Health Plan Weekly

  • Biden Admin Touts Record Marketplace Open Enrollment

    Sign-ups for health plans on the individual exchanges have hit a record high six weeks into open enrollment, according to CMS: 13.6 million people have enrolled in coverage for 2022, with a month still left to go in the annual open enrollment period. That includes 9.7 million who have enrolled in HealthCare.gov plans, which is the federal platform used by 33 states, and 3.9 million who have enrolled via the 18 state-based marketplaces.
  • Poll Shows Growing Struggle to Afford Health Care, Increasing Concerns Over Inequities Amid Pandemic

    As of October, almost one-third of Americans reported skipping medical care in the prior three months due to the costs, compared with 10% in March, according to the West Health-Gallup 2021 Healthcare in America Report. The poll surveyed more than 6,600 American adults. About 23% of people reported that health care costs are a major financial burden for their family, while 90% expected health care costs to continue to increase over the next 12 months. The COVID-19 pandemic worsened almost half of Americans’ views of the health care system, with 60% saying they became more concerned about health care inequities. Regardless of their political affiliation, the majority of Americans reported that a candidate’s plan to reduce health care costs is either a major or a minor priority when determining their vote.
  • News Briefs: Biden Promises to Deliver Free At-Home COVID Tests | Dec. 23, 2021

    On the heels of announcing that private health insurers will soon have to reimburse Americans for at-home COVID-19 tests, President Joe Biden said on Dec. 21 that the federal government will also distribute a half-billion free at-home testsDuring the president’s remarks, which come as case counts are rising due to the omicron variant, he acknowledged that “we need to do better with at-home testing,” adding that the administration will set up “websites where you can get them delivered to your home.” Biden also said the federal government will set up emergency testing sites in areas that need additional testing capacity, starting with sites in New York City.
  • Provider Lawsuit Could Tie Up Surprise Billing Regulations

    The U.S.’s two largest health care provider groups, the American Medical Association (AMA) and the American Hospital Association (AHA), sued the Biden administration on Dec. 9, asking a federal court to block regulations officials developed to implement the No Surprises Act, parts of which will come into effect on Jan. 1. Health care attorneys tell AIS Health that the suit may hinge on the providers’ allegation that federal officials stretched their legal authority too far beyond the Act’s original intent — and that the providers might win.

    The AMA and AHA (joined in the suit by two hospital systems and two North Carolina physicians) accuse the Biden administration of creating rules for the “independent dispute-resolution process that would unfairly benefit insurance companies,” in the words of an AMA press release. The provider groups target an Oct. 7 interim final rule in their lawsuit, arguing that the IFR’s guidance to the arbitrators who will decide balance billing disputes “deviates from Congress’s balanced design.” According to the providers’ legal complaint, the Biden administration’s rulemaking disrupted an “approach that did not skew towards either providers or insurers” that Congress arrived at through “compromise.”

  • Payer Execs Answer Question: ‘How’s Interoperability Going?’

    The road to complying with new data interoperability regulations has not been an easy one for health insurers, but the process has offered valuable insights to an industry that’s continually striving to modernize and better meet consumers’ needs.

    Those are some of the main takeaways from a virtual “Health Insurance Provider Interoperability Town Hall” that AHIP convened as part of its 2021 Consumer Experience & Digital Health Forum. The Dec. 8 panel discussion featured speakers from a diverse array of payers, yet many of their experiences complying with interoperability mandates had common themes.

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