Latest news with #CentersforMedicare&MedicaidServices
Yahoo
19 hours ago
- Business
- Yahoo
Dr. Oz's plan to stop Medicare waste and rising costs
Dr. Mehmet Oz, now head of the Centers for Medicare & Medicaid Services, lays it out plain: healthcare isn't just a cost, it's an investment to win the future. Want to fix Medicare, Medicaid, and save America trillions? Dr Oz says get people healthy, working, and off government dependency. On Decoding Retirement, Dr. Oz tells host Bob Powell that he is cutting waste within Medicare and Medicaid - and demanding results. He backs work requirements as common sense and insists medical debt must be tackled through price transparency and enforcement. Rising Medicare premiums? He's pushing reforms to protect seniors' wallets. Bottom line: Oz tells Powell he's in the 'change business' - and he's here to make healthcare work for hardworking Americans. Yahoo Finance's Decoding Retirement is hosted by Robert Powell. Find more episodes of Decoding Retirement at We will leave no stone unturned. There is a new sheriff in town, I promise you, if you're cheating the American people, we will come after you and if you're doing it to hurt folks who are most vulnerable, we'll be doubly vigilant at that. There's a new sheriff in town. His name is Doctor Mehmet Oz. He is the administrator of CMS, and he's responsible for the health care of 150 million plus Americans. In his new role as administrator, he is going to lean into technology, into AI, and deliver medicine in ways that have never been delivered before. But the big question is who's going to pay for all that? Well, that's what we asked him in the latest episode of Decoding Retirement. Take a uh, welcome Doctor Oz to Decoding Retirement. We're happy to have you here. Thanks for having me. Lots to talk about. Uh, we do have a lot to talk about in a short period of time. So, let's start here. You mastered the art of explaining complex medical concepts to millions of people, uh, on your television program, and now you're running a complex agency with, uh, where you're responsible ultimately for the healthcare of millions of Americans, 150+ million Americans, andCurious, what's your strategy for translating that, you know, that same clarity to an agency where a single memo could affect 66 million Medicare beneficiaries or78 million uh Medicaid, uh, beneficiaries or millions of people on ACA. What, what's the strategy? Well, the one job he didn't mention was being a heart surgeon, and actually that as well has some overlap with hosting a TV show and running a government agency. There's different amounts of blood in each category. I may be in the bloodiest terrain right now, the harshest theater, but I do believe it's the best job I've ever part because much of what I've done in my life, and I do adore heart surgery and the hosting the show was just a blissful event every single day, but much of what I do now is to take those skills, um, and allow them to be, you know, affect billions of Americans, as you mentioned. Many times those Americans feel like they've been left my very core, what I've always felt was I wanted to be in the change business. A lot of listeners probably feel the same way. You don't just want to go up every day and do your job and go home. You wanna get up and do things that changed the course of human history. At least we like to think that's certainly what I think all of us have put on earth to do is make a difference. So within this space of health care, there's many ways to do it, but something that I learned from my producers on the show, and it's a very powerful insight, is people do not care what you know until they know that you care. And so starting off with the emotional hooks about why this message matters and why what we're doing is so important, is the best way generally start any conversation. So with your permission,I want to just share a quote that's present at the entrance of the building that I work in with Secretary Kennedy and a bunch of other colleagues in Washington. It's called the Humphrey Building, and Hubert Humphrey made this statement of 50 years ago. By the way, Medicaid, 60 years old this week, which we'll talk about. So this precious gem, this backbone of the social safety net system was created 60 years ago, and because of drift or uh maybe by design, there have been lots of changes to the program, but we should always remember this quote from Hubert Humphrey, and it is that is the and it emphasizes it is the moral obligation of government. The moral obligation to take care of those at the dawn of their life, the at the twilight of their lives, the seniors, elderly, and those living in the shadows, and that haunting use of light that that Hubert Humphrey uh was was proposing, we judge the purposes of Medicaid in particular, uh, but it applies to Medicare and CHIPP, the Children's Health insurance. It applies to the Affordable Care Act. It even applies to commercial insurance, which we don't control, but offer to their