Health Plan Weekly

Until February, Jeffrey Grant had no immediate plans to retire from his role as the deputy director for operations at CMS’s Center for Consumer Information and Insurance Oversight (CCIIO), which oversees the Affordable Care Act marketplaces and other programs. 

But he says that changed when it became clear that the new administration — as part of a broader effort to pare back the federal workforce — wanted to cut from what Grant describes as an already-understaffed CMS.  

The three insurtechs — Alignment Healthcare, Inc., Clover Health Investments Corp. and Oscar Health, Inc. — each recently reported full-year 2024 earnings reports that continued to show improvements in membership and financial health.  

Ari Gottlieb, principal of health care consulting firm A2 Strategies, is a longtime critic of the companies for touting themselves as technology firms rather than focusing on health insurance. However, Gottlieb says “it was a really good year for all three” companies, each of which achieved profitability on an adjusted earnings before interest, taxes, depreciation and amortization (EBITDA) basis, plus significant gains in membership. 

With Republicans in Congress considering steep cuts to federal Medicaid spending, multiple studies have shown that the proposed policy changes could shift billions in costs to states and leave millions uninsured.

Any major cuts to Medicaid funding could also exacerbate margin pressures for U.S. health insurers, portending potentially lower enrollment and revenue headwinds, Fitch Ratings said in a recent bulletin. As of March, more than 65.6 million people are enrolled in a managed Medicaid health plan, according to AIS’s Directory of Health Plans. Centene Corp. alone accounted for 18.7% of the national market, while Elevance Health, Inc. and UnitedHealthcare ranked the second and the third largest, holding about 11.0% and 8.5% market share, respectively.

HHS Secretary Robert F. Kennedy Jr. recently rescinded a decades-old policy regarding allowing the public — and industry stakeholders like health insurers — to comment on proposed rules. Experts tell AIS Health that while the move is the opposite of “radical transparency” Kennedy promised to bring to HHS, any future rules can be kept in check through other parts of the Administrative Procedure Act (APA). 

“This is surprising when you have an administration, in particular Kennedy, who promised transparency, and this is unequivocally reducing transparency,” says Leonardo Cuello, a research professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families. 

In late February, President Donald Trump signed an executive order signaling his desire to build upon the health care price transparency regulations issued during his first administration. Those rules required hospitals and health insurers to publish lists of negotiated prices for services, including in- and out-of-network rates. But an expert tells AIS Health that issues persist with the massive amount of complex data being submitted by health care organizations — and with ensuring health plan compliance. 

The executive order directs HHS and the Labor and Treasury departments, in the next 90 days, to “take all necessary and appropriate action to rapidly implement and enforce” the price transparency rules targeting hospitals and insurers issued in Trump’s first term. This includes requiring disclosure of actual prices instead of estimates, issuing guidance to ensure standardization and easy price comparisons, and issuing guidance to update enforcement policies, according to the order.