The Trump administration's surprise decision to freeze payments to private Medicare plans is likely to supercharge tensions between physicians and insurers and create new barriers to senior care.

Why it matters: Limiting revenue in a core business for major health insurers will set off a chain reaction that ultimately affects the more than 34 million beneficiaries in Medicare Advantage plans.

• "Plans are genuinely being squeezed here, and they don't have any alternative but to really squeeze providers," said Susan Dentzer, CEO of America's Physician Groups. "That bodes very poorly for patients."

State of play: Medicare administrators last month proposed an average rate increase of 0.09% next year — a sharp departure from recent years.

• The proposal caught industry and investors off guard and sent health insurer stocks spiraling.
• Insurers and Medicare Advantage lobbyists say it doesn't keep up with rising medical costs and will make it harder to keep premiums low and offer supplemental benefits like vision care.

The concern extends to physician groups and hospitals that contract with MA plans, who are bracing for lower payments and, possibly, more reviews on doctor-ordered care. Some could drop out of the program and threaten the stability of insurers' networks.

• "It's already hard enough to get paid," said Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association. "Is this going to make it harder, because the plans are going to fight tooth and nail to hold on to every dollar?"

What's ahead: The administration is due to finalize 2027 payments in early April and could still opt to give the insurers more money.

• Election-year pressure and the prospect of service reductions or higher health costs for seniors right before the midterms could play a part in the final policy.

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The FDA's refusal to review Moderna's mRNA flu vaccine is raising questions about how the Trump administration intends to treat other new products built around the technology.

Why it matters: Some medical experts warn that the U.S. will miss out on promising new vaccines if it does not embrace the technology, which powered the COVID-19 shots and could be adapted to target other diseases, including cancer.

Driving the news: The FDA's decision, which the company disclosed on Tuesday, comes after HHS last year canceled nearly $500 million in grants for developing new mRNA vaccines.

• The FDA said that it rejected Moderna's application because the company refused to follow guidance on which current flu vaccine its new product should be compared with in its study.
• Moderna countered that the FDA hadn't objected before the study began.

What they're saying: "It seems that the federal government, at this point, has decided unjustifiably against mRNA vaccines," said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.

• He added that position "disincentivizes companies to use mRNA vaccine technology."
• Drug development experts raised concern that companies won't invest in long and expensive clinical trials if they think the FDA could move the goalposts at the end of the process.

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Senate Democrats today are reviving a Biden-era effort to set the first-ever national minimum staffing requirements for nursing homes, Axios has learned.

Why it matters: The Trump administration last year rescinded a policy that would have created baseline staffing rules for long-term care settings in response to widespread reports of patient harm due to understaffing.

• Administrators pulled the rule after nursing home executives donated millions to a Trump-aligned super PAC, the New York Times reported last month. A federal judge in Texas had also previously tossed out the regulation.

Zoom in: A bill led by Senate Finance Committee Ranking Member Ron Wyden of Oregon would require nursing homes to have a registered nurse on site 24 hours a day, seven days a week.

• Each resident in a nursing home would also get at least three and a half hours of nursing care per day, his office told Axios.
• Both mandates were included in the Biden-era regulation.

The intrigue: The bill would designate $800 million annually for state inspections of nursing homes and other health providers, and to support enforcement activities.

The other side: The nursing home industry has called staffing mandates unworkable without more funding.

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A plan to allow pharmacies to dispense ivermectin without a prescription died in the Utah legislature after receiving objections from state medical associations.

The big picture: The vote this week came amid a red state push to increase access to what some conservatives tout as an alternative treatment for COVID-19.

• Sponsors say the effort would expand medical freedom and align with Health Secretary Robert F. Kennedy Jr.'s "Make America Healthy Again" agenda.
• At least five states have already legalized ivermectin sales without a prescription: Texas, Tennessee, Arkansas, Idaho and Louisiana.

Yes, but: Multiple medical studies have found the drug isn't effective at treating coronavirus, and leading medical institutions have warned against its use outside FDA approval.

• The drug is approved for human use to treat parasitic worms and conditions such as head lice and rosacea.

The bill failed in the Utah House's health and human services committee on a 7-5 vote. The Utah Medical Association and the Utah Nurses Association opposed the proposal.

• A proposal similar to the Utah bill has been introduced in Arizona's legislature.

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🔪 The CDC is looking to cut about $600 million in public health grants for four Democrat-led states, arguing they don't reflect the agency's priorities. (Healthcare Dive)

💊 A House health panel came down hard on drug supply chain players at a hearing on what's driving rising costs. (Roll Call)

📉 Humana gained about 1 million Medicare Advantage members during the latest open enrollment but that rapid growth is weighing on profit expectations. (Stat)