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> Medicare/Medicaid Turn 60
> New HPC Commissioners
> Healthcare Extenders
> Medicare Advantage
> Transition

MONDAY REPORT

Medicaid: That Was Then, This is Now

This Wednesday, July 30, marks the sixtieth anniversary of the signing of the legislation that created Medicare and Medicaid.

President Lyndon Johnson signed the Social Security Amendments of 1965, which created the healthcare programs, during a ceremony with former President Harry Truman and his wife Bess at the Truman Presidential Library in Independence, Missouri. Johnson chose the site in recognition of Truman’s early, but unsuccessful efforts to create a national healthcare program.

LBJ said of Truman on that day, “Few can see past the speeches and the political battles to the doctor over there that is tending the infirm, and to the hospital that is receiving those in anguish, or feel in their heart painful wrath at the injustice which denies the miracle of healing to the old and to the poor. And fewer still have the courage to stake reputation, and position, and the effort of a lifetime upon such a cause when there are so few that share it.”

Johnson went on to praise Truman’s “tradition of leadership,” adding, “But there is another tradition that we share today. It calls upon us never to be indifferent toward despair. It commands us never to turn away from helplessness. It directs us never to ignore or to spurn those who suffer untended in a land that is bursting with abundance.”

Approximately 68.6 million people are currently enrolled in Medicare, of which 90.1% are over age 65. The others are younger individuals with disabilities, end-stage renal disease or amyotrophic lateral sclerosis (ALS), according to the Centers for Medicare & Medicaid Services. As of March 2025, 71.2 million people in the U.S. were enrolled in Medicaid and 7.3 million were enrolled in the Children’s Health Insurance Programs (CHIP). MassHealth (which includes Medicaid and CHIP) covers approximately 1.98 million in the commonwealth.

The One Big Beautiful Bill Act, currently known as “OB3”, will cut Medicaid by $964 billion over 10 years and spending on health insurance exchanges by $124 billion, resulting in 10 million people becoming uninsured, according to the bipartisan Congressional Budget Office, which last Tuesday updated its estimates on the law. More than 300,000 people in Massachusetts are expected to lose health coverage, placing more stress on hospital emergency departments and the currently underfunded Health Safety Net fund. The potential loss at year’s end of enhanced subsidies for customers in health exchanges, combined with new rules from the administration that shorten the enrollment period and institute stronger income verifications for enrollees, could result in another five million people losing coverage. The trillion-plus-dollar cuts coupled with the rising number of uninsured will undoubtedly result in hospitals providing more care with fewer funds and challenge providers’ ability to maintain care services and remain financially viable.

At the July 4 signing ceremony of OB3, President Trump said, “It’s the most popular bill ever signed in the history of our country, whether you’re military or anyone else, this is the single most popular bill ever signed.”

New HPC Commissioners Named

Governor Maura Healey on Friday appointed four new commissioners to the Health Policy Commission and reappointed the HPC Chair Deborah Devaux and Commissioner Jamie Willmuth, the senior policy analyst for the Massachusetts Division of the 1199 SEIU labor union.

MHA President & CEO Steve Walsh was among the four new appointees, along with Sandra Cotterell, who in 2024 retired as the CEO of the Codman Square Health Center; Christopher Leibman, senior vice president and chief access head at Biogen; and Umesh Kurpad, who retired in 2023 as CFO of Point32Health, the parent company of the health insurers Harvard Pilgrim Health Care and Tufts Health Plan. Kurpad served as CFO at Tufts Health Plan for 12 years.

The re-configuration of the HPC comes as a result of An Act Enhancing the Market Review Process, which Governor Healey signed in January. That law kept the HPC Commission as an 11-person body but required one appointee to be a “member with expertise representing hospitals or hospital health systems,” as well as someone “with expertise in healthcare innovation, including pharmaceuticals, biotechnology, or medical devices.” The governor is tasked with naming six of the 11 commissioners, two of which must be from lists of nominees from the Senate President and Speaker of the House. The other two HPC Commissioners are the Secretary of the Executive Office of Health & Human Services or designee, and the Division of Insurance Commissioner or designee. The overall intent of the legislative restructuring of the HPC was to modernize its representation.

