On October 15, the open enrollment period for Medicare begins running through December 7 for coverage starting in January 2025. In this period, 67 million Medicare eligible seniors can review features of Medicare plans offered in their area, switch from traditional Medicare to a Medicare Advantage (MA) plan (or vice versa), change their MA selection and add/change their Medicare Part D prescription drug plans.
In 2024, Medicare Advantage plans enrolled 33 million seniors and Medicare paid private insurers $462 billion to pay for their care. But conditions for Medicare Advantage have changed in recent years prompting many to ask ‘what is the Medicare Advantage?’
Background:
Medicare began July 30, 1965 as a key element in President Lyndon Baines Johnson’s Great Society program offering federal-government-paid insurance coverage for seniors at the age of 65. “Original Medicare” had two parts: Part A to cover hospitals and Part B to cover physicians and outpatient services. In 1972, coverage for adults with disabilities was added, and in 2003, coverage for prescription drugs (Part D) was added.
Its funding comes from payroll taxes paid by employers and their employees, and those who are self-employed PLUS income taxes paid on Social Security benefits, interest earned on the Medicare trust fund’s investments and Part A premiums from people who aren’t eligible for premium-free Part A.
Along the way, Congress authorized seniors the option of accessing Medicare through private insurers aka Part C (Balanced Budget Act of 1997), expanded its scope (Medicare Modernization Act of 2003) and supplemented its funding differential above Original Medicare (Patient Protection and Affordable Care Act 2010) to stimulate enrollment growth. The rationale for MA was straightforward: it offered federal regulators a lab to test care management for seniors with the dual aims of lowering their health costs and improving their health. Private insurers responded. By design, funding for MA was set above Original Medicare rates to encourage private insurer participation.
It worked. This year, the average MA enrollee had 43 plans from which to choose. By three measures, Medicare Part C has been successful:
- Enrollment growth: Enrollment in MA plans has increased from 31% of Medicare eligible adults in 2014 to 51% in 2024 and is projected to increase in 2025. Notably, enrollment in special needs and employer-sponsored MA plans has increased faster than the individual MA market which is subject to open enrollment periods. Satisfaction appears high (69% of members do not shop for another plan during open enrollment periods) and member churn is low.
- Medicare has saved money: Per the 2024 Medicare Trustees’ Report, MA has contributed to slower growth in Medicare spending than forecast. “The Social Security and Medicare programs both continue to face significant financing issues…The Hospital Insurance (HI) Trust Fund will be able to pay 100% of total scheduled benefits until 2036, 5 years later than reported last year. At that point, that fund’s reserves will become depleted and continuing program income will be sufficient to pay 89% of total scheduled benefits.”
- Private insurer participation has been strong: For health insurers, Medicare Advantage is profitable: PMPM contribution margins are 50-100% higher than individual and group lines of business. And, as CMS payments to MA have tightened, the MA insurer market consolidated with 3 (UnitedHealth, Humana, CVS-Aetna) taking advantage of operating pressures on small players to increase their share to 58% of total enrollment. Advantage: Seniors, Medicare and Corporate Insurance.
But conditions going forward suggest the MA advantage might not be as strong. The market signals are clear:
- Insurer belt tightening: Since 2023, seniors’ use of hospitals, specialty care and prescription drugs has returned to pre-pandemic normalcy cutting into insurer margins. In its CY 2025 Rate Announcement September 27, CMS announced “The average monthly plan premium for all MA plans, which includes MA plans that provide prescription drug coverage and MA Special Needs Plans (SNPs), is projected to decrease from $18.23 in 2024 to $17.00 in 2025. Benefit options will remain stable, including MA supplemental benefit offerings such as hearing, dental, and vision. The amount of rebate dollars, which can be used for supplemental benefits, will remain stable, with a slight increase, from 2024 to 2025. Enrollment in MA is projected to be 35.7 million in 2025, an increase from 2024, with MA enrollment representing approximately 51% of all people enrolled in Medicare.” This translates to lower margins for MA plans, fewer supplemental benefits for enrollees and lower payments to hospitals and physicians.
