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January 10, 2025

2026 MA Proposed Rate Announced The outgoing Biden administration has released its Advance Notice for 2026 rates and other policy changes. I quickly reviewed the 180-page Advance Notice, the CMS Fact Sheet, and CMS Press Release. Here are some highlights and Healthcare Labyrinth will have more information on rates and Star changes next week. My summary: The announcement is progress for MA plans and will be a bit of a relief for insurers and investors. But this still is a very skimpy increase given all the MA world is facing. It could mean a third year in MA benefit cuts. Details: — CMS says MA rates go up by 4.33%. But plans will take issue with including a risk score trend of 2.1% in the calculation. Plans will say they will get closer to a 2.23% because plans do not count the coding increase as a real revenue increase. They

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January 9, 2025

Musk Calls Out Goals For DOGE Tesla CEO Elon Musk, who is co-leader of Donald Trump’s proposed Department of Government Efficiency (DOGE) commission, said that the best-case scenario would be to put together $2 trillion in cuts to federal spending. He said that then DOGE would have a good shot at executing $1 trillion in reductions. Whether the goal is a real $1 trillion or $2 trillion, it is clear that healthcare program cuts will play a big role in spending reductions. #doge #government #spending #trump #congress #healthcare https://thehill.com/homenews/administration/5076095-elon-musk-doge-2t-spending-cut-goal/?tbref=hp Generic Drug Lobby Worried About Tariffs The U.S. generic drug lobby is worried about the imposition of tariffs and wants to convince the incoming Trump administration such tariffs would hurt efforts to lower drug prices. The Lobby is also pushing for so-called “skinny” labeling, biosimilar automatic interchangeability, and patent reform. (Article may require a subscription.) #drugpricing #generics #tariffs #trump #biosimilars #patents

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January 8, 2025

Exchange Enrollment Hits Record With about a week left of enrollment, the Centers for Medicare and Medicaid Services (CMS) said that the Exchanges have reached yet another record enrollment number after mostly lagging during the enrollment season. More than 23 million people have selected coverage. There are 3.2 million new enrollees. Of the people who have signed up so far, 16.7 million found coverage on the federal Exchange, with 6.9 million on the state Exchanges. This is the fourth consecutive year of enrollment records. Enhanced premium subsidies expire at the end of 2025, which could dramatically impact enrollment. Today congressional Republicans declined to say they would simply let the subsidies expire. Instead, they expect the issue to emerge during talks to extend the Trump tax cuts and the reconciliation process. I still see this as a long shot, but it is bolstered by Sen. Lisa Murkowski’s advocacy for continuation of the enhancements.

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January 7, 2025

Biden Administration Finalizes Medical Debt Provision The federal Consumer Financial Protection Bureau issued finalized regulations barring medical debts on credit reports. The rule bans credit agencies from including medical debts on consumers’ credit reports and prohibit lenders from considering medical information in assessing borrowers. To me, it is very unlikely the Trump administration will seek to overturn the regulation. I support the provision. Americans with and without insurance are unfairly saddled with huge provider bills that are exorbitant and have no basis in cost or fact. Additional article: https://www.modernhealthcare.com/politics-policy/joe-biden-bans-medical-debt-credit-scores-cfpb-donald-trump (Some articles may require a subscription.) #medicaldebt #providers #healthcare https://thehill.com/policy/healthcare/5070182-medical-debt-removed-credit-reports-cfpb Medtech Bracing For Tariffs Under Trump Medtech companies are bracing for imposition of tariffs (of at least 25%) on medical devices once Donald Trump takes office. This could drive costs up in the healthcare arena as a majority of devices are manufactured overseas. The industry also says this could impact innovation. The

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