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Stars Health Equity Change Examined A great Modern Healthcare article on the Trump administration’s proposal to expunge the Excellent Health Outcomes For All (EHO4all) health equity reward just a month before the second measurement year close. I am one of the Stars experts quoted. I make the argument that there are winners and losers when eliminating EHO4all and keeping the Reward Factor for high-performing plans. I think plans with major dual eligible populations and no near-term expectation of obtaining the Reward Factor could have a colorable argument that the rule does not give plans due process of a change. The switchback will cost Medicare billions. (Article may require a subscription.) #cms #medicareadvantage #stars #quality https://www.modernhealthcare.com/insurance/mh-medicare-advantage-star-ratings-centene-molina CVS Reports Improved Expectations At its annual investor day, CVS Health said its outlook for the year will be better than reported and it also gave a positive report for 2026. CVS says full-year 2025

Competing Senate Healthcare Bills Senate Republicans launched competing proposals today to address the healthcare debate. Some want to preserve the enhanced subsidies, while others want the enhanced subsidies to expire and be replaced by direct cash to Americans. GOP Sens. Bernie Moreno, R-OH, and Susan Collins, R-ME, introduced a bill with a two-year extension of the enhancements with some conservative reforms – an income eligibility cap at $200,000, minimum premiums of $25 per month, and fraud reforms. The main competing proposal from HELP Chair Bill Cassidy, R-LA, and Mike Crapo, R-ID, doesn’t extend the subsidies at all. Instead, it would redirect that money into Health Savings Accounts paired with bronze or catastrophic plans on the Exchanges. Certain ACA enrollees earning less than 700 percent of the federal poverty level would receive $1,000 in an HSA if they’re 18 to 49 years old, and $1,500 if they’re 50 to 64. In

Moderate GOPers Frustrated On Exchange Impasse Frustration is mounting for moderate GOP lawmakers as the GOP has no defined healthcare plan, and Democrats are capitalizing on the lack of affordability in healthcare and the expiration of enhanced subsidies in the Exchange. Millions will see surging premiums as of January 1 with no action to extend the subsidies. Dozens in the GOP caucus in the House from swing districts face an uncertain future. A few GOP senators are also vulnerable. But so far, House Speaker Mike Johnson, R-LA, bolstered by opposition from conservatives, refuses to guarantee a vote in the House. In the Senate, Majority Leader John Thune, R-SD, did agree to hold a vote and Democrats are pushing a three-year extension. Sixty votes are needed to pass the bill. Democrats would need thirteen GOP defectors. It is a near impossibility. In other news, MedPage Today talks about the irony that

Schumer Unveils Three-Year Subsidy Extension Senate Minority Leader Chuck Schumer, D-NY, unveiled a clean three-year extension of enhanced premium subsidies for a vote next week in the upper chamber. This came after a group of Senate Democrats gained a commitment from Senate Majority Leader John Thine, R-SD, for a subsidy vote when the group agreed to support a bill to reopen the government. Some Democrats have held talks with centrist Republicans to seek a compromise that would temporarily extend the enhanced subsidies while adding policies such as income eligibility caps, minimum premiums, and anti-fraud measures. This could mean the bill is amended to attract GOP votes to get to 60 votes. Some GOP senators are open to doing so, frustrated with the lack of any real GOP alternative. There are some GOP bills being developed which focus on Health Savings Account support but are not expected to be ready in

Will Subsidy Extension Pass? A Senate vote on a clean, three-year enhanced Exchange subsidy extension is scheduled for next week. And many Republicans are frustrated that their party is divided and no consensus can be reached on any compromise legislation. Any Republican bill would not be ready until after next week. That opens up the possibility that enough Republicans cross the aisle and vote with Democrats to extend the subsidies as is. House Speaker Mike Johnson, R-LA, has not yet committed to bring up the bill, but Democrats and some moderate Republicans could force a vote through a discharge petition. Given the lack of a real Republican bill, GOP lawmakers in both chambers are coming around to a temporary extension of enhanced Exchange subsidies. Conservative House and Senate Republicans either want fundamental reform or no action to extend the enhanced subsidies. Moderate Republicans in the House want either a clean

