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Preliminary Reports Show Major Exchange Premium Hikes Exchange rate filings are beginning to filter in for 2026 and the news is not good. Many insurers are asking for double-digit rate increases in the individual and small group Exchange markets. This is occurring due to the likely expiration of enhanced premium tax credits and rising costs. Reports from various states say rate hikes could be as much as 23%. Average increases seem to be well into the teens. #exchanges #aca #obamacare #coverage https://www.beckerspayer.com/payer/payers-seek-double-digit-exchange-rate-hikes-for-2026 Big PBMs Suing Over State Regulatory Laws Many states have passed pharmacy benefits manager (PBM) regulation bills  and at least two big PBMs, CVS Caremark and Express Scripts, are suing to overturn the state laws. The PBMs argue that state regulation of PBMs is preempted by the Commerce Clause and federal regulation. The problem is that the feds have been very lenient over the years, which states say

Say This Three Times: Healthcare Cut Consternation Republican senators are weighing in with leadership regarding concerns with the “Big Beautiful Bill.” Moderates are concerned about spending cuts to Medicaid and the Supplemental Nutrition Assistance Program (SNAP). Budget hawks are demanding more deficit and debt reduction and want the House compromise on state and local tax (SALT) deductions undone. The conservatives also want $200 billion in reductions to Medicare in the area of fraud, waste, and abuse (FWA). There are at least two hard “No’s” on the conservative side. There are other conservatives very concerned and looking for more reductions. On the moderate and pragmatic conservative side, there are a number of senators very concerned about reductions. The House version of the bill would not be able to pass in the Senate as written based on probable numbers of negative votes on either side of the ideological divide. At least 4

Big Beautiful Bill Update Another update on the Big Beautfiul Bill as it seeks to work its way through the Senate. A number of major developments today. A new brief from America’s Essential Hospitals says the Medicaid reductions could mean an increase in hospital uncompensated care of $42.4 billion. The Paragon Health Institute, a conservative think tank with major influence in the administration, is urging the Senate to make changes in the bill to go deeper in terms of cuts and reform. It says lawmakers should make changes in the following areas: Republicans in the Senate are looking at making cuts in Medicare to offset Medicaid cuts or add to overall savings. The likely targets are Medicare Advantage (MA) plan risk adjustment upcoding as well as potentially site neutral payment reform. The Better Medicare Alliance opposes any reduction in MA. Paragon recommended Medicare reforms that could save $712 billion, including

Of Musk, Trump, Medicaid, Medicare, The ACA, And The Uninsured The budget reconciliation saga continues a day after Elon Musk attacked the bill as “a disgusting abomination.” The president leapt into action, trying to convince Senate conservatives to support the package with promises of later spending cuts. The bill hit another pothole today with a new Congressional Budget Office (CBO) score that said the bill will mean more than $1 trillion in cuts over a decade. This is higher due to the last-minute changes made in the House to obtain enough conservatives to pass the bill. The biggest hit comes in Medicaid, with a revised reduction of $864 billion. Work requirements save $344 billion after the House accelerated the provision to no later than December 21, 2026. What’s more, the CBO projects that the Medicaid cuts and other healthcare reductions in the bill will lead to 10.9 million people becoming uninsured, including 7.8 million who

Elon Musk Drops Bomb On Budget Reconciliation Just as Elon Musk exited Washington, the world’s richest man dropped a bomb on Donald Trump’s Big Beautiful Bill by calling it “a disgusting abomination.” Rightists in the Senate were already agitated by the increase in the deficit and debt as well as what they see as a lack of deep spending cuts, but Musk’s remark has egged the conservatives on. Sens. Rand Paul, R-KY, Ron Johnson, R-WI, Rep. Mike Lee, R-UT, and Rick Scott, R-FL, have all raised issues with the deficits and debt. Lee and Paul backed Musk after his comments went viral. On the other hand, at least four moderates and pragmatists in the Senate GOP caucus have expressed concern about Medicaid cuts. Normally conservative Josh Hawley has expressed major misgivings with Medicaid cuts and he said that Trump told him Monday that the final bill would not have Medicaid cuts. That

Major Healthcare Changes At HHS, CMS Centers for Medicare & Medicaid Services (CMS) Deputy Administrator Stephanie Carlton, laid out the agency’s major priorities, which include: More details on the president’s FFY 2026 budget proposal continue to show major reductions to various agencies — an $18 billion cut to the National Institutes of Health (40%), a $3.6 billion cut to the Centers for Disease Control (CDC) (43%), and a $409 million cut to the Food and Drug Administration (FDA) (11%). A number of new initiatives prioritized by health chief Robert F. Kennedy, Jr. are funded along with restructuring tied to the new agenda. Additional articles: https://insidehealthpolicy.com/daily-news/advocates-blast-proposed-cuts-nih-cdc-research-programs and https://www.healthcaredive.com/news/hhs-2026-budget-nih-cuts-trump-healthcare/749510/ (Some articles may require a subscription.) #hhs #cms #rfkjr #nih #fda #cdc https://www.fiercehealthcare.com/regulatory/cms-deputy-stephanie-carlton-lays-out-agency-priorities-0 Budget Reconciliation Questions Continue On Meet the Press, Speaker Mike Johnson, R-LA, defended work requirements and claimed that projections from his own budget office are wrong when it said 4.8

