| | | | |  | | By Ben Leonard and Chelsea Cirruzzo | | Presented by |  | | | | | | | 
Despite Vice President Harris touting Medicare reforms, Medicare Advantage plans face challenges with fewer high-quality options and reduced benefits for 2025. | Jacquelyn Martin/AP | STARS NOT ALIGNED — Vice President Kamala Harris has touted her role in passing key reforms to Medicare throughout her campaign for the White House. But older Americans face fewer choices of high-quality private Medicare Advantage plans as they shop on Tuesday for 2025 coverage. And insurers argue that some plans are leaving the program and reducing benefits, POLITICO’s Robert King and Kelly Hooper report. “There is no stability to the program right now,” said Dr. Sachin Jain, CEO of not-for-profit SCAN Health Plan, based in California. “It’s going to be, in an election year, forcing people to think about changing their benefits.” CMS released its individual ratings last week for Medicare Advantage plans, which are administered by a private insurer and offer benefits unavailable in traditional Medicare. Each plan gets a rating of one to five stars based on performance on 40 measures, including quality of care and customer service. Only seven plans achieved five stars for 2025 compared with 38 this year and 57 in 2023. The percentage of four-star plans is also down, but not by as much as five-star plans. A plan’s rating can affect how much money it gets from Medicare. Insurers’ take: Insurers claim they’ve been forced to cut benefits due to changes imposed by the Inflation Reduction Act , which Harris cast the tie-breaking vote for in 2022. The changes include a $2,000 cap on out-of-pocket drug costs. CMS has made other moves to improve the accuracy of government payments to plans, including overhauling its audit program. The insurer-funded Better Medicare Alliance released an analysis showing that, of the 25 top Medicare Advantage insurers, 76 percent decreased their regular plan offerings. While some benefits like dental or hearing remain stable, plans are slightly cutting back on other benefits such as meal assistance and transportation to the doctor’s office. View from the agency: CMS told POLITICO that the Medicare Advantage market and the benefits and choices for older Americans are stable. The agency pointed to a slight decline in average monthly plan premiums, from $18.23 in 2024 to $17 next year. Experts say the truth about the program lies somewhere in the middle. The overall number of plans is expected to decline from 3,899 this year to 3,644 in 2025, according to an analysis from the consulting firm Avalere Health. WELCOME TO WEDNESDAY PULSE. Are there any health care issues that could be October surprises? We want to hear from you. Send your tips, scoops and feedback to bleonard@politico.com and ccirruzzo@politico.com and follow along @_BenLeonard_ and @ChelseaCirruzzo.
| | | | A message from PhRMA: Drug price “negotiations?” Higher costs and less access to medicines are not what seniors were promised when the Inflation Reduction Act (IRA) was signed into law. Learn more about the IRA’s unintended consequences. | | | | | | | | 
Dr. Kristin Lyerly of Wisconsin is one of two OB-GYNs running for seats in Congress; both have made abortion rights a central issue in their campaigns. | WLUK-TV via AP | OB-GYN HOUSE CALL — With Congress losing several doctors and health policy leaders after this term, the institution could add a pair of OB-GYNs. In the upcoming election, two Democratic doctors, Kristin Lyerly and Kelly Morrison, are running for seats in Wisconsin and Minnesota, respectively. Their campaigns come at a time when reproductive rights have become a central issue two years after the Supreme Court overturned Roe v. Wade. If elected, they’d become the only Democratic OB-GYNs in Congress. Currently, only two OB-GYNs serve in Congress: Rep. Michael Burgess (R-Texas), who’s not seeking reelection, and Sen. Roger Marshall (R-Kan.). Both Lyerly and Morrison have leaned heavily into expanding abortion rights in their campaigns. Lyerly is running for the seat vacated by former Rep. Mike Gallagher (R-Wis.), and Morrison is running for Rep. Dean Phillips’ (D-Minn.) seat. Phillips isn’t running for reelection after taking on President Joe Biden in a longshot primary challenge. The forecast: Morrison is expected to win the seat in a Minneapolis suburb district that Phillips captured by nearly 20 points in 2022. Lyerly faces long odds in a heavily Republican Green Bay-area district. Morrison, who was most recently in the Minnesota Senate, served on the chamber’s health committee and pushed legislation reforming prior authorization. Her campaign has focused on lowering health care costs, safeguarding reproductive rights and bolstering mental health and addiction treatment. Another doctor: Dr. Maxine Dexter, a pulmonologist at Kaiser Permanente, is expected to win a Portland-area seat and replace Rep. Earl Blumenauer (D-Ore.), who’s not seeking reelection. Looking for up-to-the-minute 2024 campaign coverage? POLITICO is showcasing the full breadth and depth of our reporting and analysis at politico.com/2024, a live blog where our reporters will bring you the latest scoops, share exclusive Q&As and tell you who’s winning each day over the next three weeks.
