ACA Exchanges

Centene Bets Big on ICHRAs at Investor Day

During their Dec. 12 investor day, Centene Corp. executives promised 12% to 15% in annual earnings growth and declared victory in their multiyear value creation and cost-cutting plan. Wall Street analysts responded warmly to the firm’s presentation, which featured a bold plan to grow Affordable Care Act marketplace enrollment by courting small businesses.

That plan would leverage Individual Coverage Health Reimbursement Arrangements (ICHRAs) to exploit what CEO Sarah London called a “long-term disruption opportunity” in the small-business health insurance market. Centene is the first major carrier to promise long-term, substantive growth in ICHRAs. The long-term growth prospects of ICHRAs, which allow employers and employees to buy marketplace plans, are far from clear.

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Texas Court Order Complicates Bright Health’s Risk Adjustment Repayments

The saga of Bright Health Group, Inc. became even more complex on Nov. 29, when the troubled health insurer's plan to remit unpaid risk adjustment fees to CMS was partially blocked by a Texas state judge at the prompting of the Texas Dept. of Insurance (TDI). The Texas court’s action will compel Bright to complete the receivership process for its Texas subsidiary and pay off creditors with claims in Texas before sending any capital to the federal government or other out-of-state creditors, experts say — that is, if there is any money to send somewhere in the first place.

"I know that there’s some talk now that Texas will be at the back of the line for purposes of CMS or any of the Texas plans that would have gotten the risk adjustment money, in terms of being able to collect on that,” Leah Stewart, an attorney at Reed Claymon PLLC, tells AIS Health, a division of MMIT. “I think politically they [Texas officials] probably don’t care that it impacts CMS’s deal with Bright Health. But I don’t know that they were actually angling for that, as opposed to just deciding that Bright Health of Texas doesn’t have enough money and taking it down the standard liquidation path.”

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New Pharmacy Models, Burgeoning Array of Brands Dominate CVS Investor Day

Hosting its first analyst-focused event in two years, CVS Health Corp. made a splash on Dec. 5 by introducing a pair of new drug reimbursement models, detailing its long-term margin improvement goals, and rebranding its health services segment.

Although the new pharmacy models captured the most headlines, Wall Street analysts also appeared cautiously impressed with the overall picture that CVS painted — depicting a company with ambitious goals to best its rivals in the health benefits, retail pharmacy, care delivery and health services sectors by getting its many moving parts to work together.

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News Briefs: Nearly 7.3M Sign Up for Exchange Coverage

Since open enrollment began on Nov. 1, nearly 7.3 million people have signed up for Affordable Care Act health exchange plans for 2024, according to CMS. The data is through Dec. 2 for the 32 states that use the HealthCare.gov website and through Nov. 25 for the 18 states and Washington, D.C., that have state-based exchanges. More than 1.6 million of the people who enrolled, or about 23% of the total, did not have marketplace coverage in 2023. Enrollment runs through Jan. 15, 2024, for the states using HealthCare.gov, while the deadlines vary for state-based exchanges.

Optum, UnitedHealth Group’s health services arm, employs or has contracts with nearly 90,000 physicians and an additional 40,000 advanced practice clinicians, according to Optum Health CEO Amar A. Desai, M.D. Since there are about 950,000 active physicians in the country, that means Optum employs just under 10% of them. Desai, who spoke at UnitedHealth’s investor meeting on Nov. 29, added that Optum serves not only UnitedHealth’s members but also beneficiaries from more than 100 health plans. In addition, Optum serves more than 4 million people in fully accountable care arrangements and expects that number to increase to 5 million by late 2024.

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ACA Marketplaces See Robust Enrollment, So Far

Nearly 4.6 million people have enrolled in Affordable Care Act marketplace coverage since the start of the 2024 open enrollment period on Nov. 1, a 36% increase compared to the same point during the 2023 OEP, according to CMS. This year’s open enrollment season will last from Nov. 1, 2023, to Jan. 15, 2024, in most states and longer in some state-based marketplaces (SBMs).

More than 4 million people have enrolled through HealthCare.gov in the 32 states that use that platform, and another 501,962 have enrolled across 18 states and the District of Columbia, which use their own marketplaces. Most states are seeing significant membership growth in 2024 compared with the same period last year. Mississippi reported a signup surge of almost 114%.

