Health Plan Weekly

Since taking office, the Biden administration has taken a hard line on Section 1115 Medicaid waivers, rescinding multiple demonstrations that were approved by the Trump administration and subsequently becoming ensnared in legal fights with Republican-leaning states. Such disputes may wind up being detrimental to Medicaid managed care organizations, which in some cases spent considerable resources on implementing waiver demonstration programs that may never come to fruition.

The latest legal conflict is in Georgia, where the state is trying to preserve an 1115 waiver that the Trump administration approved. Georgia’s waiver would have imposed premiums and work requirements on Medicaid beneficiaries, with the added twist of expanding Medicaid eligibility just for the population earning up to 100% of the federal poverty level — rather than 138% like with regular Medicaid expansion — and therefore receiving a smaller federal funding match.

Pandemic-driven macroeconomic uncertainty and rising prices remain the biggest challenges for employer-sponsored insurance plans, according to experts. The cost of health insurance premiums has made employer-backed health insurance unaffordable to the point of being useless for many families, while the pandemic has created a volatile environment for many employers, particularly small businesses.

During a Jan. 26 panel hosted by the Bipartisan Policy Center, a Washington, D.C. think tank, employer health insurance experts sounded off on the myriad difficulties facing plan sponsors and employee beneficiaries. Worries over cost and the pandemic took up most of the discussion.

Health insurer Anthem, Inc., reported solid fourth-quarter results on Jan. 26, with some numbers in line with expectations and others hitting above or below expectations. The company also indicated it’s bracing for medical costs to rise above normal levels this year amid the ongoing COVID-19 crisis — though perhaps not as much as in 2021.

Anthem reported $5.14 in adjusted earnings per share (EPS) for the quarter, beating the consensus of $5.11. “EPS appears to be aided by better-than-expected investment income to the tune of $0.42, which grew $23% [year over year],” Jefferies analyst David Windley wrote in a Jan. 26 note to investors.