oz Archives - Page 26 of 32 - The Healthcare Labyrinth

February 5, 2025

February 5, 2025 No Comments

Elon Musk Targeting CMS and Medicare Elon Musk and his Department of Government Efficiency (DOGE) commission is now targeting the Centers for Medicare & Medicaid Services (CMS) as part of efforts to reduce spending and waste. In particular, Musk is targeting Medicare for fraud, waste, and abuse (FWA). The DOGE representatives have gained access to payment and contracting systems. In other news, the hospital lobby is petitioning President Donald Trump to grant carveouts for medical devices and pharmaceutical products for tariffs. China is a large exporter of such products. As well, Democratic lawmakers are asking the Trump administration why some federal financial assistance recipients still aren’t receiving funds after two judges froze the spending freeze. Additional article: https://www.modernhealthcare.com/politics-policy/elon-musk-doge-fraud-medicare-medicaid and https://www.beckershospitalreview.com/legal-regulatory-issues/doge-probes-cms-for-medicare-medicaid-fraud-wsj.html and https://www.fiercehealthcare.com/providers/hospitals-ask-trump-exempt-medical-pharma-products-tariffs and https://www.fiercehealthcare.com/regulatory/trump-admin-orders-temporary-pause-most-federal-financial-assistance (Some articles may require a subscription.) #doge #fwa #cms #medicare #spending #tariffs #healthcare https://www.fiercehealthcare.com/regulatory/labor-unions-sue-trump-admin-over-treasury-takeover-citing-privacy-concerns Coalition Asks Trump To Revive PBM Reform A broad coalition of healthcare

February 4, 2025

February 4, 2025 No Comments

Party-Line Vote Advances Kennedy To Senate Floor Robert F. Kennedy, Jr. turned the vote of Sen. Bill Cassidy and gained a 14-13 Senate Finance confirmation vote, which means he has survived and will likely gain Senate confirmation. Cassidy gained concessions from the Trump administration in return for supporting Kennedy’s nomination. Whether you agree with Cassidy’s decision or not, the articles show that Cassidy spent a great deal of time gaining procedural and other commitments in return for supporting Kennedy. The concessions empower the Senate healthcare policy committees in a major way. He deserves a great deal of credit here for taking his role to advice and consent seriously. Vice President JD Vance also played a major role in working with Kennedy and Cassidy. Additional articles: https://www.modernhealthcare.com/politics-policy/rfk-jr-nomination-advanced-senate-finance-committee and https://www.medpagetoday.com/publichealthpolicy/washington-watch/114079 and https://thehill.com/homenews/senate/5125761-cassidy-says-he-secured-key-vaccine-commitments-from-rfk-jr/ and https://www.healthcaredive.com/news/rfk-jr-clears-key-hurdle-on-path-to-hhs-secretary/739096/ and https://insidehealthpolicy.com/health-insider/rfk-jr-confirmation-sent-floor-cassidy-onboard-budget-resolution-stalled (Some articles may require a subscription.) #trump #rfkjr #hhs #congress #healthcare https://www.fiercehealthcare.com/regulatory/top-republican-airs-concerns-about-rfks-bully-pulpit-and-vaccine-hesitancy Trump Sets A Deregulation

February 3, 2025

February 3, 2025 No Comments

Trump Wants To Preserve Medicaid By “Loving And Cherishing It” On Friday, President Donald Trump promised to “love and cherish” Social Security, Medicare, and Medicaid. Notice Medicaid made it to the earlier list of protected programs. Trump continued: “We’re not going to do anything with that unless we can find some abuse or waste. The people won’t be affected. It will only be more effective and better.” A sea change for Trump? Perhaps. But let’s not get too hopeful from one press statement. See my blog today on some interesting developments on the healthcare front. Trends suggest healthcare cuts may not be as deep as once suspected during the budget reconciliation process: https://www.healthcarelabyrinth.com/will-medicaid-and-the-affordable-care-act-see-huge-cuts/ #medicaid #aca #obamacare #exchanges #trump #congress #budgetreconciliation https://www.politico.com/live-updates/2025/01/31/congress/trump-love-and-cherish-medicaid-00201893 Medicare Advantage Risk Adjustment Reform While I disagree with some of the overpayment numbers quoted in this Health Affairs Forefront blog, I find interesting the authors’ position on tackling

Will Medicaid and the Affordable Care Act See Huge Cuts?

