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January 3, 2025

Murkowski Supports Exchange Premium Subsidy Extensions Sen. Lisa Murkowski, R-AK, says she supports extending enhanced premium subsidies in the Exchanges because of the help it has provided people to afford coverage. Betting odds are still that the GOP-controlled Congress will allow the subsidies to expire at the end of 2025. But Murkowski’s statement leaves some hope for a long-shot, one-year extension some time in 2025. #exchanges #aca #obamacare https://thehill.com/policy/healthcare/5066188-murkowski-obamacare-premium-subsidies Johnson Wins On Government Efficiency Pledge In a razor-thin vote, House Speaker Mike Johnson, R-LA, won re-election on Speaker today with a commitment to advance President-elect Donald Trump’s “America First” agenda and work with Trump’s Department of Government Efficiency (DOGE) commission to reduce the size and scope of government. Before the vote, he took to X to pledge to appoint experts not associated with special interests to work with DOGE. Additional article: https://thehill.com/homenews/house/5065659-mike-johnson-clinches-speakership/ (Some articles may require a subscription.) #speakerjohnson #congress

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January 2, 2025

Laws And Rules That Went Into Effect as of January 1 A series of new healthcare federal and state laws and regulations went into effect on January 1. A federal rule update requires new fields and data related to pricing that must be disclosed by hospitals related to the price transparency requirements. This will create greater compliance, consistency, and better comparisons of prices. States enacted laws that restrict prior authorization, expand mandated benefits, expand Medicaid, require bias training, require cybersecurity audits, reform pharmacy benefit managers (PBMs), restrict cost-sharing for drugs, and undertake medical-debt reform. Additional: article: https://www.modernhealthcare.com/government/state-healthcare-laws-2025-california-illinois-minnesota-arkansas (Some articles may require a subscription.) #2025 #healthcarereform #regulations https://www.statnews.com/2025/01/02/hospital-price-transparency-rules-2025-cms/ Supporters Urge Making Price Transparency A Law Many supporters of healthcare price transparency are saying the rules passed by the Trump administration and amended by the Biden administration regarding health plans and hospital price transparency should be passed as a law to ensure

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January 1, 2025

Hospitals In Better Financial Shape Going Into 2025 Hospitals and health systems are on better financial footing than a year ago. Operating margins, cash flows, outpatient revenue, average inpatient length of stay, and outpatient revenue improved from 2023. For many providers (in particular health systems), volumes have rebounded to above pre-pandemic levels. In October 2024, the mean operating margin for hospitals was 4.4%, up from 2.5% in November 2023 and 2.7% in December 2023, says consulting firm Kaufman Hall. Labor expenses have dropped and inflationary pressures have subsided. But there has been continued growth in supplies, drug expenses, and purchased service expenses. On the policy front, hospital groups are worried about budget cuts under the incoming Trump administration that could lead to the expiration of Exchange enhanced subsidies, rate cuts in Medicare and Medicaid, and a pullback on coverage overall. As well, smaller entities could struggle on the cybersecurity preparedness

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December 31, 2024

Kennedy And Oz At Odds On GLP-1s Department of Health and Human Services (HHS) Secretary-nominee Robert F. Kennedy Jr. and Centers for Medicare and Medicaid Services (CMS) Administrator-nominee Dr. Mehmet Oz are at odds over support for GLP-1 weight-loss drugs. Oz has opined that the drugs could have a positive effect on weight loss and reducing disease prevalence. Kennedy sees them as a scam and insists that the American public simply needs to eat better. The Biden administration has proposed in a draft rule to provide Medicare Part D coverage for obesity alone. Trump will need to finalize the rule or remove the provision. This will be the first test of who will win the GLP-1 coverage war. The drugs are expensive at $1,000 or greater per month at list price. #glp1s #weightlossdrugs #drugpricing #branddrugmakers https://thehill.com/policy/healthcare/5055607-rfk-jr-vs-oz-sets-up-clash-on-weight-loss-drug-coverage Employers And PBMs Under Attack A good article on the rise of lawsuits against

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December 30, 2024

Some Hope For Medicaid Hikes Medicaid managed care plans have argued that risk in the program has gone up with the Medicaid unwinding (redeterminations) and rates have become inadequate to serve remaining enrollees. A number of state Medicaid directors are now saying mid-year rate hikes could address the financial woes of plans. The Alliance of Community Health Plans is urging the current administration to urge states to re-evaluate current rates. Notwithstanding the positive signs, states will have a hard time affording major hikes given the drying up of extraordinary federal revenue given to states during the COVID pandemic. (Article may require a subscription.) #medicaid #redeterminations #rates #healthplans #managedcare https://insidehealthpolicy.com/daily-news/states-promote-mid-year-rate-adjustments-mcos-struggling-post-covid Article Recaps Tough Year for UnitedHealth Group Becker’s recounts the very tough year seen by UnitedHealth Group, including the Change Healthcare cyberattack, government investigations, and the tragic killing of executive Brian Thompson. #unitedhealthcare #tragedy #changehealthcare #cyberattacks https://www.beckerspayer.com/payer/an-unimaginable-year-for-unitedhealth.html MA Does Not Offer

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