Health Programs on the GOP Chopping Block

Politico / By Chelsea Cirruzzo
 
Driving The Day
Many GOP lawmakers want to let ACA health insurance plan subsidies expire, but GOP Sen. Lisa Murkowski feels differently. | Francis Chung/POLITICO
 
GOP FLOATS HEALTH CARE CUTS — House Republicans are circulating a menu of options amounting to more than $5 trillion in cuts they could use to bankroll President-elect Donald Trump’s top priorities this year.
 
On the table: changes to Medicare, Medicaid and the Affordable Care Act. The list from the House Budget Committee could be used to finance a party-line reconciliation bill or other spending reduction efforts. The proposed cuts are highly ambitious, but not all are likely to become law, given the narrow margins for Republicans in the House and Senate.
I caught up with POLITICO Congress reporter and former Pulse author Ben Leonard to discuss the state of play.
 
There would be a few different ways on this “menu” to cut Medicaid. Can you walk us through them? 
 
One big target is per-capita caps, favored by House Energy and Commerce Chair Brett Guthrie (R-Ky.). They’d allocate a set amount of Medicaid funding based on population instead of being an open-ended entitlement. That’s projected to save up to $918 billion.
Another major target is equalizing payments for nondisabled adults with those of traditional Medicaid enrollment — those with disabilities or low-income children, which [Republicans] say would save up to $690 billion.
 
Adding work requirements in the program is also on the table and is pegged to save $120 billion.
 
Which ones would get the most opposition from Dems?
 
They’d pretty much all be nonstarters for Democrats and even some Republicans. Medicaid insures more than 70 million Americans, and any legislation that might reduce coverage in the program would be fiercely opposed by Democrats and could be a tough vote for Republicans in swing districts.
 
The proposed ACA changes involve enhanced premium tax credits that expire at the end of the year, setting up a major policy battle. 
 
Democrats broadly support extending the enhanced subsidies, which have lowered premium costs for many Americans and led to record ACA marketplace enrollment. Many Republicans support letting them expire, arguing they’re raising health care costs, but moderate Sen. Lisa Murkowski (R-Alaska) recently said she supports extending them. Either way, Republicans will have a difficult choice: spend hundreds of billions to buoy Obamacare enrollment or raise premium costs significantly heading into an election year in 2026.
 
Are there any proposals that could get bipartisan agreement?
 
Site-neutral payments are a more bipartisan option under consideration. Limiting eligibility for ACA plans based on citizenship status could receive more bipartisan interest than it might have previously, given Democrats’ pivot on immigration after a tough election cycle. But most of the options are not expected to receive much, if any, Democratic support…

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Flu, RSV, and Norovirus Are in Full Swing, While COVID Looms

Medscape / By Lisa O’Mary

Most US states are reporting high or very high flu-like activity, while COVID-19 rates remain lower than this time last year.

The nation isn’t out of the woods yet, though, in terms of seeing another tripledemic or even quad-demic.

So far this year, the CDC estimates that 5.3 million people nationwide have had the flu, and the virus has hospitalized 63,000 people, as well as contributed to 2700 deaths, including 11 children.

Nearly 19% of influenza tests are positive, as are about 13% of tests for respiratory syncytial virus (RSV) and 7% of COVID tests, according to CDC data.

Those flu and RSV rates are similar to what was seen about this time last year, but COVID is trailing, at about half its seasonal rate. Also, COVID hospitalization rates are less than half of what they were at this time last year.

Based on wastewater surveillance data, which can help predict whether viruses are expanding or receding, RSV and COVID may still be on the upswing. The CDC says COVID wastewater activity detections are “high.” And eight US states recently reported “very high” RSV detections: Connecticut, Georgia, Louisiana, Maryland, Massachusetts, New Mexico, Pennsylvania, and South Carolina. Another 14 states logged “high” RSV wastewater levels, CDC data show.

Flu detections in wastewater monitoring nationwide is currently shown as “moderate” by the CDC, which only tracks influenza A — the type that accounts for most flu cases.

Meanwhile, norovirus rates have hit what is at least a 5-year high, with positive tests topping 22%, according to data through the end of December. Seasonal norovirus high positive test rates are typically 15% or lower.

The CDC is expected to release updated virus data early this week that will give the first look at post-holiday impacts.

SOURCES:

CDC: “National Respiratory and Enteric Virus Surveillance System (NREVSS),” “COVID-NET Weekly Rates of COVID-19 Associated Hospitalizations (Week End Date 1/4/2025),” “Wastewater COVID-19 National and Regional Trends,” “RSV Current Wastewater Viral Activity Levels Map.”

Federal Report Highlights Private Equity, Consolidation Concerns

Modern Healthcare / By Hayley DeSilva
 
Three federal agencies on Wednesday said "more effective and vigorous" enforcement is needed to protect patients harmed by healthcare's continued consolidation.
 
In a report released just days before a new administration takes over, the Health and Human Services Department, Federal Trade Commission and Justice Department said comments they sought earlier this year on the state of the industry made clear that worries about access to services and costs have intensified as consolidation and private equity's role have grown.
 
"It is clear from the commentors that the Agencies’ past actions have not sufficiently addressed the harms inflicted by anti-competitive activity in the health care sector, and more effective and vigorous antitrust enforcement is necessary to stop or reverse the trend of consolidation," the agencies wrote.
 
The report stems from the agencies' request for information in March about how market transactions have affected consolidation, patient safety, affordability, employee wages and safety as well as taxpayer burden. The agencies received comments from more than 2,000 patients, physicians, health systems, insurers, industry associations, labor unions and academic researchers. 
 
Merger and acquisition activity, particularly among hospitals and involving private equity firms, dominated many of the responses. Many hospitals and health systems have turned to mergers and acquisitions, sometimes with private equity firms, to ease financial pressures…

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Dr. Oz’s Medicare Leadership Team Takes Shape

Washington Post / By Dan Diamond
 
President-elect Donald Trump appears poised to tap a trio of health policy experts to serve as top deputies to Mehmet Oz, his pick to oversee the Centers for Medicare and Medicaid Services, according to seven people who spoke on the condition of anonymity to discuss private conversations.
 
Chris Klomp, a health-care entrepreneur, would lead the roughly $1 trillion Medicare program, which provides health coverage to about 68 million Americans. Abe Sutton, a veteran of the first Trump administration, would oversee Medicare’s innovation center, which tests new ways to deliver care to patients. Stephanie Carlton, a longtime McKinsey consultant and former GOP Senate staffer, would serve as Oz’s chief of staff, helping run the vast agency that also has responsibility for Medicaid and the Affordable Care Act.
Klomp, Sutton and Carlton did not immediately respond to requests for comment. Their proposed appointments are not finalized and are subject to further review, according to the people with knowledge of the planned selections. STAT News reported Monday night that Sutton was Trump’s pick to run the innovation center.
 
A person familiar with the Trump transition team’s plans confirmed that Klomp, Sutton and Carlton are all favored for their respective positions…

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