Dr. Oz describes changes he would bring to Medicare, Medicaid as CMS administrator
April 3 update: The Senate formally confirmed Oz as CMS administrator via a 53-45 party-line vote. He is expected to be sworn in and begin work within days. March 25 update: The Senate Finance Committee voted 14-13 along party lines to send Oz’s nomination to the full Senate for a formal confirmation vote. Democrats voting…
Affordable Care Act marketplace enrollment likely to decrease under proposed regulations
The Trump administration’s first regulations on the Affordable Care Act health insurance marketplaces are projected to reduce enrollment. As announced by CMS on March 10, a soon-to-be-published proposed rule would implement new program integrity standards for the marketplaces. Part of the motivation stated in the rule is to address “a substantial risk of improper enrollment.”…
Medicaid DSH payment cut again delayed in proposed federal funding bill (updated)
March 15 update: The bill has passed both chambers of Congress as originally drafted and described below. Hospitals that receive Medicaid disproportionate share hospital (DSH) payments would get continued relief from a pending big cut, according to the latest proposed FY25 continuing resolution (CR). A scheduled three-year, $24 billion reduction would be delayed through September…
Injunction granted on policy change that would hamper funding for teaching hospitals
A federal judge has extended a block on a Trump administration policy that would cap reimbursement for indirect medical research costs at institutions such as teaching hospitals. Per the Feb. 7 policy issued by the National Institutes of Health (NIH), add-on payments for facility and administrative expenses as part of research grants would be limited…
Going their own way: Numerous hospitals opt out of Blues settlement
Several large health systems and dozens of other hospitals and healthcare providers are pursuing antitrust litigation against Blue Cross Blue Shield (BCBS) after opting out of a record-setting settlement. Lawsuits are known to have been filed against the insurer in California, Illinois and Pennsylvania federal court since March 4, the deadline for hospitals to opt…
Congressional hearing highlights the favored approach to cutting Medicaid funding
A recent hearing of the House Oversight and Government Reform Committee showcased the rationale Republicans will use in pursuing significant Medicaid spending cuts. The Feb. 25 hearing was called to examine various federal programs that made the Government Accountability Office’s (GAO’s) High-Risk List for 2025. Because of the ongoing stakes for Medicaid, much of the…
Where value-based payment is headed during the second Trump administration
Like much of federal healthcare policy in the next few years, the push to improve value-based payment and accountable care figures to be influenced by two distinctive aspects of the Trump administration: MAHA and DOGE. MAHA is Make America Healthy Again, the movement championed by new HHS Secretary Robert F. Kennedy Jr., while DOGE is…
Settlement participation in Blues litigation may pose concerns for hospitals, attorney says
As the deadline fast approaches for hospitals to decide whether to participate in a record-setting class-action settlement with Blue Cross Blue Shield, competing views of the situation remain. By March 4, hospitals have to alert the settlement administrator if they want to opt out of the $2.8 billion agreement, which also includes injunctive relief said…
Price transparency enforcement gets a boost as Trump signs executive order
Hospitals can expect stepped-up enforcement of price transparency rules now that President Donald Trump has signed an executive order (EO) on the topic. In his Feb. 25 order, Trump noted that his first administration drafted the two sets of regulations requiring providers and insurers to make prices available to healthcare purchasers. He thinks the Biden…
Fatal shooting at Pa. hospital renews calls for legislation to enhance security
A deadly shooting at a hospital in Pennsylvania prompted additional calls for steps to increase the security of healthcare settings. On Feb. 22, a gunman took hostages in the ICU at UPMC Memorial Hospital in York, Pa. During the standoff, local police officer Andrew Duarte was shot and killed, while three hospital staff members and…