employers

House Passes Senate Version Of Budget Reconciliation Framework The House passed the Senate’s watered-down budget reconciliation framework on a party-line 216-214 vote. While the spending threshold in the bill did not change (it is de minimis), enough conservative Republicans jumped back on the bill after meetings with and pressure from House Speaker Mike Johnson, Senate Majority Leader Jon Thune, and President Trump. Conservatives are distrusting but got commitments from Trump and Johnson that as much as $1.5 trillion in cuts will be in the bill. Senate Leader Jon Thune gave a much softer commitment on levels of cuts. The House vote likely means that Congress will go after deeper cuts than not. Also controversial is the Senate bill assumes “current policy” not “current law” for budget scoring, which many, including I, call a gimmick that could lead to huge increases in deficits and debt in the future. The ongoing process

House GOP Abandons Budget Reconciliation Vote Tonight House Speaker Mike Johnson, R-LA, abandoned a vote on Senate reconciliation bill framework after rebellion by conservatives would have sunk the vote. Conservatives are upset by the Senate framework that has almost no spending reductions. In addition, the bill adopts a current-policy vs. current-law scoring of spending and taxes. The conservatives say the budget gimmick is disingenuous and would set a horrible precedent and drive up deficits and the national debt. The conservatives said they couldn’t move forward as they do not believe the Senate will agree to deep cuts if they pass the framework. The House GOP will now regroup on the issue and see if they can gather votes later in the week to pass the framework. Additional article: https://www.modernhealthcare.com/politics-policy/house-budget-resolution-medicaid-tax-cuts (Some articles may require a subscription.) #budgetreconciliation #congress #trump #spending #medicaid #healthcare https://thehill.com/homenews/house/5241418-johnson-vote-trump-budget-blueprint-conservative-opposition Study Pushes Back On MedPAC Assertions A new

Trump Backs Deep Spending Cuts Emerging from a meeting with Speaker Mike Johnson, R-LA, and House Republicans, President Trump declared he is supportive of major spending cuts. The meeting was meant to allay concerns of rightists in the House GOP caucus. Trump wrote on Truth Social: “I let them know that, I AM FOR MAJOR SPENDING CUTS! WE ARE GOING TO DO REDUCTIONS, hopefully in excess of $1 Trillion Dollars, all of which will go into ‘The One, Big, Beautiful Bill.’” Trump urged the House GOP to support a watered-down budget reconciliation framework from the Senate in the meantime but promised to help assemble meaningful reductions, most of them likely from healthcare. Trump said he would “be pushing very hard” to get deeper cuts. The budget bill looks to be a battle of the House and conservatives against the Senate and some more moderates who disagree on the level of

Medicare Advantage Plans Getting Higher Rates For 2026 The 2026 Medicare Advantage (MA) Final Notice was released this evening by the Centers for Medicare and Medicaid Services (CMS). After the Advance Notice in January, MA plans complained about a paltry rate hike of 2.23%. They asked the Trump administration to intervene and either tweak the risk model change phase-in or the one related to medical education reductions. Well, the Trump administration didn’t have to really do anything to drive up the 2026 rate. CMS did not change any policies on rates between the advance notice and final one. But the rate hike surged to 5.06% because the rate setting growth factor increased dramatically between the two notices. The change is projected to result in an increase of 5.06%, or over $25 billion, in MA payments to plans in CY 2026. MA plans and actuaries warned that trends in the program

Trump Administration Finalizes Pared Back MA And Part D Rule for 2026 The 2026 Medicare Advantage (MA) and Part D rule was finalized by the new Trump administration and it did not finalize many portions of the Biden administration proposed rule. These could be acted on after further review or never see the light of day again. Significant things not finalized: CMS did finalize several things and this is by no means a full list: The Final Notice for rates and other Star measures should be out Monday as well. CMS Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/contract-year-2026-policy-and-technical-changes-medicare-advantage-program-medicare-prescription-final Additional articles: https://www.fiercehealthcare.com/payers/medicare-advantage-final-rule-excludes-anti-obesity-drug-coverage-under-medicare-medicaid and https://insidehealthpolicy.com/daily-news/trump-finalizes-prior-auth-hospital-stay-reqs-medicare-advantage-rule and https://insidehealthpolicy.com/daily-news/cms-declines-finalize-ma-ai-guardrails-expresses-interest-future-ai-regulation and https://thehill.com/homenews/5233357-medicare-medicaid-obesity-biden-trump/ and https://insidehealthpolicy.com/daily-news/cms-scraps-biden-plan-cover-anti-obesity-medications and https://www.modernhealthcare.com/policy/medicare-advantage-prior-authorization-ai (Some articles may require a subscription.) #medicareadvantage #partd #cms #regulations #star #quality #glp1s #priorauthorization https://www.modernhealthcare.com/politics-policy/medicare-obesity-drug-coverage-trump FTC Chair Reverses Recusal And PBM Suit Can Proceed Federal Trade Commission (FTC) Chair Andrew Ferguson has reversed course on his decision to recuse himself from the agency’s

