Week in Washington

ACA

HHS released the final 2027 Notice of Benefit and Payment Parameters. Overall, the rule is estimated to reduce ACA enrollment by 1.2 million to 2.0 million.

• The final rule made a number of changes, including:
  • Codifying several OBBBA provisions such as, removing APTC eligibility for certain non-citizens
  • Finalizing requirements for CSR reporting and silver-loading
  • Increasing flexibility around bronze/catastrophic plans
• KFF released its estimate of 2026 ACA Exchange enrollment. Overall, KFF estimates 2026 enrollment will decline by 5 million enrollees on average.

Medicaid

• CMS released a proposed rule to reduce state directed payments. The proposed rule would reduce Medicaid spending by over $700 billion over 10 years, including the effects of OBBBA.

Medicare

• The Supreme Court rejected drug companies’ appeals challenging Medicare drug price negotiations. This resolves at least the constitutional questions surrounding implementation of the drug pricing law.
• The GAO released a report recommending site-neutral payment reform. The report estimates that federal savings could approach $157 billion over 10 years. Site-neutral payment reform is one of the issues that could be taken up in a future reconciliation bill.