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Reuters
an hour ago
- Reuters
Explainer: Key healthcare provisions in Trump's tax bill
July 3 (Reuters) - The U.S. House of Representatives passed President Donald Trump's tax-cut and spending bill on Thursday, which contains sweeping changes to the government's Medicaid healthcare program covering about 71 million low-income Americans. Nearly 12 million of those enrollees could lose their insurance under the program if the bill is implemented and those changes become law, according to a June estimate from the Congressional Budget Office. Below is a breakdown of some of the key healthcare provisions in the current draft of the bill and how they could affect enrollees and businesses: Frequent eligibility checks U.S. states would be required to conduct eligibility checks at least twice a year for the roughly 20 million Medicaid enrollees covered through the Affordable Care Act (ACA) expansion, rather than yearly. These "expansion enrollees" are people with incomes of up to 138% of the federal poverty level, which roughly translates to $21,597 a year in 2025. The new bill also includes provisions to prevent Medicaid beneficiaries from simultaneously enrolling in more than one state Medicaid program. Mandatory work requirements Medicaid enrollees are not currently subject to work requirements under the law, but the new bill proposes that adults aged 19-64, with a few exceptions, complete a minimum of 80 hours of work or community engagement activities a month or be enrolled in an education program at least half time to qualify for the program. The requirements will apply from January 1, 2027. Scale back on provider taxes Medicaid is jointly financed by the federal and state governments. States help cover their share by collecting taxes from hospitals and other healthcare providers, known as provider taxes. The bill would tighten federal oversight of those taxes by replacing the current 6% cap on provider tax revenue with a new limit that is indexed to inflation. It would also restrict how states structure the taxes, including stricter rules on what kinds of services can be taxed and how payments are distributed across providers. While the bill does not reduce provider tax rates directly, the changes could make it harder for states to use these taxes to draw additional federal Medicaid funds. The final version of the bill also sets up a $50 billion rural hospital fund to help rural providers who have argued that the provider tax changes would force them to scale back service. Tightening verification Medicaid is currently open to some immigrants who are lawfully present in the country, though many - including green card holders - must wait five years before they can sign up. The new bill removes Medicaid eligibility for some non-citizens, including refugees, certain abused spouses and children, and people granted asylum. Increased cost-sharing requirements The current law gives states an option to impose nominal co-payments on individuals with incomes exceeding 150% of the federal poverty level. The new bill requires states to impose mandatory cost-sharing on expansion enrollees earning more than 100% of the federal poverty level. Co-pays can reach up to $35 per service, with some exemptions, including emergency care and preventive services. The bill could put a strain on the finances of insurers and hospitals, analysts said. Spencer Perlman, director of healthcare research at Veda Partners, estimated Medicaid enrollment could drop by 5 million compared to current projections. Since Medicaid insurers are paid a fixed amount per member, the decline could directly hit revenues of insurers like Elevance Health (ELV.N), opens new tab, Centene (ELV.N), opens new tab, and Molina Healthcare (MOH.N), opens new tab, which have significant exposure. In 2024, over 88% of Molina's total membership came from Medicaid plans, Centene derived about 46%, and Elevance about 19.5%. Analysts also warned of risks to insurers' exchange businesses, forecasting ACA marketplace enrollment to fall to 18 million by 2027 from 24 million in 2025, due to eligibility restrictions and likely subsidy expirations. "For companies like Centene, this is a double whammy," Perlman said. Hospitals face similar challenges, though a proposed $50 billion rural hospital fund could offset some reimbursement cuts, Jefferies analyst Brian Tanquilut said. Drugmakers are expected to see little impact, as Medicaid typically represents under 15% of their U.S. sales, UBS analyst Trung Huynh said.
