Top of the Funnel
MCOs – Trends and Outlook. Please join us on Wednesday as we review three of the MCOs, CI, CNC and HUM which distill some of the broader industry trends in demographics, policy and regulation. Link to invite here.
CONGRESS.
Mo’ Money. HCA (+), THC (+), SGRY (+), UNH (+), ELV (+), HUM (+) CNC (-), MOH (-) The Congressional Budget Office issued its Budget and Economic Outlook: 2024-2034 this week. Medicare is expected to spend about $65B, mostly on Medicare Advantage and the Part D drug benefit. Medicaid, Marketplace and CHIP spending is expected to decrease by $58B largely due to redetermination of eligibility.
The increase represents a 7.7% increase for Medicare and a 6% increase for Medicaid.
Read full report here.
Mo’ Time. NVO (+), LLY (+) The House Budget Committee, under pressure to approve Medicare coverage of anti-obesity medications like the GLP-1 drugs, has approved a bill that would give the CBO a thirty-year window in which to consider the effects of preventive treatments. This 30-year period would be in addition to the typical 10-year budget scoring window.
While it may be possible to consider the impact of preventive care retrospectively, it is much more difficult to do so prospectively. This effort is probably just a fig leaf for the expansion of coverage that might otherwise be difficult under budget rules.
340B Reform. A bipartisan group of Senators has released a discussion draft on changes to the hotly debated 340B program. With very little legislative direction the 340B program has wandered away from what some believe to be its original purpose.
The SUSTAIN 340B Act would prevent drug companies from imposing contract pharmacy restrictions, require off-site locations to be owned and integrated with the operations of the 340B hospital or clinic, define the term “patient” and establish an oversight program funded by user fees.
Copy of discussion draft is here.
WHITE HOUSE.
Presidential Pile-on. The White House had a really bad year this week. The possibility that President Biden will withdraw/resign is heightened after what is expected to be a loss in the 14th Amendment case at the Supreme Court; a Special Prosecutor report on document handling that called into question President Biden’s mental acuity; and the unforced error of a press conference that made things worse not better.
A smoothly running White House is a necessary condition for consistent execution of executive functions. A fully functioning president is not necessarily required – see Presidents Woodrow Wilson and Ronald Reagan – but someone must be in charge.
In May sometime, we will cross the threshold into the jurisdiction of the Congressional Review Act. The CRA allows Congress to review and override executive action of the previous administration. Since passage, presidents have gotten into the habit of getting controversial rules done beyond the reach of the CRA.
Controversial rules like minimum staffing should appear before May or they risk reversal next year. It is undeniable that White House staff are giving consideration to their own futures and that can make the next few months unpredictable.
Have a great weekend.
Emily Evans
Managing Director – Health Policy
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