employees that's the goal that's what insurance is about we pull our resources, we pray we don't get sick, but if we happen to have the the bad luck of an illness, then you have to manage that and that's fundamentally why all this that matters and is made much richer if you're healthy enough to enjoy it. You cannot be a healthy country if you're not a, you know, if you're not doing these issues and you can't be wealthy if not healthy. It matters that Americans are healthy enough to to live and work longer, and I'll give you one math, uh, just tangible example. If you're born in 1964,You are now 61 years of turns out the average American retires at age if I can get you to work an extra 3 years from 61 to 64, the value to our GDP is $1 trillion.01 trillion dollars just by one group of people born in 1964 working three years longer. So that means we got $300 billion in taxes from that $1 trillion of incremental value to the GDP. So this is how I think about the investment in health. If we make America healthy, we will be a richer country for it, literally. Yeah, there's a lot of talk now about, uh, increasing health span, compressing morbidity, etc. etc. But you mentioned the Hubert Humphrey quote and I'd love to turn your attention to the one big beautiful bill where there's some controversy around how many people might not qualify for health insurance or Medicaid, uh, given the potential work requirement, uh, that will be put in place, um.I'm curious, uh, you know, your thoughts on that. Like for me, as I think about all that I've read about this topic is most of these folks are working either full or part time, um, and, uh, and it might be the red tape, right, that sort of bogs them down from getting the health care that they need and and and in light of what you just said about Hubert Humphrey, it seems like we might might not be fulfilling that promise. Excellent, excellent way of place to go because I think it highlights some of the, the arguments that happen in healthcare. So, the primary goal of Medicaid was to take care of the people identified by Hubert Humphrey. None of those categories are touched by the work requirement because it's not even a work requirement, it's a community you willing to commit to try to get a job, get an education, support your community, take care of kids, do something that shows that you actually have agency over your future. So if you're in one of those early categories, if you're a child, there are seniors in poverty or um if you're uh in living in the shadows cause you've got a chronic illness or some other reason that you can't work, you're already in. The purpose of what was to take the fraud, waste and abuse out of Medicaid was to preserve it. The expenses have gone up 50% in five years. That is just not sustainable. And so rather than shut the program down in some future administration, the president said, clean it up, take out the stuff that's not supposed to be there. The most obvious was a work requirement which most people, if they think about it, and this has been surveyed, 100% agree, if you're living in someone's they come home with that after they worked all day long and they're paying your health insurance, and they say, will you chip it? Just like help around the house, try to get a job, go get an education, you know, don't do what you're doing now, which is on average an able-bodied person on Medicaid who was never supposed to be on Medicaid originally. An able-bodied person on Medicaid is not working, watches 6.1 hours of television or video games or just hang out around the house a day.6.1 hours a day, that's not a way to live your life. And it turns out, when you give the American people that challenge, and I have confidence in the American people, I suspect you do too, most listeners as well, they take it. But when over the last uh last year and a half or so, there have been 15 million people who have come off the Medicaid rolls, who were left on there during COVID because nobody was asking questions about whether you belong on Medicaid. Of the 15 million people, 90% got other coverage the average American understands it's a sweetheart deal to get free health insurance, especially if all we're asking you to do is make your life better. And that's why I am confident it's ethically and morally the right thing to do. But it also will help preserve a program so the people that Hubert Humphrey spoke about, the people for whom 60 years ago Medicaid was created, they're protected. And you know why there wasn't a work requirement back then? It never dawned on anyone's mind that you would ever give free health insurance without asking people to chip in if they were able to. And if you look at every other social program, we have work requirements. In fact, President Obama, President Clinton, President Biden all said Democratic presidents as well as Republican presidents obviously have all said that the backbone of a social network program of a of a social safety net program is a work requirement. It's good