EP469 (Part 1): The Impact on Plan Sponsors of Medicaid Cuts, With James Gelfand, JD

In Part 1 of this two-part episode, Stacey Richter speaks with James Gelfand, President and CEO of the ERISA Industry Committee (ERIC), about the potential effects of proposed Medicaid cuts on plan sponsors and their members. They explore ways plan sponsors can prepare for the changes, including Medicaid's four major areas of possible cuts: reducing waste, fraud, and abuse; implementing work requirements; reeling in provider taxes; and addressing the "Cornhusker Kickback" from the ACA. The conversation also delves into how state governments and hospitals might respond to these cuts and suggests actions for plan sponsors to mitigate potential impacts. The episode is part one of a two-part series, with the second episode covering Medicare site-neutral payments and HSA reforms.

WHAT YOU'LL LEARN

✅ The four main areas Congress is actually looking at for Medicaid cuts: reducing waste, fraud, and abuse; work requirements; reeling in provider taxes; and addressing the "Cornhusker Kickback" carve-out from the ACA

✅ What the "Cornhusker Kickback" is and why it's become a flashpoint in the current Medicaid cuts debate

✅ What plan sponsors should be doing right now to prepare for potential Medicaid cuts, before the policy details are finalized

✅ What's likely to happen to hospitals — particularly those heavily reliant on Medicaid reimbursement — under the proposed cuts

✅ How hospital consolidation compounds the risk of these Medicaid cuts, and why a more consolidated market has fewer options to absorb the shock

WHY THIS MATTERS

Medicaid cuts don't stay contained to the Medicaid population — when hospitals lose Medicaid revenue, they look elsewhere to make up the difference, and commercial plan sponsors are usually the next stop. Understanding the four levers Congress is actually considering, rather than the political noise around them, is what lets plan sponsors get ahead of the cost-shifting before it shows up in their own claims data.

MENTIONED IN THIS EPISODE

EP464 with Al Lewis: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction.

05:22 What's happening with Medicaid cuts?

06:47 What are the four main things congress is actually looking at in cutting Medicaid?

09:12 What is the Cornhusker Kickback?

16:46 What should plan sponsors be doing right now to prepare for these potential Medicaid cuts?

20:04 What's going to happen to hospitals with these proposed Medicaid cuts?

23:41 How does hospital consolidation affect the potential future with these Medicaid cuts?