February 3, 2025 No Comments

While cuts will occur, things could be looking a bit better for Medicaid and the Exchanges In a series of blogs just before and after Donald Trump retook office, I speculated that, while there would be spending reductions impacting healthcare, I did not foresee a massive revamp in healthcare programs, specifically for the Affordable Care Act (ACA) and Medicaid. Now that we are about two weeks into the new administration and a fully GOP-controlled Congress, I felt it might be good to update readers on this all-important issue. As you know, I am a pro-coverage Republican. I think reasonably robust coverage is important for the health of our nation and to reduce costs in the future. So, based on some happenings in the past month or so, here are some of the reasons to think healthcare may not be impacted as much as one would think as the budget reconciliation

January 31, 2025

January 31, 2025 No Comments

Second Judge Enjoins Trump Spending Freeze Indefinitely President Trump’s spending freeze now has been indefinitely reversed by a second federal judge. The order was handed down late Friday. In the first case, a judge is to determine next week if a temporary injunction in the pause will be extended. Despite the rescinding of the Office of Management Budget (OMB) freezing certain spending, Democrats’ cases continued as Trump indicated the freeze is still on to ensure consistency with his executive orders that have been issued. As I have noted, this is a clear misstep by the new administration. The cases will likely weigh in on the issue of whether the executive branch is obligated to execute spending directed by the legislature and signed into law. #trump #congress #spending https://www.fiercehealthcare.com/regulatory/trump-admin-orders-temporary-pause-most-federal-financial-assistance Trump May Challenge 1115 Waivers Issued Just Before Transition The Trump administration is looking at whether it can revoke approval of 1115

January 30, 2025

January 30, 2025 No Comments

More Embarrassing Statements By Robert Kennedy At Second Hearing After a tough day yesterday, Health and Human Services (HHS) Secretary nominee Robert F. Kennedy, Jr. continued his lackluster performance in front of a Senate committee by again confusing key details in Medicaid and Medicare. It seems the man proposed to be the next health and human services chief of the United States does not quite know the four parts of Medicare, a program that has hit over $1 trillion annually. Unfortunately, the two days of grilling shows he really has no business becoming the future secretary. His nomination is hurt by his lack of healthcare policy knowledge as well as controversial positions. Democrats pounded him on these for a second day. He has yet failed to convince three key Republicans to support him – Bill Cassidy, Lisa Murkowski, and Susan Collins. Mitch McConnell might also oppose him. Three GOP no

2027 Drug Negotiations Off And Running

January 30, 2025 No Comments

What will Trump do on Medicare drug price negotiations? In a parting shot at the incoming Trump administration, outgoing President Biden’s administration issued the next list of 15 drugs subject to negotiations in Medicare prior to Biden’s White House exit. The list was due by February 1, so the early release is a challenge to the Trump administration not to repeal the negotiation law included in the Inflation Reduction Act (IRA). The prices on the 15 drugs would go into effect on January 1, 2027 after a process in 2025. In 2024, prices for the first 10 drugs were set and take effect on January 1, 2026. The Centers for Medicare and Medicaid Services (CMS) says that between November 2023 and October 2024 about 5.3 million people with Medicare Part D coverage used these drugs to treat a variety of conditions, such as cancer, type 2 diabetes, and asthma. The

January 29, 2025

January 29, 2025 No Comments

Kennedy Has Subpar Performance Before Committee While Health and Human Services (HHS) nominee Robert F. Kennedy, Jr., did not mortally wound himself before the Senate Finance Committee today at a confirmation hearing, he certainly did himself no favors, either. Kennedy was unable to articulate views on healthcare policy and reform or speak articulately on the Medicare and Medicaid programs. In fact, he confused the two programs at points and perhaps thought Medicaid looked more like the state children’s healthcare or Exchange programs. He even stated that Medicare Advantage (MA) is more expensive than the traditional one. The American public often confuses various healthcare programs, but you do not expect that from the future HHS leader. Just troubling. The hearing likely means he gets no Democratic votes. What is more worrisome for the Trump team is that some Republicans are now worried about Kennedy’s capabilities. Betting odds are that Kennedy still

January 28, 2025

January 28, 2025 No Comments

Trump Spending Freeze Order Creates Chaos A federal judge has stayed a decision by President Trump’s Office of Management and Budget (OMB) to essentially freeze billions in federal grants and disbursements. It capped a whirlwind day of confusion and vitriol. Democrats cried that the executive branch was usurping congressional authority and the lawmakers and a coalition of non-profit groups won the stay until early next week. The administration argued it had the duty to look at outlays after years of runaway spending. Objectively, what happened appeared to be the first major misstep of the administration. Whatever one’s views on the action, it was clearly not well telegraphed or rolled out. The White House had to refine what was indeed stalled at several points today, finally landing on the fact that direct aid to individuals, such as welfare, Medicaid, and Medicare, was not being impacted. But other healthcare grants that do

January 27, 2025

January 27, 2025 No Comments

KFF Finds Major Claims Denials In Exchanges The Kaiser Family Foundation (KFF) finds in a new study that health insurers selling Marketplace plans in states that use the federal Exchange rejected 19% of in-network claims on average in 2023. That is up from 16% in 2022. The rate has been steady over time, ranging from a 14% low in 2018 to a 19% high in 2015 and 2023. Insurers denied 37% of out-of-network claims in 2023. There is a huge range in denial rates among plans, from 1% to 54%. For high volume insurers, the range was 13% to 35%. “Other reasons” represented the largest category of denials (34%), with 16% tagged as excluded services, 9% as lack of prior authorization or referral, and 6% as lack of medical necessity. Other common reasons for denials included administrative issues (18%) and exceeding benefit limits (12%). While I think health plans do

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