Member: Health Plan Weekly

2020 Outlook: For Insurers, There’s More Than One ACA Court Case to Watch

Chart: Texas v. United States: A Look Back

January 13, 2020

Though the upcoming elections will shine a bright spotlight this year on the health care policy positions of lawmakers and the Trump administration, the courts will play just as big of a role — if not more — than politicians when it comes to shaping the future of the Affordable Care Act’s health insurance reforms.

The biggest case at play is Texas v. United States, which challenges the validity of the entire ACA based on Congress’ decision in 2017 to zero out the individual mandate’s tax penalty (see infographic, p. 7). Because the elimination of the tax penalty makes the individual mandate unconstitutional, Republican-led states argue, the rest of the law also has to go, as it is “inseverable” from the mandate.

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AHIP Launches Pilot to Field-Test Automated Prior Authorization

January 13, 2020

Health insurer trade group America’s Health Insurance Plans (AHIP) is partnering with six insurers to test systems and technology designed to automate parts of the prior authorization process in a bid to develop best practices.

The initiative, which AHIP calls the Fast Prior Authorization Technology Highway, or Fast PATH, will run for six months, during which AHIP and its partners will collect data to be used for an evaluation of the processes and technology used. The trade group will attempt to determine how much money and time an automated system saves providers and insurers.

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Wall Street Analysts Are Mostly Bullish on 2020 Outlook for MCOs

January 13, 2020

Analysts from major financial institutions are cautiously optimistic about the value of managed care organization stocks during 2020, citing a more stable regulatory environment and rising revenues across the industry.

Over 2018 and 2019, markets were skeptical of MCOs’ value due to regulatory turbulence in the form of attempts to roll back the Affordable Care Act, according to a Jefferies report by analysts David Windley and David Styblo.

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News Briefs

January 13, 2020

✦ Startup health care company Bright Health said Jan. 8 that it signed an agreement to acquire the California-based, family-owned health plan Universal Care, which is doing business as Brand New Day. Brand New Day, which was founded in 1983, aims to improve health outcomes among vulnerable populations with complex health conditions by focusing on care management and patient-primary care relationships, according to a release from the companies. The transaction still requires regulatory approval and is expected to close this year; the companies did not disclose the dollar amount of the deal. Bright Health sells plans in the individual and Medicare Advantage markets in 12 states.

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