tariffs

Medicare Advantage Plans Getting Higher Rates For 2026 The 2026 Medicare Advantage (MA) Final Notice was released this evening by the Centers for Medicare and Medicaid Services (CMS). After the Advance Notice in January, MA plans complained about a paltry rate hike of 2.23%. They asked the Trump administration to intervene and either tweak the risk model change phase-in or the one related to medical education reductions. Well, the Trump administration didn’t have to really do anything to drive up the 2026 rate. CMS did not change any policies on rates between the advance notice and final one. But the rate hike surged to 5.06% because the rate setting growth factor increased dramatically between the two notices. The change is projected to result in an increase of 5.06%, or over $25 billion, in MA payments to plans in CY 2026. MA plans and actuaries warned that trends in the program

Trump Administration Finalizes Pared Back MA And Part D Rule for 2026 The 2026 Medicare Advantage (MA) and Part D rule was finalized by the new Trump administration and it did not finalize many portions of the Biden administration proposed rule. These could be acted on after further review or never see the light of day again. Significant things not finalized: CMS did finalize several things and this is by no means a full list: The Final Notice for rates and other Star measures should be out Monday as well. CMS Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/contract-year-2026-policy-and-technical-changes-medicare-advantage-program-medicare-prescription-final Additional articles: https://www.fiercehealthcare.com/payers/medicare-advantage-final-rule-excludes-anti-obesity-drug-coverage-under-medicare-medicaid and https://insidehealthpolicy.com/daily-news/trump-finalizes-prior-auth-hospital-stay-reqs-medicare-advantage-rule and https://insidehealthpolicy.com/daily-news/cms-declines-finalize-ma-ai-guardrails-expresses-interest-future-ai-regulation and https://thehill.com/homenews/5233357-medicare-medicaid-obesity-biden-trump/ and https://insidehealthpolicy.com/daily-news/cms-scraps-biden-plan-cover-anti-obesity-medications and https://www.modernhealthcare.com/policy/medicare-advantage-prior-authorization-ai (Some articles may require a subscription.) #medicareadvantage #partd #cms #regulations #star #quality #glp1s #priorauthorization https://www.modernhealthcare.com/politics-policy/medicare-obesity-drug-coverage-trump FTC Chair Reverses Recusal And PBM Suit Can Proceed Federal Trade Commission (FTC) Chair Andrew Ferguson has reversed course on his decision to recuse himself from the agency’s

Oz Confirmed By Senate Dr. Mehmet Oz, M.D., was approved by the Senate to serve as administrator of the Centers for Medicare and Medicaid Services (CMS). The vote was along party lines, 53-45. Oz walks into an agency reeling from cutbacks by the Trump administration and layoffs. Meanwhile, a high-profile health influencer in the White House as a temporary employee appeared before a Politico health summit. Calley Means, close to health chief Robert F. Kennedy, Jr., said that the healthcare system has been plagued by inordinate influence from hospitals and drug makers and that CMS has been controlled by the American Medical Association (AMA). Means defended controversial HHS budget cuts and said that National Institutes of Health (NIH) research funding was not slashed. As well today, Sen. Susan Collins, R-ME, said she was very concerned about the prospects of deep Medicaid cuts given the House healthcare reduction target. Additional articles:

Senate Adopts “Current Policy” Scoring Budget Gimmick The Senate GOP has officially adopted a budget gimmick in its proposed budget reconciliation resolution. Appropriations Chair Sen. Lindsay Graham, R-SC, said he had the authority to adopt the budget scoring method and the Senate parliamentarian said it was appropriate to move forward. The resolution sets lower targets for spending cuts – a minimum of $3 billion. The resolution should be adopted later this week to align in general with the House approach. However, some conservatives in the House are already attacking the gimmick. The House approach sets a $1.5 trillion floor with a goal of $2.0 trillion in cuts over ten years. This could set up a showdown between moderates and conservatives on spending reductions. The truth is that the current policy approach means much higher deficits to 2034 and after. It is an appalling approach that further inflates our massive debt

Senate Seeks To Use Budget Gimmick In Budget Reconciliation The Senate has been forced to approach budget reconciliation the way President Donald Trump and the House Republicans want it – one “big beautiful bill” — to address taxes, spending cuts, and the debt limit. But because the Senate fears major spending cuts, it is entertaining a bit of a budget gimmick related to how the bill should be “scored” – how the Congressional Budget Office (CBO) will add up costs, savings, and the deficit. Traditionally, CBO scores apply “current law.”  Because the 2017 Trump tax cuts expire at the end of the year, extending them costs revenue. Senate budget rules say that, to avoid a filibuster cloture vote and pass the measure with 51 votes, the deficit cannot increase over the applicable budget horizon. Thus, offsetting cuts are needed. But GOP leaders in the upper chamber are looking at whether

