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February 20, 2025

Trump Limits Public Benefits To Undocumented President Donald Trump issued an executive order that limits public benefits for undocumented immigrants. It directs each federal agency to identify programs that currently allow undocumented immigrants to receive federal benefits and to comply with the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, which generally prohibits such benefits. The order also mandates the enhancement of eligibility verification systems. It also seeks to limit or bar funding state and local programs that either subsidize illegal immigration or support sanctuary policies. Fourteen states plus D.C. provide state-funded healthcare coverage to children regardless of immigration status. California is the first state to offer Medicaid coverage to all eligible undocumented individuals. #trump #immigration #healthcare https://www.beckershospitalreview.com/legal-regulatory-issues/trump-signs-executive-order-to-end-federal-benefits-for-undocumented-immigrants.html Medicaid Cuts Consternation President Donald Trump’s endorsement runs smack into his public commitment that he will not take a meat axe to Medicaid benefits. Trump this week endorsed the one-bill approach to

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Medical Pricing Is As Broken As Drug Pricing

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

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February 19, 2025

Trump Endorses House GOP One-Bill Approach President Donald Trump came out today in favor of the House GOP’s one-bill approach, surprising the Senate which felt he was taking a wait-and-see, go-slow approach on the issue. The one bill approach has steep spending reduction targets in it. Still, the fate of the House bill is uncertain. Speaker Mike Johnson can afford to lose no more than one vote on the reconciliation bill. Several moderates have expressed concerns on healthcare cuts. Some conservatives are complaining cuts are not deep enough. While leaders claim healthcare cuts to Medicaid and the Affordable Care Act (ACA) will not disrupt coverage, the savings targets could make that promise difficult to keep. Some conservatives are arguing that reductions in state reimbursement or even how much the federal government contributes should occur, which undoubtedly would impact coverage. Reining in provider taxes could also impact state financing schemes and

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February 18, 2025

Worried About House Vote, Senate Takes Different Path on Budget Reconciliation On a 50-47 vote, the Senate GOP officially started the process of passing a budget reconciliation bill in a bid to enact a portion of President Trump’s agenda.  The Senate is taking a two-bill approach to meet President Trump’s objectives, while the House is moving on one big bill. The Senate fears House Speaker Mike Johnson will not have enough votes on his plan because conservatives are demanding deep cuts and others want more moderate ones. The Senate’s first bill would spend $325 billion to bolster border operations and allow Trump’s deportation plans to be executed as well as boost defense spending and greenlight Trump’s energy plans. The Senate Republicans are planning to use a second reconciliation bill to extend Trump’s 2017 tax cuts. The second bill would include offsetting spending cuts. #budgetreconciliation #trump #congress #healthcare https://thehill.com/homenews/senate/5152221-senate-gop-budget-resolution/?tbref=hp Strange Bedfellows Against

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February 17, 2025

Study Shows How Obesity Impacts Employer Healthcare Costs UnitedHealthcare and the Health Action Council have examined how the obesity epidemic has impacted the healthcare costs of employers and how it will continue to do so in the future. About 75% of adults in the U.S. are either overweight or obese, up from 50% in 1990. Obesity rates have grown fastest among younger adults. The obese population accounts for 46% of the employers’ medical spend. Per member per month costs for obese employees are more than double ($973) than those who were not obese ($421). Metabolic conditions are common among people with obesity. For workers in their ’50s, diabetes rates are 2.5 times higher among obese individuals. Hypertension rates were three times higher. Those who were obese also had greater rates of behavioral health illnesses. Study: https://healthactioncouncil.org/media/i5qj3qah/2025-hac-white-paper.pdf #obesity #glp1s #weightlossdrugs #healthcare #chronicconditions #employercoverage https://www.fiercehealthcare.com/payers/unitedhealth-hac-study-examines-how-obesity-impacting-employer-health-costs Trump To Defend Brainwood Using Biden Arguments

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Trump’s Populism Could Spell Trouble For Big Pharma

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

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February 14, 2025

Major Staff Cutbacks In Healthcare At Federal Government The Trump administration has directed agencies to begin laying off probationary employees. The Department of Health and Human Services (HHS) and related agencies are firing up to 5,200 probationary employees as of today. About 1,300 are employed by the Centers for Disease Control and Prevention (CDC) and a sizeable number are with the National Institutes of Health (NIH). There are over 2 million federal employees. Additional article: https://www.modernhealthcare.com/labor/cdc-layoffs-cuts-trump (Some articles may require a subscription.) #hhs #nih #cdc #staffing #layoffs #trump #doge https://www.fiercehealthcare.com/regulatory/mass-layoffs-hhs-cdc-cuts-1300-probationary-workers-reports-say Trump Administration Cuts Exchange Navigator Funding Similar to what happened in its first term, the Trump administration axed Exchange Navigator funding by 90% to just $10 million. The navigator program received $98 million in the 2024 plan year but only enrolled 92,000 consumers, accounting for just 0.6% of selections through federally facilitated exchanges (FFEs) in the open enrollment period. Trump’s

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February 13, 2025

RFK, Jr. Confirmed As Health Chief; Will Chair MAHA Commission President Donald Trump’s nominee as secretary of Health and Human Services (HHS), Robert F. Kenndy, Jr., was confirmed by the Senate today on a 52-48 vote, with Mitch McConnell being the only GOP senator to not vote yes. All Democrats opposed Kennedy. Trump also signed a new executive order to establish a Make America Healthy Again (MAHA) Commission. Kennedy will chair the task force, focused on investigating the “root causes of America’s escalating health crisis.” The commission first will address childhood chronic diseases. In other news, HHS assistant secretaries were also named by Trump. One of them is an anti-trust lawyer with deep background in healthcare mergers.  This could be a clue that the Biden administration’s healthcare anti-trust agenda may not totally go away. Additional articles: https://www.fiercehealthcare.com/regulatory/trump-creates-maha-commission-chronic-disease-chaired-rfk and https://insidehealthpolicy.com/daily-news/newly-confirmed-hhs-sec-rfk-jr-lead-maha-commission and https://www.modernhealthcare.com/politics-policy/rfk-jr-full-senate-vote-hhs and https://www.healthcaredive.com/news/rfk-jr-confirmed-hhs-secretary-robert-f-kennedy-jr/740054/ and https://insidehealthpolicy.com/daily-news/trump-nominates-two-hhs-asst-secretaries-general-counsel (Some articles may require a

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Medicare Advantage In The Gunsight

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

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February 12, 2025

Healthcare Segments’ Top Priorities A good article in Fierce Healthcare on the priorities of the various healthcare segments for 2025. Here are the highlights and there will be some battles between the parties. Hospitals – extending Exchange premium subsidy enhancements, further health plan prior authorization (PA) and utilization management limits, fighting coverage reductions, and maintaining the 340b program substantially as is. Plans – relief on Medicare Advantage (MA), and PBM reform (most health plans support except those with sister company PBMs). Providers – a Medicare rate fix, reducing administrative burden, and workforce reform. Also on the agenda is extending telehealth flexibilities and the hospital-at-home program. #healthcare #healthplans #hospitals #providers #medicare #exchanges #medicaid https://www.fiercehealthcare.com/regulatory/healthcare-lobbying-2025-here-are-top-policy-issues-hospitals-payers-docs-and-tech Budget Reconciliation Progress But Showdown Looming The House announced it is moving forward with a one reconciliation bill approach and will mark up a budget resolution quickly. The resolution will allow the deficit to rise $4.5 billion

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