South Dakota voters just moved their state one step closer to expanding Medicaid through a ballot initiative, with over 67% of voters rejecting a proposed amendment to the state constitution that would have made Medicaid expansion prohibitively difficult to pass. The founder of a pro-expansion ballot initiative campaign tells AIS Health, a division of MMIT, that he’s optimistic about Medicaid expansion’s chances when it finally comes to a definitive vote in November.

If South Dakota does vote to expand Medicaid in the fall, more than 27,000 people could gain eligibility for the safety-net health insurance program, according to estimates from the Kaiser Family Foundation.

In the first enforcement action since CMS’s Hospital Price Transparency rule went into effect at the start of last year, the agency on June 7 fined two hospitals in Georgia a total of more than $1 million for non-compliance with price transparency requirements. Health policy experts tell AIS Health, a division of MMIT, that they hope CMS ramps up its enforcement efforts, which could help payers, patients, employers and other stakeholders benefit from price comparison and greater competition.

CMS levied an $883,180 penalty against Northside Hospital in Atlanta and a $214,320 fine against Northside Hospital in the Atlanta suburb of Canton, Ga. The penalties were announced the same week that a research letter published in JAMA revealed that only 5.7% of hospitals had complied with the federal transparency rule between six and nine months after the legislation was enacted on Jan. 1, 2021 — the latest in a series of studies drawing similar conclusions.

The Federal Trade Commission (FTC) on June 10 made a formal request for information to UnitedHealth Group regarding the integrated health care giant’s announced purchase of LHC Group, Inc., a home health care provider, which could be an indication that the antitrust watchdog will move to block the deal. Experts tell AIS Health, a division of MMIT, that it’s not a certainty that the FTC will take such an action, given the fragmented nature of the home health care industry, but add that UnitedHealth’s singular size and diversification exposes the firm to higher antitrust scrutiny than other national health insurance or provider firms.

UnitedHealth announced its plans to acquire LHC in April, saying it would spend about $6 billion to purchase the provider and amortize some of its debt. The health care giant revealed the FTC’s request for information in a filing with the Securities and Exchange Commission. UnitedHealth has acquired dozens of smaller companies in recent years — and antitrust regulators have begun to pay closer attention as its spending spree has gone on. Notably, in February, the Dept. of Justice sued to block UnitedHealth’s bid to acquire Change Healthcare, Inc., a data and analytics company, joining the state attorneys general of New York and Minnesota in the antitrust enforcement action.

Launching a venture-capital (VC) fund has become commonplace for many health insurers, even smaller ones, industry insiders tell AIS Health. They typically do not disclose returns — and many of these funds are so new that there haven’t been enough exits to judge performance. But the investments pay dividends for insurers in the ability to influence the strategic direction of their vendors, get preferred contracting terms — and hopefully still make some money.

There are a lot of reasons that insurers launch VC funds, says Ari Gottlieb, a principal at consulting firm A2 Strategy Group. “They don’t have the pure profit motive that a traditional venture fund has, which is just making sound investments,” he says. “They’re not designed, though, to lose money.”

Health insurers will likely issue about $1 billion in medical loss ratio (MLR) rebates this year, according to data from the Kaiser Family Foundation (KFF) and Mark Farrah Associates. That amount is a drop from both 2020 and 2021, which set the all-time highs for MLR rebates disbursed since the Affordable Care Act came into effect. Experts tell AIS Health, a division of MMIT, that the dropoff in rebates is related to pandemic utilization and a more stable policy environment for the individual marketplace.

Health plans selling insurance on the individual, small group and fully insured large group markets are required to return any premium revenue that is not spent on care (or care quality improvements) to members.

The Federal Trade Commission (FTC) on June 2 said it had filed lawsuits to block hospital mergers in New Jersey and Utah. Health policy experts tell AIS Health that health insurers and other payers likely will welcome the FTC’s actions as mergers limit competition and lead to higher prices.

The FTC is looking to block HCA Healthcare, Inc.’s acquisition of five hospitals that Steward Health Care owns in Utah. The agency is also aiming to deny RWJBarnabas Health’s purchase of Saint Peter’s Healthcare System, a non-profit that operates a hospital in New Brunswick, N.J. The Utah trial is scheduled to begin on Dec. 13 and the New Jersey trial is scheduled to start on Nov. 29.

Here’s how major health insurers’ stock performed in May 2022. Anthem, Inc. had the highest closing stock price among major commercial insurers as of May 31, 2022, at $509.61. Molina Healthcare, Inc. had the highest closing stock price among major Medicaid insurers at $290.22.

Inflation has not yet impacted health care prices, according to new research from the Kaiser Family Foundation (KFF). The KFF study reports that in the 12 months ending in April 2022, “overall prices grew by 8.3% from the previous year, while prices for medical care increased by only 3.2%.” The authors added, “This is unusual, as health prices historically outpace prices in the rest of the economy. However, the relatively high rate of inflation seen in the rest of the economy may eventually translate to higher prices for medical care. This may lead to steeper premium increases in the coming years.” Generally speaking, according to the report, prices have grown faster for commercial insurance than public payers, a trend that held up in 2022. Though inflation is greater than it has been for a generation, its impact is likely delayed in health care because of contracting cycles. “Health prices are generally set in advance, administratively or via private insurance contracting, so there may be a delay in observable price increases,” the authors observe.

Despite a pressing need to revise telehealth laws to match the new, post-pandemic expectations of patients, payers and providers, D.C. insiders tell AIS Health, a division of MMIT, that Congress may not actually pass legislation on the issue. With Congress preoccupied by the midterm elections and the possible revival of the Biden administration’s signature Build Back Better Act (BBBA), chances for standalone legislation on telehealth are slipping away.

That doesn’t mean that Congress won’t address telehealth regulations. But telehealth reforms will likely have to pass as part of a larger piece of legislation. That’s how the No Surprises Act, which banned surprise billing, finally made its way through Congress.

Health insurers have ramped up their use of digital tools to improve customer satisfaction, but still have more work to do — particularly as utilization returns to normal two years after the pandemic’s start. Customer satisfaction is lagging after several years of improving scores, and digital tools are disappointing some enrollees.

J.D. Power’s 2022 U.S. Commercial Member Health Plan Study identified call center customer support and digital tools as “key areas in need of improvement,” the advisory firm said May 26. “Health plan members expect a personalized, hands-on experience when dealing with customer support and they expect a seamless digital experience when engaging online. Health plans have some work to do to get the formulas right,” said Christopher Lis, managing director, global healthcare intelligence at J.D. Power.