Membership Growth

The Biden administration reached a deal with the Texas company Braidwood Management to preserve the Affordable Care Act’s preventive coverage mandate while the firm’s legal challenge to that provision is litigated. In March, Texas District Court Judge Reed O’Connor ruled that it’s unconstitutional for the ACA to require group and individual health plans to fully cover certain services recommended by the U.S. Preventive Services Task Force, and he said requiring employer plan sponsors to cover preexposure prophylaxis (PrEP) for HIV violates the Religious Freedom Restoration Act of 1993. The Fifth Circuit Court of Appeals temporarily stayed the ruling in May and instructed the parties in the case to agree on how the ACA’s preventive coverage mandate should be handled as an appeal of O’Connor’s ruling proceeds. As part of the agreement — which still has to be approved by the appeals court — just the parties challenging the preventive coverage mandate may opt out of covering USPSTF-recommended services or PrEP; all other health plans must cover those services without cost sharing.

Customer satisfaction with commercial health plans declined year over year, according to J.D. Power’s 2023 Commercial Member Health Plan study. The data analytics firm noted that overall satisfaction decreased by 13 points (on a 1,000-point scale), while there were declines in satisfaction with customer service by 33 points, coverage and benefits by 20 points, provider choice by 16 points, and information and communication by 16 points.

During the previous five years, overall satisfaction increased by 17 points, although there was no change from 2021 to 2022.

Christopher Lis, Ph.D., who is J.D. Power’s managing director of global health care intelligence, tells AIS Health, a division of MMIT, that plans can improve their members’ satisfaction in a few ways. He notes that plans can become “an active health partner” and provide timely and transparent information to beneficiaries and provide individualized support and service.

Medicaid resumed eligibility redeterminations in April after a multi-year pause related to the pandemic. This has profound implications for Medicaid managed care organizations, which could lose a large portion of their membership — and it is a major opportunity to boost enrollment for plans operating Affordable Care Act marketplace plans. Those plans could enroll some of the people leaving Medicaid due to redeterminations.

Exchange insurers such as Blue Cross Blue Shield of Louisiana may be able to take advantage of the opportunity. Elevance Health, Inc., the parent company of Anthem, recently announced plans to acquire Blue Cross Blue Shield of Louisiana; Anthem has about 350,000 Medicaid members in Louisiana, according to the AIS Directory of Health Plans (DHP). Blue Cross Blue Shield of Louisiana doesn’t cover any Medicaid members, but has about 70,000 marketplace members, per DHP.

The Congressional Budget Office estimated that in 2023, 248 million people who are younger than 65 will have health insurance coverage, with over 57% covered through employment-based health plans. As COVID-era policies expire over the next decade, employment-based coverage will grow to 159 million and remain the largest source of insurance.

The coverage patterns vary significantly by income. People with income less than 150% of the federal poverty level are more likely to be uninsured or covered through Medicaid or the Children’s Health Insurance Program, while those with higher income are predominantly insured through employer-sponsored coverage.

Medicaid redeterminations resumed in recent weeks after years of pandemic-related policies that suspended income verification for the safety net health insurance program, and some states — particularly Florida — seem to be moving faster than others to remove beneficiaries from their rolls, prompting a warning from the Biden administration. Experts say that the pace of redeterminations will vary from state to state — and so will redeterminations’ possible negative effect on health equity, which could intensify if states are cavalier or overaggressive with disenrollments.

“We’re looking closely at the Medicaid renewal numbers released by several states today. Keeping eligible people covered is our #1 priority. States need to do their part to keep people from losing coverage due to red tape,” said CMS Administrator Chiquita Brooks-LaSure on Twitter on June 1. The CMS-controlled Twitter account for Medicaid, while retweeting Brooks-LaSure, said that “we are closely monitoring the Medicaid renewal numbers that states are reporting,” and added that “we will continue to work directly with states to help keep eligible individuals covered.”

