ACA Exchanges

Amid ‘Family Glitch’ Fix, Enhanced ACA Subsidy Expiration Looms

While the Biden administration has proposed a long-awaited fix for the Affordable Care Act’s “family glitch” — potentially making coverage more affordable for thousands — the looming expiration of major ACA subsidy expansion threatens to overshadow that progress.

Health insurers that spoke to AIS Health, a division of MMIT, seem concerned about the potential drawback of generous financial help for exchange enrollees, but are not necessarily ready to hit the panic button yet.

“We have the unfortunate benefit, I’d characterize it, as having been through in the past other situations where there was uncertainty about the future of the market,” says Bill Tuthill, vice president of market strategy and federal markets for Highmark Inc. Perhaps the most frightening times occurred when all or major parts of the ACA were in danger of being struck down by the Supreme Court — but that threat didn’t pan out, Tuthill tells AIS Health, a division of MMIT.

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© 2024 MMIT

New Centene CEO London Will Bring Tech, Innovation Chops to Her Role

Centene Corp. on March 22 named Sarah London as its next CEO, effective immediately. London, who currently serves as the firm’s vice chairman, will fill the role held by Michael Neidorff for decades, though she has been part of a group of top executives who have handled day-to-day management of Centene since Neidorff took medical leave in late February.

In her previous management role, London was responsible for a “portfolio of companies independent of Centene’s health plans, designing differentiated platform capabilities, and delivering industry-leading products and services to third-party customers,” per a March 22 press release. Before coming to Centene, she worked for UnitedHealth Group’s venture capital arm, Optum Ventures, and its data analytics division.

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News Briefs: 14.5M Enroll in Exchange Plans for 2022

The Affordable Care Act (ACA) exchanges have set new records for enrollment, with 14.5 million people enrolling or automatically reenrolling in health insurance during the 2022 open enrollment period, per CMS. New enrollments increased by 2.5 million, or 21%, compared to 2021. Due in part to the enhanced premium subsidies made available as part of the American Rescue Plan Act, the number of enrollees receiving advance premium tax credits (APTC) increased by 2.8 million compared to 2021. According to CMS, the average monthly 2022 premium for HealthCare.gov enrollees was $111. If consumers had not received the additional tax credits, the average monthly premium after APTC for HealthCare.gov consumers would have been 53% higher, or $170, per a press release issued on the ACA’s 12th anniversary. The enhanced APTCs are set to expire at the end of the 2022 plan year, though Congress has considered proposals to make them permanent.

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Biden Admin Officials Defend Standardized Plan Requirements

Although health insurers may not approve of all the recently proposed policies for the Affordable Care Act exchanges — in particular, the reintroduction of standardized plans — the Biden administration is sticking to its guns.

That was one of the main takeaways from a discussion during AHIP’s 2022 National Conference on Health Policy and Government Programs, which took place virtually from March 14 through 17. During a March 15 session, Ellen Montz, Ph.D., who is the deputy administrator and director of CMS’s Center for Consumer Information and Insurance Oversight, highlighted three parts of the 2023 Notice of Benefit and Payment Parameters (NBPP) that she said will reinforce CMS’s goal of making the exchanges more consumer friendly.

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News Briefs: New Interoperability Rule May Be on Horizon

Biden administration officials during the annual Healthcare Information and Management Systems Society (HIMSS) Conference said CMS intends to revamp its interoperability regulations. CMS Administrator Chiquita Brooks-LaSure said the Interoperability and Patient Access final rule issued in 2020 “did not quite hit the mark” because it didn’t require standardized application programming interfaces (APIs), FierceHealthcare reported. “Our interoperability rule wasn’t interoperable enough, and it led to many open questions about how data should be exchanged,” she added.

New research from the Kaiser Family Foundation (KFF) indicates that 36% of outpatient mental health and substance use disorder visits were delivered via telehealth in the six months ending in August 2021. Those visits spiked because of flexibilities and social distancing requirements implemented during the peak of the COVID-19 pandemic, KFF concluded.

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Startup Insurers’ 2021 Losses Add Up to ‘Staggering’ $2.5 Billion

As has been the case in previous quarters, all four of the newly public health insurance startups — Oscar Health, Inc., Bright Health Group, Inc., Clover Health Investments Corp. and Alignment Healthcare, Inc. — reported losses for the final three months of 2021. However, a look at both the fourth quarter and full year reveals that there were considerable differences among those companies in terms of the severity of their losses and the trajectory of their businesses.

“The four public startup health insurers lost $2.5 billion in 2021,” observes Ari Gottlieb, a principal at the consulting firm A2 Strategy Group, who calls that a “staggering amount of money.” Bright Health — which has Medicare Advantage, Affordable Care Act exchange and health care provider assets — was responsible for roughly half of that total loss among the quartet of insurers, losing just under $1.2 billion for the full year.

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Departing Neidorff Leaves Legacy of Major Growth at Centene

Centene Corp. on Feb. 24 revealed that CEO and Chairman Michael Neidorff took immediate medical leave. That means Neidorff may have served his last day at the helm of the company he built into a Medicaid managed care powerhouse, given the fact that he has already announced plans to retire later this year after 26 years on the job.

Effective immediately, an “expanded office of the chairman” will handle day-to-day management of Centene. That group includes Vice Chairman of the Board Sarah London, President and Chief Operating Officer Brent Layton, Chief Financial Officer Drew Asher and Chief Administrative Officer Shannon Bagley.

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News Briefs: AHIP Is Critical of Biden’s Insulin Copay Cap Idea

Humana Inc. has started to integrate Kindred at Home, a home care subsidiary that the payer acquired in summer 2021, into its CenterWell Home Health subsidiary. Clinics in seven states — Washington, Oregon, Idaho, Nevada, Arizona, New Mexico and North Carolina — will now become part of the CenterWell brand, “with other locations transitioning later this year,” per a press release. Eventually, the combined CenterWell brand will “support patients from more than 350 locations across 38 states.” The Hospice, Palliative, Community and Personal Care divisions of Kindred at Home are not part of the CenterWell Home Health rebranding.

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Maine Will Combine Individual, Small-Group Insurance Markets

Maine will merge its small-group and individual exchange health insurance markets starting in plan year 2023. Experts tell AIS Health, a division of MMIT, that the move is a bid to stabilize small-group premiums, which have gone up in recent years.

According to a Feb. 15 press release from the state’s Bureau of Insurance, “the merger, which will pool the risks of the two markets and roll the Small Group coverage into the Maine Guaranteed Access Reinsurance Association (MGARA), is projected to reverse the trend of steady premium increases and declining enrollments in Maine’s Small Group Market, while supporting continued stable pricing in the Individual Market.”

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© 2024 MMIT

Small-Group Insurance Market Remains Stable Under ACA

About half of small-firm employees worked for an establishment that offered health insurance from 2013 to 2020, and the small-group market has remained relatively stable since the implementation of the Affordable Care Act, according to a recent Urban Institute study. Employee coverage rates at small firms — which have fewer than 50 employees — dropped 2 percentage points, from 57.1% in 2013 to 55.1% in 2020. Meanwhile, employees’ contributions to single and family coverage in the small-group market rose during the study period by 2.3 and 6.0 percentage points, respectively. Though many people anticipated that small firms would transition to self-insurance to avoid ACA’s regulations, small firms were much less likely than larger firms to offer a self-insured plan between 2013 and 2020.

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© 2024 MMIT