Health Plan Weekly

Price Transparency Slowdown May Aid Strategic Response

Delays are hitting some aspects of the federal price transparency agenda — the complex web of laws, rules and regulations targeting insurers, providers and pharmacy stakeholders, among others. But policy experts say it’s not time to sit back and wait.

That’s what a panel of payer- and provider-focused insiders from the Advisory Board recommended during a Dec. 1 webinar covering federal transparency requirements for the health care sector.

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Average ACA Benchmark Premium Drops for Fourth Year in a Row

Average premiums for the Affordable Care Act Marketplace benchmark silver plan fell 3.1% across the country in 2022, although the changes varied by location and type of plan, according to a Kaiser Family Foundation county-level analysis. Because the American Rescue Plan Act temporarily increased and expanded subsidies for low- and middle-income individuals and families, tax credits will cover the full premium for the lowest-cost silver plan for a 40-year-old individual earning $20,000 (155% of the federal poverty level) in two-thirds of counties nationwide. The ACA open enrollment period for HealthCare.gov and most state-based marketplaces began Nov. 1 and ends on Jan. 15.

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MCO Stock Performance, November 2021

A look at how major publicly traded insurers’ stock performed in November 2021.

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News Briefs: AMA, AHA Sue Over Surprise Billing Regulation | Dec. 10, 2021

The American Medical Association (AMA) and the American Hospital Association (AHA), the largest provider trade groups in the country, sued the Biden administration over regulations HHS issued in implementing the No Surprises Act. In a lawsuit filed Dec. 9 in the U.S. District Court for the District of Columbia, the AMA and AHA request injunctive relief of the latest interim final rule implementing the No Surprises Act. The Biden administration’s most recent rule aimed at implementing the surprise billing ban, which comes into effect on Jan. 1, 2022, has come under fire from provider groups — and members of Congress, many of them physicians — for “plac[ing] a heavy thumb on the scale of an independent dispute-resolution process that would unfairly benefit insurance companies,” in the words of an AMA press release.

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Health Insurers Embrace Vaccine Requirements for Workers

Although the Biden administration’s vaccine mandates are meeting resistance in the federal courts, many health care firms — including insurers — appear to be requiring their employees to get COVID-19 vaccinations anyway.

In a newly released survey from Willis Towers Watson, 47% of health care organizations polled said they had a vaccine requirement in place already, compared to just 18% of employers overall. On the flip side, 15% of health care companies said they were not planning to adopt a vaccine mandate, while 33% of employers overall said the same.

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TeamHealth Wins One Battle in Ongoing War With UnitedHealth

A jury recently found UnitedHealthcare underpayed Nevada emergency care subsidiaries of TeamHealth Inc. in out-of-network billing scenarios — and it’s the first of several ongoing suits between the two health care firms to wrap up. Experts say that the No Surprises Act, which comes into effect next month, will fix some of the issues raised in the lawsuit, but also point out that settling out-of-network billing disputes remains a matter of leverage.

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Optum Dominates UnitedHealth’s Investor Day, Growth Strategy

UnitedHealth Group’s Investor Day presentation, Wall Street analysts came away with the distinct impression that the company’s Optum division — which now comprises 52% of its overall earnings — was the “star of the show.”

UnitedHealth’s annual investor day “featured a heavy dose of the integration and collaboration” between Optum and UnitedHealthcare, the company’s health insurance division, to drive its long-term target of 13% to 16% earnings per share (EPS) growth, Citi analyst Ralph Giacobbe wrote in a Nov. 30 note to investors.

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Before Expanded Subsidies, ACA Exchange Plans Became Less and Less Affordable for the Middle Class

Half of families with incomes between 401% and 600% of the federal poverty level (FPL) would have paid at least 7.7% of their income for the lowest-cost bronze family plan in the Affordable Care Act exchange market in 2015, while they would have paid at least 11.3% of their income in 2019, according to a Health Affairs study. The studied population included families of four with annual incomes of $106,000 to $159,000 in 2021, two-person families with incomes of $69,680 to $104,520, and single adults with incomes of $51,520 to $77,280.

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Biden: Health Insurers Should Pay for Home COVID Tests

In remarks to staffers at the National Institutes of Health (NIH) on the federal response to the omicron variant of COVID-19, President Joe Biden said his administration intends to make home testing more accessible — and require insurance companies to cover the cost of those tests from retailers.

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News Briefs: 3M People Sign Up for HealthCare.gov Plans | Dec. 3, 2021

So far during the 2022 open enrollment period for Affordable Care Act marketplace plans, approximately 3 million people have selected plans on HealthCare.gov. That running total includes 560,000 who selected plans during week four of open enrollment, according to CMS’s weekly enrollment snapshot.

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