Health Plan Weekly

CMS on Apr. 16 revoked an eleventh-hour Section 1115 waiver the Trump administration had granted to Texas, which makes the shape of the second-most populous state’s Medicaid program after 2022 an open question. Experts say that CMS’s action is an attempt by the Biden administration to push Texas to expand Medicaid — although the state’s legislature recently voted down one such proposal.

CMS had approved Texas’ waiver request on Jan. 15, less than a week before the end of the Trump administration. The waiver would have sent about $11.4 billion to Texas annually in order for the state to compensate providers for unreimbursed care. The Trump administration approved the waiver for 10 years, a term that experts say is unusually long and likely motivated by politics.

Spurred in part by the harsh spotlight that the COVID-19 pandemic has shone on health equity issues, the Blue Cross Blue Shield Association (BCBSA) on April 20 unveiled a vast, ambitious initiative that aims to “change the trajectory of heath disparities and re-imagine a more equitable healthcare system.”

Industry experts say that now is the ideal time for such a project to kick off and that the BCBSA and its 35 member plans are well-positioned to take on such a challenge. To succeed, though, the Blues plans will need to build crucial trust among the populations they’re hoping to help, and they must act as the conduit for grassroots efforts that health insurers can’t handle on their own.

✦ Enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) grew by 10.8% between February and November 2020 to approximately 78 million, according to an issue brief by the Kaiser Family Foundation (KFF). The growth in the safety-net insurance programs follows a two-year trend of declining enrollment. “Increases in enrollment reflect changes in the economy (as more people experience income and job loss and become eligible and enroll in Medicaid and CHIP coverage) and provisions in the Families First Coronavirus Response Act (FFCRA) that require states to ensure continuous coverage to current Medicaid and CHIP enrollees to access a temporary increase in the Medicaid/CHIP match rates,” the brief said. Read more at https://bit.ly/39Lg97F.

✦ Making the expanded Affordable Care Act (ACA) marketplace tax credits included in the American Rescue Plan permanent would lower the national uninsured rate by 4.2 million, according to an analysis by the Robert Wood Johnson Foundation (RWJF) and Urban Institute. Individuals who already qualified for premium tax credits under the ACA will see more generous financial aid, including expanded access to zero- premium plans for lower-income people. In addition, people whose incomes were too high to qualify for subsidies will be eligible for reduced premiums for the first time thanks to a provision that caps marketplace premiums at 8.5% of all enrollees’ income. The subsidies are currently set to expire after 2022. Read more at https://rwjf.ws/3docTB4.

Medicare beneficiaries who shopped and made a coverage change during this last Annual Election Period (AEP) were more likely to stick with their current insurer than in years past, illustrating the dual need for insurers to engage with consumers throughout the year and to innovate with benefits that will attract and retain satisfied members, according to experts speaking at a recent webinar co-hosted by Deft Research and GHG Advisors. At the same time, Medicare Supplemental (MedSupp) customers are showing increased interest in Medicare Advantage, presenting more opportunities to disrupt that market.

Outside of a few dozen rural counties where it’s hard to create an attractive plan network, MA insurers across the country are seeing solid growth, with close to 43% of Medicare eligibles enrolling in the individual and group MA market — moving ever closer to CMS’s estimate that MA penetration will reach 50% by 2025, observed Deft Executive Vice President George Dippel during the April 8 webinar, “2021 AEP: How the Results Will Drive Plan Decisions for 2022 and Beyond.”

UnitedHealth Group began the first quarter of 2021 on a high note, reporting earnings per share (EPS) and a medical loss ratio (MLR) that both beat the Wall Street consensus estimate and saying it expects to achieve greater full-year earnings than it previously estimated. However — mirroring much of the messaging last year when the COVID-19 pandemic was massively depressing routine and elective care — executives warned that the majority of the unfavorable COVID impact they’re expecting will transpire in the second half of the year.

In fact, UnitedHealth expects roughly 70% of the predicted COVID-related $1.80 EPS hit to occur in the back half of the year, Chief Financial Officer John Rex said during an April 15 conference call to discuss the company’s financial results. He said that projection is based on UnitedHealth’s prediction that as the year wears on and vaccination rates rise, people will increasingly be able to access higher-acuity, previously deferred care.