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Election Update And The Potential Role of Healthcare Issues

While healthcare has been displaced by other economic issues and immigration as the compelling Election 24 issues of the day, I have taken the position that healthcare could very well play a role in this year’s election outcome. How so? How close is it? Let’s take a look at how close things are for the presidency and the houses of Congress. For reliable forecasts on elections, I always go to at RealClear Politics. It is very reliable and unbiased.  I also like the fact it uses polling averages to determine the current prospects of various political contenders. In addition, I have a special connection as its publishing arm, RealClear Publishing, was one of the publishers of my book, The Healthcare Labyrinth (available via this site). I went to RealClear Politics for the presidential and Senate races and looked at a few other sources for the House races. Presidential race –

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What The Recent Report On The Medicare Trust Funds Tells Us About Healthcare Policy

Each year, the trustees of both the Social Security and Medicare Trust Funds issue reports about the fiscal health of the funds. The practice is meant to spark a public policy analysis within the executive and legislative branches, but it almost never does. This year is no different. The Biden administration touted the recent report on the extension of the solvency of the Medicare Part A Trust Fund as some sort of evidence that it has worked diligently to ensure Medicare’s future. In its election-year press release from Health and Human Services (HHS) Secretary Xavier Becerra, it touted supposed remarkable achievements on the Medicare stabilization front: “The Biden-Harris Administration has left no stone unturned in our efforts to strengthen and preserve Medicare, not just for our parents and grandparents but for our children and generations to come.” But nothing could be further from the truth. The administration and Democrats have

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More Disturbing Trends On Medicare Advantage Prior Authorization

In these pages I have bemoaned the fact that the Centers for Medicare and Medicaid Services (CMS) and Capitol Hill are taking the managed care out of Medicare Advantage (MA). MA’s value proposition is based on the plans’ ability to save dollars in furnishing traditional Medicare fee-for-service (FFS) benefits and passing on the savings in the form of reduced cost-sharing, filling in gaps in the traditional benefit, and adding additional benefits. But when CMS reins in the ability to save these dollars, it will have a direct impact on the benefits American seniors and people with disabilities see. What’s more, the antiquated FFS system is fraud-ridden and of poor quality. We need innovation not mimicking the old way of delivering care. But by hobbling MA plans’ innovation, CMS and Capitol Hill are setting MA and the overall healthcare system back. Driven by some strange need to ingratiate themselves to provider

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Strong Growth From April to May In Medicare Advantage

I decided to continue my Medicare Advantage (MA) monthly enrollment blogs because of continuing strong month-over-month increases.  While we are outside of the two regular annual enrollment windows, increases in MA are still strong given the aging of America and the ability of some populations, such as dual eligibles, to continue to make changes throughout the year. As I have reported, growth from January 2023 to January 2024 was a robust 8.7% increase or 2.674 million.  Enrollment in MA reached 30.799 million in January.  Since that time, enrollment has continued to climb: Enrollment in MA has now hit 33.985 million. The growth from January 1 to May 1 represents an additional 1.53% increase or 512,000 lives. MA enrollment has now increased beyond 51% of all Medicare beneficiaries. As we saw with January 2023 to January 2024, PPO growth now significantly outstrips HMO growth. From January 1 to May 1, HMOs

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MA Plans Should Ready For Changes To Risk Adjustment Submissions?

Provider groups, anti-Medicare Advantage (MA) advocates and researchers, and even the congressional policy arm MedPAC are busy attacking MA for supposedly being over-reimbursed. Depending on the study you find, these folks will tell you that MA is over-reimbursed by as much as $88 billion annually. Of course, many of these calculations are speculative and throw in policy decisions by Congress to make Stars funding additive as well as to pay some areas of the country more than the fee-for-service (FFS) rate to promote more benefit choice in rural areas. They argue that risk adjustment coding is out of control and that MA has beneficial selection compared with the traditional program. I have told you often in these pages that I come somewhere up the middle here. I discount the critics’ views and analyses. It is strange that critics’ overpayment estimates jumped from under $20 billion for so many years to

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Health Plan Economics Part 4: Other Healthcare Trends And Their Economic Impacts On Plans

