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Dr. Mehmet Oz’s confirmation hearing shows where the Trump administration is going on Medicare drug prices and Medicare Advantage (MA). The confirmation hearing last week of Dr. Mehmet Oz, who is slated to be administrator of the Centers for Medicare and Medicaid Services (CMS) is a lesson in changing political dynamics. It also tells us that sometimes the people most supportive of a given program may be most apt to reform it. Let’s break down what occurred at Oz’s confirmation hearing in front of the Senate Finance Committee. What is interesting is that many of the lawmakers on Finance are also members of the other healthcare committee of cognizance, the Health, Education, Labor, and Pensions (HELP) committee. We cannot touch all of the ground covered at the hearing in this blog, but let’s hit the top issues and why in most cases Oz’s responses run contrary to what we may

The Health Equity Index (HEI) replaces the Reward Factor for Star Year 2027. Will the complex initiative last under Donald Treump’s anti-DEI campaign? Note: Published in collabortion with Lilac Software. If you are in need of Medicare Advantage (MA) Stars technology and expertise, visit https://lilacsoftware.com . The Health Equity Index (HEI) is officially here. Why? Well, it replaces the Reward Factor in the Medicare Advantage (MA) Star bonus prorgam for Star Year (SY) 2027, but we are smack in the middle of the measurement years that help MA plans to qualify for the new reward. Why is that? Because as opposed to measure performance, the HEI is a blend of two years of data and lags the usual measurement period a bit more. In the case of SY 2027, the HEI measurement period is a blend of measurement years (MY) 2024 and 2025. The Centers for Medicare and Medicaid Services

Reining in provider taxes is not an unreasonable way to achieve some Medicaid savings As the House Energy and Commerce Committee begins its debate over Medicaid cuts to hit an $880 billion spending cut bogey, the issue of provider taxes is sure to be raised and galvanize a great deal of controversy. GOP leaders in each chamber and President Trump have given commitments publicly that Medicaid coverage will not be cut. That seems to take off the spending cut table a massive restructuring of Medicaid (maybe, as some rightists still want this) as well as overt reductions in percentage reimbursement to states (maybe, again some rightists still want this). But the GOP is arguing that it will take a bite out of the size of Medicaid by eliminating fraud, waste, and abuse (FWA). Whether you use estimates by government authorities or external think tanks, the FWA and imporer payments numbers

Savings guide from Blue Cross Association is worthy of Congress’ consideration The Blue Cross and Blue Shield Association (BCBSA) has issued a very good report on reasonable healthcare savings that could save nearly $1 trillion over the next decade. I have raised a number of these issues in past blogs, but felt covering them again would be good as the House begins debating spending reductions to hit an $880 billion savings target in the budget reconciliation blueprint passed by the chamber in a very tight vote. BCBSA features ten policy proposals. You can view them in detail at the third link at the end of the blog. As BCBSA notes, the $1 trillion figure over a decade is not federal budget savings alone. It breaks down as such: Site neutral payments As I have suggested on numerous occasions, BCBSA proposes sweeping adoption of site neutral payments in Medicare. BCBSA says

The seven publicly traded national plans had a rough 2024 and hope to realign in 2025 I often talk about the nine major health insurers prominent at the national level in Medicare Advantage (MA). Seven of them are publicly traded while two – integrated delivery system Kaiser Permanente and Big Blue mutual Health Care Service Corporation — are non-profits. Four of the seven actually are owned by large vertically integrated companies. With the close of 2024 and reporting of final results, I thought it would be good to recap performance of the seven publicly traded big national companies. The Healthcare Dive had a great article summing it all up. I substantially based this blog on its analysis, which is at the link at the end of this blog. The insurers The results by and large show the seven insurers had a fairly troublesome 2024 but hope to realign and improve

Medicare Advantage plans’ financial woes hit 2025 enrollment growth in a big way The long delayed 2025 Medicare Advantage (MA) enrollment season results have finally been published. The January 1 enrollment statistics were up for a short time only to be taken down due to errors and presumably the transition in the White House. This week, both the January and February 2025 results were posted by the Centers for Medicare and Medicaid Services (CMS). In looking at the January results, they do not seem quite right as the growth in enrollment from January to February would be extremely high – rather unprecedented. That leads to my supposition that the January data are still wrong or CMS had major issues processing January 1 applications. As such, I am comparing January 2024 numbers to February 2025 numbers as a proxy for 2024 to 2025 year-over-year growth. The statistics show some of the

My unvarnished and dispassionate take on Trump’s assertion of executive authority Many of you are aware of my service in state government in the executive branch and have asked me about the recent controversy surrounding President Donald Trump’s broad exercise of executive power in Washington, D.C. So, while this is not exactly a healthcare blog per se, the controversy certainly impacts coverage in the nation. We are about a month into Trump 47, so it is a good time to opine on this. As such, I will give you my unvarnished and hopefully dispassionate view of things. Should we feel sympathy for what the executive is trying to do? Is Donald Trump going too far? A little background on me I served in state government in Connecticut from 1995 to 2005. I was a Republican executive appointee and eventually became the Deputy Management Secretary/Deputy Budget Director of the state and

American healthcare is in dire need of price reform. As is, employers are significantly disadvantaged. In my blog on Monday, I bemoaned the fact that American drug pricing is manyfold greater than in other developed nations. It serves as a major disadvantage to American consumers, their health, and the healthcare system as a whole. You can read that blog here: https://www.healthcarelabyrinth.com/trumps-populism-could-spell-trouble-for-big-pharma/ . I thought it made sense to reflect on some issues related to other healthcare pricing. As I have made the case often on this website, America’s healthcare pricing is fundamentally broken. A lot goes into this, but I wanted to reflect on two issues: (1) excessive employer coverage prices generated by Medicare and Medicaid actual and perceived underpayments and (2) the lack of site neutral payments in healthcare. Employer coverage price disparity I have made the case that employers in America have a disproportionate cost burden compared with

I see a sea change coming on drug pricing from Trump 47 President Trump is famous for his fluidity on issues. He is unpredictable on healthcare and that is not more true than on drug price reform. At various points of Trump 45, the president was proposing radical drug price controls that had never been seen before from a Republican president. In the case of Medicare Part B, he proposed that providers negotiate prices for the physician-administered drugs as an international reference pricing scheme rolled out over time. What’s more, he wanted most favored nation (MFN) pricing, so the U.S. price would be pegged to the lowest price in the rest of the world. The proposal did not go anywhere because of major process issues, but at the time Trump said he would do the same in Medicare Part D, the retail drug program. Since leaving office and returning, Trump

Despite Republicans liking Medicare Advantage, major funding and structural changes could occur Some of you have written me asking why I am so convinced that the Trump administration and a GOP Congress will continue to target Medicare Advantage (MA) for savings. It is true that Donald Trump likes private healthcare and MA as a program. His healthcare nominees, including incoming Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr., and Dr. Mehmet Oz, who is slated to be the Centers for Medicare and Medicaid Services (CMS) administrator, favor the program. Trump and the GOP Congress could even opt for future Medicare beneficiaries to default to MA versus the traditional fee-for-service (FFS) program. They could offer some short-term relief in terms of MA rates and pull back on the misguided Inflation Reduction Act’s (IRA) Part D out-of-pocket cap and cost-sharing changes. But many of the folks with influence over Trump