immigration Archives - Page 27 of 28 - The Healthcare Labyrinth

March 7, 2025

March 7, 2025 No Comments

Trump May Support Changes To Medicare Drug Negotiations Big Pharma says that President Donald Trump and Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. are sympathetic to the drug lobby’s concerns regarding the Inflation Reduction Act’s (IRA) “pill penalty” provision within the Medicare drug price negotiations. Drug makers say the law discourages research into small molecule drugs. Small-molecule drugs are exempt from Medicare drug price setting for nine years after FDA approval, while biologics are exempt for 13 years. Big Pharma has been lobbying to extend the small-molecule drug exclusivity period to 13 years. Some congressional bills would extend the period before price negotiation can begin for small molecule drugs to match biologics. (Article may require a subscription.) #ira #drugpricing #branddrugmakers https://insidehealthpolicy.com/daily-news/pfizer-ceo-trump-kennedy-sympathetic-pill-penalty-concerns Makary Backs Swifter Approval of Generics President Donald Trump’s nominee to lead the Food and Drug Administration (FDA), Dr. Marty Makary, pledged to accelerate the approval of

March 6, 2025

March 6, 2025 No Comments

Paragon Says Improper Medicaid Payments Could Be Over $1 Trillion The Paragon Health Institute is an extremely powerful think tank with the ear of the Trump administration and some in Congress. Its newest report, in conjunction with the Economic Policy Innovation Center, says that improper payments under Medicaid could be as much as $1.1 trillion over ten years. The Centers for Medicare and Medicaid Services (CMS) estimated improper payments at $543 billion over ten years, but Paragon says that does not include eligibility check errors. The report urges Congress to cut funding to states found with greater than 3% erroneous payments based on eligibility errors. Many of the errors are tied to the suspension of eligibility checks during the COVID pandemic. The ineligible population includes people over income limits and illegal immigrants. The report gives hope that the GOP Congress can reduce Medicaid spending and perhaps certain Medicare spending without

March 5, 2025

March 5, 2025 No Comments

Budget Reconciliation And DOGE Updates Two key developments on the spending reduction front. Republican senators met with Elon Musk on his Department of Government Efficiency (DOGE) commission reductions. Many senators, rightists and moderates, told him that Congress must sign off on the reductions. On one hand, the senators were asserting their branch’s constitutional authority. On the other, they said it insulates the DOGE cuts from court attacks. Musk was open to Senate approval but indicated he did not think some of the reductions had to come back to Congress. He also was surprised that a rescission package can be passed by just a majority vote. Rescission is authorized by the Impoundment Act of 1974. Some House Republicans want to repeal the rescission process to allow the president to exercise what they see as the president’s inherent impoundment authority. It is ironic that the same act could be used to validate

March 4, 2025

March 5, 2025 No Comments

Tariff Costs Likely Passed Through On Drugs And Medical Devices Drug and device makers abroad will be levied a tariff if their imported product origin is Mexico, Canada or China and the costs are likely to be passed through to consumers. This means various providers, including hospitals and physicians, will see cost increases. The costs, too, would be passed through in the drug channel, ultimately hitting employer groups, government programs, and consumers. Consumers could see higher premiums as well as cost-sharing hikes. Canada and Mexico will have 25% tariffs under the Trump administration’s announcement this week. China has total tariffs since September of 20% or more as well. (Article may require a subscription.) #healthcare #drugpricing #tariffs #hospitals #physicians https://www.modernhealthcare.com/digital-health/tariffs-mexico-canada-cardinal-intuitive Healthcare Entities Could See Pressure On Margins If Medicaid Cuts Pass While healthcare entities would not have major shifts in 2025, Medicaid cuts could mean pressure on margins according to Fitch,

March 3, 2025

March 4, 2025 No Comments

House Dems Run Spending Cut Ads In Swing Districts A House Democratic campaign organization officially kicked off the 2026 elections by running a television advertising blitz hitting House Republicans over the prospect of Medicaid cuts in budget reconciliation. The ads are running in 23 swing districts in 13 states. (Article may require a subscription.) #medicaid #election2026 #budgetreconciliation https://www.modernhealthcare.com/politics-policy/medicaid-cuts-tv-ads-gop BCBSMI Had Major 2024 Loss Blue Cross Blue Shield Michigan (BCBSMI), a top insurer in the nation, reported a $1.03 billion loss in 2024 due to rising costs and what it called “unsustainable” market conditions. It had revenue of $40.6 billion. It said the costs were driven by rising utilization of expensive medical services and costs for prescription and specialty drugs. Additional article: https://www.modernhealthcare.com/insurance/blue-cross-michigan-2024-healthcare-costs (Some articles may require a subscription.) #healthplans #margins #bcbsmi https://www.beckerspayer.com/payer/bcbs-michigan-posts-1b-loss-in-2024.html SNP Plans Grow In Enrollment Season While enrollment growth in Medicare Advantage (MA) was lower than previous years,

