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Hillbilly Heart: Despite His Conservatism, Could GOP VP Nominee JD Vance Be A Healthcare Maverick?

The political world is abuzz about the naming of Ohio Senator JD Vance as former President Donald Trump’s vice presidential running mate. I will stay out of the broader political fray right now, but I thought it was worth writing about how GOP candidates increasingly do not always meet a strict GOP litmus test on every issue. This could be – I emphasize could – with Vance on healthcare. Vance came to fame with his bestselling book, Hillbilly Elegy: A Memoir of a Family and Culture in Crisis, which recounted the social and economic problems his family faced during his upbringing in Kentucky and later in Ohio. Vance recounts the plight of poor white working-class families in Appalachia, including family struggles with alcoholism and drug dependence, as well as the embedded love of culture and country. He tells of his rise from this meager existence in a one-parent household to

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Medicare Advantage Plans Need To Get Their Focus On Supplemental Benefits Quickly

Medicare Advantage (MA) critics like to shout about revenue overpayments and this is sure to generate headlines and ongoing controversy. But MA plans need to worry about yet another concern from the Centers for Medicare and Medicaid Services (CMS), investigatory agencies, and Capitol Hill. This surrounds supplemental benefits and whether enrollees are benefiting from the vast amount of dollars supposedly earmarked for their utilization each year. This is yet another complicated subject so let’s try to break this down a bit. Rate-setting quick primer As we have discussed on this website often, the rate-setting process in MA has helped MA plans grow considerably. Plans submit annual bids on how much it will cost to deliver traditional Medicare benefits. It then is paid out a portion of the difference between the county benchmark and the bid amount for traditional benefits. This is called the rate rebate. The amount given back to

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Slower Growth From June to July In Medicare Advantage

As noted, I decided to continue my Medicare Advantage (MA) monthly enrollment blogs because of continuing strong month-over-month increases. Admittedly, the continuing growth is tied to remaining strong benefit packages for 2024 and appears to be isolated to a few big plans. Month-over-month growth appears to be slowing a bit, but we are so close to the Fall open enrollment season that I will keep doing these monthly snapshots for those who like to track the data. One new feature in the chart below: you may notice the percentage of MA enrollment against the total Medicare beneficiary population has changed slightly. That is because I stumbled upon a great Centers for Medicare and Medicaid Services (CMS) monthly Medicare enrollment site. It has both annual average enrollment as well as monthly enrollment. This goes all the way to the county level in each state. The site is here: https://data.cms.gov/summary-statistics-on-beneficiary-enrollment/medicare-and-medicaid-reports/medicare-monthly-enrollment . The good

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Federal Court Stays CMS Medicare Broker-Agent Compensation Reform

A stay issued by a federal court was not well publicized as it came out during the July 4 holiday, but the action could have major implications for the 2025 Medicare Advantage (MA) enrollment season. A federal judge suspended the implementation of the Centers for Medicare and Medicaid Services’ (CMS) MA broker and agent compensation reform changes. The move has major implications for the agency’s efforts to reform what I believe is a badly broken system. What problem did CMS identify? For the past number of years, the number of marketing related complaints have increased dramatically. CMS has attempted to force health plans to have better delegated oversight over the independent third-party marketing organizations (TPMOs) that have grown considerably because of the lucrative nature of enrolling MA members. Agents receive compensation each year a person stays with MA and even more for first-year enrollees. I value the role of agents

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It Is Time For Site-Neutral Payments In Our Healthcare System

Late last year, the House of Representatives passed a small step toward site-neutral payment policies in Medicare. But the Senate did not pass the bill due to opposition from the hospital industry. Since then, healthcare advocate groups have made a full court press to pass something in 2024. The hospital lobby is strong and has resisted these types of reforms for years. But advocates, health plans, and other parties have made the case that the reform is critical to lowering overall costs in the system as well as rising out-of-pocket costs for everyday Americans. Of course they are right. I have it as a key reform within one of my healthcare reform tenets – price reform. What are site-neutral payment policies? Quite simply, it means paying the same amount for the same service regardless of the place of service or location. Traditionally, outpatient hospital settings have gotten paid far more

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What Does The End Of Chevron Deference Mean For Healthcare?