for the people in the program and the welfare reforms of President Clinton back in the 90s showed that when you challenge people, they get jobs and they get out of poverty. We're going to take a short break. We'll be back with Doctor Oz, the head of CMS, right after you know, I'm curious, there was a report not recent, uh, recently that talked about, uh, in Georgia where there is a work requirement and how, uh, people who are working but who failed to fill out the paperwork then became disqualified. Did, do you worry that maybe that impediment, that red tape would prevent people from, uh, qualifying for Medicaid, uh, who might otherwise qualify, but were it not for the paperwork? So we, we areso focused on that issue. We've already launched two pilots in Louisiana and in Arizona, which have had good results so far, and we're going to broaden it out. I was speaking this weekend to the National Governors Association and I asked a few more states to join the pilot. The people running it are the same folks who who fixed the passport system in America. If you haven't tried to get a passport recently, there was actually a positive article about the The New York Times, because the passport system works now. Within 2 to 3 weeks you can get a new passport. You don't have to go to a post office or a drugstore for photos. It's all done digitally. So we have the same team run by Amy Gleeson, a United States Digital Service, and they have already started the pilot, and he's very simple. 91% of people on Medicaid have smartphones. You plug, you tap on the smartphone within the app where you're working. Let's say you'reUber driver, it knows that ADP does your payroll and so it asks you permission. Can I contact this ADP company and ask them about your hours? You say yes and boom, within 5 minutes, the entire process is less than 7 minutes. You have all your numbers you just confirm that it's OK and I'll go one step further, Bob, this is what I'm excited about and I talked about this with the governors this weekend. In that system, let's make it better. Let's connect you to the employment office of the you haven't gotten the 20 hours. So again, we're only asking you to work halftime. You don't have to work full time, even if you're able bodied, just 20 hours a week, but if you're short 3 hours, maybe we can get you a job in an area that you have expressed interest in, because you're already working in other odd jobs doing that, and that's how you get people into full-time employment, and then they get off Medicaid, they're not trapped in the system, they go into the exchanges, and they go up in the commercial health insurance, and they live fulfilling lives. I want to avoid the crisis that's been faced by many European countries where in an effort to be nice they give support to folks who then forget what it's like to work. If in the United Kingdom, which is a good example, you have generational trapped poverty where your grandfather didn't have a job, your dad didn't have a job, you've never had a job, your son doesn't have a job, and no one you know has a job that you're related to. So it's not part of the culture anymore. In America, we always worked and we need workers, so it's good for you, it's good for the country, it's good for the healthcare system. All right, I want to turn my attention. You mentioned fraud, abuse, waste. Um, when I think about Medicare Advantage, uh, we've got serious problems there, right? The Wall Street Journal, uh, has had a number of stories that exploited, uh, where companies are exploiting the system, collecting billions of dollars in taxpayer dollars. Uh, UnitedHealth just admitted that it was, um, uh, the Justice Department was investigating it. Uh, I, I feel like, you know, we've handed healthcare to a private industry and and to ill effect. So Bob, this is a very sensitive topic for everybody, because the whole point of launching Medicare Advantage was to give seniors options. You want to take your regular fee for service Medicare, which is out there and used by half the population, or do you want to use an HMO version, a managed care version?That would, if theoretically offer some benefits, you know, they maybe do a better job in in streamlining your care, they could give you supplemental benefits, they could help with your prescription pricing. They will give you things that would make your exercise classes, food support, and so Americans have sort of divided in half over this issue. In the middle of all this, if it turns out that Medicare Advantage is costing us a lot more than fee for service, you're violating the whole premise. The whole argument was, we'll give a private company a little they drive down overall costs and improve quality. So if you believe the government does it better than anybody else, then stay with them. If you believe that a private venture, let's look at, you know, the mail system, right? You could use the US Postal Service, you could use FedEx, right? So you have choice, and if you think FedEx is