Health Plan Weekly

✦ Americans’ satisfaction with their health insurance has dipped to its lowest point since 2016, according to American Customer Satisfaction Index (ASCI) Finance, Insurance, and Health Care Report for 2019-2020. The sector’s score weakened 7.2% year over year for an ASCI score of 72 out of 100, and Humana Inc. remained in the lead with a 75 — though its score declined 5%. The Blue Cross and Blue Shield Association scored an industry-average 72 but bucked the declining-satisfaction-score trend by seeing a 1% uptick. And “at the bottom of the industry, CVS Health’s Aetna plummets 7% to 71,” according to a press release summing up the report. Read more at https://bit.ly/3pZN7qL.

✦ In 2021, 30 health insurers are entering the Affordable Care Act exchanges across 20 states, and another 61 insurers are expanding within states where they already operated, according to a new analysis from the Kaiser Family Foundation. Next year there will be an average of 5.0 insurers per state in the exchanges, which is still below the high of 6.0 insurers in 2015 but far improved from the low of 3.5 in 2018. In 2021, 78% of enrollees will have a choice of three or more insurers, up from 67% of enrollees in 2020 and 58% of enrollees in 2019. Meanwhile, only 10% of counties have only a single insurer offering in 2021, down from 52% of counties in 2018. Visit https://bit.ly/3nUCYda to learn more.

On Nov. 20, as part of a health care regulatory blitz taking place in the waning days of the Trump administration, HHS finalized a once-tabled regulation that would revamp the Medicare prescription drug rebate system. This time around, HHS is promising that the so-called rebate rule won’t raise costs for Medicare beneficiaries or the federal government, but some experts remain skeptical.

The rebate rule first appeared in January 2019 in a notice of proposed rulemaking (NPRM), which aimed to remove safe-harbor protections under the federal anti-kickback statute for rebates that drug manufacturers provide to Medicare Part D plans, PBMs and Medicaid managed care organizations. But the administration pulled the proposed rule in July 2019 amid estimates from the Congressional Budget Office (CBO) and CMS’s Office of the Actuary that it would increase federal spending and Medicare beneficiary premiums.

While President-elect Joe Biden’s administration will likely move forward with some type of health insurer price transparency regulation, industry insiders say the new policy will likely differ from the rule the Trump administration recently finalized (HPW 11/6/20, p. 1).

“I think that the [new] administration will take a step back and think carefully about what makes the most sense,” Avalere Health Founder Dan Mendelson tells AIS Health. Mendelson doubts that the Trump administration rule will actually have an impact at the consumer level. Under the rule, by January 2023 health plans must offer members online shopping tools that allow them to see the negotiated rate between their provider and their plan, as well as a personalized estimate of their out-of-pocket cost for 500 of the most shoppable items and services. Effective one year later, those shopping tools will have to show the costs for all remaining items and services.

Reinsurance programs can help lower premiums in the individual insurance market, but they’re not enough by themselves — states will need to experiment with broader measures to impact underlying health care costs, particularly for unsubsidized individual market enrollees, a report from The Commonwealth Fund concludes.

However, such programs could be a tough sell as states tighten their budgets because of the COVID-19 pandemic, says study author Justin Giovannelli, an associate research professor and project director at Georgetown University’s Center on Health Insurance Reforms.