Reposted by Matt FiedlerRyan Hill @ryanreedhill.bsky.social · 11/03/2026There is great excitement about the potential for AI to reshape science, but so far very little empirical evidence about how that is (or is not??) happening in real time. I'm excited to share a new working paper with Carolyn Stein about the impact of AlphaFold on science -> 176
Matt Fiedler @mattafiedler.bsky.social · 26/11/2025There’s a feature of the abortive White House ACA subsidy proposal that I think has been underappreciated. Namely, it seems to only partially extend the enhanced subsidies for people with incomes below 200% of the FPL (~$31k for a single person). That’s about 2/3 of enrollees. 153
Matt Fiedler @mattafiedler.bsky.social · 10/10/2025Will Medicare Advantage’s growth change the degree of favorable selection into the program? My new paper w/ Samantha Crow offers an answer: probably not much. www.brookings.edu/articles/wil...brookings.eduWill Medicare Advantage's rise strengthen or weaken favorable selection? | BrookingsSamantha Crow and Matthew Fiedler examine the effect of Medicare Advantage penetration on favorable selection. 110
Matt Fiedler @mattafiedler.bsky.social · 01/07/2025What will the Senate bill mean for health coverage? We don’t yet have final CBO estimates, but it’s clear they’ll be pretty similar to the House bill. That puts the U.S. on track for an unprecedented increase in the uninsured rate that will wipe out ~3/4 of post-2013 declines. 243
Matt Fiedler @mattafiedler.bsky.social · 28/06/2025The Senate reconciliation bill, at least in its current form, appears likely to reduce coverage about as much as the House bill. If it becomes law, that would mean reversing most of recent years' insurance coverage gains: bsky.app/profile/matt... 031
Reposted by Matt FiedlerAdrianna McIntyre @adrianna.bsky.social · 26/06/2025New-to-me nugget on work requirements implementation in here: Pinging Equifax's The Work Number — which states are likely to rely on to get recent-enough employment data — "sometimes costs over $20 per person per query"donmoynihan.substack.comHow Medicaid Work Requirements Betray Work and Waste MoneyI Oversaw Work Requirements in Michigan - Here is What I Told Congress 22112
Matt Fiedler @mattafiedler.bsky.social · 25/06/2025Clever new piece from Kennah Watts and Jack Hoadley takes a first look at how decisions under the No Surprises Act arbitration process vary across arbitrators. Lots of interesting findings here, including that provider win rates vary a lot by arbitrator. 110
Matt Fiedler @mattafiedler.bsky.social · 16/06/2025From a first look at the Senate drafts, the cuts to Medicaid & the Marketplaces are similar to the House’s, maybe even a bit deeper on net. Upshot: these drafts, like the House bill, would put the US on course for an unprecedented rise in the uninsured rate. bsky.app/profile/matt... 000
Reposted by Matt FiedlerMatt Fiedler @mattafiedler.bsky.social · 10/06/2025My new piece @healthaffairs.bsky.social Forefront finds that if the House bill becomes law and enhanced premium tax credits expire on schedule, the US will see an unprecedented increase in the uninsured rate, wiping out about ~3/4 of the post-2013 decline. 144
Reposted by Matt FiedlerCitizen Cohn / Jonathan Cohn @citizencohn.bsky.social · 10/06/2025"...the US uninsured rate has never risen as far, as fast as it will if the House bill and other looming policy changes affecting insurance coverage take effect" -- @mattafiedler.bsky.social www.healthaffairs.org/content/fore...healthaffairs.orgTaking Stock Of The Health Coverage Impacts Of The House Reconciliation Bill | Health Affairs ForefrontThe US uninsured rate has never risen as far, as fast as it will if the House bill and other looming policy changes affecting insurance coverage take effect; the resulting increase would erase almost ... 145
Matt Fiedler @mattafiedler.bsky.social · 10/06/2025My new piece @healthaffairs.bsky.social Forefront finds that if the House bill becomes law and enhanced premium tax credits expire on schedule, the US will see an unprecedented increase in the uninsured rate, wiping out about ~3/4 of the post-2013 decline. 144
