June 30, 2025
Healthcare and Reconciliation: Where Things Stand Amid Floor Debate
We expect the Senate to pass the reconciliation bill within the next 24 hours, despite the current reconciliation drama (parliamentarian rulings, CBO projection of deficits post-2034, Senator Thom Tillis’s (R-NC) retirement announcement, House member opposition,…
June 26, 2025
Hospitals, Obamacare, Medicaid: Parliamentarian Decisions Likely to Force Rewriting on Provider Tax, Uncertain about CSR and Enhanced FMAP Policies
The sizable hole left by the Senate parliamentarian decisions on various Medicaid and Obamacare provisions, which were reported this morning by Senate democrats (here and here) injects uncertainty for hospitals, Obamacare insurers, Medicaid managed care,…
June 22, 2025
Obamacare: Program Integrity Rule Meets Overall Expectations, Though Relative Slight Improvement; Risk Remains
Amidst the behind-the-scenes Senate debate of its draft reconciliation bill, CMS made good on its threat to jettison improper and fraudulent Obamacare enrollment, impacting ACA insurers [OSCR, CNC, ELV, MOH] and hospitals / behavioral facilities…
June 17, 2025
Healthcare: Thoughts on the Senate Finance Draft’s Healthcare Provisions
The Senate Finance Committee’s (SFC) draft healthcare and tax portion of the reconciliation bill makes some changes, relative to the House-passed measure, but is overall consistent with that version, with the implications being lower Medicaid…
June 16, 2025
Medicare Advantage: Filling in RADV Blanks; HUM Has Most Contracts Targeted [HUM, UNH, CVS, ELV, CNC, ALHC]
Late Friday, CMS announced the latest list of Medicare Advantage (MA) contracts to be targeted for risk adjustment data verification (RADV) audits – this time for payment year (PY) 2019 – and its associated processes…
June 3, 2025
Potential Targets for Change Among Healthcare Reconciliation Policies [THC, ARDT, CNC, MOH, ELV]
As we await the Senate’s likely release of its reconciliation measure over the next week or so, we continue to expect the upper chamber to smooth the edges around some of the House-passed reconciliation bill’s…
May 21, 2025
Medicare Advantage: Ramping Up RADV Audits Clearly a Threat, But Does It Head Off Other Risks? [HUM, UNH, CVS, ELV, ALHC]
CMS’s announcement late Wednesday to turn the dial up on its risk-adjustment data verification (RADV) audits of Medicare Advantage (MA) contracts with an eye toward the entire landscape raises legitimate fears of recouping sizable past…
May 16, 2025
[CNC, MOH, ELV, OSCR, ARDT, THC, ACHC]: What’s Next for Healthcare in House’s Reconciliation Proposal
As we head into this weekend, below are our latest thoughts on the healthcare components of the reconciliation bill and where things stand and what changes may be in store. This afternoon’s sidelining of the…
May 13, 2025
[ELV, CNC, MOH, UNH, CVS] CMS Managed Care Provider Tax Proposal
Yesterday’s CMS proposal confirms our suspicion that the agency would seek to tighten state provider taxes – primarily those on managed care [ELV, UNH, CNC, MOH, CVS, CI, OSCR]– used to secure sizable federal Medicaid…
May 12, 2025
Healthcare & Reconciliation: Worst Case Avoided
The House Energy & Commerce Committee’s (E&C) reconciliation draft (text and summary) seems to largely align with our expectations regarding cuts / risks in Medicaid, Obamacare, and pharmacy benefit managers (PBM). While there were still…