In an expected move, the Supreme Court ruled that the so-called 1984 Chevron deference under the nations’ regulatory system is no more. It has now thrown the Supreme Court precedent out. It is a technically complex ruling that has major implications for policymaking throughout government. Chevron was not a precedent just for healthcare agencies but applied to every executive department and agency out there – defense, environment, health, commerce, consumer protection and more. The decision split along rather pure ideological grounds, with six more conservative justices lining up against three more liberal ones. The Chevron doctrine said that courts must give deference to reasonable interpretations of regulations issued by regulatory agencies that may be in part based on laws that are ambiguous. In essence, regulators had reasonably wide discretion to interpret what these ambiguous parts of a law meant and if so, how a law might be implemented. Proponents think that Chevron

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BCBSA Antitrust Settlement Is Bad For Healthcare Competition

This past week, the Supreme Court announced that it declined to hear a case challenging the anti-trust settlement between employer groups and Blue Cross and Blue Shield (BCBS) licensee plans nationwide as well as its association (BCBSA). While no wrongdoing was admitted, BCBS plans were accused of anti-competitive behavior in the employer market by limiting employer group contracts to so-called “home plans” as well as the product options offered. It will pay a substantial settlement and must change some of the association’s practices. You could argue the decision is a small step forward, but the decision shows what is so demonstrably wrong with competitiveness in healthcare in America. It upholds the power of entities acting as an effective monopoly in America and the fallout could even foster further consolidation of health insurers. What are the Blues? The so-called Blues plans originated back in the early 20th century when alliances of

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Strong Growth From May to June In Medicare Advantage

As noted last month, I decided to continue my Medicare Advantage (MA) monthly enrollment blogs because of continuing strong month-over-month increases. Admittedly, the continuing growth is tied to remaining strong benefit packages for 2024 and appears to be isolated to a few big plans. Many plans will rein in benefits and geographies for contract year 2025 due to significantly deteriorating bottom lines. This is being caused by the return of robust utilization, inflation picking up in the healthcare sector (especially at hospitals), poor Star scores, negative rate increases for 2024 and 2025, and new regulatory burdens (such as the new prior authorization restrictions). The recent 2024 Star recalculation, which was precipitated by losses in court by the Centers for Medicare and Medicaid Services (CMS), will mean some plans refile bids and benefits for 2025.  But we are hearing great reluctance to refile by many due to the quick deadlines, the negative

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What Do The Latest Healthcare Spending Projections Tell Us?

The latest forecasts from the Centers for Medicare and Medicaid Services (CMS) Office of the Actuary continue to show how out of control America’s healthcare spending is. Each June, the CMS Actuary re-estimates healthcare spending for the coming decade. The latest estimates continue to show a system that is badly in need of reform. While final figures for 2023 will come in December, the latest estimate on 2023 healthcare spending shows it will reach about $4.8 trillion or 17.6% of gross domestic product (GDP). That is up from $4.46 billion or 17.3% in 2022. That is a growth of 7.6% from 2022 to 2023. The major growth was in part related to the high insured rate of 93.1% due to the COVID flexibilities. While Medicaid redeterminations began again in April of 2023, the insured rate remained high in 2023. Medicare spending hit a milestone by growing 8.4% in 2023 and

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CMS’ TukeyGate Follow-up: Where Could CMS Go To Save On Medicare Stars?

After the TukeyGate court decisions that struck 2024 Medicare Advantage (MA) Star calculations, many are speculating where the Centers for Medicare and Medicaid Services (CMS) may now go to make up some of the increased costs in the Star program (see the TukeyGate blog here: https://www.healthcarelabyrinth.com/cms-tukeygate-lawsuit-decision-threatens-to-unravel-much-of-medicare-advantage-star-scoring-in-2024-and-2025-and-next-years-bids-and-benefits/ ). The increase in Stars could result in at least $1.3 billion in increased costs to Medicare in 2025. The lawsuit loss likely caught CMS by surprise, but the agency was right to recalculate and fix the major expected 2025 benefit declines in filed bids and benefits.  I still think benefits will be reined in but the hurt on seniors and those with disabilities will be less. Given budgetary pressures and the major perception of overpayments in MA, CMS will be under pressure to find savings elsewhere over the next few years. Indeed, they wanted to implement Tukey in 2024 and get the Star

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