The Health Wonk Shop

News reports across the country trumpet major mergers and consolidation involving health insurers, physician practices, pharmacy benefit managers, hospitals and health systems, and other providers, including many that integrate different services under a single umbrella. The wave of consolidation and integration has federal and state policy makers examining how it affects competition, prices, and overall costs.Three experts joined moderator Larry Levitt for a discussion about health care consolidation and integration. The panelists discussed the motivations behind horizontal and vertical consolidation in health care, its potential to lower or raise costs, the implications for patients and payers, and how policy makers could respond. Hosted on Acast. See acast.com/privacy for more information.

Amid perennial public concern about the cost of prescription drugs, the Trump administration has undertaken a raft of efforts to push or persuade drug manufacturers to lower drug prices. These include “Most Favored Nation” proposals that would tie U.S. drug prices to the lowest cost in other countries and encouraging manufacturers to make more drugs available for sale directly to consumers at discounted prices. To date, the administration has inked two voluntary deals with pharmaceutical companies to sell drugs to the Medicaid program at most-favored nation pricing and launch new drugs in the U.S. at the same price as in other countries in exchange for a three-year reprieve from new tariffs on their products. The administration also set up a website, Trumprx.gov, scheduled to launch in 2026, through which it plans to connect consumers to manufacturers and other vendors enabling direct-purchase of prescription drugs.On November 20 , three experts joined Larry Levitt, executive vice president for health policy at KFF, for a 4“Health Wonk Shop” discussion about the latest developments in prescription drug pricing and what they mean for drug manufacturers, patients and public and private health insurance programs. Among the questions to be discussed include:How did the administration’s efforts to lower drug prices square with drug price negotiation in Medicare, and a provision in the One Big Beautiful Bill Act that allows drug companies to exempt more products from those negotiations?Are the Trump administration’s moves translating into lower drug prices for consumers? Which consumers might benefit most from these efforts? Are those prices at least as low as those paid for the same drugs in comparable countries?How will the availability of drugs be affected, if at all?What might the effects be on drug prices in other countries?How effective will voluntary agreements with drug companies be over time? Hosted on Acast. See acast.com/privacy for more information.

President Trump signed into law in July a budget reconciliation package that mandates all adults who are eligible for Medicaid through the ACA expansion meet federal work and reporting requirements. At a minimum, the 41 states (including D.C.) that have expanded Medicaid under the ACA will be required to verify that individuals are working or meet certain exemptions when they apply for or renew their Medicaid coverage.Four experts, including two state Medicaid directors, joined Health Wonk Shop series moderator Larry Levitt for an hour-long discussion of how states will go about implementing the new Medicaid work requirements. Hosted on Acast. See acast.com/privacy for more information.

On Thursday, April 24, three experts joined Health Wonk Shop series moderator Larry Levitt in an hour-long discussion designed to unpack claims about fraud and abuse and put them in a larger context. The event addressed such questions as: How do state Medicaid programs ensure program integrity and what does it take to go after fraud? What are the trade-offs? How substantial is fraud and abuse relative to total Medicaid spending? How do fraud and abuse relate to improper payments? Hosted on Acast. See acast.com/privacy for more information.

Health coverage enrollment through the Affordable Care Act (ACA) marketplaces now exceeds 24 million people, a dramatic increase in recent years fueled largely by enhanced premium aid, which started in 2021 as part of the American Rescue Plan Act and extended through 2025 under the Inflation Reduction Act. But, with the subsidies set to expire at the end of this year, Congress and the Trump Administration will be faced with a choice of whether and how to extend the subsidies, alongside broader discussion about the budget. Key questions for the future of the ACA include the costs and benefits of the subsidies, the consequences for enrollees and the marketplaces should they expire, and what other changes the Trump administration and Congress might make. Hosted on Acast. See acast.com/privacy for more information.

As the 2024 presidential election draws near, there are sharp differences in former President Trump’s and Vice President Harris’ records on health coverage and spending, including the Affordable Care Act, Medicaid, prescription drugs, and more. Larry Levitt, KFF’s executive vice president for health policy, moderated a 45-minute discussion with two veteran health policy advisors to explore the election’s potential impact on these issues. The discussion addressed questions such as: What are the candidates proposing? What are the pros and cons of the various proposals? What aren’t the candidates talking about? How might the health care policy agenda play out after the election based on who controls the White House and Congress? Hosted on Acast. See acast.com/privacy for more information.