worth it, you give money to them. If not, you won't. In Medicare Advantage, I do think that uh there's been a a a a ability for the companies, the private companies to game the coding system, and by that I mean you obviously if you're an insurance company, you wanna know how sick your patients are. So instead of just saying I got what I got, I'm gonna take care of them and I'll just be honest about how sick they are, they expertly to up code to pretend the patients were sicker than they really were that got them more money. It got the shits that they can use for other purposes and they were able to take profit off the table. Uh, we obviously are examining that we have a process called RADV uh that allows us to go back, back into the late teens and for the first time audit Medicare Advantage companies and based on what we find, we're going to pull money back from them. We expect it will be billions and billions of dollars. Let me, let me turn my attention because I know we have short time to Medicare Part B. The most recent trustee's report suggests that the Part B premium will rise 11.6% next year and that, uh, we're projected to keep that percentage far in excess of, uh, average inflation over the next, uh, till 2033 or so, and some of it is due, I believe, because hospitals are now moving to outpatient care, which is a Part B cost, not a Part A cost. Uh, how do we, uh, rein in what's going on with, uh, Part B premiums because that obviously comes out of people's Social Security benefit checks. So you have a very smart audience, but just we're all on the same page. I'm gonna go through the letters real quick, so everyone's together with us. So part A is the 2.9% that comes out of everyone's paycheck every week that you get a pay stub, that pays for the hospital bill. A as in alpha, B as in boy, outpatient, also some drug infusions like chemotherapy, for example, that's associated with in a doctor's office or in the hospitals, Part B as in boy, uh, doctor's expenses as well. Part C is the Medicare advantage we were just talking about, uh, and Part D, which we might talk about, is a drug. D as in drug, uh, is the drug benefit that seniors are eligible for. So we have a major concern about Part B price increases, but we have a concern about Part A and Part C and Part part A, before I get to your question, um, the Medicare trustees report predicts that it's bankrupt in 2033. It that's 3 years shorter than we thought it was a month ago. And in their worst case scenario is that it goes bankrupt in 209. Now we're not gonna let that happen, but to fix that, you've got to take some steps, and that's why some of the things we're doing are not popular with folks who get not the beneficiaries, not the American people, but the folks who are getting paid from these programs are getting haircuts, and that's uncomfortable. Part B, which is what you asked about, is concerning cause drug prices have increased so much. But there are other things that are in Part B as well that we believe we have control over and we could get to be more efficient. A lot of this isHearing the stakeholders and then pushing back on what you've heard, and then letting them actually come up with some ideas themselves. I had an op ed this week with Marty Makary McCurry um in the Wall Street Journal Journal, and it talked about the power to convene. You mentioned prior authorization a little bit earlier. Uh, we went to all the major insurance we said, listen, we can do this with a sledgehammer and fix this issue that's frustrating the American people, the idea that you have to have all these prior authorizations for anything you want to do with your doctor, or you guys can be go fix this problem. In fact, the words we used was meek. You know, in the Bible speaks to the meek inheriting the earth. Meek doesn't mean weak, which is what I thought when I was a kid. Meek means you're armed with a sharp weapon, a sword, and you decide to sheath that sword, put it away just for now, so you and your colleagues can come up with a better we're going back to hospital systems and drug manufacturers and the prior guys, uh, the insurance companies who covered now 80% of the American people. In the case of prioritization, they voluntarily came up with a nimble solution. They're being transparent in their efforts. They're dramatically reducing the number of prior authorization claims, and they're going to do it much faster, so you know almost immediately that you're not going to be stuck for 3 weeks waiting to find out if you can get your operation or not that's diagnosed all this is part of the process with the Part B program and with the Part C, a little bit with the Medicare Advantage, and even with Part B with the drug companies for outpatient drug use, we've gone back to all of them and say we need better answers. And what you're doing now is making you a lot of money, and you can do that for another year or two, and then the bottom's gonna fall out. So maybe you want to do it with us. Come work with