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 19, 2025
Expected Federal Report on Fertility Benefits: Regulatory Recommendations Likely Incremental [PGNY]
Since we are at the 90-day mark after February 18 release of the White House’s Executive Order (EO) supportive of in-vitro fertilization (IVF), there is a hope that the Trump administration’s anticipated report of potential…
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…
May 7, 2025
PBMs: Death by a Thousand Cuts? [CI, CVS, UNH, ELV, GDRX]
The list of potential state and federal legislative threats to pharmacy benefit managers (PBMs) [CI, CVS, UNH, ELV, GDRX] seems to be growing, even though there has not been widespread enactment of these bills. Putting…
May 6, 2025
Optimism for Longer Term Resolution on Obamacare eAPTCs Remains but CMS Suggests Expiration [OSCR, CNC, MOH, ELV, HCA, THC]
Notwithstanding a recent CMS memo advising insurers to design their Obamacare plan bids assuming expiration of the enhanced premium subsidies at year-end, we remain optimistic that Congress ultimately settles on a middle ground (revision and…
April 29, 2025
[CNC, MOH, ELV, ARDT, UHS, CYH] Rising Risk of Medicaid Expansion Reforms in Reconciliation – Per-Capita Cap in the Lead
A week away from an anticipated House Energy and Commerce committee (E&C) hearing – and whose timing could easily slip – we do not see any release of pressure on Medicaid insurers [CNC, MOH, ELV,…
April 21, 2025
Medicaid Provider Tax Proposal: Too Little Info to Appropriately Size Threat [UHS, ARDT, MOH, CNC, ACHC, ENSG]
Today’s Office of Management and Budget (OMB) posting that it is reviewing a proposed CMS regulation about appropriate use of Medicaid provider taxes offers too little information to appropriately size the threat to hospitals (UHS,…
April 10, 2025
[CVS, CI, UNH]: Senate Confirmation of 3rd FTC Commissioner Allows for Future Resumption of PBM Litigation
Today’s successful Senate confirmation of Mark Meador to join the FTC as a commissioner paves the way for the FTC to officially resume its antitrust litigation against the pharmacy benefit managers (PBMs) [CVS, CI, UNH,…