There’s a feature of the abortive White House ACA subsidy proposal that I think has been underappreciated. Namely, it seems to only partially extend the enhanced subsidies for people with incomes below 200% of the FPL (~$31k for a single person). That’s about 2/3 of enrollees.

Will Medicare Advantage’s growth change the degree of favorable selection into the program? My new paper w/ Samantha Crow offers an answer: probably not much. www.brookings.edu/articles/wil...

What will the Senate bill mean for health coverage? We don’t yet have final CBO estimates, but it’s clear they’ll be pretty similar to the House bill. That puts the U.S. on track for an unprecedented increase in the uninsured rate that will wipe out ~3/4 of post-2013 declines.

The Senate reconciliation bill, at least in its current form, appears likely to reduce coverage about as much as the House bill. If it becomes law, that would mean reversing most of recent years' insurance coverage gains: bsky.app/profile/matt...

New-to-me nugget on work requirements implementation in here: Pinging Equifax's The Work Number — which states are likely to rely on to get recent-enough employment data — "sometimes costs over $20 per person per query"

Clever new piece from Kennah Watts and Jack Hoadley takes a first look at how decisions under the No Surprises Act arbitration process vary across arbitrators. Lots of interesting findings here, including that provider win rates vary a lot by arbitrator.

From a first look at the Senate drafts, the cuts to Medicaid & the Marketplaces are similar to the House’s, maybe even a bit deeper on net. Upshot: these drafts, like the House bill, would put the US on course for an unprecedented rise in the uninsured rate. bsky.app/profile/matt...

My new piece @healthaffairs.bsky.social Forefront finds that if the House bill becomes law and enhanced premium tax credits expire on schedule, the US will see an unprecedented increase in the uninsured rate, wiping out about ~3/4 of the post-2013 decline.

"...the US uninsured rate has never risen as far, as fast as it will if the House bill and other looming policy changes affecting insurance coverage take effect" -- @mattafiedler.bsky.social www.healthaffairs.org/content/fore...

My new piece @healthaffairs.bsky.social Forefront finds that if the House bill becomes law and enhanced premium tax credits expire on schedule, the US will see an unprecedented increase in the uninsured rate, wiping out about ~3/4 of the post-2013 decline.

Ok folks, we know work requirements reduce benefits without increasing work (cc: @chloeneast.bsky.social) But who loses benefits and what happens if work requirements are reversed? New evidence from linked SNAP-Medicaid data and a natural experiment in CT tell a concerning story... Thread below 👇

Interesting new paper providing clear evidence that the flu vaccine is effective at reducing both office and emergency department visits for flu in kids.

Important step from CMS to begin conducting risk adjustment data validation (RADV) audits for *all* MA contracts each year. If implemented well, this could, in effect, reduce MA risk scores by a few percentage points. But a few things to keep an eye on: www.cms.gov/newsroom/pre...

I want one, and I don’t want the US government undermining the development, distribution, and accessibility of COVID boosters.

Also unlike the ACA repeal debate, I am unsure how widely the projected loss of coverage for ~10 million people is known. The ACA debate was clearly healthcare focused. This time, I'm seeing lots of articles referencing the "budget bill," "policy bill," "tax bill," etc. The stakes are less clear.

Thread: Latest House GOP reconciliation bill language again makes the draconian #Medicaid cuts harsher. For example, mandatory work requirements now will take effect 12/31/26 instead of 1/1/29 and states have option to implement them earlier (1/x)

Latest House bill text includes another blow to the ACA, ending “silver loading.” That would increase premiums by $350 for a hypothetical family. Here’s why: www.brookings.edu/articles/und...

The updated reconciliation language doubles down on the bill’s Marketplace cuts by ending “silver loading” for the 2026 plan year. This would greatly increase many Marketplace enrollees’ premiums, compounding increases due to expiration of enhanced tax credits.

"The plan saves money mainly by removing millions of people from coverage, while offering no alternative means to insure them." Always read @lorenadler.bsky.social and @mattafiedler.bsky.social.

Congress is looking at major changes to the Medicaid expansion. New research finds it has saved 27,000 lives. www.nytimes.com/2025/05/16/h...

Eric Roberts and @joefigs.bsky.social led a groundbreaking new study on Medicaid and Medicare, out today in NEJM. I’m lucky to have been a part of it. Medicare saves lives. But is it enough to save lives of the most vulnerable Americans? The study suggests no; Medicaid still matters. (1/11)

"The plan saves money mainly by removing millions of people from coverage, while offering no alternative means to insure them." Must-read @mattafiedler.bsky.social @lorenadler.bsky.social on House Republican cuts to Medicaid and the ACA www.washingtonpost.com/opinions/202...

