Health Plan Weekly

Fewer people with employment-based health plans visited primary care practices, while more have turned to telemedicine and urgent care clinics since the COVID-19 pandemic, according to a report published by the Employee Benefit Research Institute.

Using claims data from 2013 to 2021, researchers found that primary care office visits at a family/general practice, internal medicine practice or with a medical doctor dropped during that time. The share of visits with a nurse practitioner, however, increased significantly, from 4% in 2013 to 16% in 2021.

Nearly 4.6 million have enrolled in Affordable Care Act exchange plans for 2024 since open enrollment began on Nov. 1, including 919,900 people who did not have exchange plans this year. The data captures sign-ups through Nov. 18 for people in the 32 states that use HealthCare.gov for enrollment and through Nov. 11 for people in the 17 states and Washington, D.C., that have state-based marketplaces. CMS Administrator Chiquita Brooks-LaSure said in a press release that “we have seen an increase in plan selections and a significant increase in the number of new enrollees year over year.” The open enrollment period runs through Jan. 15, 2024, for states using the HealthCare.gov website, while deadlines for state-based marketplaces vary.

The Biden administration on Nov. 16 released reports outlining steps it is taking to address social determinants of health and emphasizing the need to improve individuals’ social circumstances. The documents include the U.S. Playbook to Address Social Determinants of Health, the Call to Action to Address Health-Related Social Needs and a Medicaid and CHIP Health-Related Social Needs Framework. HHS Secretary Xavier Becerra said in a press release that “it is clear that the health of our people does not exist in a vacuum, but it is affected by our access to stable housing, healthy food and clean air to breathe.”

In the 2025 version of the government’s annual mega-regulation governing the Affordable Care Act exchanges, multiple proposals appear to be aimed at ensuring state-based marketplaces are adhering to the same standards that apply to the federal marketplace, HealthCare.gov. One health policy expert says it’s probably not a coincidence that the proposed policy changes would take effect the same year that conservative-leaning Georgia is slated to launch its own state-based exchange. 

“I see some proposals in here that are trying to safeguard against efforts to reduce the quality of exchange operations or run an exchange on the cheap,” says Sabrina Corlette, co-director of Georgetown University’s Center on Health Insurance Reforms.  

Recently, CMS revealed that health insurers Bright Health Group, Inc. and Friday Health Plans Management Services Company, Inc., have failed to pay $1.1 billion that they owe to other health insurers through the Affordable Care Act’s risk adjustment program. While Friday will never be able to pay its share — since state regulators have taken over the failed insurer — the government’s repayment agreement with Bright is raising questions about whether the current rules governing ACA risk adjustment need an overhaul. 

“Insurers that attract high-cost enrollees need to be able to count on being compensated by the risk adjustment system, and if they’re not going to be compensated, then insurers will be less willing to offer generous plan designs,” Matthew Fiedler, Ph.D., a fellow with the Brookings Schaeffer Initiative for Health Policy, tells AIS Health, a division of MMIT. 

In 2024, managed care organizations will have to manage more complex care coordination requirements and compliance with ambitious equity goals in many states — even as Medicaid programs have been forced to step up reimbursement rates across many care categories. That’s according to the 2023 edition of KFF's annual survey of state Medicaid officials, which was released on Nov. 14. 

The overwhelming majority of states are increasing Medicaid reimbursement rates across many care categories. Forty-eight states increased rates for at least one care category in 2023, and 47 will do the same in 2024. Only 21 states implemented at least one rate restriction in 2023, and 19 expect to do so in 2024. 

That means total state spending for the safety net health insurance program is likely to increase, despite the ongoing reduction in total enrollment due to the return of eligibility redeterminations. Medicaid spending per enrollee is likely to increase in 2024, KFF found, while total Medicaid spending growth in the surveyed states will likely be 8.3% in 2023, down from 9.8% in 2022.