Latest news with #CharlesSallee
Yahoo
13-05-2025
- Health
- Yahoo
NM budget expert expects Medicaid work requirements out of Congress
Charles Sallee interviews for a promotion to lead the Legislative Finance Committee on Aug. 17, 2023 at the Roundhouse in Santa Fe. (Photo by Austin Fisher / Source NM) One of the New Mexico Legislature's top budget advisers says he expects the federal government's planned budget cuts to make it harder to qualify for the state's health insurance program for low-income people. Medicaid is under threat from the executive branch and Congress. On Sunday, House Republicans released a plan that the nonpartisan Congressional Budget Office estimates would cut $715 billion cut to Medicaid funding. As of publication on Tuesday, a U.S. House committee tasked with that work was starting what was expected to be a long and grueling session on the proposals. Also on Tuesday, at the state Legislative Finance Committee's first meeting since this year's legislative session, Director Charles Sallee told lawmakers that in the worst-case scenario, the Republican proposal would translate to cuts of more than $1.1 billion for New Mexico's Medicaid program. Sallee said work requirements for some Medicaid patients are 'guaranteed' to be included in the Congressional budget as an additional eligibility condition for nondisabled adults without dependents on Medicaid. That could dramatically increase the number of people who don't qualify for health insurance under the program, he said. 'It remains to be seen just how tough Congress will make the work requirements,' Sallee said. Whether people who lose their Medicaid coverage will be able to find a low-cost or free alternative health insurance policy through the state's BeWell exchange, or lose coverage altogether remains an open question, he said. Sallee also said provider taxes, which the state government levies on nurses and hospitals, are on the chopping block. That could upend programs designed to enhance service quality in those facilities, he said. Sen. Linda Trujillo (D-Santa Fe) asked whether Congress is considering the potential increase in social costs of people losing their health insurance, and Sallee said no. 'Part of the benefit of giving people access to health insurance is that they'll go to their doctor for ear infections or things that you don't need to go to the emergency room for,' Trujillo said. 'That's an indirect cost that's going to increase, because it costs thousands of dollars more to go and get your ear looked at in an emergency room than it does to go to your health care provider.' SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
Politico
12-02-2025
- Health
- Politico
Ozempic boom weighs on state budgets
Presented by the Coalition for Medicare Choices Driving The Day DIET DRUGS DRIVE UP COSTS — Soaring costs of weight-loss drugs are leading some states to scrap the benefit for state employees, your host reports. After Colorado's spending on the highly effective but costly drugs classified as GLP-1s, which include Ozempic and Wegovy, more than quadrupled from 2023 to 2024 — with usage doubling every six months — the state health plan is proposing ending coverage, arguing it's financially unsustainable. The potential removal of coverage is sparking blowback among state workers. The state employees' union argues that ending coverage will cost the health plan in other ways: an increase in spending on obesity-related diseases and a less healthy workforce. '[State employees] are very upset about this,' Hilary Glasgow, executive director of the union, Colorado WINS, said. 'Long-term obesity drives a lot of the major fatal diseases in America, and the employees I've talked to feel like they're losing a lifeline that got thrown to them.' Why it matters: Colorado's case illustrates the broader struggles states that choose to cover the drugs for employees face as many states deal with budget shortfalls: Keep covering the drugs and risk depleting their budgets — and potentially increase premiums for everyone on their plans — or eliminate a benefit many employees rely on. At least two others — North Carolina and West Virginia — have already eliminated coverage due to cost concerns. That means those states' employees seeking the drugs for weight loss will have to pay up to $1,500 a month for the treatments. The dilemma also comes as states face their toughest budgetary pressures in years, largely because the federal cash they received during the pandemic has been spent. 'The problem is the near-term cost is so high, and the benefits that you would gain are over a longer-term period,' said Charles Sallee, director of the New Mexico Legislative Finance Committee, which is exploring options to reduce the costs of covering the drugs for state employees. 'But is that person still going to be in your health plan five years from now?' Key context: GLP-1s are growing increasingly popular: The number of Americans taking the drugs for weight loss rose more than 700 percent between 2019 and 2023, according to a recent study. Michigan, which covers about 49,000 state employees, spent $5.2 million on weight-loss drugs in 2022. That number skyrocketed to $17.5 million in 2023 and $36 million in 2024. The state's Civil Service Commission said one struggle in designing coverage is that the drugs are new, so data on the effects of long-term use is limited. 'If weight loss isn't sustained with or without GLP-1s, we aren't going to have good health outcomes, and plan costs are going to go up,' said Bethany Beauchine, director of the Bureau of Benefits Administration at the Michigan Civil Service Commission. 