1. What’s next after the enhanced ACA subsidy expiration
The failure to extend enhanced ACA subsidies motivated some lawmakers to spotlight affected constituents at the State of the Union. Sen. Tammy Duckworth, D-Ill., who boycotted the address, sent an Illinois man, whose premiums surged after the subsidies lapsed, as her guest.
Amid talks over the future of the subsidies earlier this year, President Trump pitched sending federal healthcare funds directly to consumers, bypassing insurers. A January healthcare policy framework did not provide specifics on how this plan would work.
“Since the passage of the ‘Unaffordable Care Act,’ sometimes referred to as Obamacare, big insurance companies got rich,” President Trump said. “It was meant for the insurance companies, not for the people.”
In January, President Trump floated plans to meet with 14 insurance companies to pressure them on pricing. While no such meeting has been publicly confirmed, five leading health insurance CEOs faced Congress that month, and House Republicans also subpoenaed eight insurers over ACA fraud concerns in February.
In response to the State of the Union, the Federation of American Hospitals echoed critiques of insurers.
“Across the country, American families continue to feel financial pressure, and we agree with the president’s call to lower the cost of healthcare for Americans,” the organization said in a statement shared with Becker’s. “It starts with demanding transparency from big insurers and addressing the rising out-of-pocket costs making it harder and harder for working families to make ends meet.”
2. TrumpRx moves forward
Originally intended to go live in January, the White House launched TrumpRx.gov — a federal direct-to-consumer platform offering discounted prescription drugs — Feb. 5. The administration had been negotiating most-favored-nation pricing agreements with pharmaceutical manufacturers to align U.S. prices for otherwise high-cost drugs with the lowest available in other developed nations. Currently, the website features 43 brand-name medications.
President Trump introduced Catherine Rayner, who he said was the first user of TrumpRx. She accessed an IVF drug on the site with roughly a $3,500 discount, according to the president. Fertility drugs on TrumpRx include Gonal-F, Ovidrel and Cetrotide. Based on the costs presented on the site, the president’s figure is likely based on multiple rounds of a drug.
The president also called on Congress to codify the most-favored-nation pricing structure into law.
3. ‘The war on fraud’ for Medicaid, a commitment to Medicare
At the end of 2025, the federal government froze all child care payments to Minnesota due to suspected fraud. UnitedHealth Group’s Optum has been auditing the state’s Medicaid program, recently flagging $52.3 million in direct recoveries from high-risk services over the span of 46 months. During his address, President Trump blamed the issues on “Somali pirates who ransacked Minnesota.”
Following concerns coming out of Minnesota, Texas Gov. Greg Abbott has been advocating for his own state to investigate its Medicaid program. President Trump accused California, Massachusetts and Maine of having dire fraud cases. He said Vice President J.D. Vance would lead “the war on fraud.”
The recent exposure of empty child care facilities which were receiving billions of dollars from Medicaid prompts an immediate revision of payment processes.
A solution would be to pay parents directly rather than sending lump sums to childcare facilities. Childcare benefits are slaved to income eligibility requirements for Medicaid. There is no reason to send them directly to childcare facilities. Childcare benefits could easily be added to an EBT card. The childcare benefit could easily be segregated in the EBT benefit.
Who is caring for Childcare?
Here are the specific sources and mechanisms for funding childcare:
Federal & State Government (Taxpayers): Child Care Aware® of America states that every state receives federal funds to support child care assistance programs, often known as vouchers or subsidies.
CalWORKs (California): The California Department of Social Services provides subsidized child care for TANF recipients, families transitioning off TANF, and other low-income families.
Alternative Payment Programs (CAPP): These programs use federal and state funds to provide vouchers for low-income families to pay for child care.
Head Start: Head Start programs provide federal funding for early education services for eligible families.
Tax Credits: The National Conference of State Legislatures notes that parents can receive help through the Child and Dependent Care Tax Credit, which is a tax incentive.
Local/County Funding: In some cases, county welfare departments and organizations like the Riverside County Office of Education administer these funds to ensure access to childcare.
California Department of Social Services (.gov)
In summary: All funding is from the Federal Government.
Our current system is byzantine and leaves open the ease of fraud.
Other news about fraud and abuse.
Buried in the news this week was that Conduent, the main processor for the Supplemental Nutrition Assistance Program (SNAP), which supports nearly 10 million cases monthly and processes over 1.5 billion EBT transactions annually, was hacked.
As if the SNAP/EBT system were not already a disaster, the implications of such a breach (of an unknown number) could be enormous. This should have been front-page news.
The company initially said about 4 million people in Texas were affected. That number has since jumped to 15.4 million, nearly half the state's population. Oregon's attorney general reported another 10.5 million impacted residents. Combined with other states issuing notifications, the total could reach into the dozens of millions.
The breach involved Ransomware. Conduent. has since secured its system
The stolen data includes names, Social Security numbers, medical information, and health insurance details. That combination is particularly dangerous because it can be used for identity theft, medical fraud, and highly targeted scams.Conduent processes data for large corporations, state agencies, and government healthcare programs. The company says its systems support services for more than 100 million people nationwide. However, it has not confirmed whether the breach affects that many individuals.
No comments:
Post a Comment