Health Plan Weekly

California recently became the latest state to implement a limit on health care spending growth, with a new state agency targeting an increase of no greater than 3% by 2029. Commercial payers have largely backed the spending targets, but providers have argued that the targets aren’t reachable and Medicaid stakeholders — including the state’s largest managed care organization — are concerned that the target may curtail access for beneficiaries and harm the solvency of safety net providers. 

The spending target was set by the board of the Office of Health Care Affordability (OHCA), which was established in 2022. The board’s membership was appointed by Gov. Gavin Newsom, a Democrat. The board set target spending growth rates of 3.5% in 2025 and 2026, 3.2% in 2027 and 2028, and 3.0% in 2029. OHCA will require payers regulated by the state and providers alike to meet the designated spending targets. Organizations that don't meet the spending targets will be subject to a state-overseen corrective action plan and possibly fines. 

A group of lawmakers is urging federal regulators to investigate UnitedHealth executives’ sale of company stock right after learning that the health care firm was the target of a Dept. of Justice (DOJ) investigation concerning its provider-acquisition spree. As for the investigation itself, one antitrust lawyer says it could take years before the DOJ files a case — but if it does, regulators could try to force the health care giant to spin off all or part of its Optum division. 

Meanwhile, the DOJ’s antitrust division on May 9 announced a new Task Force on Health Care Monopolies and Collusion, which it said will “guide the division’s enforcement strategy and policy approach in health care, including by facilitating policy advocacy, investigations and, where warranted, civil and criminal enforcement in health care markets.” Some of the competition concerns the task force will examine include “issues regarding payer-provider consolidation” and “serial acquisitions.”

Some insurers and retailers are backing away from their investments in provider verticals, especially retail health brands. Cigna's stake in VillageMD, a joint venture with Walgreens Boots Alliance Inc., has lost money, and VillageMD will soon close many locations instead of pursuing aggressive growth. Walmart Inc. also said it will close its health care venture. 

In recent years, diversified insurers have seen clinics in which they own a stake as a place where they can control cost of care and, ideally, improve member satisfaction by reducing the friction required to access basic care services — in addition to growing revenue in a segment that isn’t capped by medical loss ratio (MLR) rules. But that premise hasn’t always amounted to much more than a compelling story in practice. 

Although telehealth policies that were put in place in March 2020 following the onset of the COVID-19 pandemic are set to expire at the end of the year, congressional leaders are taking steps to extend the policies for an additional two years. Even if the legislation passes, more research needs to be done to assess the benefits and downsides of treating people virtually from a payer, provider and patient perspective, according to speakers at a May 1 panel organized by the National Institute for Health Care Management (NIHCM) Foundation. 

The House Ways and Means Committee on May 8 unanimously advanced legislation that would preserve Medicare beneficiaries’ access to telehealth through 2026. Reps. David Schweikert (R-Ariz.) and Mike Thompson (D-Calif.) are sponsors of bill H.R. 8261, which is known as the Preserving Telehealth, Hospital, and Ambulance Access Act.  

People with health savings account-eligible high-deductible health plans (HDHPs) use less outpatient services and fill fewer prescription medications than people with PPOs, but HSA plan enrollment appears to have no impact on total health care spending, according to a recent study published by the Employee Benefit Research Institute (EBRI).

As of 2022, 57.9% of employees were enrolled in an HSA-eligible health plan, while 32.3% of them were in an HDHP that was not associated with an HSA.