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States Seek To Mitigate Impact Of Expiring Subsidy Enhancements A handful of states have taken action to mitigate the impact of expiring subsidy enhancements in the Exchanges. The states include New Mexico, California, Maryland, Colorado, Connecticut, Arkansas, Texas, and Wyoming. Most states passed appropriations to replace some of the federal subsidy losses, while others passed premium realignment laws. #exchanges #coverage #healthcare https://www.beckerspayer.com/payer/aca/how-states-are-responding-to-expiring-aca-subsidies/ At Least 16 Health Systems Drop MA At least 16 health systems are dropping Medicare Advantage (MA) plans in 2026. Some big-name systems are included, and many are targeting big MA plans. #hospitals #healthplans #medicareadvantage https://www.beckershospitalreview.com/finance/16-health-systems-dropping-medicare-advantage-plans-2026 OIG Calls Out Payments For Deceased Enrollees The Health and Human Services’ Office of Inspector General (HHS OIG) says that state Medicaid agencies have made an estimated $289 million in improper capitation payments to managed care organizations on behalf of deceased enrollees since 2016. This comes from a series of audits. The

Major Drug Policy Developments Major drug policy developments this week. First, the hospital lobby scored a major victory when a court ordered the new 340B rebate pilot paused. The Trump administration is seeking to experiment with rebates as opposed to upfront discounts to curb the growth in the discount drug program. The administration rightfully alleges that the program is unaccountable and does not meet the original safety net purpose. The judge ordered a preliminary injunction against the “hastily assembled” pilot set to kick off on Jan. 1 on the basis it “likely” violates the Administrative Procedure Act’s (APA’s) arbitrary and capricious standard.  The judge noted Congress did authorize the federal government to create a rebate model, but regulators had not followed the APA’s requirements in doing so. Second, Rep. Anna Paulina Luna, R-FL, says she is hopeful Congress will codify President Trump’s executive order on capping prescription drug prices next

Exchange Subsidy Deal 50-50 Some lawmakers are saying that there may be a 50-50 shot at obtaining an agreement to extend enhanced Exchange premium subsidies in January. But there are major obstacles. GOP leaders in each house are tending to gravitate toward the larger conservative side of their caucuses, which is dead set against an extension. Minority Leader Chuck Schumer, D-NY, wants either a clean extension or to hang the issue around the GOP’s neck in midterms. Sen. Bill Cassidy is advocating the possibility of extending subsidies as well as seeding health savings accounts (HSAs) for some and giving Americans the ability to decide one way or another. Another leading compromise would extend for two years with some reining in of the generosity of the enhancements. The bill could come to life in this way. Four GOP lawmakers in the House signed on to a Democratic discharge petition which will

Trump Administration Unveils GLP-1 Pilot True to an earlier announcement, the Trump administration has taken the first step toward more expansive coverage of GLP-1 weight-loss drugs in Medicare and Medicaid. The president announced major deals with GLP-1 drug makers Eli Lilly and Novo Nordisk that both reduce net costs as well as set a proposed maximum $50 copay in Medicare for all coverage of GLP-1s. The new step includes the creation of the Better Approaches to Lifestyle and Nutrition for Comprehensive hEalth (BALANCE) Model. Under the model, the Centers for Medicare and Medicaid Services (CMS) negotiates directly with pharmaceutical manufacturers for lower net prices and standardized coverage terms. Negotiation areas include:  Participation will be voluntary for manufacturers, states, and plans. More information will be released in early 2026. The BALANCE Model will launch in Medicaid as early as May 2026 and in Medicare Part D in January 2027. Manufacturers, states,

Strategy On Exchange Subsidies Continues; Another Shutdown Possible House Minority Leader Hakeem Jeffires, D-NY, predicted that an extension of enhanced Exchange subsidies will pass the House with backing from both sides of the aisle. “House Democrats are going to continue to fight to get this extension through the Congress on our side. It will pass with a bipartisan majority,” Jeffries told ABC News’ “This Week.” With four GOP members joining Democrats to force a vote on the floor in January via discharge petition, the likelihood is there that the vote could pass. The three-year extension failed in the Senate, unable to get 60 votes. A bipartisan group there still thinks a compromise including a shorter extension, minimum premiums, an income cap, and fraud protections could be hammered out for each chamber. But there are reported barriers to a deal, including political pressures in the GOP caucus not to vote on any

Trump Moves Ball On Drug Prices President Donald Trump registered more wins on drug price reform. The White House announced that nine additional pharmaceutical companies have agreed to follow a most-favored-nation (MFN) drug pricing policy, with some of the companies throwing in several months’ worth of emergency drug supplies. As with other drug firms, the drug companies will lower the Medicaid prices for drugs that are more expensive than they’re sold in other countries, although prices are already deeply discounted through federal and state rebate programs. The firms will also deeply discount cash-pay customers’ drugs via the TrumpRx website. The deals also guarantee MFN prices on all new innovative medicines the nine companies bring to market. Trump has now reached deals with 14 of the 17 drug makers to which he sent letters in July demanding that they lower prices. At the same time, the Centers for Medicare and Medicaid Services

Exchange Saga Top House Democrats on Thursday called on House Speaker Mike Johnson, R-LA, to hold an immediate vote under the discharge process on extending the enhanced Exchange premium subsidies so they do not expire at the end of the year. Johnson is unlikely to do this due to objections from conservative caucus members. The House adjourns tomorrow for rest of the calendar year. A discharge petition for a bill to extend the subsidies received 218 signatures, including four moderate GOP lawmakers who snubbed the Speaker after he broke promise to run an amendment on the subsidy extension. These members are now working with moderates in the Senate to vote on a consensus bill in January. #exchanges #coverage #healthcare https://thehill.com/homenews/house/5654903-jeffries-democrats-johnson-obamacare-subsidies/?tbref=hp More Charged For Fraud in MN The Department of Justice (DOJ) charged more individuals as part of a huge Medicaid fraud scandal in Minnesota. In part the scandal focuses on