Health Plan Weekly

Staff members within HHS plan on briefing the House Energy and Commerce Committee about the department’s recent overhaul since Robert F. Kennedy Jr. took over as secretary, Politico reported on April 2. Bill Cassidy (R-La.) and Bernie Sanders (I-Vt.), the chair and ranking member of the Senate Health, Education, Labor, and Pensions Committee, sent a letter on April 1 to Kennedy asking him to testify before the committee during an April 10 hearing. Politico reported that Kennedy has not said whether he will accept that invitation. HHS announced on March 27 that it would cut 10,000 full-time positions, a process that began this week.  

In a 53-45 vote along party lines, the Senate confirmed Mehmet Oz, M.D., as the administrator of CMS on April 3. During a hearing last month before the Senate Finance Committee, Oz would not confirm whether he would support some of the deep Medicaid funding cuts floated by Republicans in Congress, but he did indicate he supports Medicaid work requirements.  

HHS on March 27 said the department will undergo a “dramatic restructuring” that will cull 10,000 full-time employees from its ranks, consolidate 28 divisions into 15, and cut the number of regional offices in half. Together with HHS’s previous workforce-reduction efforts, the total headcount at HHS will be reduced from 82,000 to 62,000.

But CMS will see the smallest number of layoffs. A fact sheet from HHS said the CMS workforce will decline by approximately 300 full-time employees, compared to 3,500 employees at the FDA, 2,400 at the Centers for Disease Control and Prevention, and 1,200 at the National Institutes of Health.

While it’s no surprise that lower health insurance premiums mean higher deductibles, some consumers, researchers and others might not realize what that can mean for the Affordable Care Act marketplace’s silver and bronze plans. 

In Charleston, South Carolina, $360 per month can get an $8,250 deductible and a $9,450 out-of-pocket (OOP) maximum for an individual above 250% of the federal poverty level (FPL). In Cheyenne, Wyoming, $773 per month buys a $5,900 deductible and $9,100 OOP max. And in Philadelphia, $383 per month can mean a $0 overall deductible — but a $5,000 prescription drug deductible and $9,450 OOP max. 

Health Care Service Corp. has completed its acquisition of The Cigna Group’s Medicare business, which significantly expanded HCSC’s footprint and boosted its Medicare enrollment.

The $3.7 billion purchase of Cigna’s Medicare Advantage, Cigna Supplemental Benefits, Medicare Part D and CareAllies businesses was announced more than a year ago. Divesting these assets “streamlines The Cigna Group’s portfolio and enables it to drive further innovation to support customers,” Cigna stated on March 19.

Although the number of primary care clinicians in the U.S. is declining in many areas, speakers at a recent webinar sponsored by the National Institute for Health Care Management noted that adopting value-based care and other models could help improve outcomes and the patient experience. They said one instance of an effective partnership between a payer and provider is the relationship between Premera Blue Cross, a Blues affiliate in Washington, and Kinwell Medical Group, a primary care medical group. 

In late 2021, Kinwell opened clinics in Washington that exclusively serve Premera members. Romilla Batra, M.D., Premera’s chief medical officer, said during the webinar that the organizations are “coming together, sharing that data seamlessly, identifying problems like access, like mental health and together coming up with solutions….We also have actionable data, which a lot of primary care providers perhaps cannot have, and that’s where this partnership becomes really real.” More than 70% of people enrolled in Premera plans live within a 30-minute drive of a Kinwell clinic.