Health Plan Weekly

For the health insurance industry — alongside the rest of the health care sector, and even the world — the COVID-19 pandemic was undeniably the event that dominated 2020. However, other issues also captured headlines and had major implications for the sector, including the U.S. election, various court cases, a slew of regulatory moves from the Trump administration, and some notable transactions.

“The outcome of the presidential election was certainly the biggest environmental change that we have seen,” says Dan Mendelson, founder of consulting firm Avalere Health.

Equities analysts are bullish on the health insurance industry in 2021, despite the challenges caused by the COVID-19 pandemic. Wall Street also expects more mergers and acquisitions will take place in 2021 than the previous year, particularly vertical deals and national carriers buying up regional health plans. However, analysts also emphasized that the uncertainty of care utilization patterns tied the pandemic continues to inject risk into their projections.

Analysts emphasized the stable cash flow that managed care firms have enjoyed over the past several years, and they observed that strong fundamentals will allow them to manage the volatility coming in 2021.

✦ On Dec. 22, Congress voted to repeal health insurers’ exemption from federal antitrust laws by amending the McCarran-Ferguson Act, which expressly delegated health insurance competition questions to states. The bill would allow the Federal Trade Commission and Dept. of Justice to take action under federal antitrust law if health insurance companies engage in anticompetitive practices. The bill does not prevent states from enforcing their own rules. However, a Dec. 2 letter signed by four state insurance commissioners, each of whom were appointed by Republican governors, announced the opposition of the National Association of Insurance Commissioners (NAIC) to the bill. The commissioners argued that “existing state consumer protection, antitrust, and unfair trade practice laws provide the necessary tools needed to help stop anti-competitive conduct. Adding a layer of federal review would only lead to increased costs, confusion, and possible conflicts in federal and state courts.” Matt Eyles, CEO of America’s Health Insurance Plans (AHIP), condemned the bill in a Dec. 22 statement, arguing it will “[add] administrative red tape and reduc[e] market competition while making health coverage less affordable for hardworking Americans.… It will unnecessarily add layers of bureaucracy, destabilize markets, create conflicting federal and state oversight requirements, and lead to costly litigation.” Read the bill at http://bit.ly/3nPmyDl and the NAIC letter at https://bit.ly/2WDRtqg.

✦ Lyft Inc. will offer 60 million rides to COVID-19 vaccination sites for low-income, uninsured and at-risk people who might be unable to access the vaccine otherwise. The program will be sponsored by partners including Anthem, Inc., Centene Corp., Epic Systems Corp., One Medical Group Inc., JPMorgan Chase Co. and United Way. “Access to reliable transportation represents a major barrier to care for millions of Americans across the country,” said Megan Callahan, VP of Lyft Healthcare. “The COVID-19 pandemic has exacerbated this problem, creating a huge challenge in making sure vulnerable populations have access to the vaccine — especially for seniors living alone, low income workers, and parents with young children.” Gail K. Boudreaux, President and CEO of Anthem added that “with the highly anticipated vaccine now rolling out across the country, we are pleased to be joining Lyft and other leading partners to ensure our nation’s most vulnerable consumers will have the opportunity to receive the vaccine.” Read more at http://bwnews.pr/3rp4nXh.

Internal equity and diversity programs could be a powerful business strategy for plans that serve under-resourced populations, two experts say.

But to make these programs truly effective, organizations must start at the top and embed equity and diversity principles in everything they do, moving beyond a mere “box-checking” mentality, said Sachin Jain, M.D., president and CEO of SCAN Group and SCAN Health Plan, based in Long Beach, Calif.