The Supreme Court’s June 28 decision overturning the Chevron precedent that required federal courts to defer to reasonable agency decisions when federal law is unclear creates potential challenges for crafting health policy legislation and regulations. On July 25, 2024, a panel of experienced policy and legal experts explored how Congress and federal health agencies are likely to adapt to the Court’s decision and what that may mean for health care policymaking.Moderated by Larry Levitt, KFF’s executive vice president for health policy, the discussion addressed questions including: How will the decision change how regulators approach drafting new regulations? What type of health policy regulations are likely to be most vulnerable to future court challenges? How will it alter the legislative process and the ability to pass new laws? To what extent will Congress be able to provide greater specificity in delegating authority to federal agencies in future legislation? Hosted on Acast. See acast.com/privacy for more information.

With Congress looking for ways to cut health care costs for patients and the Medicare program, one approach drawing bipartisan attention involves site-neutral payments for outpatient services. The idea is for Medicare to pay the same amount for a service regardless of where it is provided – a departure from current Medicare reimbursement policy, which generally pays higher rates for services provided in hospital outpatient departments versus independent physician offices and ambulatory surgical centers.Listen to a panel of experts discuss the concept of site-neutral payments, including why it has become an issue for policymakers and private payers like insurers and employers, how Medicare payments currently work, how various proposals would change the law, and the potential impact of those changes. Hosted on Acast. See acast.com/privacy for more information.

A panel of primary-care experts joined Larry Levitt, KFF’s executive vice president for health policy, for a discussion on the current state of primary care in the country, including the extent of the shortage, how it varies geographically and for different populations, the impact on people’s health, and what can be done to address it. Hosted on Acast. See acast.com/privacy for more information.

Nearly 1 in 5 consumers with health insurance say their insurer delayed or denied care in the past year due to its requirements for prior authorization, a process through which insurers can require patients to obtain approval in advance before they will agree to cover specific services.Insurers point to prior authorization as a tool to limit unnecessary and ineffective care, thereby reducing costs. However, the practice is also drawing increased scrutiny amid concerns that it creates unreasonable barriers to patients getting needed care and generates excessive paperwork burdens on doctors and other providers. Last month, federal regulators finalized new rules to govern how insurers use prior authorization in Medicare Advantage, Medicaid, the Children’s Health Insurance Program, and the Affordable Care Act’s federal Marketplace plans, while lawmakers are weighing potential broader legislation.On February 22, a panel of four experts joined Larry Levitt, KFF’s executive vice president for health policy, for a 45-minute discussion addressing the future of prior authorization requirements in health care. The panel discussed why insurers use prior authorization, its impact on patients and providers, and how the new regulations may change current practices. They also examined the potential for further regulatory or legislative actions to address ongoing concerns.ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsTroyen Brennan, MD, Adjunct Professor of Health Policy and Management, Harvard T.H. Chan School of Public Health, and a former executive at CVS Caremark and AetnaFumiko Chino, MD, Radiation Oncologist, Memorial Sloan Kettering Cancer CenterAnna Schwamlein Howard, Principal, Policy Development, American Cancer Society Cancer Action NetworkKaye Pestaina, Vice President and Director of the Program on Patient and Consumer Protection, KFF Hosted on Acast. See acast.com/privacy for more information.

Amid low unemployment and rising demand for services, today’s health care workforce is under pressure from several directions, including worker strikes; shortages of trained staff; and proposed new staffing standards for nurses and aides in nursing facilities.On November 16, a panel of three experts joined Larry Levitt, executive vice president for health policy at KFF, for a 45-minute discussion focused on the diverse challenges facing the health care workforce. The conversation touched on why and where there are worker shortages, what is driving recent strikes, how these pressures affect health systems, and how the proposed new staffing requirements could affect nursing homes. The panel also explored differences in rural and urban settings, and how the pandemic and other factors have increased burnout among health care workers.ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsGretchen Berlin, Senior Partner, McKinsey & CompanyAlice Burns, Associate Director of the Program on Medicaid and the Uninsured, KFFBianca K. Frogner, Director of the University of Washington’s Center for Health Workforce Studies, and Professor in UW’s Department of Family MedicineKFF’s virtual Health Wonk Shop series features in-depth policy discussions with experts that go beyond the news headlines to provide greater insights. Hosted on Acast. See acast.com/privacy for more information.

