Reconciliation Bill
This week House Republicans released text on the reconciliation bill. While this blog will focus only on the healthcare portions of the bill, it’s important to note that the bill has far reaching implications on a myriad of issues. For health portions of the bill that is currently being assembled some of the material changes include:
- Medicaid
- Work requirements for all states (starting in 2029)
- Ending Biden era eligibility rules and requiring eligibility checks at least 2x per year
- Require cost-sharing for Medicaid beneficiaries above the poverty level
- Penalizes states that provide coverage for undocumented immigrants
- Limit new provider taxes
- ACA
- Codify Program Integrity Rule
- Bar many legal immigrants from premium tax credits
- Rescinds the cap on PTC reconciliation repayment
- Encourages ICHRAs
- Medicare
- Address partially the cuts to doctor pay in Medicare
- Protects drugs for rare diseases for IRA drug negotiations
- Makes PBM reform
For a more in-depth look at the Medicaid provisions I recommend KFF’s tracker here. While a formal CBO score on all portions of the bill has not been released, a review by CBO of some of the provisions yielded an estimated increase in the number of uninsured by 7.6 million by 2034 . The Century Foundation estimated that the combination of policies alongside the expiration of the enhanced subsidies would increase the number of uninsured by 15 million (or about a 50% increase in the number of uninsured).
CMS
- Provider Tax Rule – CMS released a proposed rule that would aim to restrict certain types of state Medicaid tax program structures, principally established on managed care providers. The proposed rule would have a significant and immediate impact on state budgets. The press release identifies states like California, Michigan, Massachusetts, and New York as states that would need to restructure some of their taxes.
- CMMI – CMMI released a white paper on its new strategy goals. CMMI outlined that it would focus models on promoting evidence-based prevention, embedding preventive care, focusing on improving data access, and increasing competition. In particular CMMI noted that it would require all alternative payments models to include downside risk. It would also reduce the role of state government in rate setting, refining model benchmark methodology, and incentivizing reduction of unnecessary utilization.
- Most Favored Nation Drug Policy – President Trump released an executive order that ordered the federal government to consider steps to implement most favored nation pricing on drugs should drug companies not voluntarily reduce drug prices. No specific details were released on how the HHS might implement the ‘most favored nation’ drug policy.
Research You Can Use
New research in the New England Journal of Medicine found that loss of subsidized drug coverage among Medicare Beneficiaries resulted in higher mortality rates (about a difference of 3 deaths per 1000).