- Increased regulatory scrutiny: The Medicare Payment Advisory Commission (MedPAC) concluded that MA plans receive payments from CMS that are 122%of spending for similar beneficiaries in traditional Medicare, on average, translating to an estimated $83 billion in overpayments in 2024. Congress is investigating. In 2023, CMS adopted tougher audit standards specific to diagnosis codes used by private MA plans to bill Medicare on behalf of their enrollees. Audits conducted by the U.S. Department of Human Services’ Office of Inspector General (OIG) applying the new standards found the majority of private MA plans guilty of upcoding and thereby overpaid by Medicare. In 2025, cut points used by CMS to award star ratings have been modified resulting in fewer plans getting 4-star ratings that enable their participation in 5% bonus payments—a major reason recent stock declines for UHG, HUM, CVS and others. Regulatory scrutiny of MA plan marketing practices, coding, denials and prior authorization procedures will intensify reflecting bipartisan intent to constrain MA profits.
Understandably, tension between MA insurers and providers has intensified as insurers seek to protect their margins. The Change Healthcare (CH) cyber-attack (February 21, 2024) that disabled insurer payments to hospitals and physicians stoked animosity since CH is a subsidiary of UnitedHealth Group–the largest sponsor of MA plans and the healthcare juggernaut. Though operating margins for half of U.S. hospitals have recovered, insurer cuts coupled with labor and prescription drug costs have decimated care delivery in almost every community. Participation in MA plan provider networks, once SOP is now a tough call for hospitals, medical groups and other providers.
My take:
What is the Medicare Advantage?
- As a lab for innovation in care management for seniors, it’s promising.
- As an engine to drive lower costs for senior health and extended solvency to the Medicare program, it’s unclear.
- As a platform to shift incentives from fee-for-service to value across the system, it’s helpful.
But until and unless hospitals, physicians, insurers, business leaders and regulators commit to implement a transformed system of health that’s comprehensive, affordable, efficient and accountable, the Medicare Advantage will be marginalized.
In many ways, the headwinds facing MA are part of the larger narrative facing healthcare: public sentiment against consolidation and corporatization has eroded its cherished trust and confidence. It’s true for insurance, hospitals, prescription drug companies and PBMs. The blame is shared: no one of these owns the moral high ground (though a few organizations in their ranks aspire).
Paul
PS As a part-time Asheville NC resident, I received lots of well-wishes from concerned friends last week. The Hurricane that hit NE TN, SW VA, GA, SC, FL and Western NC has left unfathomable devastation. Hospitals are scrambling for power and water. And more than a hundred hospital employees across the region are among those unaccounted.
As I reflect on six days without power, continued shortages of water, food and gas, and the constant sounds of helicopters, generators and saws, I am reminded that ours is a special industry that’s vital to the wellbeing of our communities beyond our facilities and services. We’re a people business who serve others in moments of their vulnerability and need. Regrettably, when national attention moves back to Campaign 2024, the economy and the unstable Middle East, images of the massive mess across these states will fade.
The most needed after-action from Hurricane Helene should be is a deliberate re-design of the health system to assure its effectiveness in normal times and preparedness for Black Swan events like Helene. It matters now more than ever!
Resources
How 2025 Medicare Advantage ratings will be affected by cut points | Modern Healthcare
Medcare Advantage https://www.medicare.gov/publications/12026-Understanding-Medicare-Advantage-Plans.pdf
Trustees Report Summary (ssa.gov)
Nearly 7 in 10 Medicare Beneficiaries Did Not Compare Plans During Medicare’s Open Enrollment Period KFF September 26, 2024 https://www.kff.org/medicare/issue-brief/nearly-7-in-10-medicare-beneficiaries-did-not-compare-plans-during-medicares-open-enrollment-period
Medicare Advantage in 2024: Enrollment Update and Key Trends | KFF
Medicare Advantage market expected to grow in 2025, despite big changes from insurers
Medicare Advantage, prescription drug programs to remain stable for 2025 | AHA News
Medicare Advantage plans for 2025 will have some big changes (statnews.com)
How 2025 Medicare Advantage ratings will be affected by cut points | Modern Healthcare
MedPAC 2024 Report Chapter 12 Medicare Advantage Status Report https://www.medpac.gov/wp-content/uploads/2024/03/Mar24_Ch12_MedPAC_Report_To_Congress_SEC.pdf
Medicare Advantage Rates & Statistics | CMS https://www.cms.gov/newsroom/fact-sheets/2025-medicare-advantage-and-part-d-rate-announcement
The future of Medicare Advantage | McKinsey
Sections in today’s report
- Quotables
- Economy
- Hospitals
- Insurers
- Polling
- Prescription Drugs
- Private equity
Quotables
Re: affordability: “100 million Americans have medical debt totaling about $220 billion. Black and Hispanic adults, women, the uninsured, and those with lower incomes are more likely to go into debt compared to their counterparts. Nearly 75% of adults worry about being able to afford unexpected medical bills or the cost of health care services, and nearly 30% of Medicare beneficiaries reported using up all their savings to pay for medical bills or debt.
