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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Fired Food and Drug Administration (FDA) probationary workers are receiving calls that their terminations are being rescinded.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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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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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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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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January 24, 2024

Record Enrollment In Exchanges Nationwide The Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) announced something to celebrate.  Driven in part by Medicaid redetermination enrollment losses and enhanced premium subsidies, state and federal exchange enrollment reached a projected 21.3 million for 2024. An amazing achievement. Over 5 million new enrollees joined over 16 million existing members. Nearly 4.2 million people with incomes of less than 250% of the federal poverty level signed up for 2024 coverage.  They receive both premium subsidies and cost-sharing reductions. About 15% of those enrollment previously had Medicaid.  That translates to a little over 3 million – a small amount of those who lost Medicaid coverage. Over 16 million are in the federal Exchange and about 5 million in various state Exchanges. CMS press release here: https://www.cms.gov/newsroom/press-releases/historic-213-million-people-choose-aca-marketplace-coverage . CMS Snapshot here: https://www.cms.gov/newsroom/fact-sheets/marketplace-2024-open-enrollment-period-report-final-national-snapshot . HHS press release here: https://www.hhs.gov/about/news/2024/01/24/historic-21-million-people-choose-aca-marketplace-coverage.html Kaiser

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January 23, 2024

Rural Hospitals In Distress A good measure of the distress rural hospitals: most no longer deliver babies. Over half of the country’s rural hospitals aren’t offering labor and delivery services and more could end such services. Some would argue that the rural hospitals’ plight could be solved by more money for hospitals overall.  The truth is the abominable hospital price system we have in this country along with the gross inefficiency of most hospitals drains overall healthcare resources and means we do not have enough to respond to true crises, such as those in rural communities. #ruralhealthcare #hospitals Link to Article Good Summary Of New Interoperability Rule’s Impact On Health Plans Modern Healthcare has a good article summarizing the provisions and impacts of the new interoperability rule.  Among the mandates are a swifter turnaround time for medical service authorizations in 2026 and the new FHIR electronic prior authorization process in

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