us, don't make us use a out these issues, come to us with better ideas, be transparent about them. The American people will love you for it. The president won't come after you because he will otherwise. And the president's very clear about this. He does not want the American taxpayers abused and more importantly, he doesn't want the American people abused, and some of these these processes have become abusive. You know what works, Bob, really effectively?I will often go to a group of of healthcare professionals, uh, especially executives of companies, and I'll say you went into this business because you care about people. Somewhere in your psyche, same as you did, Bob, when you entered the pharmaceutical space early in your career, you went into it because you thought these drugs would cure disease and save human lives. Sometimes we forget about that fundamental driving force, and if you could just align people, remind them that people matter more than profit statements, they they get back to their roots that they want to brag to their kids and grandkids about how they made America better. This is a chance, a generational opportunity. Yeah, so, you know, we have, there's a a whirlwind of things going on. So Part B premiums are increasing, and then you mentioned Part A where, according to the trustee's report, there'll be about an 11% cut perhaps once the trust depleted. So on the one hand, costs are rising and services may decline on the hospital side if the providers experience an 11% cut. uh, uh, with respect to Part A, uh, what's the solution there? Well, I could talk about this for hours, so I'll give you a succinct answer, right? So for-profit hospitals actually are to bringing back mid-teens returns. Nonprofits are bringing single digit low returns. Now, there's other reasons that may explain this, but at its very core, there are ways of making the system more I think hospitals are challenged and the hospitals are the center of our communities, especially in rural America, which, you know, they're critical and they're not getting much of the Medicaid dollar. Only about 7% of Medicaid money goes to the rural hospitals, so they get hurt badly in these programs, um, but at its very core what these hospitals need to be able to do is use technology which we' to launch on Wednesday with the at the White House with the our effort to make America's health technology great again. It's an effort to make it easier for patients to interact with their doctors using their their phones, letting doctors use navigation support so they can help with some of these difficult decision making processes, you know, cancer drugs are changing so quickly it's almost impossible up. So how do we use the same technology that you pick the best video to watch tonight based on what you saw yesterday? Use a rideshare, uh, technology, use A&B Airbnb technology use modern tools that have made the banking system safer for fraud, waste, and abuse and allow that all to play out. It starts with two fundamental realities. You have to know who your customer we've got to be able to allow the American beneficiaries to to to to to validate who they are and then allow the system to talk to them with their medical records and you also have to get doctors to tell us where they practice and who they are. Don't replace the doctor, use AI to expend the doctor's opportunity. Allow them to use AI to intake, so they pick up subtle problems with your emotional issues and how you're not taking your meds and why not and the other issues of your life. Give it to the doctor in an organized fashion so that when they're with you, they actually give you answers. They're not just listening toyou. All right, you, uh, you already answered the question I was going to ask about AI. So how, try this one. A federal judge recently blocked a rule that would have removed medical debt from credit reports and that would have helped maybe 15 million Americans. So curious, how do you respond?And uh what's your message to patients who might be stuck with debt that is affecting their credit reports? Number one cause of bankruptcy in America is a health issue. Number the number one driver of aging, it turns out are financial issues if you include things like divorce, which often present with those kinds of catastrophes. So, uh, we have to deal with the medical debt problem which dwarfs all of the debt that we have. Um, we also have to deal with it by reducing what it costs to get care in America and by empowering people to know what it's gonna get, uh, what's gonna cost and No Surpriss Act did just that, we just never actually enforced do we have laws now that are out there to protect patients that have not been used, and hospitals should be able to tell you ahead of time what it's gonna cost. You should be able to choose accordingly. We should have protection on some of these expensive drug platforms that you might not realize you're walking into, uh, but the American people are powerful if you arm them with