Reposted by Matt FiedlerJacob Wallace @jacobwswallace.bsky.social · 02/06/2025Ok folks, we know work requirements reduce benefits without increasing work (cc: @chloeneast.bsky.social) But who loses benefits and what happens if work requirements are reversed? New evidence from linked SNAP-Medicaid data and a natural experiment in CT tell a concerning story... Thread below 👇tobin.yale.eduSNAP work requirements have biggest effect on those least able to workMost people pushed out of SNAP in Connecticut didn’t find their way back in, even when work requirements were later reversed. 4177105
Matt Fiedler @mattafiedler.bsky.social · 27/05/2025Interesting new paper providing clear evidence that the flu vaccine is effective at reducing both office and emergency department visits for flu in kids. 110
Matt Fiedler @mattafiedler.bsky.social · 23/05/2025Important step from CMS to begin conducting risk adjustment data validation (RADV) audits for *all* MA contracts each year. If implemented well, this could, in effect, reduce MA risk scores by a few percentage points. But a few things to keep an eye on: www.cms.gov/newsroom/pre...cms.govCMS Rolls Out Aggressive Strategy to Enhance and Accelerate Medicare Advantage Audits | CMSAgency Will Begin Auditing All Eligible Medicare Advantage Contracts Each Payment Year and Add Resources to Expedite Completion of 2018 to 2024 Audits 121
Reposted by Matt FiedlerMartin Gaynor @martingaynor.bsky.social · 22/05/2025I want one, and I don’t want the US government undermining the development, distribution, and accessibility of COVID boosters. 68317
Reposted by Matt FiedlerRachel Sachs @rachelsachs.bsky.social · 21/05/2025Also unlike the ACA repeal debate, I am unsure how widely the projected loss of coverage for ~10 million people is known. The ACA debate was clearly healthcare focused. This time, I'm seeing lots of articles referencing the "budget bill," "policy bill," "tax bill," etc. The stakes are less clear. 23621
Reposted by Matt FiedlerEdwin Park @edwincpark.bsky.social · 22/05/2025Thread: Latest House GOP reconciliation bill language again makes the draconian #Medicaid cuts harsher. For example, mandatory work requirements now will take effect 12/31/26 instead of 1/1/29 and states have option to implement them earlier (1/x) 17563297
Reposted by Matt FiedlerChristen Linke Young @clinkeyoung.bsky.social · 22/05/2025Latest House bill text includes another blow to the ACA, ending “silver loading.” That would increase premiums by $350 for a hypothetical family. Here’s why: www.brookings.edu/articles/und...brookings.eduUnderstanding Marketplace "Silver Loading"Christen Linke Young explains a new proposal regarding cost-sharing reductions and how it could impact families who get coverage through the ACA. 04741
Matt Fiedler @mattafiedler.bsky.social · 22/05/2025The updated reconciliation language doubles down on the bill’s Marketplace cuts by ending “silver loading” for the 2026 plan year. This would greatly increase many Marketplace enrollees’ premiums, compounding increases due to expiration of enhanced tax credits. 22915
Reposted by Matt FiedlerRachel Sachs @rachelsachs.bsky.social · 22/05/2025"The plan saves money mainly by removing millions of people from coverage, while offering no alternative means to insure them." Always read @lorenadler.bsky.social and @mattafiedler.bsky.social. 032
Reposted by Matt FiedlerMargot Sanger-Katz @sangerkatz.bsky.social · 17/05/2025Congress is looking at major changes to the Medicaid expansion. New research finds it has saved 27,000 lives. www.nytimes.com/2025/05/16/h...nytimes.comAs Congress Debates Cutting Medicaid, a Major Study Shows It Saves Lives 12617
Reposted by Matt FiedlerAaron Schwartz @aschwartz.bsky.social · 14/05/2025Eric Roberts and @joefigs.bsky.social led a groundbreaking new study on Medicaid and Medicare, out today in NEJM. I’m lucky to have been a part of it. Medicare saves lives. But is it enough to save lives of the most vulnerable Americans? The study suggests no; Medicaid still matters. (1/11)nejm.orgLoss of Subsidized Drug Coverage and Mortality among Medicare Beneficiaries | NEJMA total of 14 million Medicare beneficiaries receive the Low-Income Subsidy (LIS), which reduces cost sharing in Medicare Part D. Losing the LIS may impede medication access and affect mortality. U... 37337
