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Democrats Propose Bills To Defend Medicaid Democratic senators have proposed as many as 13 bills regarding Medicaid as the GOP continues its debate over changes to the budget reconciliation bill cuts to the low-income healthcare program. Some of the bills tackle fraud, waste, and abuse (FWA), while others protect expansion of coverage and insulate providers. #budgetreconciliation #medicaid #trump #congress #coverage https://www.fiercehealthcare.com/regulatory/democrats-make-pitch-medicaid-improvements-big-beautiful-bill-debate-heats Trump Pushes Big Pharma To Lower Price With his deadline for brand drug makers to come forward with lower prices, the Trump administration is pushing pharmaceutical companies to begin negotiations to reduce prices. If they do not, the government will begin the process of implementing most-favored-nation (MFN) pricing. “Under President Trump’s direction, HHS is demanding that pharmaceutical companies end their obstruction and come to the table—just as they already do with nearly every other economically comparable nation—to negotiate fair, transparent pricing for Americans,” a Health and Human Services (HHS)

Medicare Advantage Abuses in Focus A big day for coverage involving abuses in Medicare Advantage (MA). First, Scan CEO Sachin Jain has a good Health Affairs Forefront blog on MA enrollment issues. Jain recounts the fact that there are behind-the-scenes compensation schemes between some large MA plans and brokers and marketing organizations that lead to steerage of enrollees into plans, often when it is not in their best interest. He notes enrollment in low-rated plans is a problem. The Department of Justice filed a complaint against certain brokers and MA plans, alleging plans paid hundreds of millions of dollars in illegal kickbacks to brokers in exchange for enrollments into the plans’ products. Jain proposes a change in how compensation is made for enrollment by favoring high-performing plans and perhaps making compensation is budget neutral. Second, healthcare policy group KFF posted an issue brief regarding expected Star bonus payments in 2025. It

Public Supports Trump Drug Pricing Plan A survey commissioned by the Pharmaceutical Reform Alliance and conducted by National Research Inc. finds that a majority of voters are in favor of lawmakers and candidates who they believe will take on Big Pharma price-gouging. Most say they support President Trump’s most-favored-nation drug pricing policy, where prices in the U.S. are set based on the lowest price in other developed nations. #drugpricing #mfn #irp #trump https://thehill.com/homenews/5343025-survey-voters-big-pharma-most-favored-nation Will Senate Go After Medicare? Despite discussing proposals to rein in Medicare Advantage (MA) overpayments in the budget reconciliation bill, some Republicans are saying there is little appetite to add such cuts in. This comes from senators who sought their inclusion. In addition, the House has passed tweaks to the bill they adopted to ensure consistency with Senate Byrd reconciliation rules. Additional article: https://www.politico.com/news/2025/06/10/house-gop-reveals-list-of-tweaks-to-megabill-00398669 and https://thehill.com/homenews/house/5345047-house-gops-technical-changes-trump-agenda-bill/?tbref=hp #medicareadvantage #riskadjustment #overpayments #budgetreconciliation https://thehill.com/homenews/senate/5344838-medicare-advantage-reform-less-likely Reasons Beneficiaries Disenroll From Medicare Advantage A

Senate Now Zeroing In On Medicare Advantage The Senate appears to be zeroing in on Medicare Advantage (MA) overpayments for the budget reconciliation bill to achieve greater savings and perhaps reduce Medicaid cuts. MA plans and lobbies are lining up to oppose it, saying the reductions will impact enrollees. Sen. Bill Casidy, R-LA and Chairman of the HELP Committee, is one GOP senator examining it, which has bipartisan support (not that Democrats will vote for the bill). Exactly what would be included is open. One report says the provision would save $100 billion over the 10-year horizon and would limit the ability to include old or unrelated medical conditions in the cost of care. Another proposal would save as much as $275 billion over 10 years. Very high estimates suggest total overpayments from risk adjustments are $43 billion annually (although I have great doubt about that number). The Centers for

Preliminary Reports Show Major Exchange Premium Hikes Exchange rate filings are beginning to filter in for 2026 and the news is not good. Many insurers are asking for double-digit rate increases in the individual and small group Exchange markets. This is occurring due to the likely expiration of enhanced premium tax credits and rising costs. Reports from various states say rate hikes could be as much as 23%. Average increases seem to be well into the teens. #exchanges #aca #obamacare #coverage https://www.beckerspayer.com/payer/payers-seek-double-digit-exchange-rate-hikes-for-2026 Big PBMs Suing Over State Regulatory Laws Many states have passed pharmacy benefits manager (PBM) regulation bills  and at least two big PBMs, CVS Caremark and Express Scripts, are suing to overturn the state laws. The PBMs argue that state regulation of PBMs is preempted by the Commerce Clause and federal regulation. The problem is that the feds have been very lenient over the years, which states say

Say This Three Times: Healthcare Cut Consternation Republican senators are weighing in with leadership regarding concerns with the “Big Beautiful Bill.” Moderates are concerned about spending cuts to Medicaid and the Supplemental Nutrition Assistance Program (SNAP). Budget hawks are demanding more deficit and debt reduction and want the House compromise on state and local tax (SALT) deductions undone. The conservatives also want $200 billion in reductions to Medicare in the area of fraud, waste, and abuse (FWA). There are at least two hard “No’s” on the conservative side. There are other conservatives very concerned and looking for more reductions. On the moderate and pragmatic conservative side, there are a number of senators very concerned about reductions. The House version of the bill would not be able to pass in the Senate as written based on probable numbers of negative votes on either side of the ideological divide. At least 4

Big Beautiful Bill Update Another update on the Big Beautfiul Bill as it seeks to work its way through the Senate. A number of major developments today. A new brief from America’s Essential Hospitals says the Medicaid reductions could mean an increase in hospital uncompensated care of $42.4 billion. The Paragon Health Institute, a conservative think tank with major influence in the administration, is urging the Senate to make changes in the bill to go deeper in terms of cuts and reform. It says lawmakers should make changes in the following areas: Republicans in the Senate are looking at making cuts in Medicare to offset Medicaid cuts or add to overall savings. The likely targets are Medicare Advantage (MA) plan risk adjustment upcoding as well as potentially site neutral payment reform. The Better Medicare Alliance opposes any reduction in MA. Paragon recommended Medicare reforms that could save $712 billion, including