information. Interestingly, the health care marketplace really isn't a marketplace because in a marketplace you have willing parties with full information you don't buy stocks in a vacuum you know a lot about the companies and it's mandated and then it's, it's also enforced. We don't do that in health care. That's one of the big opportunities with the digital transformation of the system because once you have transparency, you'll say just that hospital across town charges half what they charge at my hospital for MRI scan. I'm gonna complain to my doctor and guess what happens? The doctor calls the hospital administrator, they dropped their MRI costs. The whole system doesbetter. Yeah, so, um, last question, Dr. Oz, I know we're on a short time here, uh, is you ran for Senate in the state of Pennsylvania. You're now head of CMS, and, uh, is politics in your future? Do you plan, uh, after your stint here, another run for office, uh, governor or something else? I, I literally go to bed at night trying to think of what I'm doing tomorrow. I haven't no, I haven't made vacation plans. I haven't, I, I almost missed my wife's birthday, so I've got much bigger risks. Uh, I look, I, I, I, as I started this interview off and I'm with it, I'm in the change business, and right now I'm in the best place I believe and the planet for me to be to try to help make these changes. I'm surrounded by brilliant individuals who aremission aligned. I have a president who's spectacularly desirous of making change, and the Secretary of Health and Human Services, Bobby Kennedy, who's a superstar both as a personal friend, but also as a mentor, just wants to push for for us to be bravely in front of a lot of the issues plaguing the Americanpeople. All right, question. Last question is this. I know you recently, uh, uh, enrolled, I believe, in Part A in Medicare. Is that right? Very, very, yeah, thank you for clarifying that. I, I enrolled in part A because I have health insurance that to get you for that's that's great. But Part A, you should all sign up for. It doesn't cost the government anything because if you have other insurance, the part A will be inthe background. Yeah, and then all right, I lied. One last question. I watched your video. Wait, wait, I know it's I know you know who your producer is. She's the same producer I am. I know, but actually this is my own question. I just watched your video on hospice I, I just take a moment to talk about the, the need for adults to protect themselves against scams that could put their Medicare number at risk. Uh, this is a reprehensible, uh, activity. It's, uh, run by criminal syndicates. These are not small time operators. They take advantage of people at their most vulnerable time. Takes a lot of gumption to deal with hospice issues, to make it a choice, a decision that you're done with the traditional pathway and you're you're reconciling to what might happen and to allow you, therefore to make some bold steps like joining hospice, hope, our desire is to make sure that's a clean and safe process. The reputable hospice teams are coming to us, companies and saying there's a lot of fraud out there. We're hearing all these horror stories about people who thought they're entering legitimate hospice and there's nothing there for them. And even worse, because you're not really sick, people are on these hospice programs for so we're going after them in a big way. We already have actions in several states. The Department of Justice is pursuing a lot of these leads. Uh, we will leave no stone unturned. There is a new sheriff in town, I promise you, if you're cheating the American people, we will come after you. And if you're doing it to hurt folks who are most vulnerable, we'll be doubly vigilant at that. Doctor, Doctor Oz, thank you ever so much for uh chatting with us, sharing your knowledge, your wisdom, your insight. That's greatly appreciated. Thank bless you. Take what do you think of what Dr. Oz had to say? I'll tell you what I think. A lot of questions, a lot of unanswered questions, and a lot of questions still to be asked. And that's our goal here on Decoding Retirement is to keep asking the hard questions and provide you with the information that you need to plan for and live in retirement and plan for those health care costs in retirement. We hope you enjoyed this episode of Decoding Retirement. Thanks for listening. This content was not intended to be financial advice and should not be used as a substitute for professional financial services. 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Business Journals
5 days ago
- Health
- Business Journals
Dr. Frist to Dr. Oz: Use Nashville's health care leaders as a resource
Nashville's health care leaders gathered July 22 to hear a discussion between Dr. Bill Frist and Dr. Mehmet Oz, the new Centers for Medicare & Medicaid Services administrator. Here's what Frist said to Oz, and what Oz had to say about Medicaid cuts, improving the health care landscape and getting people back to work.