With the Biden administration’s announcement of the first 10 drugs to be negotiated for Medicare as part of the Inflation Reduction Act (IRA), an array of legal challenges from the pharmaceutical industry is potentially the biggest obstacle to implementation.In court filings, individual drugmakers and the industry’s main lobbying group contend that the negotiations process is unconstitutional in a variety of ways, from violating freedom of speech to unlawful government seizure and excessive fines. They also continue to argue, as they did in the debate over the IRA, that requiring companies to negotiate the prices of drugs with the government will impede the development of new drugs.On Tuesday, September 12, two legal experts and a health policy expert joined Larry Levitt, executive vice president for health policy at KFF, for a 45-minute discussion about the legal issues underpinning these lawsuits and how they intersect with the policy goals of the legislation. ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsZachary Baron, Associate Director, Health Policy and the Law Initiative at the O’Neill Institute for National and Global Health Law at Georgetown University.Tricia Neuman, Senior Vice President and Executive Director of the Program on Medicare Policy, KFFDan Troy, Managing Director, Berkeley Research Group KFF’s virtual Health Wonk Shop series features in-depth policy discussions with experts that go beyond the news headlines to provide greater insights. Hosted on Acast. See acast.com/privacy for more information.

New weight loss drugs, such as Novo Nordisk’s Ozempic and Wegovy (semaglutide) and Eli Lilly’s Mounjaro (tirzepatide), could be transformative for people who struggle with obesity and obesity-related medical conditions, but there are major questions to consider related to insurance coverage, the cost of the drugs, and who has access.Importantly, by law, the drugs cannot be covered by Medicare for weight loss and are often covered now by private insurers in limited circumstances. Manufacturers of the drugs are lobbying for broad coverage by Medicare and other payers.On August 4, three experts joined Larry Levitt, executive vice president for health policy at KFF, for a 45-minute “Health Wonk Shop” discussion about the questions surrounding what a new generation of weight loss drugs means for patients and payers:Who could benefit most from the new weight loss drugs, and what are the barriers to accessing them?What would be the impact of Congress overturning the prohibition on Medicare covering weight loss drugs?How are employers and insurers approaching coverage of the drugs given the potentially substantial costs involved?What are the broader implications of the new drugs for U.S. obesity rates and for national health spending, including on obesity-related health conditions?ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsJuliette Cubanski, PhD, Deputy Director, Program on Medicare Policy at KFFShauna Levy, MD, MS, Assistant Professor, Division of MIS/Bariatric Surgery, Tulane University School of MedicineMichael Manolakis, PharmD, PhD, Senior Vice President, Pharmacy, Aon KFF’s virtual Health Wonk Shop series features in-depth policy discussions with experts that go beyond the news headlines to provide greater insights. Hosted on Acast. See acast.com/privacy for more information.

Pharmacy benefit managers (PBMs) are increasingly scrutinized intermediaries in the U.S. health care system, negotiating discounts on prescription medications for health insurers and employers while collecting rebates from drugmakers.Even as PBMs have taken on a larger role in drug coverage and pricing in recent decades, including through mergers with insurers, the business arrangements that shape their finances remain unusually opaque. That has led to questions about the role PBMs play in the rising cost of prescription drugs, investigations by Congress and the Federal Trade Commission into PBMs business practices, and federal and state efforts to regulate those practices and require greater transparency.On June 14, two experts joined KFF’s The Health Wonk Shop and series moderator Larry Levitt in a 45-minute discussion about the power and practices of PBMs, addressing such questions as:How do PBMs make money?What role do PBMs have in drug costs?What legislation or other reforms are being considered, and how would they affect consumers? ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsJennifer Reck, Director, Center on Drug Pricing, National Academy for State Health PolicyKaren Van Nuys, Executive Director of the Value of Life Sciences Innovation Program and Senior Fellow, University of Southern California Schaeffer Center for Health Policy and Economics KFF’s virtual Health Wonk Shop series features in-depth policy discussions with experts that go beyond the news headlines to provide greater insights. Hosted on Acast. See acast.com/privacy for more information.

