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January 10, 2025

January 10, 2025 No Comments

2026 MA Proposed Rate Announced The outgoing Biden administration has released its Advance Notice for 2026 rates and other policy changes. I quickly reviewed the 180-page Advance Notice, the CMS Fact Sheet, and CMS Press Release. Here are some highlights and Healthcare Labyrinth will have more information on rates and Star changes next week. My summary: The announcement is progress for MA plans and will be a bit of a relief for insurers and investors. But this still is a very skimpy increase given all the MA world is facing. It could mean a third year in MA benefit cuts. Details: — CMS says MA rates go up by 4.33%. But plans will take issue with including a risk score trend of 2.1% in the calculation. Plans will say they will get closer to a 2.23% because plans do not count the coding increase as a real revenue increase. They

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January 9, 2025

January 9, 2025 No Comments

Musk Calls Out Goals For DOGE Tesla CEO Elon Musk, who is co-leader of Donald Trump’s proposed Department of Government Efficiency (DOGE) commission, said that the best-case scenario would be to put together $2 trillion in cuts to federal spending. He said that then DOGE would have a good shot at executing $1 trillion in reductions. Whether the goal is a real $1 trillion or $2 trillion, it is clear that healthcare program cuts will play a big role in spending reductions. #doge #government #spending #trump #congress #healthcare https://thehill.com/homenews/administration/5076095-elon-musk-doge-2t-spending-cut-goal/?tbref=hp Generic Drug Lobby Worried About Tariffs The U.S. generic drug lobby is worried about the imposition of tariffs and wants to convince the incoming Trump administration such tariffs would hurt efforts to lower drug prices. The Lobby is also pushing for so-called “skinny” labeling, biosimilar automatic interchangeability, and patent reform. (Article may require a subscription.) #drugpricing #generics #tariffs #trump #biosimilars #patents

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What Could Healthcare Spending Cuts Look Like?

January 9, 2025 No Comments

Trump’s goal of extending the 2017 tax cuts could have major implications for healthcare In Monday’s blog, I told you that the incoming Trump administration will be dominated by budget matters in 2025, with an effort to find enough savings to extend the 2017 tax cuts. The proposed Department of Government Efficiency (DOGE) commission seems dedicated to a fundamental remake of government, programs, and regulations. While the Republican or GOP control of both Houses is tight, leaders and the rank-and-file seem ready to hitch their wagons to Trump and his agenda. But as I noted Monday, process and procedures could create challenges. With all this in mind, what might healthcare cut proposals look like? The DOGE, Trump, and congressional GOP lists will likely be culled from various sources including governmental authorities and outside conservative think tanks. The lists below include proposals from the Congressional Budget Office (CBO) and a number

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January 8, 2025

January 8, 2025 No Comments

Exchange Enrollment Hits Record With about a week left of enrollment, the Centers for Medicare and Medicaid Services (CMS) said that the Exchanges have reached yet another record enrollment number after mostly lagging during the enrollment season. More than 23 million people have selected coverage. There are 3.2 million new enrollees. Of the people who have signed up so far, 16.7 million found coverage on the federal Exchange, with 6.9 million on the state Exchanges. This is the fourth consecutive year of enrollment records. Enhanced premium subsidies expire at the end of 2025, which could dramatically impact enrollment. Today congressional Republicans declined to say they would simply let the subsidies expire. Instead, they expect the issue to emerge during talks to extend the Trump tax cuts and the reconciliation process. I still see this as a long shot, but it is bolstered by Sen. Lisa Murkowski’s advocacy for continuation of the enhancements.

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January 7, 2025

January 7, 2025 No Comments

Biden Administration Finalizes Medical Debt Provision The federal Consumer Financial Protection Bureau issued finalized regulations barring medical debts on credit reports. The rule bans credit agencies from including medical debts on consumers’ credit reports and prohibit lenders from considering medical information in assessing borrowers. To me, it is very unlikely the Trump administration will seek to overturn the regulation. I support the provision. Americans with and without insurance are unfairly saddled with huge provider bills that are exorbitant and have no basis in cost or fact. Additional article: https://www.modernhealthcare.com/politics-policy/joe-biden-bans-medical-debt-credit-scores-cfpb-donald-trump (Some articles may require a subscription.) #medicaldebt #providers #healthcare https://thehill.com/policy/healthcare/5070182-medical-debt-removed-credit-reports-cfpb Medtech Bracing For Tariffs Under Trump Medtech companies are bracing for imposition of tariffs (of at least 25%) on medical devices once Donald Trump takes office. This could drive costs up in the healthcare arena as a majority of devices are manufactured overseas. The industry also says this could impact innovation. The

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January 6, 2025

January 6, 2025 No Comments

Could Trump Bring Back International Reference Pricing Interesting Forbes article alluding to a December dinner with President-elect Trump attended by Eli Lilly CEO David Ricks. Apparently, international reference pricing to set Medicare drug prices was discussed. Subsequently, Ricks has alluded to the need to increase prices abroad in developed countries, leading some to speculate Trump could re-issue his proposal for adopting the most favored nation prices for Part B medical drugs in Medicare. At the time, Trump said he might even make the proposal applicable to Part D retail drugs in Medicare. During the campaign, he seemed to swear off the idea, but we know Trump changes his mind. He is also obsessed by being ripped off by other nations. Drug pricing is a great example. Drug makers agree to low prices in other developed countries because America pays for the vast majority of its profits (about three-quarters). The money

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What Will Trump’s Second First 100 Days Look Like?

January 6, 2025 No Comments

What will the early months of a new Trump term mean for healthcare? President-elect Donald Trump is scheduled to take office on January 20 after coming back from the political dead. Trump will become just the second president to serve non-consecutive terms. For the politically curious, the first was Grover Cleveland in 1885 and then again in 1893. Cleveland beat Republican James Blaine in 1884, winning both the electoral and popular votes. He lost to Republican Benjamin Harrison in 1888. Harrison won the electoral vote, but Cleveland won the popular vote. Cleveland came back to beat Harrison in 1892, getting both the electoral and popular vote. A now more government-savvy Trump has come out fast to put together his agenda and personnel for his second term, a major difference than what occurred in 2017 when Trump looked flat-footed during the transition. Trump already has almost all of his nominees picked

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January 3, 2025

January 3, 2025 No Comments

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

January 2, 2025 No Comments

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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Channeling Nostradamus: The Healthcare Labyrinth’s 2025 Predictions

January 2, 2025 No Comments

Even a master seer would have problems predicting what will occur in healthcare in 2025 In my last blog, I gave you my healthcare year-in-review for 2024. After that, as I always do each year, I play Nostradamus to prognosticate about what will happen in the next twelve months in the world of healthcare. Despite my Irish last name, I do have French blood (well, 50% French Canadien, so I count it). But I don’t claim to be an oracle or seer like our 16th century physician, apothecary, and astrologer friend. I do take a page from Nostradamus, though, in that my healthcare predictions for 2025 (not really prophecies) will be sometimes deliberately vague (they include a lot of mays, coulds, shoulds, perhaps, likelys and possibles) so as to amass a reasonable record for those tracking and putting together my forecasting report card for the history books. It also tends to make my

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