Medicaid funding questions swirl after White House orders widespread spending pause (updated)
Jan. 29 update: The White House on Wednesday retracted the OMB memo implementing the general pause of federal grant and loan spending, saying a stringent review of agency spending nonetheless will continue and funding for agencies and programs could still be frozen if deemed to be used in a way that’s contrary to the administration’s…
Proposed MA rate notice for 2026 looks promising for health plans, which soon could reap more gains
The Biden administration’s final action with respect to Medicare Advantage (MA) provided a boost to health plans, which could fare better yet under the Trump administration. For 2026, MA plans would receive a 2.23% increase in their payment benchmarks, according to an advance rate notice posted Jan. 10. That would represent a reversal from 2024…
Medicare Part D drug price negotiations are set to include GLP-1s, but questions abound
GLP-1 medications made the second round of drugs that are subject to price negotiations under the Inflation Reduction Act (IRA), according to a CMS announcement during the final days of the Biden administration. However, the future of Medicare’s price negotiation authority is uncertain following the transition of power in Washington, D.C. Congressional Republicans have criticized…
GOP puts ideas for major healthcare spending cuts in writing
Big healthcare provisions and programs face the prospect of cutbacks as congressional Republicans look to pass a budget for the remainder of FY25. With Donald Trump in place for a second presidential term starting Monday afternoon and narrow Republican majorities in both chambers of Congress, the GOP has a chance to influence federal policy on…
UnitedHealth Group leaders reflect on slain colleague, how the industry can improve
In their first investor call since the targeted killing of their colleague spawned intense debate about aspects of the U.S. healthcare system, UnitedHealth Group leaders said a systemwide focus on improvement is needed. CEO Andrew Witty began this week’s Q4 earnings call by paying tribute to Brian Thompson, UnitedHealthcare’s chief executive, who was fatally shot…
Hospital financials projected to continue trending upward despite various X-factors
Hospitals are coming off a year of improved stability that should continue even with looming questions and challenges for 2025, according to recent data and insights. As reported in December, Fitch Ratings upgraded the sector outlook (login required) for not-for-profit (NFP) hospitals to neutral/stable after more than two years in which the outlook was categorized…
In pushing through restrictions on medical debt reporting, CFPB brushes off criticisms and concerns
Rebuffing apprehensions of healthcare providers and debt collectors, the Consumer Financial Protection Bureau (CFPB) published a final rule to block medical debt from appearing in a consumer’s credit history. As initially proposed in June, the regulations prohibit lenders from obtaining and using information about medical debt when determining a consumer’s credit eligibility (exceptions may include…
Medicare financial support for low-wage hospitals hits another roadblock in the courts
Plaintiff hospitals won a second consecutive appeals-court victory in the legal fight over Medicare’s low-wage-index policy. In December, the U.S. Court of Appeals for the Ninth Circuit upheld a district court’s ruling that the policy of increasing wage-index values for rural hospitals starting in 2020 was impermissible under the Medicare statute. The decision echoed a…
In surprise move, Biden administration terminates the Medicare Advantage Value-Based Insurance Design Model
A nearly decade-long effort to promote value-based insurance design (VBID) in Medicare Advantage (MA) will be discontinued after 2025, the Biden administration announced in December. The MA VBID Model has aimed to use health plan benefits design to encourage healthy behaviors and promote whole-person health among segments of beneficiaries. It began in 2017 and, after…
Amid tight margins, MedPAC seems set to recommend an additional hospital payment boost
Hospitals have improved financially in the latest reporting period but still should receive a supplementary Medicare payment increase, according to a meeting of the Medicare Payment Advisory Commission (MedPAC). For 2026, Congress should authorize a 1% increase beyond the amount calculated using the statutory methodology, commissioners said during a December discussion. The notion is likely…