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 30, 2025
[LIVN, INSP, GMED, MMSI, BSX, MDT] CMS Prior Auth Demo Device Headwinds
We view CMS’s new Medicare prior authorization model – announced late Friday and scheduled for implementation Jan. 1, 2026 – as an incremental headwind for device manufacturers within the selected therapeutic and geographic areas, which…
June 27, 2025
[EXAS, GH, GILD, MYGN, HOLX] Preventive Services: SCOTUS Takes
Consistent with our expectations, the Supreme Court today upheld the validity of U.S. Preventive Services Task Force (USPSTF) appointments and – by extension – the mandate that insures cover recommended services without patient cost-sharing, lifting…
June 27, 2025
PRCT: Medicare Rate Expectations
With CMS likely to publish its CY26 physician / hospital outpatient rate proposals the week of July 7-11, we continue to expect physician payments for PRCT’s Aquablation to fall ~20% ($765 to ~$600) [see prior…
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 24, 2025
Reconciliation Update: It’s Now about Timing
In our view, the debate over the reconciliation bill isn’t about whether or not it will pass—it’s mostly a foregone conclusion that it will—but whether Congress can get it done by President Trump’s desired date…
June 24, 2025
[EW] Quick Word on TAVR Coverage Update
Having received a number of questions on an “update” posted to CMS’s National Coverage What’s New Report yesterday – which some have taken to imply a near-term reopening of the agency’s coverage policy for transcatheter…
June 23, 2025
Home Health: Potential Substance of Upcoming CY26 Medicare Rate Proposal [AMED, PNTG, BTSG, ADUS, AVAH]
In the upcoming CY26 Medicare payment proposal for home health (HH) agencies [AMED, PNTG, BTSG, ADUS, AVAH, UNH], which we expect within the next two weeks based on historical patterns, we think it is more…
June 23, 2025
Capitol Policy Weekly: June 23-27: Iran, NATO Summit/Defense Spending, Reconciliation and Stablecoins
The House and Senate are both in session this week with the U.S. attack on Iran and reconciliation likely leading the headlines. President Trump is scheduled to give a speech at the NATO summit in…
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…