Affordability concerns are highest among lower income households and the uninsured, yet they also extend to those with health care coverage. Family premiums have increased 22% and deductibles have increased 10% over the last five years… Due to the soaring price of health care, one in five adults say they have not filled a prescription, and in the last 12 months, one in four adults have skipped or postponed health care visits. Not surprisingly, skipped or postponed care leads to worsening health problems. These high costs likely factor into the 20% of adults who have not sought counseling or therapy for a mental health concern. Those who are able to receive treatment for depression or anxiety had almost double the OOP costs compared to those not treated. In addition to high direct health care costs, indirect costs like transportation, childcare, and time off work add to the burden of accessing care…
Affordability efforts seek to reduce the costs of clinical care, as well as expand access to nonclinical services like food, transportation, and housing. While affordability efforts alone cannot overturn underlying causes of systemic racism, they can mitigate the negative impact, especially for low-income and marginalized communities.
Healthcare Transformation Task Force Advancing Affordability Resource (hcttf.org)
Re: Hospital consolidation: “Hospital consolidation has been a subject of particular focus in part because nearly one third of all health spending goes towards hospital care. Consolidation may allow providers to operate more efficiently and help struggling providers keep their doors open in underserved areas, but often reduces competition. A substantial body of evidence has found that consolidation can contribute to higher prices, with unclear effects on quality.”
Re: biomedical research national strategy needed: “The complex and compounding nature of health challenges facing people in the United States calls for the development of a national strategic vision. Currently, the National Institutes of Health, the largest federal funder of biomedical research, operates out of 27 largely independent institutes and centers, without purposeful and structured coordination and focus. Although organizations within the biomedical industry are important contributors to scientific progress and gains in health, they may be incentivized to focus on issues that are most profitable rather than on areas of greatest need.
A national strategic vision, developed and implemented at the federal level and overseen by a nationally appointed advisory body, would help to ensure that the biomedical research enterprise directs its energy toward challenges most relevant to the U.S. population…”
Toward a Biomedical Research Enterprise That Better Serves the United States the New England Journal of Medicine October 1, 2024 https://www.nejm.org/doi/full/10.1056/NEJMsb2412007?query=RP
Re: whole of government approach to cybersecurity: “Hospitals and health systems for years have prioritized cybersecurity, and the good news is their defenses block the majority of attacks. But no individual hospital can defend against all of these very sophisticated nation-states sponsored attacks. We need a whole-of-government approach to preventing and mitigating cyberattacks, including the federal government going after the bad guys just the way it has effectively done in counterterrorism.”
AHA Today October 4, 2024 News on Interoperability, Telemedicine Prescribing – pkeckley@paulkeckley.com – PaulKeckley.com Mail (google.com)
Re: Commentary on state reform policies: “Reducing spending growth to just 1 percentage point below projected trends would lead to annual savings of more than $1 trillion by 2037. Because targets are aspirational, states also need to implement specific policies that can directly address the major drivers of spending growth…lack of competition in health care markets leads to higher prices and often lower quality of care. Many U.S. markets — 90% of hospital markets, 65% of specialist markets, 57% of insurer markets, and 39% of primary care markets — are already too concentrated to support meaningful competition…
Resistance to reforms that threaten the profits of large corporations and health systems will be fierce and well-funded, and opponents of reform can legitimately point to the limited impact of each approach up to this point…
Nearly 50 years ago, when health care accounted for only 7% of the gross domestic product (as compared with 17% now) …Since that time, the financialization of health care has increased dramatically, to the detriment of the public and the medical profession…”
Re: Epic-Particle lawsuit update: On one side is one of its biggest and most influential users: the nation’s largest electronic health records vendor, Epic Systems. On the other is Particle Health, a small startup in the data-sharing space that accuses Epic of muzzling its access to critical patient data and ruining its business.
And now, each side wants Carequality to prove that it is right.
Epic and Particle Health are calling on Carequality to release the findings of an investigation Epic requested after it accused Particle of misusing patient data…
How Carequality navigates the conflict carries big implications not just for Epic and Particle, but for the future of health data sharing. It will show whether data exchanges like Carequality can be objective brokers in an environment filled with sharp-elbowed competitors jostling to mine highly lucrative patient data for insights that experts say can transform health care. Because participation in data exchanges like Carequality are voluntary and built on trust, experts told STAT, the system will fall apart if organizations feel like their data isn’t being stewarded well, or if they feel Carequality has lost control over the framework
Epic Systems, Particle drag a tiny nonprofit into antitrust lawsuit (statnews.com)
Re: national debt and campaign 2024: “America’s political leaders have a spending problem.