Oz Confirmed By Senate Dr. Mehmet Oz, M.D., was approved by the Senate to serve as administrator of the Centers for Medicare and Medicaid Services (CMS). The vote was along party lines, 53-45. Oz walks into an agency reeling from cutbacks by the Trump administration and layoffs. Meanwhile, a high-profile health influencer in the White House as a temporary employee appeared before a Politico health summit. Calley Means, close to health chief Robert F. Kennedy, Jr., said that the healthcare system has been plagued by inordinate influence from hospitals and drug makers and that CMS has been controlled by the American Medical Association (AMA). Means defended controversial HHS budget cuts and said that National Institutes of Health (NIH) research funding was not slashed. As well today, Sen. Susan Collins, R-ME, said she was very concerned about the prospects of deep Medicaid cuts given the House healthcare reduction target. Additional articles:

Senate Adopts “Current Policy” Scoring Budget Gimmick The Senate GOP has officially adopted a budget gimmick in its proposed budget reconciliation resolution. Appropriations Chair Sen. Lindsay Graham, R-SC, said he had the authority to adopt the budget scoring method and the Senate parliamentarian said it was appropriate to move forward. The resolution sets lower targets for spending cuts – a minimum of $3 billion. The resolution should be adopted later this week to align in general with the House approach. However, some conservatives in the House are already attacking the gimmick. The House approach sets a $1.5 trillion floor with a goal of $2.0 trillion in cuts over ten years. This could set up a showdown between moderates and conservatives on spending reductions. The truth is that the current policy approach means much higher deficits to 2034 and after. It is an appalling approach that further inflates our massive debt

Senate Seeks To Use Budget Gimmick In Budget Reconciliation The Senate has been forced to approach budget reconciliation the way President Donald Trump and the House Republicans want it – one “big beautiful bill” — to address taxes, spending cuts, and the debt limit. But because the Senate fears major spending cuts, it is entertaining a bit of a budget gimmick related to how the bill should be “scored” – how the Congressional Budget Office (CBO) will add up costs, savings, and the deficit. Traditionally, CBO scores apply “current law.”  Because the 2017 Trump tax cuts expire at the end of the year, extending them costs revenue. Senate budget rules say that, to avoid a filibuster cloture vote and pass the measure with 51 votes, the deficit cannot increase over the applicable budget horizon. Thus, offsetting cuts are needed. But GOP leaders in the upper chamber are looking at whether

Enrollment Marketing and Fraud Take Center Stage The lobby representing marketing agents and brokers is blasting Democrats’ legislation that would slap civil or criminal penalties on agents and brokers who submit fraudulent information regarding Exchange enrollment. It points the finger at the federal government for failing to enforce laws to protect consumers. At the same time, a report from Senate Finance Committee Ranking Member Ron Wyden says Medicare Advantage (MA) insurers are spending an increasing amount on fees and commissions paid to brokers. The report states that MA plans increasingly rely on third-party marketing organizations and lead generators to drive enrollment. Spending on such fees and commissions increased from $2.4 billion in 2018 to $6.9 billion in 2023. As well, the Paragon Health Institute is citing the indictment of two men for allegedly running a scheme to glean commissions by enticing people to misstate their expected income to gain subsidized

Trump Yet To Clarify Tariffs On Healthcare Products Donald Trump has yet to decide how potential tariffs on pharmaceutical products will be structured. In February, Trump said that tariffs on pharmaceuticals and other essential products would be about 25% and that U.S. companies may get a phase-in period for imported goods, giving them time to shift production onshore. In a new survey of 200 healthcare industry experts, 82% said they expect tariff-related import expenses to increase hospital and health system costs by 15%. So, most of the tariff costs will be passed through. Additional article: https://www.beckershospitalreview.com/supply-chain/hospital-finance-supply-leaders-predict-15-increase-in-tariff-related-costs/ (Some articles may require a subscription.) #drugpricing #branddrugmakers #tariffs https://insidehealthpolicy.com/inside-drug-pricing-daily-news/trump-undecided-structure-potential-pharma-tariffs-wh-says HCSC Joins Big Leagues An interesting article on Health Care Service Corporation’s recent acquisition of Cigna’s Medicare businesses. While Medicare Advantage (MA) has significant headwinds, HCSC leadership believes in MA’s long-term viability. It does not plan to become as much of a behemoth as the big