Reposted by Matt FiedlerCitizen Cohn / Jonathan Cohn @citizencohn.bsky.social · 15/05/2025"The plan saves money mainly by removing millions of people from coverage, while offering no alternative means to insure them." Must-read @mattafiedler.bsky.social @lorenadler.bsky.social on House Republican cuts to Medicaid and the ACA www.washingtonpost.com/opinions/202...washingtonpost.comOpinion | 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. 1149
Matt Fiedler @mattafiedler.bsky.social · 30/04/2025How would a federal Medicaid work requirement affect enrollment? My new paper looks back at an Arkansas requirement very similar to one the House passed in 2023. I estimate an Arkansas-like policy would reduce Medicaid enrollment for ppl subject to it by 34% in the long run: 132
Reposted by Matt FiedlerCitizen Cohn / Jonathan Cohn @citizencohn.bsky.social · 20/04/2025GOP leaders are now saying they want to protect Medicaid for "the truly vulnerable" That's actually code for a big cut -- and taking out a piece of the ACA with it My latest at @thebulwark.bsky.social www.thebulwark.com/p/health-ins...thebulwark.comHealth Insurance for Millions Is Now on the Chopping BlockRepublicans’ very quiet, very serious effort to go after Obamacare’s Medicaid expansion. 17302156
Reposted by Matt FiedlerAdrianna McIntyre @adrianna.bsky.social · 16/04/2025Aside from the bigger picture, I’m not sure where Cassidy gets the idea that “states are supposed to pay 40%.” FMAP is calculated according to a formula in statute, which enforces a floor of 50% and a ceiling of 83% match. Louisiana is only paying 32 cents on the dollar. 1014249
Reposted by Matt FiedlerLarry Levitt @larrylevitt.bsky.social · 14/04/2025Speaker Johnson here is trying to frame Medicaid coverage of working people -- who are eligible based on the ACA Medicaid expansion in 40 states plus DC -- as "fraud, waste, and abuse." bsky.app/profile/atru... 1914658
Reposted by Matt FiedlerProf Keith Marzilli Ericson @profericson.bsky.social · 07/04/2025🚨 Rethinking Moral Hazard: Moral hazard in health insurance—the increased spending that comes when you get insured—is usually seen as wasteful due to insurance’s price distortion. This paper challenges that view. 14815
Matt Fiedler @mattafiedler.bsky.social · 27/03/2025A quick thread on the policy implications of this interesting WSJ piece on duplicate Medicaid enrollments. There is likely room for sensible reform here, but the potential savings are much smaller than the gross amount of the duplicate payments. www.wsj.com/health/healt...wsj.comTaxpayers Spent Billions Covering the Same Medicaid Patients TwiceWhen recipients signed up in two states at once, insurers often got paid by both. “It definitely is wasteful,” said one former state Medicaid director. 100
Reposted by Matt FiedlerEdwin Park @edwincpark.bsky.social · 18/03/2025New Urban Institute estimates of mandatory #Medicaid work requirements. At least 4.6-5.2 milion people would lose Medicaid coverage but would be significantly higher if work requirements apply beyond Medicaid expansion, some exemptions aren't automatically provided: www.urban.org/research/pub... 01213
Reposted by Matt FiedlerJordan Matsudaira @jdmatsudaira.bsky.social · 12/03/2025The dismantling of NCES is insane and will critically hobble progress in improving education - this agency is so important it existed more than 100 years before the creation of Department of Education. 210453
Reposted by Matt FiedlerMartin Austermuhle @maustermuhle.bsky.social · 11/03/2025NEW in @51st.news: House Republicans just voted to defund D.C. police and schools. As part of a spending bill to avert a federal government shutdown, they could force D.C. to slash $1.1 billion out of its budget, and no one understands really why. 51st.news/house-republ...51st.newsDollars and nonsense: House Republicans vote to defund D.C. police and schoolsCongress could force D.C. to cut $1.1 billion out of its local budget, but no one really understands why. 140947562
Reposted by Matt FiedlerRachel Sachs @rachelsachs.bsky.social · 11/03/2025CMS projects 750k-2 million people will "lose coverage as a result of this rule" in 2026 but notes this may be an underestimate due to administrative burdens imposed by the rule (pp. 271-2). This is on top of millions CMS expects to lose coverage if enhanced tax credits expire this year (p. 260). 53030