They know entitlement programs feature benefit promises far exceeding their tax base, but have done nothing to make them sound. Meanwhile, both parties demand more spending increases — despite the national debt soaring to $35 trillion, or more than $100,000 for each American, rich and poor alike. Under rosy assumptions, over $20 trillion in debt is projected to be added over the next decade…
Much of the growing debt is baked into the budgetary cake, and experts have long warned about rising costs when the Baby Boom generation retires. But growing Social Security payouts — long ago engineered to rise faster than prices — are only part of the problem. Soaring health spending, driven by the same demographic factors and compounded by exploding medical costs, is an even bigger challenge…
While both campaigns suggest we can have higher spending and debt alongside lower prices and interest rates, recent experience suggests otherwise…
The reality is every American will pay, especially those with modest incomes and younger Americans who will suffer the longest from higher taxes, inflation and interest rates. We should demand more from our leaders than promises of bigger giveaways, followed by empty handwringing about the soaring debt and financial pain that inevitably result. “
Matt Weidinger, Paul Ryan Stop the insanity. Our national debt now tops $35 trillion Fox News October 3, 2024
Re: governance: “Steward’s Ralph de la Torre is resigning. What about the board of directors?
As CEO of a hospital network that served thousands of patients, de la Torre did not trample on these principles all by himself. Over the course of his tenure, he had help.”
Boston Globe October 1, 2024
Economy
BLS September jobs report: Highlights:
- The economy added 254,000 jobs—higher than the average of the prior 12 months (203,000).
- Unemployment was down for the second straight month to 4.1%, from 4.2% in August.
- Friday’s report also signaled that hiring this summer wasn’t as weak as initially thought. Revised figures show employers added 72,000 more jobs in July and August combined than earlier reported.
- Health care added 45,000 jobs in September, below the average monthly gain of 57,000 over the prior 12 months. Over the month, employment rose in home health care services (+13,000),
- hospitals (+12,000), and nursing and residential care facilities (+9,000).
- The average monthly increase in overall healthcare hiring during the first nine months of the year was 53,977 jobs added, slightly less than 2023’s 55,378 positions.
Employment Situation Summary – 2024 Q03 Results (bls.gov)
BGH: employer health costs: Key Findings from Business Group on Health’s 2025 Employer Health Care Strategy Survey:
- Before plan design changes, the projected health care cost trend, which refers to the anticipated percentage increase in the cost to treat patients year over year, jumped from 6% in 2022 to almost 8% for 2025.
- The median percentage of health care dollars spent on pharmacy rose from 21% in 2021 to 27% in 2023.
- 79% of employers said they saw a heightened interest in obesity medications, including GLP-1s, among their covered members.
- While these medications are a standard treatment for diabetes (covered by 96% of employers in 2024), eligibility has broadened to include obesity (covered by 67% of employers in 2024) and cardiac conditions (covered by 34% of employers in 2024). 96% of employers expressed concern about the long-term cost implications of GLP-1s.
- 40% of employers identified cardiovascular conditions as their No. 3 cost driver, up from 30% in 2023.
- 79% of survey respondents reported that improving access is a top mental health priority for 2025.
Business Group on Health, August 2024
Hospitals
Kaufman Hall: August Hospital flash report: Highlights:
- Average nonprofit hospital margins held at 4.2% in August. Margins have been relatively flat since March when they hit 4.3%.
- Operating margins were up 14% year to date from 2023 to 2024 on average. The average operating EBITDA margin grew 10% in the same timeframe.
- Net operating revenue per day was up 7% in August year over year. Inpatient and outpatient revenue per calendar day were up 6%.
- Total expenses per calendar day increased 7% on average in August compared to the same period last year. The expense breakdown was: Labor expense per calendar day: +5%, non-labor expense per calendar day: +6%, Supply expense per calendar day: +7%, Drugs expense per calendar day: +5%, Purchased service expense per calendar day: +12%
- Average length of stay dropped 1% in August year over year and is down 2% from July.
National Hospital Flash Report: August 2024 Metrics | Kaufman Hall
Kaufman Hall: 3Q 2024 M&A: The volume of announced transactions grew significantly in Q3 2024. With 27 announced transactions, Q3 had the highest level of activity thus far in 2024…Announced sales resulting from the Steward Health Care bankruptcy represented a significant amount of this volume, with 11 of the 27 announced transactions involving Steward hospitals.