Enrollment Marketing and Fraud Take Center Stage The lobby representing marketing agents and brokers is blasting Democrats’ legislation that would slap civil or criminal penalties on agents and brokers who submit fraudulent information regarding Exchange enrollment. It points the finger at the federal government for failing to enforce laws to protect consumers. At the same time, a report from Senate Finance Committee Ranking Member Ron Wyden says Medicare Advantage (MA) insurers are spending an increasing amount on fees and commissions paid to brokers. The report states that MA plans increasingly rely on third-party marketing organizations and lead generators to drive enrollment. Spending on such fees and commissions increased from $2.4 billion in 2018 to $6.9 billion in 2023. As well, the Paragon Health Institute is citing the indictment of two men for allegedly running a scheme to glean commissions by enticing people to misstate their expected income to gain subsidized

Trump Yet To Clarify Tariffs On Healthcare Products Donald Trump has yet to decide how potential tariffs on pharmaceutical products will be structured. In February, Trump said that tariffs on pharmaceuticals and other essential products would be about 25% and that U.S. companies may get a phase-in period for imported goods, giving them time to shift production onshore. In a new survey of 200 healthcare industry experts, 82% said they expect tariff-related import expenses to increase hospital and health system costs by 15%. So, most of the tariff costs will be passed through. Additional article: https://www.beckershospitalreview.com/supply-chain/hospital-finance-supply-leaders-predict-15-increase-in-tariff-related-costs/ (Some articles may require a subscription.) #drugpricing #branddrugmakers #tariffs https://insidehealthpolicy.com/inside-drug-pricing-daily-news/trump-undecided-structure-potential-pharma-tariffs-wh-says HCSC Joins Big Leagues An interesting article on Health Care Service Corporation’s recent acquisition of Cigna’s Medicare businesses. While Medicare Advantage (MA) has significant headwinds, HCSC leadership believes in MA’s long-term viability. It does not plan to become as much of a behemoth as the big

HHS And Related Health Agencies Will Downsize By 20,000 The Department of Health and Human Services (HHS) will slash an additional 10,000 full-time jobs after laying off or “buying out” about the same number already. Prior to the moves, the agencies collectively had 82,000, so the workforce will be downsized by about 25%. These cuts are in line with the Department of Government Efficiency (DOGE) commission’s workforce optimization efforts and are slated to save the agencies $1.8 billion per year. HHS is also reorganizing and will cut the department from 28 divisions to 15 and close five regional offices. Job reductions include: Additional articles: https://www.fiercehealthcare.com/regulatory/rfk-jr-prepares-10000-job-cuts-across-hhs-new-wave-worker-reductions and https://insidehealthpolicy.com/daily-news/hhs-major-new-reorg-includes-agency-mergers-10k-more-job-cuts and https://www.healthcareitnews.com/news/hhs-reduce-workforce-20k-jobs-major-agency-wide-restructure and https://thehill.com/policy/healthcare/5218547-trump-administration-plans-hhs-cuts/ and https://www.medpagetoday.com/washington-watch/washington-watch/114854 and https://www.modernhealthcare.com/labor/hhs-cuts-rfk-jr (Some articles may require a subscription.) #congress #trump #doge #budgetreconciliation #healthcare #hhs #cms #fda #cdc #nih https://www.healthcaredive.com/news/hhs-job-cuts-reorganization-rfk-trump/743569 Bipartisan Prior Auth Reform Bill Unveiled Again Rep. Mark Green, R-TX, reintroduced a major new prior authorization restriction bill

Medicare Advantage Deductibles Surged in 2025 A survey by online broker eHealth finds that the average deductible for a Medicare Advantage (MA) plan in 2025 more than doubled to $315. The average deductible for MA plans during the enrollment period was $315, compared to $132 in 2024, or an increase of 139%. Premiums decreased from $9 per month to $5 per month, but MA plans clearly had to save by increasing deductibles and cost-sharing as well as reducing benefits and footprints. In other news, Becker’s also reports on the fastest-growing non-profit Blue Cross and Blue Shield plans in terms of MA enrollment. Chartis says Blue Cross Blue Shield non-profit plans accounted for around 30% of MA enrollment growth in 2025. That number does not include for-profit Elevance Health, one of the big national plans which is also a Blues licensee. Big BCBS plan gainers were BCBSMI, Highmark, and Horizon. Chartis also

Hard-Hitting Study Could Drive Medicaid Budget Cuts A study by the Paragon Health Institute and the Economic Policy Innovation Center could help drive certain cuts adopted by Republicans during the budget reconciliation process. The study focuses in on California and various ways the authors say the Golden State effectively exploits matching rules and launders money to fund its state share at the expense of the federal Medicaid budget. It also indicates that the schemes provide dollars to cover undocumented immigrants, even though federal law bars enrollment in Medicaid. The GOP in Congress is known to want to stay away from explicit coverage reductions in Medicaid. But it is looking at reining in the amount states are demanding in match as well as eliminating or at least reducing the use of provider taxes for state match. Study: https://paragoninstitute.org/wp-content/uploads/2025/03/California-Money-Laundering-Scheme_FOR-RELEASE_V3.pdf #medicaid #healthcare #coverage #budgetreconciliation https://thefederalist.com/2025/03/24/red-states-are-paying-for-californias-illegal-aliens-health-care GLP-1 Spending Outpaces Specialty Drugs Spending on GLP-1