February 28, 2025

March 1, 2025 No Comments

More 2024 Insurance Financial Results A number of additional health plans announced financial results for 2025. Clover Health’s stock dipped Feb. 28 after the company announced an earnings per share loss and a 2% miss on quarterly revenue. But the company reported a full-year 2024 adjusted EBITDA of $70 million, a huge year-over-year increase of $112 million. Alignment Healthcare achieved its first year of positive adjusted EBITDA as a company. It also reported a huge surge in enrollment. Blue Cross Blue Shield of Massachusetts reported a $400 million operating loss in 2024, driven by spending on GLP-1 medications and other rising medical costs. The company posted a -4.3% operating margin in 2024, compared to a 0.4% margin in 2023. In other news, Becker’s reports on Blues’ MA enrollment as well as insurers who gained and lost membership for 2025 in MA. Additional articles: https://www.fiercehealthcare.com/payers/clover-health-nets-70-million-adjusted-ebitda-misses-revenue-goals and https://www.fiercehealthcare.com/payers/alignment-healthcare-posts-701-million-quarterly-revenue-beats-expectations and https://www.beckerspayer.com/payer/bcbs-massachusetts-reports-400m-loss-driven-by-glp-1-spending.html and https://www.beckerspayer.com/payer/bcbs-plans-ranked-by-medicare-advantage-members-2025.html #healthplans

February 27, 2025

February 27, 2025 No Comments

Another Study Shows Impact Of Medicaid Reimbursement Cuts To States A second study finds the major impact of reducing federal dollars for Medicaid to states. States that expanded Medicaid coverage could have to find $44.3 billion annually in state budget cuts or increased revenue to maintain what they have. The Urban Institute and Robert Wood Johnson Foundation (RWJF) say state spending would be hiked by about 25.6% on average if that occurred. Twelve states have trigger laws that would drop the expansion if the enhanced reimbursement is halted. I told you yesterday about a Kaiser Family Foundation (KFF) analysis of the spending reductions related to a Medicaid per capita cap program. KFF finds that capping per enrollee spending could reduce federal Medicaid expenditures by $532 billion to nearly $1 trillion over 10 years depending on how states respond. KFF also finds that eliminating the Medicaid expansion matching rate as well

February 26, 2025

February 27, 2025 No Comments

MA Growth Down Markedly In Enrollment Season The Centers for Medicare and Medicaid Services (CMS) finally published some data on the 2025 enrollment season and growth is down considerably. This is likely tied to the financial crisis in the industry. The January report still seems to have issues so many analysts are either comparing February 2024 to February 2025, January 2024 to February 2025, or a month in late 2024 to February 2025. I will have a comprehensive blog on this subject tomorrow. Different outlets have ranges of numbers in their coverage. My calculation is that enrollment grew about 4.4% from January 2024 to February 2025. This is down from 8.7% in 2024 and 6.1% in 2022. Of the big nine national health plans, seven gained enrollment from January 2024 to February 2025. But just five of them gained from December 2024 to February 2025. In other news, the Kaiser

February 25, 2025

February 25, 2025 No Comments

House Passes Budget Framework; Healthcare Cuts Heat Up The House adopted a budget reconciliation bill today with just one GOP defection. House Speaker Mike Johnson and President Donald Trump got three other doubters to convert to “yes.” The vote was 217 to 215. The bill paves the way for final passage down the road but a great deal of work has to occur, with committees now meeting on spending cut targets. This includes $880 billion in healthcare spending cut targets. Johnson and perhaps Trump convinced holdouts that Medicaid rolls will not be cut except for work requirements and if someone is illegally on the program. It may be hard to keep the commitment with a large reduction bogey. The victory was major for Johnson but he now needs to hold all these folks in place as spending cuts are debated in committees. Meanwhile, healthcare news is heating up due to the

February 24, 2025

February 24, 2025 No Comments

More Surprises From Trump On Drug Pricing Donald Trump’s Centers for Medicare and Medicaid Services (CMS) in late January said it would continue Medicare drug price negotiations. Then, in a Super Bowl interview, Trump bemoaned the cost of GLP-1 weight-loss drugs in America compared with other developed nations. Now, the Trump administration has chosen to defend the Medicare drug price reform law in court. In a filing Feb. 19, the government agreed with the legal arguments used by the Biden administration and by a lower court. Trump so far is not what Big Pharma hoped. #ira #medicare #partd #drugpricing #branddrugmakers https://www.fiercehealthcare.com/payers/trump-admin-defends-ira-drug-price-negotiation-program-novartis-lawsuit FDA Workers May Be Headed Back To Work Fired Food and Drug Administration (FDA) probationary workers are receiving calls that their terminations are being rescinded. The Department of Government Efficiency (DOGE) commission clearly jumped the gun on firing all probationary positions throughout government. #doge #layoffs #trump #spending https://www.fiercehealthcare.com/regulatory/mass-layoffs-hhs-cdc-cuts-1300-probationary-workers-reports-say United Comes

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