united Archives - The Healthcare Labyrinth

What Could Healthcare Spending Cuts Look Like?

January 9, 2025 No Comments

Trump’s goal of extending the 2017 tax cuts could have major implications for healthcare In Monday’s blog, I told you that the incoming Trump administration will be dominated by budget matters in 2025, with an effort to find enough savings to extend the 2017 tax cuts. The proposed Department of Government Efficiency (DOGE) commission seems dedicated to a fundamental remake of government, programs, and regulations. While the Republican or GOP control of both Houses is tight, leaders and the rank-and-file seem ready to hitch their wagons to Trump and his agenda. But as I noted Monday, process and procedures could create challenges. With all this in mind, what might healthcare cut proposals look like? The DOGE, Trump, and congressional GOP lists will likely be culled from various sources including governmental authorities and outside conservative think tanks. The lists below include proposals from the Congressional Budget Office (CBO) and a number

What Will Trump’s Second First 100 Days Look Like?

January 6, 2025 No Comments

What will the early months of a new Trump term mean for healthcare? President-elect Donald Trump is scheduled to take office on January 20 after coming back from the political dead. Trump will become just the second president to serve non-consecutive terms. For the politically curious, the first was Grover Cleveland in 1885 and then again in 1893. Cleveland beat Republican James Blaine in 1884, winning both the electoral and popular votes. He lost to Republican Benjamin Harrison in 1888. Harrison won the electoral vote, but Cleveland won the popular vote. Cleveland came back to beat Harrison in 1892, getting both the electoral and popular vote. A now more government-savvy Trump has come out fast to put together his agenda and personnel for his second term, a major difference than what occurred in 2017 when Trump looked flat-footed during the transition. Trump already has almost all of his nominees picked

Channeling Nostradamus: The Healthcare Labyrinth’s 2025 Predictions

January 2, 2025 No Comments

Even a master seer would have problems predicting what will occur in healthcare in 2025 In my last blog, I gave you my healthcare year-in-review for 2024. After that, as I always do each year, I play Nostradamus to prognosticate about what will happen in the next twelve months in the world of healthcare. Despite my Irish last name, I do have French blood (well, 50% French Canadien, so I count it). But I don’t claim to be an oracle or seer like our 16th century physician, apothecary, and astrologer friend. I do take a page from Nostradamus, though, in that my healthcare predictions for 2025 (not really prophecies) will be sometimes deliberately vague (they include a lot of mays, coulds, shoulds, perhaps, likelys and possibles) so as to amass a reasonable record for those tracking and putting together my forecasting report card for the history books. It also tends to make my

The Healthcare Labyrinth 2024 Year In Review Blog

December 30, 2024 No Comments

A busy year in healthcare with insurer woes and a presidential election that brought changing political winds As is my tradition at year’s end, I reflect back on all that occurred in healthcare in the year. It was a big year in healthcare and the election portends another massive one next year. I will have my 2025 predictions blog on Thursday. So, here are the major healthcare happenings from 2024. You can go to various blogs at the blog tab to learn more. In a few instances, I call out good blogs to go back to as well. NHED shows robust healthcare growth National healthcare expenditure data (NHED) was published for 2023. Costs rose 7.6% from 2022 to 2023 and reached almost $4.9 trillion. This made spending on healthcare expeditures hit 17.6% of the gross domestic product (GDP). Healthcare expenditure will consume almost one-fifth of the economy by 2032. Insurer

The Two Sides Of Drug Prices After Negotiations

December 26, 2024 No Comments

The discounted Medicare drug prices makes progress but much more has to be done In A Tale of Two Cities, Charles Dickens famously started his novel with: “It was the best of times, it was the worst of times.” In many ways, the adage could well describe the current state of Medicare drug price negotiations. Medicare drug price negotiations background Medicare drug price negotiations became possible with the passage of the Inflation Reduction Act of 2022. The law required Medicare to begin negotiating drug prices with brand drug manufacturers. These drugs largely lack generic competition. Eligible drugs are phased in over time, with the first ten already set to have discounted pricing as of January 1, 2026. The next fifteen drugs subject to negotiation will be announced in February 2025, with final negotiated prices taking effect on January 1, 2027. The bill over time covers both Part D retail and

National Healthcare Expenditure Data Issued for 2023: What Does It All Mean?

