March inSights
Summaries and Scoops: The Things You Should Know
March was a busy month!
What’s Going up on the Hill?
Republicans in Congress continued their march towards reconciliation with a proposal that would cut $880 billion in federal health care spending, most of it from Medicaid. While the House and Senate budget resolutions are very different from each other, it now appears that Republican leadership will develop a budget resolution that aligns both Chambers and vote on it by April 11 - before the Easter recess. Should be an interesting first half of April on the Hill!
What’s Up at the White House?
While there’s been a lot of activity at the White House, it has largely revolved around non-health policy related issues. That said, President Trump did sign two Executive Orders (EO) that have some health policy implications. First, the President signed an EO that rescinds previous EOs and presidential memorandum on COVID-19 and infant formula supply issues. He also signed an EO that requires agencies to eliminate “information silos” as a way to address fraud, waste and abuse. This later EO could have implications on Medicare, Medicaid, and Marketplace systems.
What’s Cooking at Humphrey?
It’s hard to keep up with all the changes coming out of HHS, but the biggest one for sure is the reorganization of the Department. Secretary Kennedy announced last week a significant reorganization of the Department which will result in a nearly 20,000 dedicated civil servants losing their jobs, including 300 people in CMS. In addition to the staff reductions, whole agencies will disappear, including the Administration for Community Living, or ACL. On top of these personnel changes, HHS issued a proposed rule that rolls back ACA Marketplace efficiencies as well as Medicaid guidance on how states can use waivers to address health related social needs. Finally, the Department cancelled millions of dollars in funding for HIV and diabetes prevention activities as well as grants to states for public health actives.
Spotlights
There’s been a ton of new reports out this month, but the one I thought deserved a little “spotlight” is a new Commonwealth Fund report on the economic impact from Medicaid and SNAP cuts. Given that these two programs are on the chopping block to fund tax cuts for the wealthy, I thought it was a helpful report to show how cutting them will hurt state economies. The report’s toplines are that cutting Medicaid and SNAP could lead to 1 million lost jobs, a $113 billion reduction in states’ GDPs by 2026, and $9 billion in lost state and local tax revenues.
Here’s a link to the full report: https://www.commonwealthfund.org/publications/issue-briefs/2025/mar/how-cuts-medicaid-snap-could-trigger-job-loss-state-revenue
Slants
On March 10th, CMS issued the 2025 Marketplace Integrity and Affordability Proposed Rule that proposes to roll back commonsense strategies the Biden Administration put in place to help people enroll in and keep their ACA coverage. The rationale for these changes is to address “fraud, waste, and abuse” - an argument that we’ve heard also used to justify $880 billion in Medicaid funding cuts. But in reality all these changes will do is cover fewer people while creating more red tape, a less efficient enrollment process, and fewer opportunities to enroll. Specifically:
1. Shorter Open Enrollment Period = Fewer People Covered. The proposal to shorten the Open Enrollment period by a month means fewer people will sign up. A better way to ensure "consumers maintain continuous coverage into the new year" would be to restore the $360 million in Navigator funding that was recently cut. Navigators play an important role in enrollment and outreach, and with that money, they could implement targeted continuous coverage efforts.
2. The Monthly SEP for Low-Income People is NOT an Incentive for Sick People to Sign Up Whenever They Want. When CMS announced the proposed rule earlier this month, it suggested that the monthly special enrollment period, or SEP, for individuals making less than 150% of the federal poverty level (or $23,500 for a single person, and $40,000 for a family of three) encourages adverse selection. That's not we found during the Biden Administration. In fact, CMS noted in the 2025 final payment notice that the adverse selection risk may be lower than what it initially expected.
3. Rolling Back Program Efficiencies = More Red Tape and Paperwork. The rule also proposes to roll back commonsense verification efficiencies the Biden Administration put in place to cut red tape and make it easier on consumers applying for and renewing their coverage.
If you want to read a more in depth analysis on this rule, would highly recommend reading Katie Keith’s and Jason Levitis’ Health Affairs articles.
Something Sweet
Happy Pi Day &
Happy 15th Birthday, ACA!
March was a special month - we celebrated Pi Day on March 14th and the 15th anniversary of the enactment of the Affordable Care Act on March 23. In honor of these monumental holidays, I decided to try out a new recipe for a Birthday-Cake Pie. This recipe can be found in Erin McDowell’s “The Book on Pie.” This is a custard-y type pie, which is generally not my favorite type of pie (more of a fruit kinda gal). But I found that I couldn’t stop eating this straight out of the fridge while it was still cold. The crust is a basic crumb crust that you make out of vanilla wafers. Ms. McDowell suggests topping the pie with either a chocolate meringue or chocolate whipped cream. I tried it with the chocolate whipped cream, but I really just enjoyed eating it plain. Let me know if you try it and your thoughts/reviews!
Happy Baking!
For the Crust
1 ¾ cups vanilla wafer crumbs
1/4 cup granulated sugar
6 tablespoons unsalted butter
In a medium bowl, stir the crumbs, sugar and salt together to combine. The crust should easily hold together in clumps when you press it together between your fingers (if it doesn’t, add a little more melted butter, 1 tablespoon at a time, until it does. Press the crust evenly into the bottom and up the sides of ungreased 9 inch pie plate: First make an even layer in the bottom of the pan, then press the rest of the crumps up the sides. Preheat the oven to 350 degrees Fahrenheit. Bake for 10 to 12 minutes until begins to lightly brown at the edges.
For the Pie
1 cup granulated sugar
1/3 cup all-purpose flour
2 large eggs, separated
1 cup heavy cream
4 teaspoons vanilla extract
¼ teaspoon almond extract
½ teaspoon fine sea salt
¼ teaspoon cream of tartar
1/3 cup round confetti sprinkles, plus more for serving
Preheat the oven to 375 degrees Fahrenheit with a rack in the lower third. In a medium bowl, whisk ½ cup of the sugar and the flour to combine. In a small bowl, light whisk the egg yolks. Add the egg yolks, cream, vanilla and almond extracts, and salt to the sugar mixture and whisk until well combined. Place the egg whites and cream of tartar in the bowl of a stand mixer fitted with the whip attachment and whip on medium-high speed until foamy, about 1 minute. With the mixer running, add the remaining ½ cup sugar in a slow, steady stream and then continue to whip to medium peaks, 3 to 5 minutes. Add about one quarter of the meringue to the egg yolk mixture and gently whisk to incorporate. Whisk in the remaining meringue in two or three additions. Gently fold in the sprinkles. Place the parbaked crust on a baking sheet. Pour the custard into the pie crust and gently sprinkle more sprinkles over the top. Bake until the pie appears set, 35 to 40 minutes. Cool to room temperature.
Make Ahead and Storage
The pie, without any topping, can be made 24 hours ahead and stored at room temperature. Store leftovers in an airtight container in the fridge.
