Health Plan Weekly

✦ Humana Inc. on Dec. 3 unveiled that it will acquire the remaining 50% of iCare, a Wisconsin-based Medicaid plan that it already owned in part. iCare, which Humana previously co-owned with Centers for Independence, Inc., “currently serves 44,000 members through Wisconsin’s Medicaid SSI program, BadgerCare program, and Medicare D-SNP plans for people who are eligible for both Medicare and Medicaid,” according to a press release. The move will allow Humana to offer Medicare D-SNP plans in Wisconsin and increase the company’s overall Medicaid membership to more than 730,000 across four states: Florida, Illinois, Kentucky and Wisconsin. Visit https://bit.ly/2JBjE6j.

✦ America’s Health Insurance Plans and the Blue Cross Blue Shield Association sent a letter to lawmakers on Dec. 3 in an effort “to urge bipartisan action for COVID-19 relief in the final weeks of the 116th Congress.” Among other legislative priorities, the insurer groups call for “eliminating price gouging by setting a reasonable market-based pricing benchmark for [COVID-19] tests administered out of network,” and “providing temporary funding for the full cost of COBRA premiums for Americans who lose their job or are furloughed.” Read the letter to congressional leaders at https://bit.ly/39Np3lg.

At its annual investor day on Dec. 1, UnitedHealth Group predicted that it will incur $2 billion in extra, incidental expenditures in 2021 caused by the ongoing COVID-19 pandemic. Still, Wall Street analysts agreed with UnitedHealth executives’ overall bullish outlook, citing the payer-provider giant’s projected growth in Medicare Advantage (MA) enrollment and ongoing strong returns from its OptumHealth provider segment.

Citi analyst Ralph Giacobbe wrote in a Dec. 2 investor note that he was convinced by UnitedHealth executives’ assertions that COVID-19 held back projected 2021 revenue growth, and he anticipated “a higher baseline to consider when contemplating future years.”

Health care industry insiders say that employers of all sizes are beginning to take a serious look at moving some of their health benefits to Individual Coverage Health Reimbursement Arrangements (ICHRAs) starting in 2022. However, ICHRAs face a somewhat uncertain future with the incoming Biden administration, and some experts aren’t convinced that they presently offer plan sponsors enough value to entice large numbers of firms to move away from traditional employer-sponsored insurance plans.

In July 2019, the Trump administration finalized new regulations for ICHRAs, giving employers greater flexibility to reimburse qualifying employees for buying their own health insurance policies (HPW 7/1/19, p. 1). According to HealthCare.gov, employers can “offer certain types of employees a traditional group health plan and other types of employees an individual coverage HRA,” but “can’t offer the same type of employees a choice between a traditional group health plan and an individual coverage HRA.”

by Jinghong Chen

In 2019, people with employer-sponsored health plans spent 11.5% of their median household income on premiums and deductibles, compared to 9.1% in 2010, according to a recent study published by The Commonwealth Fund. The number of states where 10% or more of employees’ median income was spent on premiums and deductibles rose to 37 in 2019, up from 10 in 2010. On average, people in states where the median income is lower than national median income face higher health care costs.

In a proposed rule released on Nov. 25, CMS floated some ambitious changes to the regulations governing the Affordable Care Act (ACA) exchanges, most notably allowing states to ditch a centralized health plan marketplace and instead rely on private web brokers, agents and insurers to enroll people in coverage.

However, as with the recent revival of a rule that restructures the prescription drug rebate system in Medicare Part D (HPW 11/25/20, p. 5), legal experts say this regulation may never be implemented as written.