Time of India
6 days ago
- Business
- Time of India
Boston Scientific lifts annual profit forecast, sees smaller tariff impact
Bengaluru: Boston Scientific raised its annual profit forecast on Wednesday, banking on strong demand for its heart devices , and trimmed its expectation for tariff-related costs to half of the previously projected amount. Shares of the company rose 4.8% in morning trading following the results. "Based on the current schedule of expected tariffs, we now anticipate a full-year headwind of about $100 million, down from a $200 million estimate," CFO John Monson said during a call with analysts. The company expects to offset the remaining tariff impact through strong sales performance, favorable product mix and spending control, Monson added. A rise in surgical procedures has boosted sales for medical device makers such as Boston Scientific, helping counter broader concerns about healthcare spending. Executives credited strong trial results and expanded product indications for fueling physician adoption of key cardiovascular devices such as Watchman and Farapulse, the firm's main growth drivers that saw steady quarterly demand. The company said the proposed rules by the Centers for Medicare & Medicaid Services regarding certain cardiac procedures would further benefit its technologies. Farapulse, which is approved in the U.S. for some patients with intermittent atrial fibrillation, competes with Johnson & Johnson's Varipulse and Medtronic's PulseSelect in the pulsed field ablation (PFA) market. Rival Johnson & Johnson last week posted strong medtech sales, aided by its heart devices, Varipulse and Trupulse. JP Morgan analyst Robbie Marcus said the profit forecast raise was larger than many had expected, especially given Boston Scientific is now moving past the initial U.S. rollout of Farapulse. "That said, the outlook still appears conservative to us," Marcus added. Boston Scientific now expects 2025 adjusted profit of $2.95 to $2.99 per share, up from its prior view of $2.87 to $2.94.
USA Today
18-07-2025
- Business
- USA Today
Health insurance costs are about to spike again: What to expect in 2026.
Consumers who buy health insurance through the Affordable Care Act marketplace will likely face double-digit rate hikes next year. Insurers plan a median premium increase of 15% for 2026 plans, which would be the largest ACA insurance price hike since 2018, according to a Peterson-KFF Health System Tracker analysis published July 18. And many working-age consumers who get their health insurance through the workplace won't be spared, either. Benefits consultant Mercer said more than half of big employers expect to shift a larger share of insurance costs to employees and their families next year by raising deductibles, copays or out-of-pocket requirements. KFF said the ACA insurers cited factors such as medical cost inflation, the expiration of tax credits instituted during former President Joe Biden's administration that made plans cheaper, and tariffs on prescription drugs and medical device imports. Still unknown is how President Donald Trump's and Congressional Republicans' tax cut and spending law might impact next year's ACA health insurance rates, experts said. Trump's tax cut law has "created a lot of uncertainty," said Matt McGough, a policy analyst for KFF's program on the ACA. "Insurers weren't sure how to handle it." Millions of nondisabled adults are projected to lose Medicaid coverage due to the law's work-or-volunteer requirement, but the law also will impact some who buy ACA plans. Trump's law and a federal rule will end a special sign-up period for people who earned less than 150% of the federal poverty level − a group that had significant enrollment gains in recent years. The enrollment perk allowed low-income Americans to sign up for coverage year-round, making it easier for families to sign up, McGough said. The law also ends automatic ACA enrollment renewals for consumers, who will be required to update income and other information annually. Trump administration officials have said the Biden administration's enrollment policies for Medicaid and the Affordable Care Act allowed fraud and abuse. In a July 17 news release, the Centers for Medicare & Medicaid Services said it discovered 2.8 million Americans were potentially enrolled in Medicaid or Children's Health Insurance Program plans in multiple states, or they were simultaneously enrolled in Medicaid/CHIP plans and subsidized ACA plans. The agency said it initiated steps to ensure people weren't simultaneously enrolled in multiple, taxpayer-subsidized insurance plans. In a statement, U.S. Health and Human Services Secretary Robert F. Kennedy, Jr. said the Trump administration "will no longer tolerate waste, fraud, and