Matt Fiedler @mattafiedler.bsky.social · 26/02/2025I was honored to testify before the health subcommittee of House Energy & Commerce this morning on pharmacy benefit manager reform (and, as it turned out, answer many members' questions on pending Medicaid policy changes too). My four main points (on PBMs): 141
Reposted by Matt FiedlerJohn Graves @johngraves.bsky.social · 14/02/2025Four primary levers to *reduce* Medicaid costs are: 1. ↓ Eligibility 2. ↓ Benefits 3. ↓ Payment rates 4. ↑ "Ordeals" (frequent redetermination, more paperwork / hoops, like work reqts, ↑ prior auth / utilization mgmt) The primary lever to *shift* fed costs to states is ↓ matching rates. 183
Matt Fiedler @mattafiedler.bsky.social · 13/02/2025In the 2026 MA Advance Notice, CMS said that it may begin calibrating the MA risk adjustment model using encounter data (snippet below). Unfortunately, this change would not achieve what CMS hopes it would—and might well be a step in the wrong direction. 110
Reposted by Matt FiedlerNicholas Bagley @nbagley.bsky.social · 28/01/2025Excellent rundown of the legality -- or, rather, illegality -- of OMB's funding freeze from @davidasuper.bsky.social: 1126
Reposted by Matt FiedlerSam Bagenstos @sbagen.bsky.social · 28/01/2025I see some suggestions, in the reporting regarding the OMB impoundment order, that a mere delay in spending appropriated funds is legal. But that's not really true. The delay OMB has ordered specifically contradicts the Impoundment Control Act. A thread. 9151271891
Reposted by Matt FiedlerSam Bagenstos @sbagen.bsky.social · 28/01/2025Medicaid is FFA. But it might be practically exempt bc the statutory formula for paying FMAP means a pause is inconsistent with (non-ICA) law. So the “required by law” exception in the memo should apply. 4114
Reposted by Matt FiedlerAdrianna McIntyre @adrianna.bsky.social · 10/01/2025The GOP's "menu" of reconciliation pay-fors (via Politico) makes it clear that cost-savings aren't possible without deep cuts to Medicaid — these big-ticket proposals will both hurt beneficiaries *and* piss off governors. www.politico.com/f/?id=000001... 25217116
Matt Fiedler @mattafiedler.bsky.social · 09/01/2025Estimates of Traditional Medicare costs used to set Medicare Advantage benchmarks are subject to sampling error since TM enrollment is finite. How big a problem is this? New paper has an answer: Not too big in the medium-term, though there’s room to improve in tiny counties. 1121
Reposted by Matt FiedlerLoren Adler @lorenadler.bsky.social · 16/12/2024A lot of overblown rhetoric flying around in the PBM debate. There are real issues in the market, though many tied to broader issues of market power & adverse selection. Our attempt to draw out the key trade-offs & effects of different policy options. www.brookings.edu/articles/a-b...brookings.eduA brief look at current debates about pharmacy benefit managersMatthew Fiedler, Loren Adler, and Richard G. Frank explain the current debate on PBMs and qualify the proposals being considered in Congress. 062
Matt Fiedler @mattafiedler.bsky.social · 12/12/2024Apropos of the ongoing conversation about health care administrative costs, resharing my testimony to Senate Budget on the administrative costs generated by provider-payer interactions and how policymakers could reduce them. Four main points: 151
Reposted by Matt FiedlerLawson Mansell @lawsonmansell.bsky.social · 06/12/2024As @awgaffney.bsky.social has noted in the past, "It's the prices" is a mostly correct but imperfect summation of health spending drivers. It's the way we finance our health system, both the perverse incentives that distort the market and the unnecessary admin burden created by the fragmentation. 092
Reposted by Matt FiedlerLarry Levitt @larrylevitt.bsky.social · 05/12/2024New from the Congressional Budget Office: Not extending enhanced ACA premium assistance beyond 2025 would ultimately lead to 3.8 million more people uninsured. www.cbo.gov/system/files... 12317
Matt Fiedler @mattafiedler.bsky.social · 21/11/2024How much do nongroup plans pay providers? Really enjoyed this new paper from Hanson et al. that finally offers a good answer. Short answer: less than group plans, but a lot more than Medicare. Link: www.healthaffairs.org/doi/full/10.... 0178