Nursing Home Staffing Rule In Dustbin The controversial rule seeking to impose nursing home staffing requirements has been officially repealed by the federal government after a judge struck down the Biden administration provision. The rule would have meant huge costs for the industry and actually either forced the shutter of smaller firms or led them to sell out to massive consolidators in the industry. The rule was a political sop to the unions as well. Additional article: https://www.modernhealthcare.com/politics-regulation/mh-cms-nursing-home-staffing-mandate-repealed/ (Some articles may require a subscription.) #nursinghomes #staffing #medicaid #medicare https://www.fiercehealthcare.com/regulatory/hhs-closes-book-controversial-nursing-home-staffing-mandate New ACCESS Model Tests Chronic Care In Medicare The Centers for Medicare and Medicaid Servies (CMS) announced a new payment model on December 1. The ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model tests an outcome-aligned payment approach in Medicare. The model is aimed at expanding access to new technology-supported care options that help people improve their health and prevent

Exchange Subsidy Debate Still Dominates Hill The Exchange subsidy debate continues to dominate Capitol Hill. Sen. Amy Klobuchar, D-MN, predicted Sunday that the Senate will hold a vote on extending Exchange subsidies. “That vote will happen. And whether it will pass is in the hands of Donald Trump and the Republicans,” Klobuchar told CNN. Senate Majority Leader John Thune, R-SD, has committed to a vote, while House Speaker Mike Johnson, R-LA, has not. House Minority Leader Hakeen Jeffries, D-NY, is pressing centrist Republicans to help Democrats extend the tax credits before they expire at the end of the month by signing on to his discharge petition to force a vote in the House. Moderate Republicans in the House say they have their own discharge petition but are waiting to see what the Senate does. Many are critical of President Trump’s equivocation on the subsidies – in one breath he is ready to

Populist Trump Attacks Health Plans President Donald Trump has turned to attacking health plans in the wake of a concerted effort from Democrats accusing him and the GOP of not doing enough to tackle affordability. Trump was thought to be preparing an enhanced subsidy extension plan, but it is either delayed or won’t happen due to opposition from GOP conservatives in Congress. Trump is said to have supported a two-year extension with some reforms of the enhancements along with introducing subsidies for Health Savings Accounts for some to use.  In a recent social media post he directed his ire on healthcare affordability to health plans, saying: “The only healthcare I will support or approve is sending the money directly back to the people, with nothing going to the big, fat, rich insurance companies, who have made $trillions, and ripped off America long enough.” Of course, that is not true. But Trump may

What Is On GOP Menu For Subsidies? A good article in The Hill on Thanksgiving breaking down the GOP dilemma on what to do with the Exchange enhanced subsidy expiration that is looming. The issue pits moderate Republicans against conservative ones. There are competing proposals across the House and Senate. The dilemma: Extend the subsidies and endorse Obamacare or let the subsidies expire and deal with the electoral fallout in 2026. This could be major in dozens of moderate Republican swing districts in the House and several seats in the Senate. Here are some bills percolating on the Republican side: Moderates in both parties in House: One bill would extend the enhanced subsidies for two years but make some changes to assuage conservatives. Those earning less than $200,000 per year for a family of four would keep their subsidies and those earning between $200,000 and $300,000 for a family of four would

Deeper Dive On 2025 Medicare Drug Price Negotiations The Trump administration announced the results of the second round of Medicare drug price negotiations, taking credit for the 2025 process that it says led to much deeper price reductions than in 2024’s process. The 2025 set prices will go into effect in 2027. The administration said $12 billion in federal savings would occur due to the negotiations in 15 drugs. That is computed at 44% off of net (after rebates) costs, compared with 22% or $6 billion under Biden’s negotiations in 2024 for ten drugs. Under another calculation, the 2025 savings is $8 billion or 36%. Consumers would save an estimated $685 million in out-of-pocket costs. The medications are used by about 5.3 million Medicare beneficiaries. The negotiated savings range from 38% to 85% off the drugs’ list prices. Total spending on the drugs is about $42.5 billion. The administration reached agreement with brand drug makers