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Morning Briefing

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Wednesday, Feb 22 2023

Full Issue

Medicare Advantage Enrollment Reaches 31 Million Though Is Slowing

In an analysis by the Chartis Group, enrollment in Medicare Advantage 2023 plans is up 5.5%. Last year's signups grew 9% over the previous year. Other news relates to inpatient claim denials, Medicare drug pricing negotiations, and more.

Medicare Advantage growth slowed for the 2023 plan year, according to a report the Chartis Group published Tuesday. Enrollment increased 5.5% for this year, down from a record 9% the prior year, driven by California and a handful of other states where the number of people signed up for private Medicare plans actually fell, said Nick Herro, a principal at the Chartis Group and co-author of the study. (Tepper, 2/21)

Healthcare systems have found themselves in precarious financial standing due to a dramatic increase in the number of inpatient claims being denied by health insurers based on the lack of medical necessity, according to data collected by accounting and technology firm Crowe. These level-of-care reimbursement disputes are especially rising in frequency among Medicare Advantage plans. (Lagasse, 2/21)

The popular Medicare Advantage program, known for attractive perks 鈥 yet questioned for some policies 鈥 is facing a recent series of critiques over its practices and cost to the U.S. budget. It鈥檚 part of what might be called a battle for Medicare鈥檚 heart and soul being fought by powerful interests in North Carolina, where hundreds of thousands have enrolled for the plan, and beyond.聽(Goldsmith, 2/22)

On Medicare drug costs 鈥

The Medicare agency risks legal challenges from the pharmaceutical industry as it scrambles to meet rapidly approaching deadlines in President Joe Biden鈥檚 landmark drug pricing law, attorneys say. The timeline Congress set in the Inflation Reduction Act (Public Law 117-169) to begin negotiating certain drug prices are 鈥渢remendously tight鈥 for the Centers for Medicare & Medicaid Services, said Jonathan Blum, the agency鈥檚 principal deputy administrator and chief operating officer. (Castronuovo, 2/22)

A group of senators is urging the Biden administration to rethink its restrictive coverage determination for emerging Alzheimer's disease treatments. The letter to Department of Health and Human Services Secretary Xavier Becerra and Centers for Medicare & Medicaid Services (CMS) Administrator Chiquita Brooks-LaSure is signed by 20 senators comprising 18 Republicans and two Democrats. (Minemyer, 2/21)

Meanwhile, Sen. Bernie Sanders is skeptical about the future of Medicare for All 鈥

Sen. Bernie Sanders (I-Vt.) said 鈥淢edicare for All,鈥 a system that would establish government-run health care for all U.S. citizens, 鈥渁in鈥檛 going to happen鈥 during the next two years amid a divided Congress.聽(Gans, 2/21)

On Medicaid news from Missouri and Tennessee 鈥

The Missouri Senate has given initial approval to expanding how long someone would have access to Medicaid coverage after giving birth. However, the expansion will only occur after around 5,000 people are removed from the state鈥檚 Medicaid program. Senators gave first-round approval to legislation on Tuesday that expands coverage for one full year after giving birth. It must go through one more vote before moving on to the House. (Kellogg, 2/21)

KHN: In Tennessee, A Medicaid Mix-Up Might Land You On A 鈥楳ost Wanted鈥 List

Life was upended for LaShonia Ingram over the past year, and a shadow still follows her around. Search her name online, and the first result includes the words 鈥渇raud鈥 and 鈥渕ost wanted.鈥 鈥淚t was horrible. I couldn鈥檛 get a job,鈥 said the 42-year-old mother from Memphis, Tennessee. 鈥淎ll doors were being closed in my face.鈥 (Farmer, 2/22)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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