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House GOP To Allow Vote On Exchanges But By Amending Major Reform Bill Two major decisions from GOP leaders in the House today. First, it will allow a vote on an Obamacare extension to appease several dozen vulnerable Republicans in swing districts. Second, but this will come via an amendment on a broad reform bill from Republicans focused on more conservative reforms. The main bill will feature the following reforms. Exchange cost-sharing subsidies would be funded to lower Silver premiums. This has positive and negative effects depending on subsidy status and income. Greater self-insurance provisions would be included, along with pressing for cheaper plan designs. Some pharmacy benefits manager reforms would be included. Even if the amendment passed, the bill would ultimately not pass in all chambers because it would be viewed as a poison pill by Democrats, especially in the Senate. Democrats are attempting to force a separate vote

Dueling Healthcare Plans Fail In Senate As expected, both the Democratic and GOP healthcare bills failed to get the 60 votes needed to pass in the Senate today. Democrats’ clean three-year extension of enhanced Exchange premium subsidies failed 51-48. Four Republicans, including Sens. Susan Collins, R-Maine, and Lisa Murkowski, R-Alaska, voted with Democrats. The GOP proposal from Republican Sens. Bill Cassidy, R-LA, and Mike Crapo, R-ID, also failed by a 51-48 vote. Meanwhile, a growing number of centrist Democrats are joining forces with Republicans on bipartisan bills combining a shorter subsidy extension with policy reforms that could attract enough votes over time to past both chambers.  Additional articles: https://www.fiercehealthcare.com/regulatory/dueling-democrat-republican-aca-subsidy-plans-fail-senate and https://www.beckerspayer.com/payer/aca/competing-bills-tackling-aca-subsidies-fail-in-senate/ and https://thehill.com/homenews/senate/5644661-republican-senators-democratic-obamacare-bill/ and https://thehill.com/homenews/house/5643381-obamacare-aca-subsidies-democrats-division/?tbref=hp (Some articles may require a subscription.) #exchanges #healthcare #coverage https://www.modernhealthcare.com/politics-regulation/mh-senate-healthcare-vote-aca-subsidies Highmark and BCBS KC To Affiliate As regional blues struggle to compete in a more competitive environment, Highmark and Blue Cross and Blue Shield Kansas

Quick Recap Of House and Senate On Exchange Subsidies and Reform The Senate is expected to vote Thursday on two proposals. The first is a Democratic proposal for a straight three-year extension of the enhanced Exchange subsidies. It is not expected to gain the 60 votes needed for passage as too few Republicans will join Democrats. But anything is possible right now. The second is a GOP bill sponsored by Bill Cassidy, R-LA, and Mike Crapo, R-ID. It would not extend the enhanced subsidies, but fund health savings accounts (HSAs) for people who earn up to 700% of the federal poverty level. Those aged 18-49 would get $1,000 and those aged 50-64 would get $1,500. This bill is not expected to reach 60 votes, either, as few Democrats will vote with Republicans. Other compromise bills would extend the subsidy expansions for two years and make some reforms, including income caps,

Stars Health Equity Change Examined A great Modern Healthcare article on the Trump administration’s proposal to expunge the Excellent Health Outcomes For All (EHO4all) health equity reward just a month before the second measurement year close. I am one of the Stars experts quoted. I make the argument that there are winners and losers when eliminating EHO4all and keeping the Reward Factor for high-performing plans. I think plans with major dual eligible populations and no near-term expectation of obtaining the Reward Factor could have a colorable argument that the rule does not give plans due process of a change. The switchback will cost Medicare billions. (Article may require a subscription.) #cms #medicareadvantage #stars #quality https://www.modernhealthcare.com/insurance/mh-medicare-advantage-star-ratings-centene-molina CVS Reports Improved Expectations At its annual investor day, CVS Health said its outlook for the year will be better than reported and it also gave a positive report for 2026. CVS says full-year 2025

Competing Senate Healthcare Bills Senate Republicans launched competing proposals today to address the healthcare debate. Some want to preserve the enhanced subsidies, while others want the enhanced subsidies to expire and be replaced by direct cash to Americans. GOP Sens. Bernie Moreno, R-OH, and Susan Collins, R-ME, introduced a bill with a two-year extension of the enhancements with some conservative reforms – an income eligibility cap at $200,000, minimum premiums of $25 per month, and fraud reforms. The main competing proposal from HELP Chair Bill Cassidy, R-LA, and Mike Crapo, R-ID, doesn’t extend the subsidies at all. Instead, it would redirect that money into Health Savings Accounts paired with bronze or catastrophic plans on the Exchanges. Certain ACA enrollees earning less than 700 percent of the federal poverty level would receive $1,000 in an HSA if they’re 18 to 49 years old, and $1,500 if they’re 50 to 64. In