“The reforms that were made to the structure of the Health Policy Commission last session were designed to ensure that every sector of the healthcare industry would be represented on the board, a prerequisite for establishing a multifaceted approach to reducing healthcare cost growth for our residents,” said House Speaker Ronald J. Mariano (D-Quincy) of Healey’s choices. “The appointments that are being announced today will help to ensure that industry leaders, across each sector of the commonwealth’s healthcare system, will have their voices heard, united by the common goal of delivering quality, affordable healthcare to every Massachusetts resident.”

“I am deeply grateful that the governor has asked me to serve on the HPC,” said Walsh, who helped write the law establishing the HPC over a decade ago. “Massachusetts patients and providers are facing profound challenges that will likely intensify, but they are also part of a state that believes in collaborative problem solving, innovative public policy, and bold action to support the people at the heart of care delivery. That is exactly the type of progress the Health Policy Commission makes possible, and I look forward to helping shape a stronger healthcare system along with my fellow commissioners.”

As Deadlines Near, Extension Efforts Ramp Up

A number of healthcare programs are set to expire at the end of the hospital fiscal year (September 30) or the end of the 2025 calendar year unless Congress or in some case the administration step in to extend the programs.

One example of a “health extender” at risk come September 30 is the Special Diabetes Program that provides $160 million annually to the National Institutes of Health for type 1 diabetes research. Other extenders facing a September deadline include the moratorium on Disproportionate Share Hospital cuts and funding for the Acute Hospital Care at Home Program.

Last week, 200 groups from across the U.S., including tMED, the Massachusetts Telemedicine Coalition that MHA convenes and which represents more than 50 healthcare provider organizations, wrote to the Drug Enforcement Administration (DEA) asking it to help extend a soon-to-expire waiver allowing the prescribing of controlled substances through telemedicine.

Under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, a prescribing practitioner—subject to certain exceptions—may prescribe controlled medications to a patient only after conducting an in-person evaluation of that patient. In response to the COVID-19 pandemic, the DEA, in concert with the U.S. Department of Health and Human Services, granted temporary exceptions to the in-person evaluation requirements; providers are operating under a third extension of these telemedicine flexibilities through December 31, 2025.

In its letter to the newly confirmed DEA Administrator Terry Cole, the healthcare groups urge the DEA to engage in policymaking that would allow access to tele-prescribing for controlled substances without the in-person evaluation requirement, and to ensure a plan is in place in the coming months “to prevent millions of Americans from losing access to their medical treatments in December of 2025.” Read the full letter with signatories here.

In a related note, the Medicare COVID-19-era telehealth flexibilities that have allowed telemedicine to thrive in recent years, and which have been extended a number of times, are scheduled to permanently sunset on September 30, 2025, unless Congress and the administration acts.

House Ways and Means Hearing Examines Medicare Advantage

Last Tuesday, the U.S. House Ways and Means Committee held a hearing entitled “Medicare Advantage: Past Lessons, Present Insights, Future Opportunities.” During the hearing, lawmakers expressed bipartisan concern over administrative burdens for providers, particularly prior authorization delays, inconsistent payment practices, and high denial rates. Witnesses testified that rural hospitals are especially affected, citing delayed discharges due to post-acute care authorization lags, and readmission non-payment policies that penalize providers even when readmissions are unrelated.

Several members of Congress highlighted how these practices are financially destabilizing hospitals, especially in underserved and rural areas. They emphasized the need for reforms to ensure timely payments and to reduce administrative friction. Witnesses called for modernizing prior authorization through automation and better integration with electronic health records. Legislative proposals such as the Prompt and Fair Pay Act and the REAL Health Providers Act were also discussed as potential solutions to improve provider reimbursement and to ensure accurate provider directories.

The hearing occurred at a time when a wide swath of the public is expressing dissatisfaction with some insurer policies. KFF poll results released last Friday shows, “A large majority of the public (73%) think that delays and denials of services and treatments by health insurance companies are a major problem … Six in ten (57%) Republicans, eight in ten (79%) independents, and over eight in ten (84%) Democrats consider delays and denials of services by health insurance companies to be a major problem.”

Transition

Greg McFarland is the new CEO of MetroWest Medical Center, which includes Framingham Union Hospital in Framingham and Leonard Morse Hospital in Natick. Most recently, he served as COO at Hillcrest Medical Center in Tulsa, Oklahoma, a 656-bed tertiary facility offering trauma, NICU, stroke, cardiac, and burn services. McFarland holds a Master of Healthcare Administration from Trinity University and a bachelor’s degree from Eastern New Mexico University.

John LoDico, Editor