January

Executive Order Aims to Boost ACA Exchanges, Medicaid

January 29, 2021

President Joe Biden on Jan. 28 launched his Affordable Care Act-centric health insurance agenda with an executive order that will reopen the federal health exchange for a special enrollment period. The administration also directed federal agencies to roll back widely criticized changes to Medicaid as part of a broader review of Trump administration regulations.

The new executive order, which the administration framed as a pandemic relief measure, demonstrates the administration’s emphasis on expanding coverage through the ACA. The special enrollment period (SEP) will run from Feb. 15 to May 15 and will be bolstered by a more aggressive effort to promote enrollment through advertising.

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2021 Outlook: Employer Groups Want Legislation on Drug Pricing, Telehealth

January 29, 2021

Trade groups representing employer health plan sponsors have a busy lobbying agenda for 2021 now that Democrats control the presidency and both chambers of Congress. The trade groups, the ERISA Industry Committee (ERIC) and Purchaser Business Group on Health (PBGH), both to some degree support lowering the eligible age for Medicare, aggressive action to lower prescription drug prices and comprehensive telehealth reform.

The common theme for both organizations across all their policy goals is a desire to lower health care costs and, broadly speaking, improve the risk pool for plan sponsors. While those goals are in alignment with the aims of the managed care industry most of the time, there are points where plan sponsors and carriers’ interests deviate — which could mean health insurance trade groups might team up with the plan sponsor lobby on one bill but square off on another.

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Equities Analysts Downplay Anthem’s 2021 Guidance Slip

January 29, 2021

Anthem, Inc.’s stock value dropped roughly 7% in early trading on Jan. 27 after the insurer reported its fourth-quarter and full-year 2020 financial results, but it wasn’t the company’s performance last year that triggered investor concern. Instead, the catalyst was Anthem’s 2021 earnings per share (EPS) guidance of “greater than $24.50,” which dipped below the Wall Street consensus of $25.37.

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Who Would Benefit From Removing Employer Coverage ‘Firewall’?

January 29, 2021

Between 6% and 13% of people in nonelderly households with employer-sponsored coverage could pay lower premiums in the Affordable Care Act marketplaces if there was no longer a “firewall” preventing people who have access to affordable, comprehensive employer-based coverage from accessing ACA subsidies, according to a study by the Commonwealth Fund. Currently, an estimated 26% of nonelderly people with employer coverage whose income is below 200% of the federal poverty level (FPL) spend more than 8.5% of their income on after-tax premium contributions. The researchers analyzed the potential effects of allowing more employees to use subsidies to purchase ACA marketplace plans, both with the current subsidy schedule and an enhanced schedule that passed the U.S. House of Representatives in June 2020 and would extend subsidies to all income levels and caps premiums contributions at 8.5% of income. The study found that Black, Hispanic and American Indian or Alaska Native individuals could particularly benefit from such a policy change, as could individuals in the South.

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Report: CMS Should Integrate Social Factors Into Payment

January 29, 2021

As CMS re-evaluates its priorities under the new Biden administration, it should seriously consider making policy changes that integrate “drivers of health” (DOH) into payment policies for Medicare, Medicaid and the individual market, says a new report from four top independent health care foundations and think tanks.

The recommended changes would make it easier for insurers and providers to implement initiatives that address socioeconomic, environmental and behavioral factors that directly impact health, according to the report, “Investing in Health: A Federal Action Plan.” Manatt Health, The Health Initiative, Blue Shield of California Foundation and the Commonwealth Fund sponsored the report.

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News Briefs

January 29, 2021

Effective July 1, 2021, Humana Inc. will become the fifth Medicaid managed care organization to contract with South Carolina, the insurer said on Jan. 27. Centene Corp., Blue Cross Blue Shield of South Carolina, SelectHealth and UnitedHealthcare are the state’s four other MCOs, Citi analyst Ralph Giacobbe pointed out in a research note. Starting on Jan. 1, 2022, Humana will also begin enrolling new Healthy Connections Prime members, a new “expanded option for South Carolinians who have both Medicare and Medicaid, operating under a joint demonstration contract between the state and the federal government.” Read more at https://bit.ly/3t8BnUq.

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