Moderate GOPers Frustrated On Exchange Impasse Frustration is mounting for moderate GOP lawmakers as the GOP has no defined healthcare plan, and Democrats are capitalizing on the lack of affordability in healthcare and the expiration of enhanced subsidies in the Exchange. Millions will see surging premiums as of January 1 with no action to extend the subsidies. Dozens in the GOP caucus in the House from swing districts face an uncertain future. A few GOP senators are also vulnerable. But so far, House Speaker Mike Johnson, R-LA, bolstered by opposition from conservatives, refuses to guarantee a vote in the House. In the Senate, Majority Leader John Thune, R-SD, did agree to hold a vote and Democrats are pushing a three-year extension. Sixty votes are needed to pass the bill. Democrats would need thirteen GOP defectors. It is a near impossibility. In other news, MedPage Today talks about the irony that

Schumer Unveils Three-Year Subsidy Extension Senate Minority Leader Chuck Schumer, D-NY, unveiled a clean three-year extension of enhanced premium subsidies for a vote next week in the upper chamber. This came after a group of Senate Democrats gained a commitment from Senate Majority Leader John Thine, R-SD, for a subsidy vote when the group agreed to support a bill to reopen the government. Some Democrats have held talks with centrist Republicans to seek a compromise that would temporarily extend the enhanced subsidies while adding policies such as income eligibility caps, minimum premiums, and anti-fraud measures. This could mean the bill is amended to attract GOP votes to get to 60 votes. Some GOP senators are open to doing so, frustrated with the lack of any real GOP alternative. There are some GOP bills being developed which focus on Health Savings Account support but are not expected to be ready in

Will Subsidy Extension Pass? A Senate vote on a clean, three-year enhanced Exchange subsidy extension is scheduled for next week. And many Republicans are frustrated that their party is divided and no consensus can be reached on any compromise legislation. Any Republican bill would not be ready until after next week. That opens up the possibility that enough Republicans cross the aisle and vote with Democrats to extend the subsidies as is. House Speaker Mike Johnson, R-LA, has not yet committed to bring up the bill, but Democrats and some moderate Republicans could force a vote through a discharge petition. Given the lack of a real Republican bill, GOP lawmakers in both chambers are coming around to a temporary extension of enhanced Exchange subsidies. Conservative House and Senate Republicans either want fundamental reform or no action to extend the enhanced subsidies. Moderate Republicans in the House want either a clean

Nursing Home Staffing Rule In Dustbin The controversial rule seeking to impose nursing home staffing requirements has been officially repealed by the federal government after a judge struck down the Biden administration provision. The rule would have meant huge costs for the industry and actually either forced the shutter of smaller firms or led them to sell out to massive consolidators in the industry. The rule was a political sop to the unions as well. Additional article: https://www.modernhealthcare.com/politics-regulation/mh-cms-nursing-home-staffing-mandate-repealed/ (Some articles may require a subscription.) #nursinghomes #staffing #medicaid #medicare https://www.fiercehealthcare.com/regulatory/hhs-closes-book-controversial-nursing-home-staffing-mandate New ACCESS Model Tests Chronic Care In Medicare The Centers for Medicare and Medicaid Servies (CMS) announced a new payment model on December 1. The ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) Model tests an outcome-aligned payment approach in Medicare. The model is aimed at expanding access to new technology-supported care options that help people improve their health and prevent

Exchange Subsidy Debate Still Dominates Hill The Exchange subsidy debate continues to dominate Capitol Hill. Sen. Amy Klobuchar, D-MN, predicted Sunday that the Senate will hold a vote on extending Exchange subsidies. “That vote will happen. And whether it will pass is in the hands of Donald Trump and the Republicans,” Klobuchar told CNN. Senate Majority Leader John Thune, R-SD, has committed to a vote, while House Speaker Mike Johnson, R-LA, has not. House Minority Leader Hakeen Jeffries, D-NY, is pressing centrist Republicans to help Democrats extend the tax credits before they expire at the end of the month by signing on to his discharge petition to force a vote in the House. Moderate Republicans in the House say they have their own discharge petition but are waiting to see what the Senate does. Many are critical of President Trump’s equivocation on the subsidies – in one breath he is ready to