December 23, 2024 No Comments

2023 saw a major surge in healthcare spending coming out of the COVID pandemic One of my Christmas traditions is to write about the release of the Centers for Medicare and Medicaid Services (CMS) Actuary’s National Healthcare Expenditure Data (NHED) for a given calendar year. This usually is released in the middle of December each year for the prior year. It literally takes CMS about a year to capture, calculate, and categorize all the data for a year given the size and labyrinthine complexity of our healthcare system. Each year as well, usually in the first half of June, the CMS Actuary updates healthcare spending projections for ten outyears. Why is this so important? First, it is the main comprehensive source of data for calculating the history and future of healthcare spending. Most other studies rely in some form on the CMS Actuary’s NHED reports. Second, it is a treasure trove

November To December Medicare Advantage Enrollment Statistics Signal Some Trends For 2025

December 19, 2024 No Comments

Some evidence that MA enrollment is slowing and big national plans realigning The 2025 enrollment season for Medicare Advantage (MA), known as the Annual Election Period (AEP), has come to a close as of Dec. 7, with some getting through Dec. 31 due to plan terminations. In this period, people can make changes between the traditional fee-for-service (FFS) program and MA or between MA plans. Standalone Part D (PDP) can be added or switched as well. Then, from Jan. 1 to Mar. 31, we have the perhaps misnamed MA Open Enrollment Period (MA OEP). In these three months, only those in MA can switch back to FFS and add a Part D plan or switch MA plans. Those enrolling in an MA Part C only plan can also add a standalone Part D plan. We are in a very odd time. Plan terminations and geographic contractions were major. Benefit cutbacks,

Be Level-Headed On Medical Loss Ratio Rules

December 16, 2024 No Comments

CMS’ MLR proposals are understandable, but caution is needed In a parting shot at the private managed care industry, the Biden administration’s Centers for Medicare and Medicaid Services (CMS) issued a 2026 Medicare Advantage (MA) and Part D proposed rule for 2026 that would make major changes to the minimum medical loss ratio (MLR) requirements in the Medicare managed care program. This comes as Capitol Hill is shining a light on a number of MA program issues, including overpayments, risk adjustment abuses, supplemental benefits, marketing, poor Star performance, and the vertical integration of top national health insurers. These top national players control about three-quarters of all MA enrollment right now. Minimum MLR explained Most lines of business now have MLR requirements except self-funded employer plans. In these cases, businesses are at risk for healthcare expenditures as opposed to insurers. Insurers will still administer such plans usually for a set administrative

Stories From Open Enrollment Show The Problems With Our Healthcare System

December 12, 2024 No Comments

My work with everyday consumers shows how irrational and broken the healthcare system really is. I am known as the healthcare guy to family and friends. For the past many years, I have had a bit of a part-time job in Q4, unpaid as it is. Given my background, I receive calls from a rather extended network of people seeking my aid and advice on the enrollment seasons – traditional Medicare with Medicare Supplement, Medicare Advantage (MA), Medicare Part D, the Federal Employees Health Benefit Program (FEHBP), the Exchanges, and employer group coverage. In retirement I plan to expand this free service for a variety of reasons, all of which I have learned from the past decade working with people. Here are some of this year’s cases in hopes that some of them resonate (sometimes unfortunately) with your friends and family and you can offer some advice as well. In

I Am Shocked By The Vitriol Post UnitedHealthcare Executive’s Assassination

December 9, 2024 No Comments

Somehow the overall failings of the healthcare system are the fault of health plan executives I wade into this debate with some anxiety, but I am frankly astonished by the online vitriol since the blatant assassination of UnitedHealthcare CEO Brian Thompson. Law enforcement believes the killing was clearly targeted, especially given the inscriptions on shell casings which said “delay, deny and defend.” Terribly, some have celebrated Thompson’s death or argued that he deserved to die given his business’ practices. Others have used the tragedy to attack health plans as evil entities that seek simply to deny or delay care. The social media comments single health insurers out as the sole bogeyman in the national healthcare debate. Far-left groups’ posts speculate about soon-to-be-unearthed sinister plots and treachery that are at the heart of the assassination. To me, all the comments are unfortunate and lack important perspective. Bruce Japsen, a writer for

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