One of the 11 transactions related to the Steward bankruptcy—Health Care Systems of America’s assumption of operations at eight hospitals in Florida, Louisiana, and Texas—was among the four “mega merger” transactions announced in Q3 (transactions in which the annual revenue of the seller, or smaller party, exceeds $1 billion). The other three mega mergers were:
- Florida-based Orlando Health’s announced acquisition of Alabama-based Brookwood Baptist Health from Tenet
- Prime Healthcare’s planned acquisition of eight Ascension-owned hospitals in Illinois
- The intended combination of South Dakota-based Sanford Health and Wisconsin-based Marshfield Clinic Health System
M&A Quarterly Activity Report: Q3 2024 | Kaufman Hall
KFF Study: Hospital concentration in metro markets: “This analysis examines the competitiveness of markets for hospital care, based on RAND Hospital Data—a cleaned and processed version of cost reports from Medicare-certified hospitals—and American Hospital Association (AHA) survey data. This piece describes competition among independent hospitals and health systems, referring to both as “health systems” throughout for brevity. Competition is measured in three ways: the share of metropolitan statistical areas (MSAs) controlled by a small number of health systems, the level of market concentration in MSAs based on the Herfindahl-Hirschman Index (HHI), and the share of hospitals affiliated with health systems over time. Using hospital data from 2022 (the most recent year available), this analysis focuses on general short-term or general medical or surgical hospitals depending on the dataset and excludes federal hospitals.” Key takeaways:
- One or two health systems controlled the entire market for inpatient hospital care in nearly half (47%) of metropolitan areas in 2022.
- In more than four of five metropolitan areas (82%), one or two health systems controlled more than 75% of the market.
- Nearly all (97% of) metropolitan areas had highly concentrated markets for inpatient hospital care when applying HHI thresholds from antitrust guidelines to MSAs.
GAO report: Price transparency compliance: “From 2021-2023, CMS initiated 1,287 enforcement actions from 2021 through 2023, with 851 of the actions initiated in 2023. As part of these enforcement actions, CMS issued over $4 million in civil monetary penalties to 14 hospitals that did not take timely corrective action.
However, CMS does not have assurance that pricing data hospitals report are sufficiently complete and accurate, and CMS has not assessed such risks to determine if additional enforcement actions are needed. Without an assessment, CMS does not know whether the data are usable to help increase competition. While CMS officials stated that they do not have the resources to check the accuracy and completeness of all hospital pricing data, the agency has cost-effective enforcement options it could consider, if needed, such as using risk-based or random sampling.”
HEALTH CARE TRANSPARENCY: CMS Needs More Information on Hospital Pricing Data Completeness and Accuracy GAO-25-106995. Published: Oct 02, 2024 www.gao.gov/reports/GAO-25-106995
BLS: Employment and healthcare workforce: “Employment gains in healthcare have been slightly weaker this year than last but the overall numbers mask some dramatic swings in different parts of the industry, particularly in hospitals.”
The average monthly increase in overall healthcare hiring during the first nine months of the year was 53,977 jobs added, slightly less than 2023’s 55,378 positions. In hospitals, the gains have been robust. Employers added an average of 17,500 jobs per month in the first three quarters, versus an average of 14,900 jobs in 2023. Meanwhile, new hiring in nursing and residential care facilities has fallen dramatically. An average of 9,356 people were hired monthly during the first nine months of this year, down from 2023’s average of 12,944 jobs. Hiring in ambulatory healthcare services, which includes offices of physicians and dentists, was slightly lower in 2024 compared with the same period in 2023, by an average of 411 fewer new jobs per month.
US Bureau of Labor Statistics www.bls.gov
Fitch: wage pressure in NFP hospitals: “The year-over-year wage growth for nonprofit hospital employees has slowed substantially after a sustained period in 2021 and 2022 during which it outpaced the private sector as a whole and health care outside the hospital…
Hourly wage growth averaged 3% in 2024, compared with 4.2% in 2023. Hospital wage inflation peaked late in 2021 at more than 8% But hospitals still spend significantly on labor, both due to wage inflation and an increase in their workforce since 2022 to address demand for care that was put off through the pandemic. Still, worker shortages remain. Job openings in the healthcare and social assistance sector are also continuing their steady decline, down from 7.9% in January to 6% as of July. That said, the latest job openings rate remains high compared to the 4.2% average rate from 2010 to 2019.
