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November 21, 2024

November 21, 2024 No Comments

Commonwealth Study Covers The Underinsured A very important study from The Commonwealth Fund found that close to a quarter of people who have health coverage are underinsured. This is consistent with other findings that put the number of uninsured and underinsured at about 85 million Americans. In essence, the underinsured are Americans that have coverage but, in many ways, have a hard time accessing the benefits due to high out-of-pocket costs. In my book, The Healthcare Labyrinth (available at this site), I discuss that affordable universal access is needed to address both the uninsured and underinsured crisis. The Commonwealth Fund polled a national sample of adults aged 18 to 64 and found that 23% are underinsured. Most (about 66%) are in employer-sponsored health plans. About 14% were in individual or Exchange plans and 11% were in Medicaid. About 57% who were underinsured said they skipped care because of the cost. About

Growth From October To November In Medicare Advantage

November 21, 2024 No Comments

Medicare Advantage (MA) growth continues as we enter 2025 enrollment season I decided to continue my Medicare Advantage (MA) monthly enrollment blogs because of continuing month-over-month increases. The growth is tied to remaining strong benefit packages for 2024. Increases in MA enrollment still occur outside of the enrollment season given the aging of America and the ability of some populations, such as dual eligibles, to continue to make changes throughout the year. We are now in the enrollment season for 2025 and I wonder if we will see the normally robust month-over-month growth. So far, it seems to be there. New enrollees see huge value in enrolling in MA over the traditional fee-for-service (FFS) program. This value difference likely will continue to drive some growth in 2025 even with reductions in benefits, increased premiums and cost-sharing, and less choice in some geographies. The reductions are being caused by the return of

November 20, 2024

November 20, 2024 No Comments

More on Mehmet Oz’s Healthcare Positions President-elect Donald Trump’s nominee for the Centers for Medicare and Medicaid Services administrator, Mehmet Oz, has raised concerns with high insulin prices and the role of pharmacy benefit managers (PBMs). At the same time, he has not taken a position on Medicare drug price negotiations. He favors permanent telehealth expansions and has invested in numerous digital health companies over the years. This means he may support artificial intelligence, remote monitoring, wearables, and digital therapeutics. Oz has long been a supporter of Medicare Advantage (MA) and even pushed for the concept of Medicare Advantage for All, which would have eliminated employer coverage and put everyone in private plans outside of Medicaid. Additional articles: https://insidehealthpolicy.com/daily-news/oz-raised-concerns-pbms-insulin-costs-his-ira-views-unclear and https://insidehealthpolicy.com/daily-news/oz-would-bring-support-permanent-telehealth-ai-wearables-dtx-cms and https://thehill.com/policy/healthcare/5000821-trump-oz-cms-medicare-medicaid/ (Some articles may require a subscription.) #oz #cms #trump #medicareadvantage https://www.beckerspayer.com/payer/dr-oz-on-medicare-advantage-5-things-to-know.html PBMs Sue Over FTC Litigation Process The country’s largest pharmacy benefit managers (PBMs) and group purchasing

November 19, 2024

November 19, 2024 No Comments

The Land of Oz: Trump Nominates Mehmet Oz As CMS Administrator President-elect Donald Trump has nominated television personality and surgeon Dr. Mehmet Oz to oversee the Centers for Medicare and Medicaid Services (CMS). Oz had a successful TV show for thirteen years, although has become controversial over supplements, alternative treatments, and COVID treatment. He lost to John Fetterman in a 2024 Senate race. He is a cardiothoracic surgeon and went to Harvard and Penn. He holds patents on a variety of devices related to heart surgery. Additional articles: https://www.modernhealthcare.com/politics-policy/donald-trump-mehmet-oz-cms-administrator and https://www.healthcaredive.com/news/trump-dr-oz-nominate-medicare-medicaid-cms/733416/ and https://insidehealthpolicy.com/daily-news/oz-s-embrace-alternative-medicine-could-influence-cms-policy and https://www.beckershospitalreview.com/hospital-management-administration/president-elect-trump-taps-dr-oz-for-cms-administrator-10-things-to-know.html and https://thehill.com/policy/healthcare/4998738-trump-oz-cms-nomination/ (Some articles may require a subscription.) #cms #trump #healthcare #healthcarereform https://www.fiercehealthcare.com/payers/tv-personality-and-surgeon-dr-oz-nominated-run-medicare-medicaid AMA Study Says Health Insurance Is Highly Concentrated A new study by the American Medical Association (AMA) finds that many regions are “stubbornly highly concentrated” when it comes to commercial health coverage. The AMA study found that 95% of metropolitan statistical area

November 18, 2024

November 18, 2024 No Comments

Retiree Coverage Dropping Dramatically; Employers Rely More On Medicare Advantage The Kaiser Family Foundation (KFF) finds that the number of employers providing retiree coverage is dropping dramatically. Among large employers that offer health benefits to active workers, the share offering retiree coverage has dropped from 66% in 1988 to 24% in 2024. The trend will create huge new affordability issues for the nation as aging continues. Still, that covers 14.5 million Medicare beneficiaries with important secondary coverage to fill in the big holes in the traditional Medicare program. In order to continue coverage and limit costs, employers more and more are turning to wrapping the retiree benefit around Medicare Advantage (MA), known as EGWPs. About 56% of large employers offering retiree health benefits in 2024 offer coverage to at least some retirees through an MA plan, more than double the share in 2017 (26%). About 53% require enrollment in MA.

