Health Plan Weekly

If their annual filings with federal regulators are any indication, major U.S. health insurers know they have a public-perception problem — and they are concerned by it. But the big question, according to health policy and public relations experts, is how they plan to turn things around. 

“For decades, the insurance industry has been acting its way into this reputation,” says Max Marcucci, who leads the global risk and reputation practice at Leidar, a communications consultancy. At each firm, “there probably needs to be some real reflection on…what actions could we take, as a company, to try to change people’s perceptions?”  

While Mehmet Oz, M.D., was noncommittal about his stance on Medicaid funding cuts, the nominee for CMS administrator during a March 14 Senate Finance Committee hearing voiced clear support for requiring some Medicaid beneficiaries to prove employment to keep receiving benefits.  

According to one Wall Street analyst, such strong backing for Medicaid work requirements bodes ill for managed care insurers — not just because of potential enrollment loss, but because it could also make the whole risk pool more expensive to cover. 

Since Donald Trump returned to the presidency, officials in several states have moved to resurrect their Medicaid work requirements demonstrations. During the confirmation hearing of Mehmet Oz, M.D., Trump’s pick to lead CMS, Oz also signaled that he supports Medicaid work requirements. However, if Congress passes a federal Medicaid work requirement, millions of beneficiaries could lose eligibility for health care coverage, according to recent studies.

During Trump’s first term, CMS approved 13 Section 1115 waivers that conditioned Medicaid coverage on meeting work and reporting requirements, but most were either struck down by federal judges or never implemented. The Biden administration then withdrew the waivers in all states. The only work mandate in effect is in Georgia, after the state successfully sued the Biden administration over its decision to rescind the state’s waiver. The state partially expanded Medicaid while also implementing work requirements in 2023, but its Georgia Pathways to Coverage program enrolled only 6,948 people as of Feb. 28, 2025, roughly 75% fewer than the state had estimated. As of January, the program had a backlog of 16,000 applications awaiting processing, according to the state’s documents.

As the federal government considers potential drastic cuts to Medicaid funding, vulnerable children could be impacted because Medicaid covers nearly all children in foster care, according to speakers who discussed the issue in a recent webinar. The panelists noted that states are increasingly adopting managed care strategies to help meet the needs of foster care children and that they expect more states to follow suit as they grapple with a shifting Medicaid landscape. 

Katie Olse, senior director of child and family wellbeing at Sellers Dorsey, said during the March 12 Medicaid Health Plans of America webinar that 26 states are serving foster children via managed care. Ten of those states have health plans devoted exclusively to foster care, while North Carolina on Dec. 1 will launch a statewide, integrated managed care plan for foster children and their families. 

Price transparency has reemerged as a hot topic after President Donald Trump signed an executive order directing increased enforcement of rules requiring hospitals and health plans to post their negotiated rates. Employers can use this wealth of data from insurers and health systems to design the best benefit plans for their employees — if they use the data correctly — noted the panelists of a March 18 webinar sponsored by Catalyst for Payment Reform, an independent, nonprofit organization. 

Before the Transparency in Coverage (TiC) rule went into effect in 2022, employers did not have much pricing data to work with, said Shay Forbes, head of employer solutions with Turquoise Health. “Generally, it’s been nearly impossible for employers to get data” before the transparency rules took effect, he noted during the webinar.