Health Plan Weekly

UnitedHealth Group is going on the defensive as public sentiment toward the health care giant continues to founder. In recent weeks, UnitedHealth has fought a shareholder proposal requesting reports on delayed and denied care, and it hired a law firm specializing in defamation cases to push back against what it views as spurious claims on social media.  

And the Dept. of Justice opened an investigation into UnitedHealthcare’s Medicare Advantage billing practices and whether it improperly recorded diagnoses that would lead to higher payments, The Wall Street Journal (WSJ) reported. In a statement, UnitedHealthcare called the WSJ report “misinformation” and that the government “regularly reviews all MA plans to ensure compliance and we consistently perform at the industry’s highest levels on those reviews...[a]ny suggestion that our practices are fraudulent is outrageous and false.” 

In a move that some experts say could affect CMS’s ability to effectively regulate the health insurance markets that it oversees, Donald Trump’s administration has reportedly fired scores of staffers as part of an expansive effort to trim the federal workforce.  

Recent reports indicate that starting on Valentine’s Day and continuing through the Presidents Day weekend, thousands of workers at HHS and its various agencies — including CMS, FDA, the Centers for Disease Control and Prevention and more — received notice that their employment was ending. Many of them were still in their probationary period for new employees, and some indicated they were told their firing was due to poor performance despite receiving glowing reviews. 

The utilization rate of health care services — the number of visits, admissions, or prescriptions per incident or prevalent case — is the primary driver of health care spending variation across the nation, according to two recent JAMA studies.

The researchers who conducted one of the studies analyzed data from 3,110 counties across four payer types, seven care categories, 148 health conditions and 38 age-sex groups, which accounted for 76.6% of personal health care expenditures between 2010 and 2019. The study estimated that health care spending grew from $1.7 trillion in 2010 to $2.4 trillion in 2019.

CMS on Feb. 14 slashed the budget for the Affordable Care Act Navigator program by 90%, citing wasteful spending and minimal impact in signing up people for exchange plans. Kaye Pestaina, director of KFF’s Program on Patient and Consumer Protections, tells AIS Health that the cuts could have a significant impact on consumers because Navigators are impartial and play a major role in informing people of their coverage options, particularly in rural and underserved areas. However, it remains unclear what the impact on ACA exchange enrollment will be. 

The agency announced that it will reduce funding for the program to $10 million starting for plan year 2026. That means the change will go into effect later this year when people consider their ACA exchange coverage options during the open enrollment period that begins on Nov. 1. CMS said the change will save a total of $360 million over a four-year period and apply for the 30 states and Washington, D.C., that use the federal HealthCare.gov platform.  

If enhanced subsidies for Affordable Care Act exchange plans expire at the end of the year and aren’t renewed by Congress, it could upend a market that has seen massive growth in the past four years, according to two health policy experts who spoke during a KFF webinar on Feb. 10. However, Brian Blase, a former adviser to President Donald Trump, argued that the subsidies are too high and oversight of the exchanges in many states is lax, contributing to inflated costs for insurance and fraud among brokers and enrollees. 

Blase’s comments come amid speculation about a rule currently pending at the Office of Management and Budget that concerns ACA “program integrity.” While it’s not clear yet what that rule will entail, it could be focused on rolling back ACA-related regulations that increase federal spending.