The idea of imposing work requirements in Medicaid is making a comeback in Congress and at the state level.Some House Republicans are pushing to include such a measure in any deal to raise the debt ceiling. The policy resonates with a larger message of personal responsibility, and advocates suggest that work requirements could help achieve budget savings and create a pathway to prosperity for low-income people. Opponents argue that imposing requirements will not significantly increase work since most Medicaid enrollees already work, and would just create an additional administrative barrier to maintaining Medicaid coverage.On the state level, Georgia is poised to implement work requirements in a limited expansion of Medicaid this summer after a court overturned the Biden administration’s attempt to block the move administratively. In Arkansas, the only state to have implemented work and reporting requirements, thousands of people were disenrolled for failure to comply, including some who were eligible but could not navigate the process.On Tuesday, April 25 , three experts joined series moderator Larry Levitt in a 45-minute discussion about work and reporting requirements in public programs such as Medicaid, their effects on enrollment and employment, and what we can expect on the state and federal levels regarding the future of Medicaid work requirements.ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsMadeline Guth, Senior Policy Analyst, Program on Medicaid & Uninsured, KFFHeather Hahn, Associate Vice President, Center on Labor, Human Services, and Population, Urban InstituteAngela Rachidi, Senior Fellow and Rowe Scholar, American Enterprise InstituteKFF’s virtual series, The Health Wonk Shop, features conversations with experts, diving into timely health policy issues for a deeper discussion beyond the news headlines. Hosted on Acast. See acast.com/privacy for more information.

Medicare Advantage is the rapidly growing private plan alternative to traditional Medicare that provides coverage to approximately half of Medicare beneficiaries.Controversy has arisen over a Biden Administration proposal for changes to payments to insurers for the coming year, including how the health risk of enrollees is captured, as well as a plan for recouping payments not supported by audits. The Centers for Medicare and Medicaid Services estimated the payments to plans per enrollee would increase by 1% in 2024, and supporters argue the approach would help to reduce inappropriate overpayments to insurers. Critics, including the insurance industry and Republicans in Congress, contend that this represents a cut to Medicare and will lead to higher costs for beneficiaries.On Tuesday, March 21, three experts joined series moderator Larry Levitt in a 45-minute discussion on Medicare Advantage, addressing such questions as: What has driven the growth in Medicare Advantage enrollment? What are the implications of enrollment being concentrated in a few insurance firms? Is the federal government overpaying plans? What would the new rules and proposed changes do, and how would they affect beneficiaries?ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsJeannie Fuglesten Biniek, Associate Director, Program on Medicare Policy, KFFTom Kornfield, Senior Consultant, AvalereRichard Kronick, Professor of Family and Preventive Medicine and Adjunct Professor of Political Science, UC San DiegoKFF’s virtual conversation series, The Health Wonk Shop, features conversations with experts, diving into timely health policy issues for a deeper discussion beyond the news headlines. Hosted on Acast. See acast.com/privacy for more information.

With the November midterm elections comes changes in Congress and state legislatures. While full election results remain in flux, there is the possibility of a shift from unified Democratic control of the White House and Congress to divided power. A split in political control of the federal government raises big questions around what can be feasibly accomplished to address health policy issues in the next two years.What can we expect for legislating in the next Congress? Are there health policy areas that are ripe for bipartisan solutions to overcome gridlock? What might be targets for oversight from a Republican-led House? What further progress can the Biden Administration make on health care through executive actions?On Tuesday, November 15, two experts joined series moderator Larry Levitt in a 45-minute discussion looking at what’s ahead for health policy on the Hill, in the Administration, and in the states after the election.ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsChris Jennings, Founder & President, Jennings Policy Strategies Inc.Jennifer Young, Partner, Tarplin, Downs & Young, LLC (TDY)KFF’s virtual conversation series, The Health Wonk Shop, features conversations with experts, diving into timely health policy issues for a deeper discussion beyond the news headlines and taking questions from viewers over Zoom. Hosted on Acast. See acast.com/privacy for more information.

