socialdeterminants

Medicare Advantage plans’ financial woes hit 2025 enrollment growth in a big way The long delayed 2025 Medicare Advantage (MA) enrollment season results have finally been published. The January 1 enrollment statistics were up for a short time only to be taken down due to errors and presumably the transition in the White House. This week, both the January and February 2025 results were posted by the Centers for Medicare and Medicaid Services (CMS). In looking at the January results, they do not seem quite right as the growth in enrollment from January to February would be extremely high – rather unprecedented. That leads to my supposition that the January data are still wrong or CMS had major issues processing January 1 applications. As such, I am comparing January 2024 numbers to February 2025 numbers as a proxy for 2024 to 2025 year-over-year growth. The statistics show some of the

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

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

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

Despite Republicans liking Medicare Advantage, major funding and structural changes could occur Some of you have written me asking why I am so convinced that the Trump administration and a GOP Congress will continue to target Medicare Advantage (MA) for savings. It is true that Donald Trump likes private healthcare and MA as a program. His healthcare nominees, including incoming Health and Human Services (HHS) Secretary Robert F. Kennedy, Jr., and Dr. Mehmet Oz, who is slated to be the Centers for Medicare and Medicaid Services (CMS) administrator, favor the program. Trump and the GOP Congress could even opt for future Medicare beneficiaries to default to MA versus the traditional fee-for-service (FFS) program. They could offer some short-term relief in terms of MA rates and pull back on the misguided Inflation Reduction Act’s (IRA) Part D out-of-pocket cap and cost-sharing changes. But many of the folks with influence over Trump