Recess Appointments Are A Bad Idea Unless There Are Extreme Circumstances

November 18, 2024 No Comments

The Senate should resist being pressured and fulfill its constitutional duties. The Republic will survive a speedy but thorough vetting process for nominees. While this blog’s topic would impact healthcare, I admit I am straying a bit from my normal musings here on the website. I usually try to keep politics largely out of my blogging. I describe myself as a moderate Republican, who holds healthcare views that span both of today’s parties. I tend to favor reasonably expansive healthcare coverage with government support, lining me up with Democrats. I think it is a wise and compassionate position. Affordable universal access will save healthcare dollars and is key to healthcare reform, which also includes price reform and a pivot to care management. At the same time, I remain a fiscal conservative who thinks that our national debt and deficits will lead to a lower standard of living and less opportunity

November 15, 2024

November 15, 2024 No Comments

Payers Expect Continuation of Enhanced Exchange Subsidies Health plan executives say they expect continuation of enhanced premium subsidies in the Exchange in some form past 2025. Oscar Health CEO Mark Bertolini says both parties have an incentive to extend the subsidies. Executives think there will be a bipartisan solution to extend the subsidies. Expiration of the subsidies could lead to surging premiums and destabilization of access and participation by insurers. At the same time, the price tag is big, especially as the GOP plans for its extension of the Trump tax credits. I expressed in a recent blog that there could be an extension of the enhanced subsidies via a year-end stop-gap bill or during a 2025 master bill. But I am not as optimistic as the plan executives. #aca #obamacare #exchanges https://www.beckerspayer.com/policy-updates/payer-executives-expect-limited-change-in-aca-subsidies.html KFF Looks At 2025 Medicare Advantage Offerings Just after Medicare Advantage (MA) benefits were released, the Kaiser Family Foundation

November 14, 2024

November 14, 2024 No Comments

RFK Jr. Nominated By Trump To Be HHS Secretary In the biggest news of the day, President-elect Donald Trump nominated Democratic supporter Robert F. Kennedy Jr. to be Health and Human Services (HHS) Secretary. Kennedy is known to be a vaccine skeptic and someone who will focus on food safety, fluoride, and chronic disease. He is also known to be extremely critical of a number of the regulatory agencies under HHS, especially the Food and Drug Administration (FDA), and the food and drug industries. Many are already characterizing the nomination as one of the toughest battles along with Attorney General nominee Matt Gaetz. Additional articles: https://www.modernhealthcare.com/politics-policy/rfk-jr-robert-f-kennedy-hhs-donald-trump-vaccines-covid-19-pandemic and https://www.healthcaredive.com/news/trump-nominates-rfk-jr-to-lead-hhs/733009/ and https://www.medpagetoday.com/washington-watch/washington-watch/112913 and https://www.beckershospitalreview.com/hospital-management-administration/trump-picks-rfk-jr-as-hhs-secretary-7-things-to-know.html and https://thehill.com/policy/healthcare/4991324-trump-nominates-kennedy-health-department/ and https://thehill.com/policy/healthcare/4991964-rfk-jr-vows-to-be-honest-public-servant-as-hhs-chief/ and https://insidehealthpolicy.com/daily-news/rfk-jr-trump-s-choice-lead-hhs-sets-stage-health-information-war and https://kffhealthnews.org/news/article/trump-rfk-maha-federal-health-agencies-takeover/ and https://www.modernhealthcare.com/politics-policy/cdc-director-mandy-cohen-rfk-jr-robert-f-kennedy-vaccines-donald-trump (Some articles require a subscription.) #hhs #rfkjr #trump #healthcare https://www.fiercehealthcare.com/regulatory/rfk-jr-selected-lead-department-health-and-human-services CMS Says It Will Deprioritize Star Call Center Measures A Centers for Medicare and Medicaid Services (CMS) executive

The GOP Should Safeguard The ACA

November 14, 2024 No Comments

The Affordable Care Act saves and is a prudent investment for America In my blog on Monday ( https://www.healthcarelabyrinth.com/what-will-happen-in-healthcare-with-gop-firmly-in-control/ ), I told you about the fact that a GOP Washington could mean a big change for healthcare policy. On one hand, I predicted that seismic changes may not occur for a number of reasons – 2026 election politics, Donald Trump’s desire to leave a legacy, and tight margins in each chamber of Congress. On the other hand, I said budget measures would be passed to extend tax cuts and that would have impact on healthcare and coverage. If seismic changes to healthcare occurred, the biggest worry would be what could happen to the Affordable Care Act (ACA). As I said Monday, Trump and his VP partner, JD Vance, sought to downplay talk of ACA repeal. But they did weigh in on possible changes during the campaign. GOP Speaker Mike Johnson

November 13, 2024

November 13, 2024 No Comments

End-Of-Year Stop Gap Funding In Flux With the House staying Republican, some are saying the stop gap measure to fund government by the end of the calendar year is now in flux. Some Republicans want to punt any substantive legislative action to the new Congress when the GOP is fully in control. Others want to pass substantive legislation, including several healthcare initiatives. They could include pharmacy benefit manager reform, hospital transparency, and site-neutral payments. One of the top issues that many aim to pass in the lame-duck session is instituting site-neutral payment rules for outpatient care. This is heavily opposed by the hospital lobby, but it is gaining bipartisan momentum. It is unknown how expansive any proposal would be (some or all outpatient services) and whether it would apply just to Medicare or include commercial. The Congressional Budget Office (CBO) projects that the most robust site-neutral legislation would save more

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