immigration

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

HHS And Related Health Agencies Will Downsize By 20,000 The Department of Health and Human Services (HHS) will slash an additional 10,000 full-time jobs after laying off or “buying out” about the same number already. Prior to the moves, the agencies collectively had 82,000, so the workforce will be downsized by about 25%. These cuts are in line with the Department of Government Efficiency (DOGE) commission’s workforce optimization efforts and are slated to save the agencies $1.8 billion per year. HHS is also reorganizing and will cut the department from 28 divisions to 15 and close five regional offices. Job reductions include: Additional articles: https://www.fiercehealthcare.com/regulatory/rfk-jr-prepares-10000-job-cuts-across-hhs-new-wave-worker-reductions and https://insidehealthpolicy.com/daily-news/hhs-major-new-reorg-includes-agency-mergers-10k-more-job-cuts and https://www.healthcareitnews.com/news/hhs-reduce-workforce-20k-jobs-major-agency-wide-restructure and https://thehill.com/policy/healthcare/5218547-trump-administration-plans-hhs-cuts/ and https://www.medpagetoday.com/washington-watch/washington-watch/114854 and https://www.modernhealthcare.com/labor/hhs-cuts-rfk-jr (Some articles may require a subscription.) #congress #trump #doge #budgetreconciliation #healthcare #hhs #cms #fda #cdc #nih https://www.healthcaredive.com/news/hhs-job-cuts-reorganization-rfk-trump/743569 Bipartisan Prior Auth Reform Bill Unveiled Again Rep. Mark Green, R-TX, reintroduced a major new prior authorization restriction bill

Medicare Advantage Deductibles Surged in 2025 A survey by online broker eHealth finds that the average deductible for a Medicare Advantage (MA) plan in 2025 more than doubled to $315. The average deductible for MA plans during the enrollment period was $315, compared to $132 in 2024, or an increase of 139%. Premiums decreased from $9 per month to $5 per month, but MA plans clearly had to save by increasing deductibles and cost-sharing as well as reducing benefits and footprints. In other news, Becker’s also reports on the fastest-growing non-profit Blue Cross and Blue Shield plans in terms of MA enrollment. Chartis says Blue Cross Blue Shield non-profit plans accounted for around 30% of MA enrollment growth in 2025. That number does not include for-profit Elevance Health, one of the big national plans which is also a Blues licensee. Big BCBS plan gainers were BCBSMI, Highmark, and Horizon. Chartis also

Hard-Hitting Study Could Drive Medicaid Budget Cuts A study by the Paragon Health Institute and the Economic Policy Innovation Center could help drive certain cuts adopted by Republicans during the budget reconciliation process. The study focuses in on California and various ways the authors say the Golden State effectively exploits matching rules and launders money to fund its state share at the expense of the federal Medicaid budget. It also indicates that the schemes provide dollars to cover undocumented immigrants, even though federal law bars enrollment in Medicaid. The GOP in Congress is known to want to stay away from explicit coverage reductions in Medicaid. But it is looking at reining in the amount states are demanding in match as well as eliminating or at least reducing the use of provider taxes for state match. Study: https://paragoninstitute.org/wp-content/uploads/2025/03/California-Money-Laundering-Scheme_FOR-RELEASE_V3.pdf #medicaid #healthcare #coverage #budgetreconciliation https://thefederalist.com/2025/03/24/red-states-are-paying-for-californias-illegal-aliens-health-care GLP-1 Spending Outpaces Specialty Drugs Spending on GLP-1

Trump Aligned Think Tank Wants Drug Price Reductions America First Policy Institute (AFPI), a conservative think tank friendly with Donald Trump, says the administration should bring back Trump 45’s international reference pricing policy for drugs across federal health programs and in the commercial market. So far, the Trump administration has firmly backed the Medicare drug price law. The think tank says there are many ways the pricing could be implemented, including via the drug law. The push for commercial application is watershed. AFPI also recommends the Trump administration restrict drug makers’ ability to charge lower prices internationally than in America and use its trade negotiation power to press countries to stop using so-called “freeloading” policies. (Article may require a subscription.) #drugpricing #trump #ira #branddrugmakers https://insidehealthpolicy.com/inside-drug-pricing-daily-news/trump-aligned-think-tank-calls-admin-bring-back-mfn-policy Surprise Nomination For CDC Director In a surprise, Donald Trump announced that he will nominate Susan Monarez to lead the Centers for Disease Control and