The Congressional Budget Office (CBO) garnered headlines recently when it projected that not only will the uninsured rate reach a record low this year, it will creep up again in the next 10 years. In a June 1 webinar hosted by Health Affairs, a CBO official expounded upon how those projections came about, noting that at the behest of Congress, the agency is closely following how coverage shifts affect particular demographics.

In its new projections, CBO said that the uninsured rate among people who are younger than 65 will increase from an unprecedented 8.3% this year to 10.1% in 2033, which would still be below the 12% rate from 2019 before the COVID-19 pandemic. The estimates, which were published in Health Affairs on June 24, show the impact that the expiration of temporary policies put into place during COVID will have on insurance coverage.

Medicare Advantage enrollment grew by more than 507,000 lives during the 2023 Open Enrollment Period (OEP), according to CMS’s May data release and AIS’s Directory of Health Plans. That’s a significant increase from last year’s OEP, when plans added about 230,000 new members from February to May 2022. The news comes just weeks after a KFF analysis found that the number of seniors enrolled in MA vs. original Medicare officially crossed the 50% threshold.

Shortly after the city of New York inked a deal with CVS Health Corp.-owned Aetna to administer a PPO plan to some 250,000 retirees and their eligible dependents, a group of former city employees are suing to block Mayor Eric Adams (D) from transitioning their retiree health care coverage away from fee-for-service (FFS) Medicare. According to news reports, the class action lawsuit was filed in the state Supreme Court on May 31 by nine individual municipal retirees and the NYC Organization of Public Service Retirees, which sued to block the implementation of a previous contract with Elevance Health, Inc. (then Anthem). The original transition was supposed to begin on April 1, 2022, but the city revised its plans after a state Supreme Court judge ruled that the proposal violated city law by requiring retirees who opted out of the switch to pay $191 per month to maintain their FFS coverage. That July, Elevance backed out of the deal. In the “final approved plans, retirees who opt out of the city’s coverage will have to pay for any supplemental coverage on their own,” reports Becker’s Payer Issues. The plaintiffs alleged that the option to switch to FFS with Medicare Supplemental Insurance is cost prohibitive and that the new coverage offering constitutes nothing more than a “bait and switch,” according to Crain’s New York Business. The $15 billion pact with Aetna is expected to save the city $600 million a year.

Still intent on standing apart from established Medicare Advantage competitors with their use of technology, Medicare-focused “insurtechs” Alignment Healthcare, Inc. and Clover Health Investments Corp. recently reported first-quarter 2023 earnings that showed shrinking losses and increasing insurance revenue. While both insurers are focused on retaining and/or growing their MA membership, fellow startup Bright Health Group, Inc. will soon shed its MA business — its last insurance asset — to continue growing its noninsurance segment focused on value-based care (VBC) delivery.

Declaring a “strong start to the year,” Alignment Healthcare, Inc. on May 4 posted first-quarter revenue of $439.2 million, reflecting year-over-year growth of 27.1%. That was aided largely by a nearly 21% jump in health plan premium revenue to $399.7 million as MA membership climbed 16% to 109,700 lives, the company reported.

As CMS continues to tighten oversight of misleading marketing activities, the agency will soon require Medicare Advantage organizations to file all materials that mention any type of benefit. In a May 10 memo from the Medicare Drug & Health Plan Contract Administration Group, CMS explained that while it previously interpreted the mentioning of widely available benefits (e.g., vision, dental, premium reductions) as “general descriptions” that were not “made with sufficient intent to draw attention to a particular plan or subset of plans” and lead to an enrollment decision “without information on the associated costs for enrollees,” complaints received through various channels have indicated otherwise. Therefore, CMS is expanding its interpretation of “marketing” to “include content that mentions any type of benefit covered by the plan and is intended to draw a beneficiary’s attention to plan or plans, influence a beneficiary’s decision-making process when selecting a plan, or influence a beneficiary’s decision to stay enrolled in a plan (that is, retention-based marketing) and thus subject to review.” As such, the agency will require any material or activity that is distributed by any means and mentions any benefit to be submitted into the Health Plan Management System effective July 10.