Week in Washington is brought to you by Michael Cohen, PhD. Tune in each week to read the latest on healthcare policy and get a glimpse of what’s on the horizon.
Week in Washington
Health Insurer Financial Performance
KFF analyzed insurance market performance in 2021. Overall, they found that insurers on average had lower gross margins in 2021 relative to 2020. MA insurers had the highest gross margins while group market margins were relatively the lowest. Medical loss ratios also increased relative to 2020 across the board.
Eli Lilly announced price reductions of 70% for its most commonly prescribed insulins. This includes cutting the list price of Humalog, Lilly’s mostly commonly prescribed insulin. This goes into effect in Q4 of 2023, right before the change in Medicaid rebate policy (which goes into effect in 2024)
President Biden this week announced that he would protect ACA, Medicare, and Medicaid from potential funding cuts as part of any debt ceiling deal. Previously, some House Republicans had floated the idea of large cuts to Medicaid and ACA (premium tax credits) to reduce the deficit in exchange for raising the debt ceiling.
Medical Claims Increasing Complexity
New research conducted by Peterson-KFF Health System tracker found that the complexity at which claims were being billed levels in outpatients setting was increasing over time. The upcoding would result in more expensive care.
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