More Fallout From Budget Reconciliation The saga over the House reconciliation bill and what the Senate will do continues. Republicans in swing or moderate districts returned home to town halls with tough questions from their constituents about Medicaid and other social service cuts as well as the fact that deficits will increase under the bill. A healthcare policy group KFF issue briefer allocates the Congressional Budget Office’s federal spending reductions and enrollment losses across the states. The CBO’s latest cost estimates say the bill would reduce federal Medicaid spending by $723 billion over the decade timeframe and that the number of uninsured would increase by 7.6 million due to those cuts. KFF finds that the biggest reduction areas in Medicaid are: Federal cuts to states represent 11% of federal spending on Medicaid over the period. By state, the cuts range from 5% in Wyoming, Alabama, and Wisconsin to 15% in

FDA Commissioner Says Cost-Cutting Could Hurt Generic Introductions President Trump’s first Food and Drug Administration (FDA) Commissioner, Scott Gottlieb, made a great point in an opinion piece at statnews.com.  Gottlieb says that Trump did a tremendous job introducing generics swiftly under his first few years in office. Reductions at FDA now could be a boon for brand drug makers as generic approvals will be further backlogged and allow brand makers to effectively maintain a monopoly after patents expire. (Article may require a subscription.) #drugpricing #generics #brands #branddrugmakers #fda https://www.statnews.com/2025/05/28/fda-division-policy-development-generic-drugs-doge-cost-cutting-trump-glp-1s/ PBMs Sue Arkansas Over Ownership Law Pharmacy benefit management managers Express Scripts and CVS Health are suing Arkansas officials to challenge a law that bars PBMs in the state from owning pharmacies. Additional article: https://www.fiercehealthcare.com/regulatory/arkansas-governor-signs-bill-barring-pbms-owning-pharmacies (Some articles may require a subscription.) #pbms #drugpricing #pharmacies https://www.modernhealthcare.com/legal/express-scripts-cvs-health-arkansas-pbms Healthcare Costs For Average Person Went Up 6.7% in 2025 The  Milliman Medical Index (MMI), which

Study Shows Proliferation Of GLP-1s A new study finds that the number of people prescribed GLP-1 drugs for weight management has skyrocketed over the past five years. FAIR Health’s study finds that just over 2% of adults in the U.S. took a GLP-1 to treat obesity or being overweight in 2024, up from just 0.3% in 2019. For those not diabetic, the percent of such adults increased from 0.03% in 2019 to 0.67% in 2019, or 1,960.9%. While big national providers have sought to expand GLP-1 coverage while de-risking impacts, other plans are discontinuing coverage due to surging costs. A number of Blues are discontinuing obesity-only GLP-1 coverage. In other news, compounders continue filling compounded GLP-1 drugs by arguing individual formulations are allowable. Additional article: https://www.modernhealthcare.com/insurance/bcbs-plans-michigan-massachusetts-glp1-coverage and https://www.healthcaredive.com/news/glp1-obesity-weight-loss-adoption-fair-health/748963/ and https://insidehealthpolicy.com/inside-drug-pricing-daily-news/telehealth-companies-use-loophole-continue-glp-1-sales (Some articles may require a subscription.) #weightlossdrugs #glp1s #healthplans #pbms #drugpricing #branddrugmakers https://www.fiercehealthcare.com/payers/fair-health-heres-how-much-glp-1-prescriptions-obesity-overweight-have-grown-2019 MA Industry Divided On Risk Adjustment Audits

Senate Conservatives Want Deep Cuts Conservative senators are arguing that huge new spending cuts need to be added to the budget reconciliation bill if they are to vote for the package. One lawmaker called the bill a “debt bomb.” At least four senators on the right have raised issues with the long-term implications of more debt and deficits. Deficits will grow from $2.2 trillion a year in FFY 2025 to more than $2.5 trillion in FFY 2035. Many want a return to pre-pandemic levels of spending. The Senate problem is a group of moderates who could sink the bill want fewer Medicaid cuts. Also, a good article on the provider tax reductions and impacts on states and providers. And a good article talking about impacts to younger Americans of losing Medicaid. Additional article: https://stateline.org/2025/05/27/republicans-target-a-tax-that-keeps-state-medicaid-programs-running/ and https://www.healthcaredive.com/news/medicaid-cuts-impact-young-adults-urban-institute/749030/ #budgetreconciliation #trump #congress #medicaid #coverage https://thehill.com/homenews/senate/5316940-trump-bill-fiscal-concerns-republicans CMS To Investigate Illegals On Medicaid Rolls The