Wakely Wire

New Insights

Whitepapers, briefs, press releases and more

Potential Election Impacts on the Individual Market

During the Biden administration there has been a dramatic increase in enrollment in the individual market, specifically the Marketplace. Marketplace enrollment increased from 11.4 million in 2020 to nearly double that amount to 21.4 million in 2024. This has happened as a result of numerous factors including legislation and operational changes since the Biden Administration ... Read more

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Week in Washington 12/5/24

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 ... Read more

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Newsworthy Findings

CMS Recalculates Medicare Advantage Stars for UnitedHealth, Centene

After both insurers challenged the agency in court, the CMS improved scores for 12 UnitedHealth contracts and seven Centene contracts.

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Editor's Note
The CMS increased stars for 12 UnitedHealth contracts and seven Centene contracts in revised ratings released Monday. Four of these contracts made the jump from 3.5 to 4 stars, gaining bonuses in the future bid pricing.

CMS Proposes New Guardrails on Medicare Advantage Prior Authorizations, Marketing

The Biden administration is attempting to push through a slew of reforms to the controversial MA program in its final months in power.

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Editor's Note
This will apply to patients in Connecticut, New York, and Missouri. Exclusions to this cap will be granted to those under 22 and maternity patients.

Anthem Blue Cross Blue Shield To Cap Anesthesia Coverage After Certain Time Frame

Those who use Anthem Blue Cross Blue Shield insurance will likely soon have to pay out of pocket for anesthesia services should their surgeries fall outside a specific time limit.

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Editor's Note
This will apply to patients in Connecticut, New York, and Missouri. Exclusions to this cap will be granted to those under 22 and maternity patients.

CMS Enters Agreement With Vertex, Bluebird To Improve Access To Gene Therapies

The Centers for Medicare & Medicaid Services said on Wednesday it had entered into agreements with Vertex Pharmaceuticals and bluebird bio to help increase patient access to their gene therapies.

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Editor's Note
These agreements will associate payments to the drug-based health outcomes of those in Medicaid insurance plans.

9 States Poised To End Coverage for Millions if Trump Cuts Medicaid Funding

More than 3 million adults in nine states would be at immediate risk of losing their health coverage should the GOP reduce the extra federal Medicaid funding that’s enabled states to widen eligibility.

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Editor's Note
If Congress cuts federal funding, Medicaid expansion would be at risk in all states that have opted into it — even those without trigger laws — because state legislatures would be forced to make up the difference.

Bonus Article

Just for Fun

Math Joke:

Why did the boy refuse to drink the water with eight ice cubes in it?

Prior Week

Q: Which king loved fractions?
A: Henry the ⅛.

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