Congress
-The Senate bipartisan group working on extending enhanced premium tax credits failed to reach agreement. The key sticking point on negotiations are around abortion coverage.
-Several outlets reported that some Senators were focusing their efforts on rules governing pharmacy benefit managers and other health care savings items. The potential changes could include things like delinking the price of a drug from PBM compensation in Part D and aligning Medicare payments to hospital outpatient departments with freestanding physician offices.
-House Republicans are considering a second reconciliation package for this Spring. The package’s health items could include items like shifting ACA premium tax credits to HSA like accounts and instituting further cuts to the Medicaid program.
Executive Watch
President Trump threatened to withhold all federal money from states and cities his Administration has deemed resisting his immigration policies starting February 1st. Courts have generally ruled against such attempts previously. The list can be found here.
ACA Data
Marketplace Enrollment – CMS released the latest Marketplace snapshot. Overall enrollment is down year over year 3.5%. New enrollment is down almost 12%. There is concern that enrollment could drop further as many current returning enrollees may not pay their own premiums or stay enrolled.
MLR – CMS also released 2024 commercial MLR data. Rebates across all markets were up this year to $1.64 billion (up from $957 million). Individual market rebates were up dramatically to $1.18 billion.
National Health Care Spending
CMS released an updated picture on spending and utilization in the US. Overall, the analysis found that spending increased 7.2% in 2024, with the use and intensity of health care increased particularly for hospital care, physician, clinical services, and retail prescription drugs. The US uninsured rate increased slightly, primarily due to Medicaid redetermination.
