Health Plan Weekly
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Marketplace MLR Rebates Likely to Drop After Record Highs
Health insurers will likely issue about $1 billion in medical loss ratio (MLR) rebates this year, according to data from the Kaiser Family Foundation (KFF) and Mark Farrah Associates. That amount is a drop from both 2020 and 2021, which set the all-time highs for MLR rebates disbursed since the Affordable Care Act came into effect. Experts tell AIS Health, a division of MMIT, that the dropoff in rebates is related to pandemic utilization and a more stable policy environment for the individual marketplace.
Health plans selling insurance on the individual, small group and fully insured large group markets are required to return any premium revenue that is not spent on care (or care quality improvements) to members.
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FTC Files Lawsuits to Block Hospital Deals in N.J. and Utah
The Federal Trade Commission (FTC) on June 2 said it had filed lawsuits to block hospital mergers in New Jersey and Utah. Health policy experts tell AIS Health that health insurers and other payers likely will welcome the FTC’s actions as mergers limit competition and lead to higher prices.
The FTC is looking to block HCA Healthcare, Inc.’s acquisition of five hospitals that Steward Health Care owns in Utah. The agency is also aiming to deny RWJBarnabas Health’s purchase of Saint Peter’s Healthcare System, a non-profit that operates a hospital in New Brunswick, N.J. The Utah trial is scheduled to begin on Dec. 13 and the New Jersey trial is scheduled to start on Nov. 29.
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MCO Stock Performance, May 2022
Here’s how major health insurers’ stock performed in May 2022. Anthem, Inc. had the highest closing stock price among major commercial insurers as of May 31, 2022, at $509.61. Molina Healthcare, Inc. had the highest closing stock price among major Medicaid insurers at $290.22.
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News Briefs: Inflation Hasn’t Yet Affected Health Care Prices
Inflation has not yet impacted health care prices, according to new research from the Kaiser Family Foundation (KFF). The KFF study reports that in the 12 months ending in April 2022, “overall prices grew by 8.3% from the previous year, while prices for medical care increased by only 3.2%.” The authors added, “This is unusual, as health prices historically outpace prices in the rest of the economy. However, the relatively high rate of inflation seen in the rest of the economy may eventually translate to higher prices for medical care. This may lead to steeper premium increases in the coming years.” Generally speaking, according to the report, prices have grown faster for commercial insurance than public payers, a trend that held up in 2022. Though inflation is greater than it has been for a generation, its impact is likely delayed in health care because of contracting cycles. “Health prices are generally set in advance, administratively or via private insurance contracting, so there may be a delay in observable price increases,” the authors observe.
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With Elections Coming, Chances for Telehealth Reform Dwindle
Despite a pressing need to revise telehealth laws to match the new, post-pandemic expectations of patients, payers and providers, D.C. insiders tell AIS Health, a division of MMIT, that Congress may not actually pass legislation on the issue. With Congress preoccupied by the midterm elections and the possible revival of the Biden administration’s signature Build Back Better Act (BBBA), chances for standalone legislation on telehealth are slipping away.
That doesn’t mean that Congress won’t address telehealth regulations. But telehealth reforms will likely have to pass as part of a larger piece of legislation. That’s how the No Surprises Act, which banned surprise billing, finally made its way through Congress.
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