Former Rep. Burgess Leading Contender For CDC Chief Former Representative Michael Burgess, M.D., R-TX, is a top choice for Centers for Disease Control and Prevention (CDC) director. Former Rep. Dave Weldon’s nomination was pulled over vaccine skepticism. Burgess, 74, practiced obstetrics and gynecology before going to Congress in 2003. He chose not to seek re-election in 2024. He is known as a major health policy wonk, supported COVID vaccination, and was an advocate for providers. At the same time, he is a conservative and not in favor of major expansion of government programs. He led the House’s Energy and Commerce Subcommittee on Health. He also headed the GOP Doctor’s Caucus. Another name that has been floated is Florida Surgeon General Joseph Ladapo, M.D., who is an ardent vaccine skeptic and would be extremely controversial. #cdc #trump #congress #nominations  https://www.fiercehealthcare.com/regulatory/former-rep-michael-burgess-md-likely-next-cdc-director-nomination-report First 60 Days Of Trump 47 Healthcare Modern Healthcare has a

OptumRx Rolls Out Transparent Reimbursement OptumRx says it is rolling out a new cost-based reimbursement model for pharmacies. It says it expects the change to be a positive one for the more than 24,000 independent and community pharmacies as well as members. Optum said it will begin to roll out the updated models now and intends to have a full implementation in place by January 2028.  The model will reimburse pharmacies more for dispensing brand-name medicines to address longstanding complaints that expensive prescriptions are losing money for drugstores. The model recognizes that with the penetration of generics, some work must be done to deal with the brand reimbursement problem. This will help stocking of brand drugs. Pharmacists are skeptical and feel this is an effort to forestall passage of pharmacy benefits manager (PBM) reform. Additional articles: https://www.modernhealthcare.com/insurance/unitedhealth-optumrx-brand-name-drugs and https://insidehealthpolicy.com/inside-drug-pricing-daily-news/new-optum-rx-pharmacy-pay-model-met-skepticism (Some articles may require a subscription.) #drugpricing #pbms https://www.fiercehealthcare.com/payers/optum-rx-overhaul-pharmacy-reimbursement-models C-SNPs Growth

Cigna Closes $3.3 Billion Deal To Sell MA Business Cigna officially closed its $3.3 billion sale of its Medicare line of business to Health Care Service Corporation (HCSC). The deal includes Medicare Advantage (MA) lives, Medicare Part D lives, its Medicare supplement business, and its CareAllies physician ownership. HCSC jumps to 950,000 members from about 240,000 members. Cigna actually grew MA from about 600,000 to 700,000 in the past year. Cigna CEO David Cordani was known to be frustrated with the lack of profitability in the MA line and wants to focus on services entity Evernorth and the commercial insurance line. In other news, United’s Optum Rx pharmacy benefits manager (PBM) said it would eliminate up to 25% of reauthorizations, initially focusing on 80 drugs. This amounts to 10% of overall prior authorizations. Additional articles: https://www.fiercehealthcare.com/payers/cigna-closes-33b-sale-medicare-plans-hcsc and https://www.beckerspayer.com/m-and-a/cigna-hcsc-close-3-3b-medicare-advantage-sale/ and https://www.fiercehealthcare.com/payers/optum-rx-reduce-reauthorizations-80-drugs and https://www.modernhealthcare.com/insurance/optumrx-drug-prior-authorization and https://www.healthcaredive.com/news/optum-rx-eliminate-prior-authorizations/742910/ and https://www.beckerspayer.com/payer/optum-rx-to-eliminate-prior-authorization-for-80-drugs/ (Some articles may require

Trump Administration Sides With Hospitals Over Drug Makers in 340B Lawsuit The Department of Health and Human Services (HHS) has filed for summary judgment in its favor regarding lawsuits on the 340B program, siding with hospitals over drug makers. This is consistent with the Biden administration. While I am not a fan of brand drug makers, it is clear that hospitals and some other providers are abusing the intent of the program. Trump is on the wrong side of this policy issue. #340b #drugpricing #branddrugmakers https://www.fiercehealthcare.com/ai-and-machine-learning/rfk-jrs-hhs-picks-biden-admins-legal-fight-against-340b-rebates Rising Hospital Margins Hospitals across the nation logged a monthly median operating margin of 4.4%, up from 3.7% in December and 2.1% reported for all of 2024. #hospitals #margins https://www.fiercehealthcare.com/providers/hospitals-kick-2025-modest-operating-margin-gains-high-inpatient-revenue MedPAC Wants Medicare Provider Rate Hikes MedPAC, the congressional policy arm, has recommended tying the rate of physician and other health professionals’ payment increases in 2026 to the Medicare Economic Index minus 1 percentage