Health Plan Weekly

The Department of Justice (DOJ) on March 27 filed a statement of interest in a U.S. District Court in Illinois that supported health care providers’ cases against multiple health insurers and MultiPlan, a data analytics firm that offers health care cost management services such as out-of-network claims repricing. The filing suggests that if the court agrees that payers used MultiPlan’s algorithm to collude on suppressing prices paid to providers, such conduct could be considered an antitrust violation, according to Loren Adler, a fellow and associate director at the Brookings Center on Health Policy. 

Adler tells AIS Health he is “curious about the DOJ’s motivation” for the filing, but he notes that an ultimate ruling in favor of providers could lead to higher reimbursement and overall health care costs. Adler points out that this is different than other health care antitrust cases the DOJ has pursued, including when payers or hospitals merge and raise prices. In those cases, the plaintiffs and agencies want to have more competition and lower prices. 

During the 2025 open enrollment period, 24.3 million people enrolled in Affordable Care Act marketplace plans, setting a record for the fourth consecutive year. ACA marketplace signups have now more than doubled since 2020, with most of the growth occurring in states won by President Donald Trump in the 2024 election, according to a new KFF analysis.

About 17.1 million people enrolled through HealthCare.gov between Nov. 1, 2024, and Jan. 15, 2025, in the 31 states that use that platform. Another 7.2 million enrolled across 19 states and Washington, D.C., which use their own marketplaces. Georgia transitioned to its own state-based marketplace this year.

During his mid-March confirmation hearing before the Senate Finance Committee, Mehmet Oz, M.D., expressed tentative interest in an idea floated by a Democratic senator: expanding the often-overlooked Basic Health Program (BHP). Health policy experts say that while the program was only implemented by two states, it could get a fresh look now that enhanced Affordable Care Act subsidies are set to expire at the end of the year. 

Referring to a conversation that occurred prior to the hearing, Sen. Maria Cantwell (D-Wash.) began, “You and I talked about this concept of bundling up the working population at 150% above the Medicaid rate — as New York has done, as Minnesota has done, as now other states are trying to do — and creating that incentive juxtaposed to the exchange.” She then asked the CMS administrator nominee, who was confirmed on April 3, “Do you believe in that concept?”  

The “well-intentioned” Inflation Reduction Act (IRA) of 2022 could cause more harm than good in the world of payers, pharmacies and drug development, according to experts who spoke at the 2025 Academy of Managed Care Pharmacy conference in Houston, held March 31 through April 3. 

The IRA introduced a $2,000 cap on Medicare Part D beneficiaries’ out-of-pocket drug costs in the catastrophic phase of coverage, which took effect this year. When the cap is met, the remaining cost responsibility is shouldered by payers and drug manufacturers, which both are now paying a larger share of those costs than they did before the IRA. 

Individual Coverage Health Reimbursement Arrangements are not just an option for small businesses or for firms facing the prospect of big premium hikes in their traditional employer-sponsored plans, panelists argued during a recent webinar seeking to dispel ICHRA “myths.” 

“We hear people say sometimes that the system isn’t set up to support large groups,” said Ben Light, vice president of partnerships at Zorro, which offers employers an “end-to-end” ICHRA and health benefits platform. “And we actually think that the system is set up to support large groups in many ways.”