Funding Timing
The main thing worth monitoring about Congress this month is the battle around government funding. Congress has until Oct 1 to pass a budget bill. House Speaker is looking to have a continuing budget resolution through March while Senate leaders want a shorter continuing that only goes until November. Typically end of year items that effect health policy (e.g., sequestration, provider payments) are included in budget bills so if there is no budget bill it may make it harder to pass those items.
MA Bonus Payments Down
KFF research estimated that quality bonus payments to Medicare Advantage plans was down about $1 billion to $11.8 billion in 2024. This is an 8% decrease. Between 2015 and 2023 bonus payments increased about 400%. KFF research also highlighted per enrollee bonus payments were highest for employer and union-sponsored plans and lowest for special needs plans.
Mental Health Rule
The Biden Administration finalized new mental health parity requirements on issuers and employees. The rules add more restrictions on using nonquantitative treatment limitations for mental health and substance use disorder benefits compared to medical or surgical benefits (this would include things like prior authorization). The rule also requires plans and issuers to collect and evaluate data related to the nonquantitative treatment limitations they place on mental health/substance use and change networks if the results are insufficient. AHIP and ERISA Industry Committee (which represents large employers) pushed back against the rules. The ERISA Industry Committee is considering litigation to challenge the rule. Given the overturned Chevron deference such a challenge is more likely to succeed.
ACA Coverage over Time
New Treasury research calculated the number of unique individuals that participated in ACA Marketplace from January 2014 through May 2024. Overall, over 49.4 million unique individuals had coverage through the Marketplace during this time. This means nearly 1 in 7 US residents at some point and time had Marketplace coverage. The research also calculated the number of participants by state ranging from Florida (28.7%) to Hawaii (5.8%). The Marketplace was designed to provide coverage for those that did not have access to other forms of coverage so states with less access to other forms of coverage (e.g., didn’t expand Medicaid) have a higher percentage of participation.
Hospital Wage Inflation Cools
Fitch Rating research found that hospital wage inflation is cooling in 2024. So far wage increases have been about 3% in 2024 compared to 4.2% in 2023. The cooling wage inflation should reduce over medical cost trends in 2024 and potentially 2025.
New Census Data
The Census Bureau released the 2023 Census data this week. They found that Employment-based coverage slightly decreased while Medicare and Marketplace coverage increased. Uninsured numbers for children (those under 19) also increased. The expectation is that uninsured rates will increase in 2024 given Medicaid redetermination results.
