Health Plan Weekly

The health insurance industry’s largest trade group is asking the Biden administration not to implement a proposal that would hold insurers responsible for discriminatory decisions made by clinical algorithms — saying HHS should instead work with stakeholders to better understand the issue. 

The Nondiscrimination in Health Programs and Activities Proposed Rule, which HHS rolled out in August, primarily serves to reinstate nondiscrimination regulations that the Trump administration unwound — for example, by specifying that sex-based discrimination encompasses sexual orientation and gender identity. The proposals apply to all health programs and activities receiving federal financial assistance, such as hospitals that take Medicare patients and all health insurers that receive federal funding.  

Medicare beneficiaries in nearly every state will have more Medicare Advantage plans to choose from and see lower premiums this fall when shopping for coverage, according to CMS’s recently released landscape files for the 2023 plan year. And both major insurers and regional plans at press time were touting new offerings such as Part B buyback plans, flexible spending features that include allowances for utilities, and enhanced dental coverage. 

“What we’re seeing is kind of a continuation of what we’ve seen in the past several years, which is expanding of not only the big five but also of the smaller insurers as well, and then increased focus on supplemental benefits and the Special Supplemental Benefits for the Chronically Ill (SSBCI), and continued expansion into the D-SNP [Dual-Eligible Special Needs Plan] market,” observes Betsy Seals, co-founder and CEO of Rebellis Group, LLC.

Recently, UnitedHealth Group and Change Healthcare Inc. received welcome news when a federal judge ruled that their $13 billion deal could proceed despite the U.S. Dept. of Justice’s contention that it would illegally stifle competition. While it isn’t yet clear whether the DOJ will appeal the ruling, experts say the case itself offers important lessons for the health care industry and other firms mulling similar transactions. 

“It was enlightening when looking at information concerns that increasingly will be the subject of antitrust challenges,” antitrust attorney David Balto tells AIS Health, a division of MMIT. “But the first time you step in the water with a somewhat novel theory, it’s going to be hard. So I think they established some good groundwork for future antitrust challenges.”