Loren Adler

Network matching: An attractive solution to surprise billing | Brookings Loren Adler, Matthew Fiedler, and Benedic Ippolito explore network matching as a solution to surprise out-of-network medical bills.

Network matching would align hospital & clinician networks so payment is set through contracting, not OON leverage or IDR.

Indiana's law would restrict the tools needed to achieve that alignment.

www.brookings.edu/articles/net...

Why inflationary: when an insurer contracts with a hospital but can’t penalize OON care, negotiations lean more on the fallback price.

For many OON ancillary bills, that fallback is now the No Surprises Act's IDR, where awards tend to be well above pre-law in-network rates.

Indiana First in Nation to Block Insurer Penalties That Threaten Patient Access Indiana First in Nation to Block Insurer Penalties That Threaten Patient Access to Care Bipartisan SEA 189 stops insurer reimbursement cuts tied to out‑of‑network providers   Indiana has become the fi...

Indiana appears poised to ban insurer penalties when hospital care involves out-of-network ancillary clinicians.

That blunts market forces by limiting contracting leverage in anesthesia, EM, radiology, & likely ↑ prices, spending, & premiums.

wimsradio.com/2026/03/03/i...

Detainee they are interviewing was a college student in Columbia. Waited in Mexico until he had a 2024 immigration interview in CA - a scheduled appointment - where he was told he was a danger to society. Claims he has no criminal record, never even got a traffic ticket. Was immediately detained

4-5 ACIP members seem fundamentally opposed to the committee’s central purpose throughout its history—to provide population-level recommendations for how vaccines _should_ be used—viewing even a rec. as an impediment to informed consent, etc. So we’ll be doing this over and over for other vaccines.

FDA plans to tap oncology-expert Pazdur as nation’s top drug regulator Richard Pazdur, a longtime Food and Drug Administration employee, would lead its center that oversees over-the-counter and the majority of prescription drugs.

scoop: RICHARD PAZDUR set to be named FDA's top drug regulator

He'd initially turned down job leading agency's CDER but reconsidered

Hospital chain UHS just reported and joined peers in blowing the doors off on pricing. Revenue per comparable admission +9.8% YoY, revenue per comparable patient day +11.5% YoY. No wonder managed care name costs are exploding.

"experts say"
www.cnn.com/2025/08/11/b...

HHS announced today they will consider Head Start a welfare program, not an education program, and will subject it to new citizenship requirements. This goes against decades of legal precedence that all children in America have a right to education. Announcement here. www.hhs.gov/press-room/p...

1977: why would the bartender in star wars even care if some robots with artificial intelligence came into his bar

2025: ohhh ok

Byrd Rule Violations Continue to Mount on the Republicans’ “One Big, Beautiful Bill” | U.S. Senate Committee On The Budget The Official U.S. Senate Committee On The Budget

Seventh set of Byrd droppings is out, and WOW!

We won on trans care in Medicaid, provider taxes, FMAP, immigrants in Medicaid, and other issues.

These victories are amazing for the people they help - and cost Rs more than $250 billion of their savings by rough calculations, largely not curable.

Finance Committee text is out - this has the Medicaid cuts and the tax cuts. Will go through it in this thread.

But what we can say for certain is that, like the House version, this would be BY FAR the largest Medicaid cuts in history, kicking many millions of people off their health insurance.

An important point that the Big Beautiful Bill, as currently constructed, would barely dent federal spending when you factor in the added interest costs on the increased federal debt.

Lots of damage for such a minimal net spending reduction.

www.nytimes.com/2025/06/09/o...

CBO predicts the House-passed work requirements would cause 4.8 million more people to go uninsured, most of whom the evidence suggests are likely to be working or should be exempt

Excellent op-ed today describing some of the on-the-ground challenges: www.nytimes.com/2025/06/08/o...

More bureaucracy, more paperwork, and a less efficient government.

No more coverage lifeline for people between jobs.

That's what prior attempts with Medicaid work requirements have delivered, all without even increasing employment.

Percent change in after tax income for 2027. The tax cuts for the top 5% are much larger than for anyone else. The top 1% on average gets $70,542 tax cut.

New JCT analysis of the House-passed budget reconciliation bill is out.

Under the GOP plan, more tax cuts go to millionaires than the entire half of America combined.

This graph shows just the tax side. Include the Medicaid & SNAP cuts (which we'll get from CBO soon), & it's a cut for the poorest.

This is VERY bad and chilling news. As far back as I can think of the federal government has allowed researchers access to restricted government data while upholding the highest standards of data security and confidentiality.

These data belong to us all, they should be accessible to researchers.

A helpful rundown of the House-passed reconciliation bill's effects on Medicaid & the ACA, including how its scale compares to the 2017 repeal & replace efforts

www.brookings.edu/articles/new...

Cost estimate: www.cbo.gov/publication/...

More coverage detail: www.cbo.gov/publication/...

From CBO:

• 11.8 million lose coverage due to One Big Beautiful Bill provisions

• 16M fewer w/ coverage in 2034 when incorporating the 4.2M expected coverage loss from expiration of enhanced ACA subsidies

That's a 57% ↑ in # of uninsured compared to June 2024 current policy projection

Plenty of ways to save big $$ w/o taking health insurance from >10 million & ↑ costs for millions more.

Here's one alternative path: www.healthaffairs.org/content/fore...

From a fiscal perspective, even better would be to ditch the bill's net tax cuts that will add trillions to our debt.

In the search for spending savings, House Republicans could've gone after overpayments to insurers & hospitals in Medicare.

Instead, they singled out people w/ the lowest incomes for the lion's share of cuts.

Then re-directed that $$ mainly for more high-income tax cuts.

Quick summary of the "big, beautiful bill":

>10 million more uninsured

>1 million low-income seniors see higher Medicare premiums & cost-sharing

Large ACA premium ↑

~ 30% cuts to SNAP

~ $3 trillion in new debt

Makes low-income households worse off & high-income households better off.

Opinion | How do Republicans plan to cut health coverage? Two basic ways. The House reconciliation plan’s provisions add up to millions more going without insurance.

A look at how the House Republican proposals would cut health coverage:

www.washingtonpost.com/opinions/202...

Thread. 33 of 40 #Medicaid expansion states (+DC) will now face a 10 point cut in their expansion match rate under House GOP reconciliation bill. Latest language penalizes not only states using own funds to cover undocumented kids but also states covering legal immigrant kids/pregnant women (1/x)

This is Gary Cohn trying to reassure investors about the U.S. economy. He’s not very good at it: www.politico.com/news/2025/05...

Amid all the other news, it's easy to become inured to the basic facts here. Öztürk:

-Is not accused of committing any crime

-Is nonviolent

-Was in this country legally

-Merely engaged in speech that the administration objects to

-Has been locked up for six weeks

Despite legal resident status and having been charged with no crime, our Georgetown colleague Badar Khan Suri has been designated a 'high risk' prisoner and for that reason gets only two hours of outdoor time PER WEEK. His traumatized son "cries all the time" and has ceased speaking.

Republicans argued that allowing Medicare to negotiate drug prices (as passed in the 2022 IRA) would destroy pharmaceutical innovation in the US. Will CBO score the innovation impact of a nearly 40% cut to NIH funding - and if so, how?