How would a federal Medicaid work requirement affect enrollment? My new paper looks back at an Arkansas requirement very similar to one the House passed in 2023. I estimate an Arkansas-like policy would reduce Medicaid enrollment for ppl subject to it by 34% in the long run:

GOP leaders are now saying they want to protect Medicaid for "the truly vulnerable" That's actually code for a big cut -- and taking out a piece of the ACA with it My latest at @thebulwark.bsky.social www.thebulwark.com/p/health-ins...

Aside from the bigger picture, I’m not sure where Cassidy gets the idea that “states are supposed to pay 40%.” FMAP is calculated according to a formula in statute, which enforces a floor of 50% and a ceiling of 83% match. Louisiana is only paying 32 cents on the dollar.

Speaker Johnson here is trying to frame Medicaid coverage of working people -- who are eligible based on the ACA Medicaid expansion in 40 states plus DC -- as "fraud, waste, and abuse." bsky.app/profile/atru...

🚨 Rethinking Moral Hazard: Moral hazard in health insurance—the increased spending that comes when you get insured—is usually seen as wasteful due to insurance’s price distortion. This paper challenges that view.

A quick thread on the policy implications of this interesting WSJ piece on duplicate Medicaid enrollments. There is likely room for sensible reform here, but the potential savings are much smaller than the gross amount of the duplicate payments. www.wsj.com/health/healt...

New Urban Institute estimates of mandatory #Medicaid work requirements. At least 4.6-5.2 milion people would lose Medicaid coverage but would be significantly higher if work requirements apply beyond Medicaid expansion, some exemptions aren't automatically provided: www.urban.org/research/pub...

The dismantling of NCES is insane and will critically hobble progress in improving education - this agency is so important it existed more than 100 years before the creation of Department of Education.

NEW in @51st.news: House Republicans just voted to defund D.C. police and schools. As part of a spending bill to avert a federal government shutdown, they could force D.C. to slash $1.1 billion out of its budget, and no one understands really why. 51st.news/house-republ...

CMS projects 750k-2 million people will "lose coverage as a result of this rule" in 2026 but notes this may be an underestimate due to administrative burdens imposed by the rule (pp. 271-2). This is on top of millions CMS expects to lose coverage if enhanced tax credits expire this year (p. 260).

I was honored to testify before the health subcommittee of House Energy & Commerce this morning on pharmacy benefit manager reform (and, as it turned out, answer many members' questions on pending Medicaid policy changes too). My four main points (on PBMs):

Four primary levers to *reduce* Medicaid costs are: 1. ↓ Eligibility 2. ↓ Benefits 3. ↓ Payment rates 4. ↑ "Ordeals" (frequent redetermination, more paperwork / hoops, like work reqts, ↑ prior auth / utilization mgmt) The primary lever to *shift* fed costs to states is ↓ matching rates.

In the 2026 MA Advance Notice, CMS said that it may begin calibrating the MA risk adjustment model using encounter data (snippet below). Unfortunately, this change would not achieve what CMS hopes it would—and might well be a step in the wrong direction.

Excellent rundown of the legality -- or, rather, illegality -- of OMB's funding freeze from @davidasuper.bsky.social:

I see some suggestions, in the reporting regarding the OMB impoundment order, that a mere delay in spending appropriated funds is legal. But that's not really true. The delay OMB has ordered specifically contradicts the Impoundment Control Act. A thread.

Medicaid is FFA. But it might be practically exempt bc the statutory formula for paying FMAP means a pause is inconsistent with (non-ICA) law. So the “required by law” exception in the memo should apply.

The GOP's "menu" of reconciliation pay-fors (via Politico) makes it clear that cost-savings aren't possible without deep cuts to Medicaid — these big-ticket proposals will both hurt beneficiaries *and* piss off governors. www.politico.com/f/?id=000001...

Estimates of Traditional Medicare costs used to set Medicare Advantage benchmarks are subject to sampling error since TM enrollment is finite. How big a problem is this? New paper has an answer: Not too big in the medium-term, though there’s room to improve in tiny counties.

A lot of overblown rhetoric flying around in the PBM debate. There are real issues in the market, though many tied to broader issues of market power & adverse selection. Our attempt to draw out the key trade-offs & effects of different policy options. www.brookings.edu/articles/a-b...

Apropos of the ongoing conversation about health care administrative costs, resharing my testimony to Senate Budget on the administrative costs generated by provider-payer interactions and how policymakers could reduce them. Four main points:

As @awgaffney.bsky.social has noted in the past, "It's the prices" is a mostly correct but imperfect summation of health spending drivers. It's the way we finance our health system, both the perverse incentives that distort the market and the unnecessary admin burden created by the fragmentation.

New from the Congressional Budget Office: Not extending enhanced ACA premium assistance beyond 2025 would ultimately lead to 3.8 million more people uninsured. www.cbo.gov/system/files...

How much do nongroup plans pay providers? Really enjoyed this new paper from Hanson et al. that finally offers a good answer. Short answer: less than group plans, but a lot more than Medicare. Link: www.healthaffairs.org/doi/full/10....