September

State Moves to Claw Back Funds Raise Medicaid Plans’ Ire

September 30, 2020

As state budgets continue to be squeezed by the COVID-19 pandemic and related economic downturn — and as health insurers report large profits due to low utilization of routine health care services — state officials are perhaps understandably eyeing Medicaid managed care organizations as sources of extra funding. But at least one health insurer isn’t happy about a tactic states are using, with CMS’s blessing, to claw back money from MCOs.

The issue in question is the use of risk corridors in MCO contracts, according to Kamran Hashim, vice president of policy and planning at Molina Healthcare, Inc.

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For Payers, Heightened Risk to ACA May Not Spell Doom

September 25, 2020

In a year when a pandemic and a presidential election are already fueling high levels of uncertainty, the Sept. 18 death of Justice Ruth Bader Ginsburg — which could tip the scales in favor of striking down the Affordable Care Act (ACA) — was hardly welcome news for health insurers. However, industry analysts and legal experts say there are plenty of reasons not to hit the panic button just yet.

“This definitely increases the chance of the Supreme Court striking down the full ACA. But we’re going from a pretty low likelihood base,” says Chris Sloan, an associate principal at consulting firm Avalere Health. “The odds are still really stacked against anything materially changing for the ACA.”

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Broad Coalition Urges COBRA Subsidies, Applauds New Bill

September 25, 2020

The COVID-19 pandemic and associated economic crisis have led to steep losses in the number of people with health insurance, and lawmakers should take swift action to provide temporary funding to bolster COBRA so that people can remain on their employer-sponsored plans, says a coalition that includes business groups, employer organizations, insurers and consumer groups.

The coalition, the Alliance to Fight for Health Care, released a report on Sept. 22 indicating that nearly 7.5 million Americans enrolled in commercial health insurance lost their coverage in April and May. This number, which is based on two surveys conducted by America’s Health Insurance Plans (AHIP), is expected to rise substantially by the end of 2020, as layoffs continue to outpace new job openings and temporary job losses turn permanent.

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Fixing Surprise Billing Could Save Billions in Premiums

September 25, 2020

A study published Sept. 11 in the American Journal of Managed Care found that a federal law to rein in surprise medical billing could reduce overall health insurance premiums by 1% to 5%. The study, which was prepared by researchers at the USC-Brookings Schaeffer Initiative for Health Policy, was lauded by health insurance experts for looking at surprise billing’s impact on the insurance system at large, an area that they say has not been studied extensively.

The study is based on 2017 data compiled by the Health Care Cost Institute, which is drawn from claims submitted to UnitedHealthcare, Humana Inc. and CVS Health Corp.’s Aetna. The data is compiled from 568.5 million claims submitted by 44.8 million covered lives.

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A Closer Look at COVID-19 Diagnostic, Antibody Testing Charges

September 25, 2020

The rates that providers and laboratories charge for COVID-19 diagnostic and antibody testing — prices that “have important implications for out-of-network plans, uninsured patients, and other payers with little negotiating power” because of provisions in the CARES Act — far exceeded their Medicare reimbursement rates, according to a recent study published in the Society of General Internal Medicine. By analyzing administrative claims data from the COVID-19 Research Database, the study found that independent labs — which performed almost half of all COVID-19 diagnostic tests — charged $140.41 on average, while the Medicare rate was $51.31. Independent labs performed more than 95% of all antibody tests, with an average charge of $62.30, compared to the Medicare rate of $42.13. Across the country, average diagnostic testing fees ranged by state, from a low of $64.98 in Utah to a high of $505.65 in Washington, D.C. For antibody testing, New Mexico providers and labs charged an average of $195.41, more than four times of the average charge in New York ($45.85).

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Would Health Insurers Embrace Underwriting Again?

September 25, 2020

Since at least the 2017 saga when Republicans tried to repeal and replace the Affordable Care Act (ACA), one of the law’s most visible — and politically charged — components has become its protections for people with preexisting conditions. Now, with the makeup of the Supreme Court slated to shift, some experts believe those same provisions are the most at risk from being struck down alongside the law’s now-defunct individual mandate (see story, p. 1).

But that begs the question: Would health insurers actually want to go back to a pre-ACA world?

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