News reports across the country trumpet major mergers and consolidation involving health insurers, physician practices, pharmacy benefit managers, hospitals and health systems, and other providers, including many that integrate different services under a single umbrella. The wave of consolidation and integration has federal and state policy makers examining how it affects competition, prices, and overall costs.

Three experts joined moderator Larry Levitt for a discussion about health care consolidation and integration. The panelists discussed the motivations behind horizontal and vertical consolidation in health care, its potential to lower or raise costs, the implications for patients and payers, and how policy makers could respond.

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Amid perennial public concern about the cost of prescription drugs, the Trump administration has undertaken a raft of efforts to push or persuade drug manufacturers to lower drug prices. These include “Most Favored Nation” proposals that would tie U.S. drug prices to the lowest cost in other countries and encouraging manufacturers to make more drugs available for sale directly to consumers at discounted prices. To date, the administration has inked two voluntary deals with pharmaceutical companies to sell drugs to the Medicaid program at most-favored nation pricing and launch new drugs in the U.S. at the same price as in other countries in exchange for a three-year reprieve from new tariffs on their products. The administration also set up a website, Trumprx.gov, scheduled to launch in 2026, through which it plans to connect consumers to manufacturers and other vendors enabling direct-purchase of prescription drugs.

On November 20 , three experts joined Larry Levitt, executive vice president for health policy at KFF, for a 4“Health Wonk Shop” discussion about the latest developments in prescription drug pricing and what they mean for drug manufacturers, patients and public and private health insurance programs. Among the questions to be discussed include:

• How did the administration’s efforts to lower drug prices square with drug price negotiation in Medicare, and a provision in the One Big Beautiful Bill Act that allows drug companies to exempt more products from those negotiations?
• Are the Trump administration’s moves translating into lower drug prices for consumers? Which consumers might benefit most from these efforts? Are those prices at least as low as those paid for the same drugs in comparable countries?
• How will the availability of drugs be affected, if at all?
• What might the effects be on drug prices in other countries?
• How effective will voluntary agreements with drug companies be over time?

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President Trump signed into law in July a budget reconciliation package that mandates all adults who are eligible for Medicaid through the ACA expansion meet federal work and reporting requirements. At a minimum, the 41 states (including D.C.) that have expanded Medicaid under the ACA will be required to verify that individuals are working or meet certain exemptions when they apply for or renew their Medicaid coverage.

Four experts, including two state Medicaid directors, joined Health Wonk Shop series moderator Larry Levitt for an hour-long discussion of how states will go about implementing the new Medicaid work requirements.

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The Supreme Court’s June 28 decision overturning the Chevron precedent that required federal courts to defer to reasonable agency decisions when federal law is unclear creates potential challenges for crafting health policy legislation and regulations. On July 25, 2024, a panel of experienced policy and legal experts explored how Congress and federal health agencies are likely to adapt to the Court’s decision and what that may mean for health care policymaking.

Moderated by Larry Levitt, KFF’s executive vice president for health policy, the discussion addressed questions including: How will the decision change how regulators approach drafting new regulations? What type of health policy regulations are likely to be most vulnerable to future court challenges? How will it alter the legislative process and the ability to pass new laws? To what extent will Congress be able to provide greater specificity in delegating authority to federal agencies in future legislation?

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With Congress looking for ways to cut health care costs for patients and the Medicare program, one approach drawing bipartisan attention involves site-neutral payments for outpatient services. The idea is for Medicare to pay the same amount for a service regardless of where it is provided – a departure from current Medicare reimbursement policy, which generally pays higher rates for services provided in hospital outpatient departments versus independent physician offices and ambulatory surgical centers.

Listen to a panel of experts discuss the concept of site-neutral payments, including why it has become an issue for policymakers and private payers like insurers and employers, how Medicare payments currently work, how various proposals would change the law, and the potential impact of those changes.

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