Congress
End of Year – Congress is currently focused on end of year packages. This week Republicans sent a health care related offer according to Politico. The package would include a three-year extension of current Medicare telehealth rules, a 2.5% bump to Doctor Medicare payments, funding for federally qualified health centers, and extending telehealth coverage for high deductible health plans. It would also delink PBM payments from the list price of drugs for Medicare. Given the timing the fate of this legislation is uncertain. Congress is likely finalizing all legislation in the next two weeks before going on recess until the next Congress takes over.
2025 Legislation – Politico reported that incoming Senate Majority Leader John Thune would push for two separate reconciliation bills in 2025. The first would be defense/immigration/energy related and the second would be tax (and presumably health) related. This would mean that potential changes to health policy may not occur until later in the year.
Medicaid Funding
KFF reported that 9 states have “trigger” clauses in the legislation which authorized Medicaid Expansion. This would mean that should the federal matching rate decrease for their Medicaid Expansion program, absent new legislation their Medicaid Expansion programs would sunset. There have been reports that the Trump Administration is considering reducing Medicaid funding, especially for Medicaid Expansion.
CMS Regulations
- OMB announced that it had received the final ACA Notice of Benefit and Payment Parameters as well as the proposed Medicare Advanced Notice. These two will likely be the final major health related Biden Administration regulations.
- CMS did release the Medicare Advantage Policy and Technical regulation before Thanksgiving. The proposed regulation would make a major change and require Medicare as well as Medicaid to cover anti-obesity drugs. The proposed rule would need to be finalized and survive legal challenges for it to be implemented.
Research You Can Use
- Joseh Hnath et al analyzed the landscape of insurer competition in the Medicare Advantage program. They found that national carrier market share increased from 26 percent in 2012 to 66 percent in 2023 and the national market share of non-Blue regional carriers decreased from 25 percent to 6 percent. They further find that given trends improvement in concentration at the local level are unlikely.
- Abraham et al found that insurers are deeply involved in administrative services only (ASO) contracts for self-insured employed. They found that the largest ASO contractors (CVS, Cigna, and Elevance) provide services for 118 million enrollees.
