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Medicare Advantage Abuses in Focus A big day for coverage involving abuses in Medicare Advantage (MA). First, Scan CEO Sachin Jain has a good Health Affairs Forefront blog on MA enrollment issues. Jain recounts the fact that there are behind-the-scenes compensation schemes between some large MA plans and brokers and marketing organizations that lead to steerage of enrollees into plans, often when it is not in their best interest. He notes enrollment in low-rated plans is a problem. The Department of Justice filed a complaint against certain brokers and MA plans, alleging plans paid hundreds of millions of dollars in illegal kickbacks to brokers in exchange for enrollments into the plans’ products. Jain proposes a change in how compensation is made for enrollment by favoring high-performing plans and perhaps making compensation is budget neutral. Second, healthcare policy group KFF posted an issue brief regarding expected Star bonus payments in 2025. It

Public Supports Trump Drug Pricing Plan A survey commissioned by the Pharmaceutical Reform Alliance and conducted by National Research Inc. finds that a majority of voters are in favor of lawmakers and candidates who they believe will take on Big Pharma price-gouging. Most say they support President Trump’s most-favored-nation drug pricing policy, where prices in the U.S. are set based on the lowest price in other developed nations. #drugpricing #mfn #irp #trump https://thehill.com/homenews/5343025-survey-voters-big-pharma-most-favored-nation Will Senate Go After Medicare? Despite discussing proposals to rein in Medicare Advantage (MA) overpayments in the budget reconciliation bill, some Republicans are saying there is little appetite to add such cuts in. This comes from senators who sought their inclusion. In addition, the House has passed tweaks to the bill they adopted to ensure consistency with Senate Byrd reconciliation rules. Additional article: https://www.politico.com/news/2025/06/10/house-gop-reveals-list-of-tweaks-to-megabill-00398669 and https://thehill.com/homenews/house/5345047-house-gops-technical-changes-trump-agenda-bill/?tbref=hp #medicareadvantage #riskadjustment #overpayments #budgetreconciliation https://thehill.com/homenews/senate/5344838-medicare-advantage-reform-less-likely Reasons Beneficiaries Disenroll From Medicare Advantage A

Senate Now Zeroing In On Medicare Advantage The Senate appears to be zeroing in on Medicare Advantage (MA) overpayments for the budget reconciliation bill to achieve greater savings and perhaps reduce Medicaid cuts. MA plans and lobbies are lining up to oppose it, saying the reductions will impact enrollees. Sen. Bill Casidy, R-LA and Chairman of the HELP Committee, is one GOP senator examining it, which has bipartisan support (not that Democrats will vote for the bill). Exactly what would be included is open. One report says the provision would save $100 billion over the 10-year horizon and would limit the ability to include old or unrelated medical conditions in the cost of care. Another proposal would save as much as $275 billion over 10 years. Very high estimates suggest total overpayments from risk adjustments are $43 billion annually (although I have great doubt about that number). The Centers for

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