Health Plan Weekly

Just one day after the Biden administration extended the public health emergency (PHE) through mid-October, AHIP published a report arguing that price-gouging on COVID-19 tests continues to be a problem. Crucially, that issue was created when pandemic relief legislation removed health insurers’ ability to hold down out-of-network charges for COVID tests, the trade group says.

Health policy experts who have studied COVID test prices and pandemic relief legislation say that AHIP’s findings are not at all off base. However, there may be little chance of addressing insurers’ concerns anytime soon.

✦ More than two million people have signed up for health care coverage during the pandemic special enrollment period on HealthCare.gov, according to CMS. Signups have undoubtedly been boosted by the expanded premium subsidies that were included as part of the American Rescue Plan Act, the March pandemic recovery bill. According to CMS, “of the new and returning consumers who have selected a plan since April 1, 1.2 million consumers (34%) have selected a plan that costs $10 or less per month after the American Rescue Plan’s (ARP) premium reductions.

✦ Latinos were more likely to embrace virtual mental health care than people in other U.S. racial or ethnic groups, according to a new analysis prepared by Anthem, Inc. Anthem reviewed claims data from Medicaid members in 14 states and found that, during the peak of the pandemic, 40% of Latino members used virtual mental health services, compared to 34% of white members, 33% of Asian members and 28% of Black members. The payer also said that virtual visits accounted for 49% of its reimbursed Medicaid mental health visits during the pandemic and it reimbursed a lower volume of mental health visits during the pandemic than it normally would have: “While telehealth did boost visits during COVID-19, it didn’t make up for the dramatic drop in in-person visits for all races and ethnic groups.”

During the company’s July 15 call to discuss second-quarter 2021 financial results, UnitedHealth Group executives — perhaps unsurprisingly — fielded a question about how the company is approaching Aduhelm (aducanumab), the pricey new Alzheimer’s disease therapy that continues to be shrouded in controversy.

Chief Medical Officer Richard Migliori, M.D., told analysts that “we are continuing to develop our clinical policy as well as our ultimate position on coverage, but in doing so we’re looking forward to getting the guidance that we need from Medicare.” CMS on July 12 said it was opening a National Coverage Determination analysis on Aduhelm, which will ultimately specify how Medicare will cover the $56,000 per year treatment. In the meantime, coverage will be determined at a local level by Medicare Administrative Contractors, the Biden administration said.

by Jinghong Chen

People with employer-sponsored and individually purchased private insurance were more likely to report poor access to health care, higher costs of care and less satisfaction with care compared with individuals covered by public insurance programs, according to a recent study published in JAMA Network Open. The researchers studied data from the 2016-2018 Behavioral Risk Factor Surveillance System on nearly 150,000 individuals and found that Medicare beneficiaries were more likely to have a health care provider and were the most satisfied with their care compared with individuals enrolled in other programs. Meanwhile, individuals with private insurance were more likely to have medical debt.

As Democrats in Congress move toward passing an ambitious economic agenda, much is undecided about health care — including how the federal government might further push holdout states to expand Medicaid. Experts say the shape of any changes to Medicaid is still forming, and that a new bill introduced by Democratic Georgia Sens. Raphael Warnock and Jon Ossoff and Wisconsin Democrat Sen. Tammy Baldwin is highly preliminary.

The Medicaid bill, titled the Medicaid Saves Lives Act (MSLA), was introduced July 12, and its main policy would be creating “a program to provide health care coverage to low-income adults in States that have not expanded Medicaid,” according to text released by Warnock’s office. The bill was introduced as Democratic leadership agreed to a $3.5 trillion budget framework that includes much of President Joe Biden’s agenda.