The era of government-financed COVID tests, vaccines, and therapeutics is likely coming to an end soon. In August, the Administration announced that by January 2023, it expects to end its purchase and distribution of COVID vaccines, citing a lack of federal funds. The announcement signals the shift in the United State’s response to the pandemic and a transition from government-led vaccination initiatives to the commercial market.The commercialization of COVID-related services raises important questions around how people will access vaccines and treatments, how they will be priced, and to what extent they will be covered by insurance. It also has implications for ongoing control of the pandemic.On Wednesday, October 19th, a panel of experts joined series moderator Larry Levitt in a 45-minute discussion exploring the government’s plan to transition the distribution of COVID tests, vaccines, and therapeutics to the commercial market and its potential implications for consumers and insurers.ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsJen Kates, Senior Vice President and Director of Global Health & HIV Policy, KFFDawn O’Connell, Assistant Secretary for Preparedness and Response, U.S. Department of Health and Human ServicesRena Conti, Associate Professor, Department of Markets, Public Policy and Law, Questrom School of Business, Boston University Hosted on Acast. See acast.com/privacy for more information.

As the 2022 mid-term elections approach, inflation and gas prices are on the top of voters’ minds. While health care prices have often risen faster than the rest of the economy, the prices for medical services are generally set in advance – often tied to the calendar year – creating a delay between wage and cost increases due to inflation and the prices for medical services.The pressures of inflation are far reaching, affecting providers, insurers, government programs such as Medicaid and Medicare, and, ultimately, the American people. Over the coming months, health care providers and insurers will wrap up pricing negotiations and set premiums for the next year. Amid these negotiations, there remain big questions as to how economic policy and legislation such as the Inflation Reduction Act will influence pricing and payment for insurance and health care, including prescription drugs, and who will bear the brunt of rising costs.KFF’s virtual conversation series, The Health Wonk Shop, features conversations with experts, diving into timely health policy issues for a deeper discussion beyond the news headlines and taking questions from viewers over Zoom.ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsCynthia Cox, Vice President and Director for Program on the ACA, KFFCorey Rhyan, Senior Analyst of Health Economics and Policy, AltarumSuzie Desai, Senior Director & Sector Lead of U.S. Not-for-Profit Healthcare Group, S&P Global Ratings Hosted on Acast. See acast.com/privacy for more information.

Medication abortion, also known as medical abortion or abortion with pills, has been FDA-approved as safe and effective since 2000 for the termination of pregnancies through the first 10 weeks. Its use in the United States has grown in recently years and now it accounts for just over half of all abortions , yet a majority of adults and women between ages 18-49 have not heard of it.The June 24th Supreme Court decision overturning Roe v. Wade eliminated the federal standard protecting the right to abortion. The outcome of the decision: roughly half the states are expected to ban or severely restrict abortion, resulting in a patchwork of abortion laws that differ widely state to state. Given that medication abortion can now be provided via telehealth and many will seek the pills through websites and online pharmacies, there are big questions regarding how accessible medication abortion will be and its regulation at both the state and federal level.On Wednesday, July 20th, a panel of experts joined series moderator Larry Levitt in a 45-minute discussion about the use and safety of medication abortion and the current and future policy and practical challenges for accessing it across the country.This was the fourth installment of KFF’s virtual conversation series, The Health Wonk Shop. The series features conversations with experts, diving into timely health policy issues for a deeper discussion beyond the news headlines and taking questions from viewers over Zoom.ModeratorLarry Levitt, Executive Vice President for Health Policy, KFFPanelistsLaurie Sobel, Associate Director of Women’s Health Policy, KFFJamila Perritt, MD, President & CEO, Physicians for Reproductive HealthDaniel Grossman, MD, Professor and Director of Advancing New Standards in Reproductive Health, UCSFFrancine Coeytaux, Co-Founder and Co-Director, Plan C Pills Hosted on Acast. See acast.com/privacy for more information.