Worst of Labor Downturn Nearing an End for U.S. NFP Hospitals https://www.fitchratings.com/research/us-public-finance/worst-of-labor-downturn-nearing-end-for-us-nfp-hospitals).
Insurers
Humana: Medicare Advantage “The problem sits in one simple troublesome factor for Humana: 45% of its membership resides in this plan. So as a result, just 25% of Humana’s members are in 4-star or greater plans, which is a massive reduction from 94% of members in 2024. Humana’s troubles have been ongoing. Since the start of 2024, Humana has seen a 43% loss in market value, with management noting throughout Q1 and Q2 that regulatory changes along with the current utilization environment would be incredibly difficult to stomach. “Note: the share of Humana Medicare Advantage enrollees in plans with at least four stars fell from 94% to 25%.
Humana’s Medicare Advantage Squeeze https://hospitalogy.com/articles/2024-10-03/humana-medicare-advantage-squeeze-star-ratings
UnitedHealth: On September 30, UnitedHealth Group filed a lawsuit against the Centers for Medicare and Medicaid Services, asking a TX judge to halt the federal agency from lowering the insurance company’s 2025 Medicare Advantage quality ratings. UHG asked the judge to intervene immediately, since Medicare Advantage star ratings come out Oct. 10, and force Medicare to recalculate its scores without including the call center measure. The UHG suit alleges CMS’ assessment of its call center was “an arbitrary and capricious assessment” leading to Star Ratings below 4 necessary to CMS MA bonus payments.
UnitedHealth suit challenges Medicare Advantage star ratings | STAT (statnews.com)
Polling
Gallup-West Health: Campaign 2024: Per the Gallup-West Health online surveys conducted Sept. 9-16 with 3660 adult respondents: Highlights:
- 67% say healthcare is not receiving enough attention during the 2024 presidential campaign, while 6% say it is getting too much attention and 27% the right amount.
- 67% are very or somewhat concerned that a major health event could lead to medical debt, including 62% of Republicans, 67% of independents and 71% of Democrats.
- A candidate’s position on protecting Medicare and Social Security is the single most or among the most important healthcare-related issues in determining 63% of Americans’ vote in the upcoming presidential election, while a candidate’s position on lowering the cost of healthcare (57%) is close behind. The importance of a candidate’s position on mental healthcare (43%) is near the same level of importance as reducing drug costs (47%) as the single most or among the most important issues determining their vote. This mirrors Americans’ broader dissatisfaction with this issue area, as 73% say the government is not doing enough to ensure the public has access to affordable mental healthcare.
- Americans 65 and older are much more likely than those 18 to 49 to say a candidate’s positions on protecting Medicare and Social Security and lowering drug costs are among the most important issues or the single most important issue in determining their vote. Conversely, younger and older voters place about equal importance on a candidate’s positions on lowering healthcare costs and their mental healthcare policies.
- Democrats are more likely than Republicans and independents to say that various healthcare-related issues are at least among the most important when determining their vote in the upcoming election. Independents fall roughly between Republicans and Democrats when it comes to the importance of these issues. Democrats are much more optimistic than Republicans and independents about improving access to affordable healthcare in the next five years. The most recent numbers from the West Health-Gallup Healthcare Affordability Indexshow that just over half of the American public say they can pay for medicine or healthcare if they needed it today, declining from a high of 61% in 2022. 58% of Democrats believe access is very or somewhat likely to improve, while majorities of Republicans (70%) and independents (64%) say improvement is not very or not at all likely.
Five Things to Know: Healthcare and the U.S. Election (gallup.com)
Prescription Drugs
CMS readies changes for 2nd round of drug price negotiation program
Medicare drug coverage gets a facelift for 2025 (axios.com)
Private equity
State regulatory activity: “Legislation targeting private equity-linked healthcare transactions faltered in several state legislatures this year, potentially deterring other states from considering similar bills and teeing up more dealmaking over the next year.
More than a dozen states have passed laws over the last several years bolstering notification requirements for healthcare transactions, some of which specifically cite corporate owners of healthcare entities like private equity and real estate investment companies. But last week, California… became the sixth state to nix legislation designed to bolster merger reviews.
As state laws take shape, the federal government seeks more information that agencies say will help them craft more robust regulations.
The Federal Trade Commission, Justice Department and Health and Human Services Department launched a probe in March, requesting information on the effects of private equity and other corporate investor-backed healthcare transactions, especially those involving companies the FTC deems serial acquirers.”
How private equity bills targeting healthcare deals fared in 2024 | Modern Healthcare
