With a law finally passed that extends enhanced Affordable Care Act subsidies for another three years, health insurers and government agencies can now start their consumer-outreach campaigns for the upcoming open enrollment period in earnest. But they’ll also be prepping for a bigger challenge down the road: Ensuring a smooth transition for people who will no longer be covered by Medicaid after the COVID-19 public health emergency (PHE) ends.

To that end, the Biden administration on Aug. 30 rolled out a plan called the “Assister Strategy to Support Medicaid Unwinding.” As part of that plan, HHS said it’s allocating $100 million to Navigator grantee organizations for the 2022-2023 budget period as well as reviving the Enrollment Assistance Program (EAP), which established temporary storefronts and labor forces that the Obama administration used in the ACA marketplaces’ early years to supplement Navigators’ outreach efforts. For the new version of the EAP, the Biden administration will deploy “mobile assisters” across population centers identified by HHS.

While a recently proposed rule from HHS would mostly reinstate nondiscrimination protections that the Trump administration unwound, it also addresses an emerging issue that is likely to stir up controversy in the health insurance industry: bias in clinical algorithms.

The regulation, posted Aug. 4 in the Federal Register, would for the first time at the federal level prohibit a covered entity “from discriminating against any individual on the basis of race, color, national origin, sex, age, or disability through the use of clinical algorithms in decision-making,” explains a July 27 Health Affairs article summarizing the proposal. “Covered entities” include all health programs and activities receiving federal financial assistance, including health insurance issuers that get federal funding.

About 3.7 million people could gain access to health care if the current 12 nonexpansion states were to fully implement a Medicaid expansion in 2023, according to a recent Urban Institute analysis.

In the upcoming gubernatorial elections in November, Medicaid expansion could be a key issue in several nonexpansion states, including Wisconsin, Kansas and Georgia. All three states had several failed attempts to fully expand Medicaid eligibility.

The federal government and patient advocates have directed withering criticism regarding behavioral health coverage toward health plans in recent months. AHIP, the health insurance industry’s largest trade group, responded this week with a statement from its board emphasizing its commitment to equitable access to mental health benefits.

In January, the federal agencies that regulate health plans published a biannual report which found that health insurers have systematically failed to document the level of mental health care access they provide to members. That documentation is part of a yearslong federal effort to make plans comply with mental health care parity laws, which stipulate that health plans are not allowed to impose benefit limitations — non-quantitative treatment limits (NQTLs) — on mental health care that are more severe than limits placed on medical and surgical benefits.

CMS on Aug. 31 proposed a new regulation aimed at streamlining applications, verifications, enrollment and renewals for Medicaid and Children’s Health Insurance Program (CHIP) coverage. The rule would make a host of changes, such as eliminating the requirement that individuals apply for other benefits as a condition of Medicaid eligibility, requiring that states conduct renewals no more than once every 12 months, and establishing specific guidelines for states to check available data prior to terminating eligibility when a beneficiary cannot be reached due to returned mail. CMS said it estimates that “this proposed rule would remove barriers to enrollment and increase the number of eligible individuals who obtain coverage and are continuously enrolled in Medicaid and CHIP.”

Employers are beginning to see the value of individual coverage health reimbursement arrangements (ICHRAs), managed care insiders tell AIS Health, a division of MMIT. Brokers and third-party experts say that while uptake has been slow so far, the ICHRA market could take substantive amounts of business away from both self-funded and fully insured commercial insurance books, particularly among medium-sized employers.

ICHRAs allow employers and employees to purchase Affordable Care Act marketplace plans. Employees select a plan on a health exchange or through a private broker, and their employer reimburses the member each month for a fixed amount of premium. Unlike exchange plans purchased by individuals, exchange plans purchased as part of ICHRA are not subsidized by advance premium tax credits. The market is still in its infancy: ICHRAs were created by the Trump administration in 2019, and the first policies in the segment were sold for the 2020 plan year.

Health Care Service Corp. (HCSC) recently agreed to acquire Trustmark Health Benefits, a third-partner administrator (TPA) of health benefits. The pending deal continues HCSC’s expansion from its roots as primarily a traditional commercial insurer to other areas like TPAs and Medicare, and the diversification push is likely to continue, according to health insurance industry analysts who spoke with AIS Health, a division of MMIT.

For several years, HCSC has been a client of Trustmark Health Benefits, a firm that has more than 600 clients across the U.S. The companies Trustmark works with have self-insured health plans, meaning they are responsible for the cost of providing benefits to their employees. Trustmark generates revenue by helping companies in areas such as administering claims, managing risk, setting up virtual care and engaging with customers.

Despite worrying macroeconomic trends, health insurers have done well this year so far, with all the largest publicly traded health insurance firms posting year-over-year earnings growth in the first half of 2022. Experts tell AIS Health, a division of MMIT, that they don’t expect health insurers to struggle despite ominous signs across the economy.

Those headwinds include inflation; a possible recession, which could decimate employer-based insurance enrollment; medical cost growth; and the resumption of Medicaid eligibility redeterminations, which will force unprecedented amounts of disenrollment. But experts say that insurers with a mix of business lines should be in a strong financial position. The largest risk is likely to insurers that carry a coverage mix disproportionately focused on the commercial market.

After a year in which health care cost trend flatlined, costs for self-funded plan sponsors increased “significantly” — by 8.2% — in 2021, according to the Business Group on Health’s 2023 Large Employers’ Health Care Strategy and Plan Design Survey. In addition, for the first time in the history of the annual survey, cancer eclipsed musculoskeletal conditions as the top driver of large firms’ health costs.

In 2020, 78% of polled employers said cancer was the top cost-driving condition, and the share rose to 80% in 2021 and 83% in 2022. The percentage of employers identifying musculoskeletal conditions as the most expensive condition dropped each of the three years, from a high of 90% in 2020, down to 84% in 2021 and 76% in 2022.

Health care spending per person varied significantly across the nation in 2019, and differences between states grew across time, according to a recent Health Affairs study. State-level health care spending per person ranged from $7,250 in Utah to $14,500 in Alaska in 2019, while annualized growth rates per person ranged from 1.0% in Washington, D.C., to 4.2% in South Dakota from 2013 to 2019.

In 2019, Medicare and Medicaid spending combined accounted for more than one third of total health expenditures in most states, ranging from 27% in Alaska to 48% in Arkansas. The study shows that out-of-pocket spending varied more than overall spending. For example, while South Dakota’s overall health care spending is 50% higher than Arizona, the average South Dakotan spent nearly three times as much out-of-pocket per year ($4,600) compared to the average Arizonan ($1,700).