The Medicare Payment Advisory Commission — the statutory independent body that advises Congress on the entire Medicare program — has slammed the Medicare Advantage program for a 'fundamental lack of transparency' in how large portions of taxpayer money are being spent, particularly when it comes to the generous annual rebates being paid every year to the big insurance companies that operate the program. In all, the Medicare trustees estimate that the privatized Medicare Advantage program will cost U.S. taxpayers $547 billion this year, more than three times as much as it did a decade ago.
The University of Maryland Medical System filed a lawsuit against Physicians Care MCO, accusing the company of denying $15 million in claims for health services. Physicians Care MCO is one of four companies that manage Medicaid claims for the state of Maryland.
Key healthcare provisions in the One Big Beautiful Bill Act, especially the proposed Medicaid cuts and Affordable Care Act marketplace reforms, would lead to 16,642 preventable deaths every year if implemented, according to a new analysis published in Annals of Internal Medicine.
Extra subsidies put in place during the pandemic — which reduced some premiums by more than half — are in place only through Dec. 31. Without enhanced subsidies, ACA insurance premiums would rise by more than 75% on average, with bills for people in some states more than doubling, according to estimates from KFF.
Last year, 20 states were considering regulating PBMs through legislation. Now, all 50 have bills that would impact PBMs or drug benefits. The rapid increase year over year reflects the stalemate in Congress on meaningful PBM reforms, while state governments are facing unhappy constituents complaining about PBM actions.
For proponents, the ideas behind the work requirement are simple: Crack down on fraud and stand on the principle that taxpayer-provided health coverage isn't for those who can work but aren't. The measure includes exceptions for those who are under 19 or over 64, those with disabilities, pregnant women, main caregivers for young children, people recently released from prisons or jails, or during certain emergencies. It would apply only to adults who receive Medicaid through expansions that 40 states chose to undertake as part of the 2010 health insurance overhaul. Advocates and sick and disabled enrollees worry, based largely on their experience, that even those who might be exempted from work requirements under the law could still lose benefits because of increased or hard-to-meet paperwork mandates.