Sen. Mark Warner, D-Va., has introduced a bill that would roll back most of the healthcare cuts under HR 1, add a public option to the ACA exchanges and apply Medicare drug pricing rules to commercial health plans.
10 things to know:
- The bill would repeal most of the healthcare provisions in the 2025 reconciliation law, including Medicaid work requirements set to go into effect in 2027. The temporary 2026 increase to the Medicare physician fee schedule, the permanent telehealth safe harbor for high-deductible health plans and the Rural Health Transformation Program would not be reversed.
- The enhanced ACA premium tax credits would be made permanent starting in 2027, following their expiration at the end of 2025.
- HHS would offer a public plan on the exchanges starting in 2028. Premiums could be no higher than comparable exchange plans, and the agency could require Medicare and Medicaid providers to accept it.
- States that expanded Medicaid late would retroactively get the higher federal match that early expansion states received. States would also get more federal Medicaid funding automatically when their unemployment rate rises.
- Medicare could negotiate prices on more drugs, reaching 50 a year by 2032. Commercial insurance plans would also get those negotiated prices unless they opt out.
- Employer and individual market plans would have to cap enrollees’ drug costs at $2,000 a year for individuals and $4,000 for families starting in 2028. Insulin would be capped at $35 a month with no deductible.
- Medicare Advantage plans would have to adopt electronic prior authorization and publicly report their approval rates, denial rates and decision times, codifying CMS policy that already or will soon require the same.
- MA enrollees could switch coverage midyear if their plan drops their physician from its provider network. Traditional Medicare would also begin covering hearing aids in 2028.
- Hospitals, labs, imaging centers, surgery centers and health plans would face stricter price transparency rules with financial penalties. Large employers would also be entitled to receive full access to their claims data from PBMs and TPAs.
- PBMs would be banned from spread pricing within the Medicaid program. They would pass the full drug payment to pharmacies and be paid a flat administrative fee.
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