Health Plan Weekly

Although the November elections may alter the balance of power in Congress and change which party controls the White House, Democratic lawmakers this week introduced legislation that would advance a key policy priority for Affordable Care Act supporters and health insurers alike: Making enhanced ACA subsidies permanent. 

One health policy expert says the timing of the move makes sense, despite the imminent elections. 

“It’s good to kind of get the bill on the table and get people talking about the issue,” says Katherine Hempstead, Ph.D., senior policy adviser at the Robert Wood Johnson Foundation. She also tells AIS Health, a division of MMIT, that it’s important to “raise the profile of…how there will be chaotic [rate] filing next year if there’s uncertainty about whether the tax credits are going to be there or not.”  

Across the U.S., UnitedHealthcare’s negotiated commercial rates with hospitals for hip and knee replacements last year ranged from $11,203 to $106,427, according to a Sept. 20 analysis published in JAMA Health Forum. Meanwhile, the same study found that the negotiated rates for hip and knee replacements in the Chicago area varied significantly by hospital and payer. 

Allison Oakes, Ph.D., the study’s lead author, tells AIS Health the variation was “staggering” and “inexcusable” and occurred even as insurers are subject to the Transparency in Coverage (TiC) rule that went into effect in 2022.  

With nearly all states having completed the Medicaid “unwinding process” that shed millions of people from the rolls, a new analysis finds that total Medicaid and Children’s Health Insurance Program (CHIP) enrollment is actually higher than it was before the COVID-19 pandemic. One expert tells AIS Health that private insurers helped conduct crucial outreach to ensure people losing coverage could get insured elsewhere — although Medicaid managed care organizations (MCOs) still are grappling with the financial consequences of the unwinding.  

More than 25 million people lost their Medicaid or Children’s Health Insurance Program (CHIP) coverage and over 56 million had their coverage renewed during the Medicaid eligibility redetermination process, according to a KFF analysis of data released by states and CMS. Though millions have been disenrolled, nearly 10 million more people are currently enrolled in Medicaid/CHIP than at the start of the pandemic. 

Starting in April 2023, states were permitted to resume disenrolling people from Medicaid who no longer qualify after a multiyear pause of routine eligibility checks during the COVID-19 public health emergency. Compared to pre-pandemic levels, total Medicaid/CHIP enrollment is now higher in all but four states: Colorado, Montana, Arkansas and Tennessee. Missouri and North Carolina saw Medicaid/CHIP enrollment growth of more than 50%, as of May 2024. 

In the latest twist in Arizona’s controversial quest to implement new statewide long-term care contracts with Centene Corp. and UnitedHealth Group, a Republican state senator said he is looking into the potential mismanagement of state taxpayer dollars by Gov. Katie Hobbs (D). That includes the questionable procurement of Medicaid contracts serving approximately 26,000 elderly and disabled members conducted by the Arizona Health Care Cost Containment System (AHCCCS).