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ACA Marketplaces See Robust Enrollment, So Far

Nearly 4.6 million people have enrolled in Affordable Care Act marketplace coverage since the start of the 2024 open enrollment period on Nov. 1, a 36% increase compared to the same point during the 2023 OEP, according to CMS. This year’s open enrollment season will last from Nov. 1, 2023, to Jan. 15, 2024, in most states and longer in some state-based marketplaces (SBMs).

More than 4 million people have enrolled through HealthCare.gov in the 32 states that use that platform, and another 501,962 have enrolled across 18 states and the District of Columbia, which use their own marketplaces. Most states are seeing significant membership growth in 2024 compared with the same period last year. Mississippi reported a signup surge of almost 114%.

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News Briefs: Trump Revives ACA Repeal Talk

Former President and current Republican presidential candidate Donald Trump posted on TruthSocial on Nov. 25 that he is “seriously looking at alternatives” to the Affordable Care Act. He added that the failure to overturn the ACA during his presidency “was a low point for the Republican Party, but we should never give up!” Following Trump’s comments, Citi analyst Jason Cassorla wrote in a note to clients that “we got the sense that the Trump headline didn’t have as much of a dampening impact in comparison to the headlines from back in 2017 when the repeal/replace rhetoric was in full swing and Republicans offered alternative such as block grants and other considerations.” Cassorla added that “as the 2024 election rhetoric heats up, we remain watchful of any momentum change on this front.”

CVS Health Corp.-owned Aetna has reversed course on a previously announced telehealth coverage change, Politico reported. The insurer had planned on ending virtual coverage for intensive outpatient and partial hospitalization program care on Dec. 1, but an Aetna spokesperson told Politico that Aetna would no longer go through with that decision. Groups such as the American Society of Addiction Medicine and the Consortium Representing Eating Disorders Care raised concerns about the proposed change.

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Copay Accumulators Get a Reprieve: Commercial Plans’ Use Will Not Be Restricted by CMS – Yet

The Centers for Medicare and Medicaid Services wants clarification from the federal court that recently ruled against the agency’s interpretation of the law when it comes to commercial insurance plans’ use of copay accumulators before it revises its current policy on such programs.

The Health and Human Services Department filed a motion with the U.S. District Court for the District of Columbia on Nov. 27 seeking an explanation for the court’s late September decision that the policy, which allows plans to use copay accumulators broadly, must be set aside and remanded back to CMS because of the agency’s contradictory reading of the same statutory and regulatory language.

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News Briefs: Nearly 4.6M People Have Enrolled in ACA Exchange Plans for 2024

Nearly 4.6 million have enrolled in Affordable Care Act exchange plans for 2024 since open enrollment began on Nov. 1, including 919,900 people who did not have exchange plans this year. The data captures sign-ups through Nov. 18 for people in the 32 states that use HealthCare.gov for enrollment and through Nov. 11 for people in the 17 states and Washington, D.C., that have state-based marketplaces. CMS Administrator Chiquita Brooks-LaSure said in a press release that “we have seen an increase in plan selections and a significant increase in the number of new enrollees year over year.” The open enrollment period runs through Jan. 15, 2024, for states using the HealthCare.gov website, while deadlines for state-based marketplaces vary.

The Biden administration on Nov. 16 released reports outlining steps it is taking to address social determinants of health and emphasizing the need to improve individuals’ social circumstances. The documents include the U.S. Playbook to Address Social Determinants of Health, the Call to Action to Address Health-Related Social Needs and a Medicaid and CHIP Health-Related Social Needs Framework. HHS Secretary Xavier Becerra said in a press release that “it is clear that the health of our people does not exist in a vacuum, but it is affected by our access to stable housing, healthy food and clean air to breathe.”

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Elevated Outpatient Care, No Recession: 2023 Has Surprised Analysts

Three quarters into 2023, Moody’s Investors Service says the predictions it made at the start of the year for the health insurance sector — namely, earnings growth in the mid-to-high single digits — have largely proven accurate. However, while financial results were consistent with the credit rating firm’s expectations, analysts said in a new report that the reasons for those results were not exactly what they predicted.

“Our outlook was premised on reduced membership as a result of Medicaid redeterminations and the impact of a possible recession on commercial membership,” the analysts wrote in a report released on Nov. 20. “However, with no recession this year, commercial membership has been better than expected, but its growth has been offset by higher-than-expected MA [Medicare Advantage] utilization.” Additionally, “although Medicaid redeterminations are underway, their impact so far has been relatively small.”

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