Health Plan Weekly

Although there’s a divided Congress this year — with Republicans controlling the House and Democrats in charge of the Senate — there are still a variety of health care policy issues that federal and state legislators alike have in their crosshairs, experts said during a recent webinar hosted by the Alliance for Health Policy. And some of those agenda items could be of considerable interest to health insurance companies. 

Paul Edattel, principal of Todd Strategy Group, LLC, a federal government affairs firm, said he expects the newly Republican-controlled House to zero in on budgetary issues. “Budgetary issues are top-of-mind for House Republicans and some Senate Republicans,” he remarked during the Jan. 25 webinar. “Things like the operating budget for the Department of Health and Human Services...will be under really heightened scrutiny relative to prior Congresses.” 

Elevance Health, Inc. on Jan. 25 reported adjusted earnings per share (EPS) of $29.07 in 2022, representing a 12% increase from 2021. Gail Boudreaux, the company’s president and CEO, told analysts on a conference call that it was the fifth consecutive year in which Elevance’s adjusted EPS had hit or exceeded its 12% to 15% annual target increase. That came as the insurer, which was known as Anthem, Inc. until last year, ended the year with more than 47.5 million medical members, up nearly 2.2 million from the end of 2021. 

David Windley, a Jefferies analyst, wrote in a note to investors on Jan. 25 that Elevance’s fourth quarter “was solid (maybe not exceptional),” citing the company’s 89.4% medical loss ratio (MLR) and adjusted EPS of $5.23, which beat the Wall Street consensus estimate of 90.1% and $5.19, respectively. Windley noted that Elevance “still has a long way to go” with improving its full-year 5.4% operating margin, although he noted the 3.4% fourth-quarter operating margin was a 10 basis-point improvement from the fourth quarter of 2021. 

New research conducted by Avalere on behalf of the Better Medicare Alliance (BMA) suggests Medicare Advantage plans aid in earlier detection of type 2 diabetes and that seniors diagnosed with type 2 diabetes generally fare better than similar patients in fee-for-service (FFS) Medicare. Specifically, lower medical spending and rates of inpatient hospitalizations/emergency department visits observed by researchers may be particularly compelling for policymakers as they consider the overall value of the MA program.

With MA serving more seniors than ever before — having just reached a milestone of enrolling more than 30 million Medicare-eligible beneficiaries — and one-third of seniors estimated to have a diagnosis of type 2 diabetes, it is important to look at how these patients’ care differs in MA vs. traditional Medicare, asserted Matt Kazan, managing director with Avalere, during a Jan. 12 webinar hosted by BMA. In many cases, there are “major differences,” he noted.