Upcoming Regulations
HHS released its unified agenda of planned regulations for the near term. A few upcoming regulations worth monitoring are noted below. These regulations are expected to be released between late summer and early winter….
- ACA – Proposed regulations that could impact the ACA include changes to requirements on short-term limited duration plans, changes to 1332 waiver and 1333 compacts, expanding access to ICHRAs, pre-enrollment verification requirements, and changes to MHPAEA requirements.
- Medicare – CMS intends to propose a mandatory pilot program to reduce Medicare expenditures. There are also pilot programs/CMMI models that would tie some Medicare drug prices to most-favored nation pricing for Part B and Part D drugs.
- Medicaid – Several regulations would continue to implement provisions of OBBBA such as the hold harmless threshold.
- Other – HHS is also intending to release regulations around reducing potential fraud, waste, and abuse. There are also potential changes to preventative service requirements. For example, Secretary Kennedy Jr. has previously stated that preventive services should include testing for Alzheimer’s disease, which can be expensive. HHS is also intending to propose ways of making it easier for individuals to get compensation for alleged COVID vaccine-related injuries. Forthcoming proposed regulations may also increase transparency requirements on insurance carriers and changes to explanation of benefits.
2027 ACA Rates – KFF released data on 2027 ACA rates based on an analysis of 16 states (plus DC) and 77 issuers. KFF found that the median insurer proposed rate increase (i.e., not enrollment weighted) was around 14%. Generally, the modal proposed rate increase was in the 10% to 15% range.
Research You Can Use
New research from Betsy Cliff and Giacomo Meille found that health care spending grew faster among Americans with higher incomes than those with lower incomes. From 2005 to 2023, the researchers, after controlling the age and health differences, found that health spending increased 1.8% per year among people in the highest income quintile while those in the lowest income quintile saw no growth. Outpatient and prescription drug usage were key factors in the differences. Consequently, when thinking about trends, it’s important to think about income differences within the population.