This blog is the last of a four-part series on Health Plan Economics. In this series, I plan on simply laying out some important trends in different lines of business and some of the impacts from a healthcare economics standpoint. Here is my plan, subject to change of course based on breaking news: April 25 – Medicare Advantage and Rumors Of Humana’s acquisition by Cigna April 29 – How The Lapse Of Premium Subsidies Could Hurt The Exchanges’ Relatively Stable Finances May 2 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike May 6 – Other Healthcare Trends And Their Economic Impacts On Plans — Part 4 – Other Healthcare Trends And Their Economic Impacts On Plans We are at the end of our four-part series on health plan economics. This last installment is on some healthcare trends we see in the marketplace and how that impacts

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Health Plan Economics Part 3:  How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike

This blog is part of a four-part series on Health Plan Economics. In this series, I plan on simply laying out some important trends in different lines of business and some of the impacts from a healthcare economics standpoint. Here is my plan, subject to change of course based on breaking news: April 25 – Medicare Advantage and Rumors Of Humana’s acquisition by Cigna April 29 – How The Lapse Of Premium Subsidies Could Hurt The Exchanges’ Relatively Stable Finances May 2 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike May 6 – Other Healthcare Trends And Their Economic Impacts On Plans — Part 3 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike Now that we have covered Medicare Advantage and the Exchanges, let’s move this week to what is happening in Medicaid managed care. Note that I base many of my

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Health Plan Economics Part 2:  How The Lapse Of Premium Subsidies Could Hurt The Exchanges’ Relatively Stable Finances

This blog is part of a four-part series on Health Plan Economics. In this series I plan on simply laying out some important trends in different lines of business and some of the impacts from a healthcare economics standpoint. Here is my plan, subject to change of course based on breaking news: April 25 – Medicare Advantage and Rumors Of Humana’s acquisition by Cigna April 29 – How The Lapse Of Premium Subsidies Could Hurt The Exchanges’ Relatively Stable Finances May 2 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike May 6 – Other Healthcare Trends And Their Economic Impacts On Plans — Part 2 – How The Lapse Of Premium Subsidies Could Hurt The Exchange’s Relatively Stable Finances I hope you are enjoying this blog series on health plan economics. Last week we covered some economics in the news right now for Medicare Advantage. This

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Health Plan Economics Part 1:  Medicare Advantage And New Rumors Of A Cigna-Humana Combination

This blog starts a four-part series on Health Plan Economics. In this series I plan on simply laying out some important trends in different lines of business and some of the impacts from a healthcare economics standpoint. Here is my plan, subject to change of course based on breaking news: April 25 – Medicare Advantage and Rumors Of Humana’s acquisition by Cigna April 29 – How The Lapse Of Premium Subsidies Could Hurt The Exchange’s Relatively Stable Finances May 2 – How Falling Medicaid Enrollment is Impacting Health Plans and Providers Alike May 6 – Other Healthcare Trends And Their Economic Impacts On Plans — Part 1 – Medicare Advantage and New Rumors of Cigna-Humana Combination I had not thought much about the failed Cigna-Humana combination since it fell apart late last year. But I was intrigued by Jeffries analyst who just reported that the math now may work again

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Major Medicaid Managed Care Changes Follow Medicare Ones

Following major changes in Medicare Advantage (MA) and Part D, the Centers for Medicare and Medicaid Services (CMS) finalized a number of rules impacting Medicaid, but specificially managed care. With the vast majoirty of Medicaid beneficiaries in managed care, CMS is targeting numerous prorgams to the managed care programs in states.  What are the major changes impacting Medicaid managed care? Waiting times/access Rates, spending, and transparency Quality and satisfaction Nursing homes The Biden administration finalized numerous changes impacting nursing homes, including minimum staffing requirements and directing that 80% of all payments from Medicaid (over a six-year period and with some flexibility) go to wages for aides and nurses.  The problem with the rule is that rates just are not sufficient enough to meet these requirements and proposals Biden has made. Proposals to increase dollars have not yet passed.  The fear is that the moves in each case could force many

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