Health Plan Weekly

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.

Although a judge has already ruled in a lengthy court battle over the breakup fee and damages related to Anthem, Inc.’s failed attempt to acquire Cigna Corp., litigation related to the doomed deal apparently is not yet over. Instead, a lawsuit recently filed by Cigna shareholders seeks to hold that company’s leaders responsible for their alleged “sabotage” of the acquisition.

Anthem and Cigna first unveiled their $54 billion transaction in 2015, on the heels of Aetna Inc. and Humana Inc. announcing their own blockbuster combination. The Dept. of Justice sued to block both deals on antitrust grounds in 2016, and federal judges sided with regulators in both cases in February 2017.