Like picking petals from a daisy

Many politicians have found that one day Trump loves you, the next, he loves you not. He is equally fickle about policy.

President Trump on Sunday threatened to veto legislation extending enhanced ACA premium subsidies. He made the veto threat during an impromptu talk with reporters aboard Air Force One, according to Bloomberg.

His remarks came a week after he apparently thought an extension was important enough for Republicans to go easier on their abortion restriction demands.

It’s not clear what impact Trump’s new position will have on negotiations. Last Thursday, 17 House Republicans voted for a three-year extension of the premium tax credits, the first time that any Republican has voted for ACA credits. At the time, Republican lawmakers said Trump’s support of a subsidy extension was key to convincing more Republicans to back the policy as the parties negotiate in the Senate.

Sen. Lisa Murkowski (R-Alaska) said she still expects the Senate to propose a compromise this week. Sen. Jeanne Shaheen (N.H.), a lead negotiator for Democrats, said she doesn’t expect Trump’s comment to impede negotiations.

It appears Trump had a change of heart after meeting with Cato Institute Director of Health Policy Studies Michael Cannon. In a Truth Social post, Trump said Cannon proposed codifying into law a regulation from Trump’s first term that allows people to buy short-term health coverage that lasts up to 12 months and renew that coverage for a maximum of 36 months. Here’s Cannon’s argument for that approach.

drug costs

Investigating high drug costs

Congressional Medicare advisers are looking into why the public health program is paying private insurers so much more to cover enrollees’ drug benefit.

Last month, Bob Herman reported that Medicare spent a record $16 billion in 2024 to help offset losses for health insurers that sell Medicare drug plans, a warning that seniors are using more drugs than expected after the Inflation Reduction Act capped their annual drug costs in Part D.

The federal government used to cover the vast majority of seniors’ catastrophic costs. Now that it doesn't, Medicare’s capitated monthly payments to plans is the primary mechanism for subsidizing Part D premiums, according to the nonpartisan Medicare Payment Advisory Commission, which is scheduled to hear about the increased bids on Thursday. In 2025, insurers’ national average bid amount for Part D coverage increased by 180 percent, and the average bid amount rose sharply again this year, according to MedPAC.

Higher bids drive up premiums, but the Biden administration gave insurers big subsidies to keep premiums stable.

For many insurers, drug expenses shot up more than 20% last year, according to Bob, in part due to the proliferation of GLP-1s.

Medicare advantage

Coding for profit

Bob also wrote about a Senate Judiciary Committee report that goes after UnitedHealth Group for using coding as a “a major profit-center strategy.”

UnitedHealth, which enrolls 10 million seniors in Medicare Advantage plans, used its command over health care providers to push them to add more diagnoses, or codes, to their patients. That drives up reimbursements for the company.

Sen. Chuck Grassley (R-Iowa), who chairs the committee, requested information from UnitedHealth in February after STAT and the Wall Street Journal reported on the different ways UnitedHealth codes the diagnoses of its Medicare Advantage members.

A departure explained

Richard Pazdur, who spent 26 years at the FDA, abruptly left the agency last month soon after taking over as director of the drug center. On Monday night, Pazdur made his first public remarks about the circumstances leading up to his departure at a STAT event in San Francisco at the J.P. Morgan Healthcare conference.

Pazdur said there were “promises made, promises not kept” by his superiors, though he declined to say who had broken those promises, including whether it was FDA Commissioner Marty Makary or health secretary Robert F. Kennedy Jr. Pazdur also warned that politics and “chaos” unleashed by the Trump administration were undermining the FDA’s work, and criticized the way a new voucher program for select drugs had been rolled out.

More here from Elaine Chen in California.

medicaid

Medicaid boom and bust

The federal government approved $60 billion worth of extra Medicaid funds for hospitals, doctors, nursing homes, and other medical providers in the closing months of 2025, but the good times will not last.

Bob wrote this one, too. The Biden administration allowed states to apply for funds that put Medicaid’s payments on par with the much higher rates that commercial insurers pay. But Republican’s new tax law will start phasing out those increases in 2028.

340b

Discounts vs. rebates

It looks like the Trump administration plans to drop its appeal of a court ruling against a payment policy the administration was testing in the 340B hospital drug discount program, according to Ed Silverman.

The pilot called for letting drugmakers pay rebates to hospitals, instead of providing up front discounts, for some drugs in the 340B program. A U.S. appeals court last week temporarily blocked the pilot for failing to adequately consider the impact on safety-net hospitals and clinics.