Health Plan Weekly

While the Biden administration has proposed a long-awaited fix for the Affordable Care Act’s “family glitch” — potentially making coverage more affordable for thousands — the looming expiration of major ACA subsidy expansion threatens to overshadow that progress.

Health insurers that spoke to AIS Health, a division of MMIT, seem concerned about the potential drawback of generous financial help for exchange enrollees, but are not necessarily ready to hit the panic button yet.

“We have the unfortunate benefit, I’d characterize it, as having been through in the past other situations where there was uncertainty about the future of the market,” says Bill Tuthill, vice president of market strategy and federal markets for Highmark Inc. Perhaps the most frightening times occurred when all or major parts of the ACA were in danger of being struck down by the Supreme Court — but that threat didn’t pan out, Tuthill tells AIS Health, a division of MMIT.

For years, health plan sponsors have banded together in purchaser groups in an effort to keep prices down and share benefit design best practices. Yet new research from the Commonwealth Fund indicates that purchaser groups have had marginal success in slowing the growth of health care costs.

Despite these limitations, health care insiders tell AIS Health, a division of MMIT, that purchaser groups have an important role to play in managing price growth. They also say that, while hospital consolidation has a large role in driving up health care prices, health insurers have not done their part to stop prices from increasing — and in fact may have incentives to keep prices rising.

Both UnitedHealth Group and Change Healthcare Inc. are making it increasingly clear that they aren’t giving up on their proposed $13 billion transaction despite federal regulators’ move to block the deal. However, one antitrust attorney is skeptical that the two companies will ever end up combining.

Bloomberg reported on April 1 that Change “is in advanced talks” to sell its payment integrity business — ClaimsXten — to private equity firm New Mountain Capital for more than $2 billion, citing “people with knowledge of the matter.” The news outlet noted that no deal had yet been struck, and that it is not clear whether the divestment would still proceed if UnitedHealth’s deal to buy Change unravels.

Medicare Part B will now cover eight over-the-counter, at-home COVID-19 tests per month with no cost sharing for beneficiaries starting April 4, according to a new Biden administration policy. Medicare Part B and Medicare Advantage beneficiaries will be able to order the tests from a government website or acquire them from participating retailers through the end of the public health emergency.

The new benefit will not require much participation from Medicare Advantage plans, although their members are eligible to receive it. Members can submit purchases for reimbursement or obtain the tests for free from retailers.