abuse at the expense of our most vulnerable citizens." Higher health costs, end of COVID-era tax credits Higher health care spending is the top factor driving health insurance premiums higher - accounting for roughly half of the expected insurance price hikes, McGough said. Another significant factor is Biden's COVID-19 pandemic-era tax credits, which made ACA plans cheaper for consumers and drove record high enrollment, will expire at the end of the year. The nonpartisan Congressional Budget Office estimated about 5 million could lose health insurance after the tax credits expire. KFF said the expiring tax credits will increase ACA consumers' out-of-pocket premium payments more than 75% on average. Healthier enrollees will likely choose to drop their coverage, leaving insurance plans with groups of sicker patients who require more health care, McGough said. KFF's review of 105 ACA insurers in 19 states and Washington D.C. found most are seeking rate hikes of 10% to 20% for coverage next year. Another 28 insurers will seek rate hikes of 28% or more. State and federal insurance regulators must sign off on proposed rate hikes before they are finalized this fall. Most working-age Americans get health insurance through their or a spouse's employer. These large employers will be more willing to pass along a larger share of health insurance costs to workers and their families next year, a July 16 report from benefits consultant Mercer found. Mercer said 51% of large employers say they are likely or very likely to shifts cost to workers through higher deductibles or out-of-pocket maximums. A year ago, 45% of employers were willing to make their workers absorb a higher share of the health bill. Employers health benefits costs are expected to rise 6% in 2025 and could rise even faster in 2026. To curb those cost increases, employers are adjusting insurance plan options for workers and their families, said Beth Umland, Mercer's director of research for health and benefits. Earlier this decade, employers were reluctant to shift significant health costs to workers due to the tight labor market. But with health costs rising faster than inflation, more companies are willing to do so, Umland said. Companies also are increasingly offering plans that encourage workers to get care from narrower networks of doctors and hospitals who have negotiated discounts with the insurance plan, Umland said.
India Today
18-07-2025
- Health
- India Today
More than 20 states sue federal government over new health insurance rule
More than 20 Democratic-led states filed a lawsuit on Thursday challenging a new federal health insurance rule that tightens restrictions for enrolling in marketplace plans through the Affordable Care Act (ACA) and bans coverage requirements for gender-affirming lawsuit, led by New Jersey, California, and Massachusetts, also includes 18 other states. They argue that the new rule could strip coverage from millions of Americans, drive up healthcare costs, and harm state health rule, set to take effect in August, shortens open enrolment windows, eliminates year-round enrolment for low-income Americans, and adds verification requirements. It also prohibits states from including gender-affirming care in the ACA's list of essential health benefits, according to a report by the Associated Press. On its website, the Centers for Medicare & Medicaid Services (CMS) says the rule 'finalizes additional safeguards to protect consumers from improper enrolments and changes to their healthcare coverage, as well as establishes standards to ensure the integrity of the ACA Exchanges.''As New Jersey and other states prepare for the 2026 open enrollment period, the Trump administration is seeking to cause confusion and chaos in the healthcare marketplace, increase costs for our state, and create barriers to enrollment,' New Jersey Attorney General Matthew Platkin said in a the lawsuit was filed, a representative for the US Department of Health and Human Services (HHS) said in a statement that the rule strengthens oversight, ensures subsidies go to people who are truly eligible, and will lower individual health insurance premiums. The rule, finalized by CMS in June, includes provisions meant to limit improper enrollments and the improper flow of federal lawsuit challenges parts of the rule that shorten enrollment periods and impose a monthly $5 fee on some marketplace shoppers. It also targets a provision barring transgender healthcare from the list of essential health benefits subject to mandatory coverage under the states argue that the rule imposes burdensome and expensive paperwork requirements and will force consumers to spend millions to prove eligibility for coverage and subsidies.- Ends(Inputs from Agencies)Must Watch
