Health Plan Weekly

On Sept. 19, the Biden administration filed a petition asking the U.S. Supreme Court to review the case Braidwood Management, Inc. v. Becerra, which challenges the legality of the Affordable Care Act’s requirement that nearly all health insurers must cover a slew of preventive services without cost sharing.  

Legal experts tell AIS Health, a division of MMIT, that the case could have significant ramifications for patients and the health care industry alike. And they say how it plays out may partly depend on who wins the upcoming elections.  

“We’re getting close to four years in terms of when it was filed, but the stakes of this case remain really significant for tens of millions of Americans,” says Zachary Baron, director of the Health Policy and the Law Initiative at the O'Neill Institute. More than 150 million Americans have benefited from no-cost coverage of preventive services, he says, including lung cancer screenings, statins used to lower cholesterol, mammograms, vaccines and birth control.  

Although the November elections may alter the balance of power in Congress and change which party controls the White House, Democratic lawmakers this week introduced legislation that would advance a key policy priority for Affordable Care Act supporters and health insurers alike: Making enhanced ACA subsidies permanent. 

One health policy expert says the timing of the move makes sense, despite the imminent elections. 

“It’s good to kind of get the bill on the table and get people talking about the issue,” says Katherine Hempstead, Ph.D., senior policy adviser at the Robert Wood Johnson Foundation. She also tells AIS Health, a division of MMIT, that it’s important to “raise the profile of…how there will be chaotic [rate] filing next year if there’s uncertainty about whether the tax credits are going to be there or not.”  

Across the U.S., UnitedHealthcare’s negotiated commercial rates with hospitals for hip and knee replacements last year ranged from $11,203 to $106,427, according to a Sept. 20 analysis published in JAMA Health Forum. Meanwhile, the same study found that the negotiated rates for hip and knee replacements in the Chicago area varied significantly by hospital and payer. 

Allison Oakes, Ph.D., the study’s lead author, tells AIS Health the variation was “staggering” and “inexcusable” and occurred even as insurers are subject to the Transparency in Coverage (TiC) rule that went into effect in 2022.  

With nearly all states having completed the Medicaid “unwinding process” that shed millions of people from the rolls, a new analysis finds that total Medicaid and Children’s Health Insurance Program (CHIP) enrollment is actually higher than it was before the COVID-19 pandemic. One expert tells AIS Health that private insurers helped conduct crucial outreach to ensure people losing coverage could get insured elsewhere — although Medicaid managed care organizations (MCOs) still are grappling with the financial consequences of the unwinding.