Insights: Healthcare

Medicare Physician Reimbursement

Included in the House Energy & Commerce (E&C) Committee’s section of the reconciliation bill are reforms to reimbursements under the Medicare Part B Physician Fee Schedule (PFS). Notably, the bill does not include temporary relief from the -2.93% conversion factor cut in effect for CY25. However, the bill does include long-term reforms to PFS...

Pharmacy Benefit Managers (PBMs)

Republicans on the House Energy & Commerce (E&C) Committee have included as part of their section of the reconciliation bill various reforms regarding PBMs. Specifically, those include (1) a ban on spread pricing in the Medicaid program, (2) a prohibition on PBM compensation being based on a drug’s list price in the Medicare Part D program (so...

Affordable Care Act (ACA) Subsidies

The House Ways & Means (W&M) Committee has released the legislative text covering its portion of Republicans’ reconciliation legislation. Notably, the bill text does not include an extension of the ACA enhanced subsidies (which will expire at the end of this calendar year). However, the bill – as well as the E&C bill – includes various...

After weeks of debate, the House Energy & Commerce (E&C) Committee has released the legislative text covering its portion of Republicans’ reconciliation (tax/spending) legislation. A markup (vote) on the measure will occur later today. As previously noted, E&C faced a minimum $880b target for spending reductions, the bulk of which was expected...

Medicare Advantage (DOJ/Brokers)

The DOJ has filed a False Claims Act (FCA) lawsuit against Aetna, Elevance, and Humana – as well as affiliated brokers eHealth, GoHealth, and SelectQuote – alleging they orchestrated a kickback scheme in which the insurers bribed the brokers to steer would-be Medicare Advantage (MA) beneficiaries exclusively into their policies. The complaint...

Medicare (Site Neutral)

The prospect of Medicare site neutral reforms has been simmering in the background of the reconciliation debate, but the issue has largely been sidelined as Republicans debate the breadth of their proposed Medicaid cuts. However, Republican leaders are increasingly struggling to balance the demands of moderates and conservatives regarding the...