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Exchange Compromise Is Slipping Sen. Bernie Moreno, R-OH, a leading supporter of a compromise on extending enhanced Exchange premium subsidies, says a deadline of the end of January has been set for having a compromise framework ready and that the main holdup remains abortion. The earlier goal of having a bill this week will not be met. Meanwhile, the Republican Study Committee, the largest caucus of conservatives in the House, unveiled a framework for a second reconciliation bill. Such a bill would only need a majority in each house to become law. The bill addresses affordability broadly and includes some provisions on healthcare. Additional article: https://thehill.com/homenews/house/5686728-gop-housing-health-energy-reforms/?tbref=hp #exchanges #healthcare #coverage #pbms #medicaid https://thehill.com/homenews/senate/5687461-senate-obamacare-compromise-deadline Government May Pull Back 340B Reform – For Now A court filing appears to show that the Department of Health and Human Services (HHS) will pull back on its contentious 340B Rebate Pilot, at least for now. The

Trump May Veto Subsidy Bill If Passes; Exchange Enrollment Down So Far The Centers for Medicare & Medicaid Services (CMS) reports that about 22.8 million consumers have signed up for 2026 individual market Exchange coverage through Jan. 3. This is surprisingly robust with 12 more days to enroll. About 21.4 million enrolled in 2024 and about 24.3 million enrolled in 2025. About 23.6 million people enrolled in the Exchanges plans through Jan. 4, 2025. The 800,000 drop so far is likely less than most had expected. The Congressional Budget Office (CBO) said 2.2 million will lose coverage in 2026 due to the expiring enhanced subsidies. The CBO said an average of 3.8 million more uninsured people annually would result from 2026-2034. The results so far include 15.6 million Exchange selections in the 30 states using the HealthCare.gov platform for the 2026 plan year and 7.2 million plan selections in the

J&J Becomes Latest Drug Firm To Strike Price Deal Johnson & Johnson arrived at a deal with the Trump administration to lower prices for certain prescription drugs in exchange for tariff relief. As with other deals, J&J will offer specific drugs for sale directly to consumers at significant discounts through the Trump administration’s TrumpRx website. It will offer its drugs to the Medicaid program at comparable prices to other developed countries. It will also give the most-favored-nation (MFN) price on new drug introductions. J&J said it is planning two new U.S. manufacturing facilities as part of a previously announced $55 billion investment. #drugpricing #branddrugmakers #mfn   https://thehill.com/policy/healthcare/5681535-johnson-johnson-trump-drug-prices/?tbref=hp Congress Could Ban PA in Medicare FFS Lawmakers explored the merits of a bill that would block the Centers for Medicare & Medicaid Services (CMS) from implementing a pilot program to test whether prior authorization (PA) should be piloted in traditional Medicare fee-for-service (FFS). The model would be tested

The Courageous 4 Becomes The Courageous 17 The House voted 230-196 to extend enhanced Exchanges premium subsidies for three years as is, with 17 GOP lawmakers joining Democrats. This was after four GOP members signed on to a discharge petition to force a vote. House Speaker Mike Johnson, R-LA, and other leaders are livid, but the members were courageous to buck their party to cast a vote they believed in. They tried very hard to get the GOP leaders to agree to a compromise and even simply to hold a vote. Johnson broke his word on the vote under pressure from head-in-the-sand conservatives. The measure is not expected to pass the Senate as a similar bill failed to reach 60 votes there, but a compromise continues to be negotiated in the upper chamber between moderates on both sides of the aisle, which then would face a rocky road back in the

Exchange Compromise Being Developed In Senate A bipartisan group of senators is working on a compromise to extend the enhanced Exchange subsidies that expired on December 31. The draft compromise would extend the subsidies for two years but add reforms, including income caps for subsidies, minimum premium payments, and appropriations of cost-sharing subsidies. To combat fraud, the bill would penalize health plans that enroll phantom enrollees. The bill would also include expansion of health savings accounts (HSAs) by giving subsidized enrollees the choice of the current Exchange subsidy or having the money go to a pre-funded account beginning the second year of the extension.  The official draft may be released next week. Some Democrats say the caucus could agree to such changes. Others are upset by any minimum premium, even $5 or $10 a month. That seems like a ridiculous position. But abortion could spell doom for the compromise. Republicans

WSJ Finds Excess Rx Refills At Medicare Plans Via Mail Order Many argue The Wall Street Journal has it out for health plans as it has had many hard-hitting investigations of fraud and bad practices over the past year or so. Some parts of the industry have accused the Journal of being wrong or behind the times, but the newspaper seems to constantly find scandal afoot, especially among the big national plans. Some of its findings, which are hard to question, have led to ongoing investigations by federal regulators and Capitol Hill. The Journal’s latest expose finds that mail order pharmacies – again the biggest owned by the big national healthcare players — regularly overfill Medicare prescriptions. The Journal finds that excessive filling is a common practice at mail order firms. Too-frequent refills by all U.S. pharmacies cost Medicare and patients $3 billion between 2021 and 2023 says the Journal.

Johnson Under Fire From Moderates On Healthcare As Congress returns this week, House Speaker Mike Johnson, R-LA, is facing a backlash from moderates in his already divisive caucus with a razor-thin majority. Moderates are upset that Johnson refused to hold a vote on Exchange subsidy extensions. After that, four members sided with Democrats on a discharge petition to force a vote in January. These moderates are committed to reaching a compromise with the Senate to extend the subsidies in some form. #exchanges #healthcare #coverage #congress #gop #speakerjohnson https://thehill.com/homenews/house/5667397-mike-johnson-house-republican-moderates/?tbref=hp AHIP Goes On Offensive Against Cost Blame AHIP, the health plan lobby, is continuing its media campaign to note that plans are not responsible for huge surges in costs and premiums. It notes that plans made just 0.8% in 2024 and the industry’s profits are now regulated by various rules and laws. However, vertically integrated healthcare behemoths, which own insurers, typically do