Health Plan Weekly

The saga of Bright Health Group, Inc. became even more complex on Nov. 29, when the troubled health insurer's plan to remit unpaid risk adjustment fees to CMS was partially blocked by a Texas state judge at the prompting of the Texas Dept. of Insurance (TDI). The Texas court’s action will compel Bright to complete the receivership process for its Texas subsidiary and pay off creditors with claims in Texas before sending any capital to the federal government or other out-of-state creditors, experts say — that is, if there is any money to send somewhere in the first place. 

"I know that there’s some talk now that Texas will be at the back of the line for purposes of CMS or any of the Texas plans that would have gotten the risk adjustment money, in terms of being able to collect on that,” Leah Stewart, an attorney at Reed Claymon PLLC, tells AIS Health, a division of MMIT. “I think politically they [Texas officials] probably don’t care that it impacts CMS’s deal with Bright Health. But I don’t know that they were actually angling for that, as opposed to just deciding that Bright Health of Texas doesn’t have enough money and taking it down the standard liquidation path.” 

A megamerger reportedly brewing between The Cigna Group and Humana Inc. could create a health insurance giant with 31 million members that’s capable of rivaling UnitedHealth Group and CVS Health Corp — if the deal could weather antitrust challenges.

Cigna’s health insurance products cover more than 17 million people nationwide, and almost 80% of its members are enrolled in administrative services only (ASO) employer-based health plans, according to the latest data from AIS’s Directory of Health Plans (DHP). Humana, meanwhile, enrolls over 13.7 million people, with nearly 42% in Medicare Advantage plans, including those serving people who are dually eligible for Medicare and Medicaid. It also has a large contract with TRICARE, the health insurance program serving military service members, retirees and their families.

Since open enrollment began on Nov. 1, nearly 7.3 million people have signed up for Affordable Care Act health exchange plans for 2024, according to CMS. The data is through Dec. 2 for the 32 states that use the HealthCare.gov website and through Nov. 25 for the 18 states and Washington, D.C., that have state-based exchanges. More than 1.6 million of the people who enrolled, or about 23% of the total, did not have marketplace coverage in 2023. Enrollment runs through Jan. 15, 2024, for the states using HealthCare.gov, while the deadlines vary for state-based exchanges.  

Optum, UnitedHealth Group’s health services arm, employs or has contracts with nearly 90,000 physicians and an additional 40,000 advanced practice clinicians, according to Optum Health CEO Amar A. Desai, M.D. Since there are about 950,000 active physicians in the country, that means Optum employs just under 10% of them. Desai, who spoke at UnitedHealth’s investor meeting on Nov. 29, added that Optum serves not only UnitedHealth’s members but also beneficiaries from more than 100 health plans. In addition, Optum serves more than 4 million people in fully accountable care arrangements and expects that number to increase to 5 million by late 2024.  

The Cigna Group is reportedly discussing a multibillion-dollar deal with Humana Inc. that would create a diversified health insurance giant capable of going toe-to-toe with UnitedHealth Group and CVS Health Corp.  

Industry observers agree that such a transaction would receive robust regulatory scrutiny — with many predicting a high likelihood that federal officials will lob a legal challenge. However, opinions vary about how much the companies’ respective PBM businesses present a major antitrust risk. 

News of the potential deal came from a Nov. 29 Wall Street Journal article, which cited people familiar with the matter speaking on condition of anonymity. Assuming the talks don’t fall apart, the terms of the deal could be finalized by the end of the year, the article stated.