| | WALGREENS TO SHUTTER 1,200 STORES — Retail pharmacy giant Walgreens will close about 1,200 locations over the next three years, the company said Tuesday, about 1 in 7 of its stores. “We are focusing on stabilizing the retail pharmacy by optimizing our footprint,” Walgreens Boots Alliance CEO Tim Wentworth said in a statement. Wentworth took over as CEO last year and has tried to take the company in a better financial direction. The bigger picture: The move comes amid broader challenges for retailers like Walgreens and Walmart that have tried to broaden their standing in health care. Many, including Walgreens with its VillageMD clinics, have experimented with new ways to deliver health care. In April, Walmart said it would close all its 51 health centers and telehealth arm, saying the health division isn’t a sustainable business model. CVS Health also said Tuesday that it would close more than two dozen pharmacies, Healthcare Dive reported, and discontinue some infusion services. Primary care typically runs on slim margins. Analysts have been skeptical that retailers can scale retail primary care models nationwide. “This has been a part of healthcare that’s been struggling to be profitable. It has become less essential to have a neighborhood pharmacy right near you,” Craig Garthwaite, professor of strategy at Northwestern University’s Kellogg School of Management, told Pulse. “Standalone primary care is a really hard place to make money right now.”
| | | | A message from PhRMA:   | | | | | COST OF CHANGE — The toll of the massive cyberattack on Change Healthcare in February has cost parent company UnitedHealth Group nearly $2.5 billion, the company said in its earnings report Tuesday. That includes more than $1.7 billion in direct response costs. John Rex, chief financial officer, said the company is still working to bring transaction volumes at billing processor Change Healthcare back to pre-attack levels. The background: The attack stemmed from the failure to implement two-factor authentication, leading to widespread disruptions in provider payments nationwide. Cyberattacks have surged in the sector, threatening patients’ lives and health care organizations’ bottom lines. Lawmakers in Congress have proposed sweeping legislation that would require HHS to enforce minimum cybersecurity standards in the health care sector.
| | RSV ANXIETY SOFTENS — After a surge in RSV cases in the 2022-2023 respiratory virus season fueled heightened concerns about the virus, public concern about it is waning, according to a new nationwide survey from the Annenberg Public Policy Center of the University of Pennsylvania. The U.S. saw an early surge in respiratory syncytial virus in the season beginning in 2022, which led to a spike in hospitalizations. The virus typically causes mild symptoms but can be severe in infants and older adults. There was also a shortage of RSV vaccines last fall after manufacturer Sanofi underestimated demand. According to the survey, U.S. adults’ concern about themselves or family members contracting the virus rose after that surge but has fallen this year. Despite the dip in concern about RSV, worries about Covid-19 and flu haven’t faded, the survey found.
| | | | A message from PhRMA: Seniors are feeling the true cost of drug price “negotiations.”
Instead of saving money, some Medicare patients will pay more for medicines.
Others may not be able to get their medicines – 89% of insurers and PBMs say they plan to reduce access to medicines in Medicare Part D because of the Inflation Reduction Act.
Higher costs and less access. That’s not what seniors were promised.
Learn more. | | | |  | | The CDC is projecting this fall and winter respiratory virus season will be similar to or slightly milder than last year's.
| | AN EARLY GOODBYE — New York City Health Commissioner Ashwin Vasan will step down Friday, months before his planned departure in January, POLITICO’s Maya Kaufman reports. He cited family needs that have “taken on greater urgency” since he announced last month his plans to resign. Vasan has led the department — one of the world’s largest public health agencies — since March 2022, after being appointed by Mayor Eric Adams. He was previously CEO of the mental health nonprofit Fountain House. On the horizon: Dr. Michelle Morse, the city’s first chief medical officer, will serve as interim commissioner of the Department of Health and Mental Hygiene until a permanent replacement is appointed. The department, like many city agencies, is contending with extended vacancies in key roles — chiefly the position of first deputy commissioner and chief program officer, which is second in command to the health commissioner. The move comes amid broader turmoil in the Adams administration after the mayor was indicted last month on corruption charges, which he denies.
| | | | The Wall Street Journal reports on how to navigate changes in Medicare plans. CNN reports that bystanders without medical training are increasingly administering the opioid overdose reversal drug naloxone. | | | | Follow us on Twitter | | | | Follow us | | | | |
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