMS) as part of efforts to reduce spending and waste. In particular, Musk is targeting Medicare for fraud, waste, and abuse (FWA). The DOGE representatives have gained access to payment and contracting systems. In other news, the hospital lobby is petitioning President Donald Trump to grant carveouts for medical devices and pharmaceutical products for tariffs. China is a large exporter of such products. As well, Democratic lawmakers are asking the Trump administration why some federal financial assistance recipients still aren’t receiving funds after two judges froze the spending freeze. Additional article: https://www.modernhealthcare.com/politics-policy/elon-musk-doge-fraud-medicare-medicaid and https://www.beckershospitalreview.com/legal-regulatory-issues/doge-probes-cms-for-medicare-medicaid-fraud-wsj.html and https://www.fiercehealthcare.com/providers/hospitals-ask-trump-exempt-medical-pharma-products-tariffs and https://www.fiercehealthcare.com/regulatory/trump-admin-orders-temporary-pause-most-federal-financial-assistance (Some articles may require a subscription.) #doge #fwa #cms #medicare #spending #tariffs #healthcare https://www.fiercehealthcare.com/regulatory/labor-unions-sue-trump-admin-over-treasury-takeover-citing-privacy-concerns Coalition Asks Trump To Revive PBM Reform A broad coalition of healthcare

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February 4, 2025

Party-Line Vote Advances Kennedy To Senate Floor Robert F. Kennedy, Jr. turned the vote of Sen. Bill Cassidy and gained a 14-13 Senate Finance confirmation vote, which means he has survived and will likely gain Senate confirmation. Cassidy gained concessions from the Trump administration in return for supporting Kennedy’s nomination. Whether you agree with Cassidy’s decision or not, the articles show that Cassidy spent a great deal of time gaining procedural and other commitments in return for supporting Kennedy. The concessions empower the Senate healthcare policy committees in a major way. He deserves a great deal of credit here for taking his role to advice and consent seriously. Vice President JD Vance also played a major role in working with Kennedy and Cassidy. Additional articles: https://www.modernhealthcare.com/politics-policy/rfk-jr-nomination-advanced-senate-finance-committee and https://www.medpagetoday.com/publichealthpolicy/washington-watch/114079 and https://thehill.com/homenews/senate/5125761-cassidy-says-he-secured-key-vaccine-commitments-from-rfk-jr/ and https://www.healthcaredive.com/news/rfk-jr-clears-key-hurdle-on-path-to-hhs-secretary/739096/ and https://insidehealthpolicy.com/health-insider/rfk-jr-confirmation-sent-floor-cassidy-onboard-budget-resolution-stalled (Some articles may require a subscription.) #trump #rfkjr #hhs #congress #healthcare https://www.fiercehealthcare.com/regulatory/top-republican-airs-concerns-about-rfks-bully-pulpit-and-vaccine-hesitancy Trump Sets A Deregulation

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February 3, 2025

Trump Wants To Preserve Medicaid By “Loving And Cherishing It” On Friday, President Donald Trump promised to “love and cherish” Social Security, Medicare, and Medicaid. Notice Medicaid made it to the earlier list of protected programs. Trump continued: “We’re not going to do anything with that unless we can find some abuse or waste. The people won’t be affected. It will only be more effective and better.” A sea change for Trump? Perhaps. But let’s not get too hopeful from one press statement. See my blog today on some interesting developments on the healthcare front. Trends suggest healthcare cuts may not be as deep as once suspected during the budget reconciliation process: https://www.healthcarelabyrinth.com/will-medicaid-and-the-affordable-care-act-see-huge-cuts/ #medicaid #aca #obamacare #exchanges #trump #congress #budgetreconciliation https://www.politico.com/live-updates/2025/01/31/congress/trump-love-and-cherish-medicaid-00201893 Medicare Advantage Risk Adjustment Reform While I disagree with some of the overpayment numbers quoted in this Health Affairs Forefront blog, I find interesting the authors’ position on tackling

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