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February 25, 2025

House Passes Budget Framework; Healthcare Cuts Heat Up The House adopted a budget reconciliation bill today with just one GOP defection. House Speaker Mike Johnson and President Donald Trump got three other doubters to convert to “yes.” The vote was 217 to 215. The bill paves the way for final passage down the road but a great deal of work has to occur, with committees now meeting on spending cut targets. This includes $880 billion in healthcare spending cut targets. Johnson and perhaps Trump convinced holdouts that Medicaid rolls will not be cut except for work requirements and if someone is illegally on the program. It may be hard to keep the commitment with a large reduction bogey. The victory was major for Johnson but he now needs to hold all these folks in place as spending cuts are debated in committees. Meanwhile, healthcare news is heating up due to the

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February 24, 2025

More Surprises From Trump On Drug Pricing Donald Trump’s Centers for Medicare and Medicaid Services (CMS) in late January said it would continue Medicare drug price negotiations. Then, in a Super Bowl interview, Trump bemoaned the cost of GLP-1 weight-loss drugs in America compared with other developed nations. Now, the Trump administration has chosen to defend the Medicare drug price reform law in court. In a filing Feb. 19, the government agreed with the legal arguments used by the Biden administration and by a lower court. Trump so far is not what Big Pharma hoped. #ira #medicare #partd #drugpricing #branddrugmakers https://www.fiercehealthcare.com/payers/trump-admin-defends-ira-drug-price-negotiation-program-novartis-lawsuit FDA Workers May Be Headed Back To Work Fired Food and Drug Administration (FDA) probationary workers are receiving calls that their terminations are being rescinded. The Department of Government Efficiency (DOGE) commission clearly jumped the gun on firing all probationary positions throughout government. #doge #layoffs #trump #spending https://www.fiercehealthcare.com/regulatory/mass-layoffs-hhs-cdc-cuts-1300-probationary-workers-reports-say United Comes

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Trump Tests Limits Of Power By Stretching Article 2 Of The Constitution

My unvarnished and dispassionate take on Trump’s assertion of executive authority Many of you are aware of my service in state government in the executive branch and have asked me about the recent controversy surrounding President Donald Trump’s broad exercise of executive power in Washington, D.C. So, while this is not exactly a healthcare blog per se, the controversy certainly impacts coverage in the nation. We are about a month into Trump 47, so it is a good time to opine on this. As such, I will give you my unvarnished and hopefully dispassionate view of things. Should we feel sympathy for what the executive is trying to do? Is Donald Trump going too far? A little background on me I served in state government in Connecticut from 1995 to 2005. I was a Republican executive appointee and eventually became the Deputy Management Secretary/Deputy Budget Director of the state and

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February 21, 2025

Centene and Molina Could Be Hurt By Medicaid Cuts Medicaid managed care-dominant insurers Centene and Molina could be hurt by Republicans’ plans for cuts to Medicaid. The House GOP has a target of $800 billion in healthcare spending reductions. While President Trump and GOP leaders have promised no dramatic changes to Medicaid, the targets would clearly mean deep reductions. While work requirements and fraud cuts are certain, other impacts could be reimbursement changes at the state level. Centene is the largest Medicaid managed care insurer with 13 million Medicaid beneficiaries as of Dec. 31. The membership generates 62% of the company’s revenue. Medicaid represents 88% of Molina’s membership and nearly 80% of its revenue for 2024. (Article may require a subscription.) #medicaid #managedcare #budgetreconciliation #trump #congress #molina #centene https://www.modernhealthcare.com/insurance/medicaid-cuts-centene-molina-healthcare WSJ Says DOJ Probing United The Wall Street Journal reports that the Department of Justice (DOJ) is probing UnitedHealth Group’s billing

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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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