'What we're trying to figure out is whether the plan costs will stay manageable with the use of the GLP-1s.' WELCOME TO WEDNESDAY PULSE. We hope our D.C. readers are staying warm amid the snowy weather. Send tips, scoops and feedback to khooper@ and ccirruzzo@ and follow along @Kelhoops and @ChelseaCirruzzo. AROUND THE AGENCIES CMMI TO SCRAP DEMOGRAPHIC DATA — The Center for Medicare and Medicaid Innovation will stop collecting data from its payment model participants on race, ethnicity, sexual orientation, gender identity and preferred language, your host reports. The new policy is aimed at implementing executive orders from President Donald Trump that instruct federal agencies to remove policies and activities that promote diversity, equity, inclusion and accessibility, the organization said Tuesday in an email to CMMI managers and obtained by POLITICO. CMMI was created as part of the Affordable Care Act to test alternative payments and care delivery under Medicare, Medicaid and the Children's Health Insurance Program. The organization will also 'consider' continuing to collect self-reported disability status 'pending further review,' the email said. 'In keeping with President Trump's Executive Orders, [the Centers for Medicare and Medicaid Services] is reviewing all of its programs and publications to make sure they align with the President's priorities,' said CMMI's parent agency in a statement. Key context: Trump has called DEI policies discriminatory and said they undermine 'the Constitution's promise of colorblind equality.' Why it matters: Health experts have argued that collecting demographic data, including on race and ethnicity, can help identify and correct health disparities. The Biden administration in 2021 launched a strategic redesign of CMMI with a major focus on improving health equity and encouraging rural and underserved medical providers to sign up for value-based care payment models. A key part of the strategy required payment model participants to collect data on the demographic characteristics of beneficiaries to help address health disparities. Eye on Insurers HUMANA DEFENDS MEDICARE ADVANTAGE — Humana CEO Jim Rechtin on Tuesday defended insurers and Medicare Advantage amid a 'volatile few months,' as the industry has come under intense public and congressional scrutiny over care denials and high costs. 'Americans understandably want high-quality, affordable care that is easy to navigate,' he said during the company's fourth-quarter earnings call. 'Too often, that is not what they are receiving today. There is no one company and there is no one sector that is responsible for this. It is a system challenge.' Rechtin touted what he called the benefits of Medicare Advantage — the privately run alternative to Medicare that enrolls more than half of the eligible population — over traditional Medicare, including more affordable care and better access to care. But he emphasized the need to improve the program, including simplifying navigation for patients and providing better customer service. Rechtin said the company will invest heavily over the next year in improving operations and quality of its MA plans. Why it matters: The comments come as insurers have come under fire for how often they deny care, especially after the shooting death of UnitedHealthcare CEO Brian Thompson in December, with the incident sparking outrage on social media pointed toward the industry. Lawmakers in Congress also have grown increasingly critical of insurers' prior authorization practices. Other major insurers, like Cigna, have since announced plans to focus on and improve customer satisfaction rates. Key context: A forecast profit for 2025 that fell below Wall Street's expectations accompanied Rechtin's comments. Humana and other MA insurers continue to deal with elevated medical costs and an uncertain regulatory environment. Rechtin said the company isn't yet providing an outlook for 2026 because of those uncertainties, including not knowing what CMS' final payment rate notice for 2026 will be and ongoing litigation against the agency over a downgrade in Humana's star ratings — a key metric assessing plan quality that the government uses to determine bonus payments. In Congress PRESSURE IS ON ARRINGTON — House Budget Chair Jodey Arrington (R-Texas) has the opportunity to make the enormous cuts to federal spending he's always wanted, POLITICO's Rachael Bade and Meredith Lee Hill report. But the Texas Republican is at risk of being outmaneuvered by fellow chairs, senior leaders and the Senate as frustration mounts over his struggle to advance President Donald Trump's vast policy agenda. The House Republicans' budget blueprint, blessed by Speaker Mike Johnson, has long been stalled in the chamber. On Tuesday, Arrington called for a Thursday committee meeting to resolve vast differences on and advance the plan — and he now has less than 48 hours to figure out how to make it all work. 'We'll soon find out if Jodey is in over his head,' one GOP lawmaker, granted anonymity to speak candidly, texted shortly after Arrington announced the Thursday markup. Arrington will have to take on the difficult task of bridging the deficit-minded politics of the hard right with the more pragmatic concerns of swing-district Republicans wary of political blowback. He's also facing increasing pressure from top House leaders as they try to swiftly deliver Trump's legislative agenda. Key context: Arrington made clear that his heart lies with the panel's most conservative members, who want to seize the opportunity to get the nation's fiscal trajectory on track. He's long agitated for Republicans to get control of skyrocketing spending on the mandatory programs — including Medicare and Medicaid — that largely drive federal budget deficits. Names in the News Dr. Daniel Knecht is joining EmblemHealth as chief medical officer. Knecht most recently served as chief clinical innovation officer at CVS Caremark. Marvin Figueroa is joining BGR Group as a vice president in the health and life sciences practice. Figueroa was most recently chief of staff to former Sen. Laphonza Butler (D-Calif.). WHAT WE'RE READING POLITICO's Kyle Cheney reports on President Donald Trump's escalating clashes with federal courts. STAT's Sarah Owermohle and Rachel Cohrs Zhang report on how Robert F. Kennedy Jr. could revive a dormant task force to scrutinize vaccine safety. KFF Health News' Daniel Chang reports on the big perks a small Florida town is offering to attract a new doctor.