The Guardian
an hour ago
- The Guardian
Labour's 10-year health plan for the NHS is bold, radical
The government's 10 Year health plan to revive, modernise and future-proof the NHS in England – has arrived as the service is facing a dual crisis. It has been unable for a decade now to provide the rapid access – to GPs, A&E care, surgery, ambulances and mental health support – which people need and used to get. Normalisation of anxiety-inducing, frightening and sometimes fatal delay has produced a less tangible, but also dangerous, crisis – of public satisfaction, born of a profound loss of trust that the NHS will be there for them or their loved ones when they need it. Barely one in five people in Britain are happy with the NHS. Polling by Ipsos this week, ahead of the NHS's 77th birthday on Saturday, found that about 60% of voters have seen little improvement in it during Labour's first year in office. About the same proportion do not expect things to be much better by the time of the next election in 2029. It is hyperbole to say, as the plan does, that 'the NHS now stands at an existential brink'. The dissatisfaction with access problems is acute – but behind it lies enduring public support for the service itself. However, it is no wonder Keir Starmer and Wes Streeting have acknowledged the seriousness of the patient's condition and diagnosed radical surgery. It is blindingly obvious that, as the plan says: 'The status quo is no longer an option.' The authors of the 168-page document have produced a serious, detailed and impressive piece of work. It is unsparing in describing the many failings that mean the NHS is not just often frustrating for patients to use but also ill equipped to deal with the relentless demand for care created by an ageing, growing and increasingly unhealthy population, which is unlikely to fall soon. It also charts a new course for a service so indispensable that it is part of the nation's DNA. Labour's repeated claim that the Conservatives had left the NHS 'broken' helped win them last year's general election. And it has allowed the party during its time in government to blame the service's every dysfunction – staff shortages, overcrowded hospitals, inadequate mental health care – on its predecessors. But that time is over. The plan implicitly acknowledges that this narrative, a frequent refrain by Streeting, is no longer enough. After a year in power, this is Labour's prescription for how it will nurse the patient back to health. This – progress on delivering the planned transformation – is now a legitimate yardstick by which to judge Labour's stewardship of the nation's most treasured institution. Sign up to First Edition Our morning email breaks down the key stories of the day, telling you what's happening and why it matters after newsletter promotion The plan is as bold and radical as Streeting insists. But its key objectives – 'three big shifts' in the NHS's modus operandi from analogue to digital, treatment to prevention and hospital to community-based care – are familiar. They have been the stuff of previous NHS plans, and multiple inquiries, for decades – much promised, but rarely delivered. For example, the planned network of new 'neighbourhood health centres', with teams of health professionals and patient-friendly long opening hours, are very similar to the 'Darzi centres' proposed by the last Labour administration, of which few actually opened. Streeting does not pretend that the job of transformation will be easy. But there is a daunting array of obstacles to overcome. Will money needed to temporarily 'double run' old and new services during the transition be found? Will staff used to working in hospitals prove willing to switch to community settings? Will the gamble on technology pay off? Will the plan's failure to include big shifts to improve public health – such as mandatory reformulation of food or minimum unit pricing of alcohol – mean that the tidal wave of often-avoidable illness continues to outrun the NHS's ability to treat it? And will the decision to shed half of NHS England's 15,300 staff during its merger with the Department of Health and Social Care mean that Streeting does not have enough progress-chasers to ensure his tablets of stone are yielding real change? But the greatest risk Streeting faces is time. Alan Milburn, health secretary under Tony Blair and now Streeting's chief adviser, admitted later that the 2000 NHS plan bought him time to rescue the service from the derelict state his predecessors had left it in. But the often snail-like pace of previous NHS reforms suggests that, despite Labour having four more years in power, even that may not be enough for this plan to produce real, tangible benefits – changes to waiting times and the convenience of interacting with the NHS that patients notice. Voters keen to see 'our NHS' restored and improved may need to temper their expectations of rapid change, and ministers may have to do so too.
Medical News Today
an hour ago
- Medical News Today
Abecma (idecabtagene vicleucel) and cost
The cost of Abecma can vary based on several factors, including your insurance coverage. Coupons and drug savings programs can also lower the price you'll pay for cost and savingsAs with all medications, the cost of Abecma can vary. Factors that may affect the price for Abecma you'll pay include:your treatment planyour insurance coveragethe pharmacy you usethe cost of the visit to your healthcare professional to receive Abecma infusionswhether Abecma has a savings program (see the 'Financial and insurance assistance' section)To find out what the cost of Abecma will be for you, talk with your doctor, pharmacist, or insurance provider. Abecma coupons and savingsTo save money on your Abecma prescription, explore these Optum Perks vs. generic or biosimilar drugsAbecma is a type of immunotherapy called chimeric antigen receptor (CAR) T-cell therapy. CAR T-cell therapies are made using cells from your own immune system. It is a custom-made treatment. It isn't available in a biosimilar or generic is a brand-name cell therapy. Its active ingredient is idecabtagene vicleucel, which is made using cells from your body's immune system. »To learn more about how Abecma is made and given, see this in-depth ARE COSTS DIFFERENT FOR BIOLOGIC DRUGS VS. BIOSIMILAR DRUGS?Biologic drugs can be expensive because of the research needed to test their safety and effectiveness. The manufacturer of a biologic drug can sell it for up to 12 years. When the biologic drug's patent expires, multiple manufacturers can create biosimilar versions. This marketplace competition may lead to lower costs for biosimilars. Also, because biosimilars are very similar to biologic drugs, they don't require the same costly and insurance assistanceIf you need financial support to pay for Abecma, or if you need help understanding your insurance coverage, help is available. For example:A program called Cell Therapy 360 is available for Abecma. For more information and to find out whether you're eligible for support, call 888-805-4555 or visit the program websites provide details about drug assistance programs, ways to make the most of your insurance coverage, and links to savings cards and other services. Two such websites are: Medicine Assistance ToolNeedyMeds» Learn more about saving money on prescriptions with or without considerationsYou may want to consider the following information if you have insurance and receive authorization: If you have insurance, your insurance company may require prior authorization before it covers Abecma. This means the company and your doctor will discuss Abecma in regard to your treatment. The insurance company will then determine whether the medication is a drug requires prior authorization but you start treatment without the prior approval, you could pay the full cost of the medication. You can ask your insurance company whether Abecma requires prior of insurance coverage: Abecma is given by your doctor or another healthcare professional. If you have insurance, the price of your Abecma doses may be billed through your medical coverage instead of the prescription drug portion of your insurance plan. This depends on your specific insurance plan and where you receive your Abecma doses, such as at your doctor's office, an infusion clinic, or a you have questions about this process, contact your doctor or your insurance Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
