Health Plan Weekly

Several months into a pandemic that has fundamentally changed American life, researchers are just starting to understand the impact of COVID-19 on the U.S. health care system. During an Oct. 19 webinar hosted by the Kaiser Family Foundation, experts attempted to shed some light on that wide-ranging impact while underscoring that the effects of the crisis are still evolving.

Michael Kleinrock, a research director at the IQVIA Institute for Human Data Science, said one of the questions he’s most often asked is “when are we going to start catching up” from the missed doctor visits, delayed surgeries and other types of health care utilization deferred by patients during the height of the COVID-19 lockdowns. Although utilization has bounced back from the significant drops it saw in the spring, based on IQVIA’s analysis it hasn’t yet completely returned to normal levels, he pointed out, “so we’re not catching up.”

With the 2020 election drawing ever closer, the Trump administration has been approving states’ waiver applications at a brisk pace — greenlighting Georgia’s Section 1115 Medicaid waiver on Oct. 15, and another Medicaid waiver from Nebraska on Oct. 20. Further, CMS has said that it’s on the cusp of approving Georgia’s unique plan to remake its individual insurance market.

Health policy experts tell AIS Health that the fate of the three waiver programs depends not only on who wins the White House on Nov. 3, but also on the outcome of a case pending before the Supreme Court. They also say that if former Vice President Joe Biden is elected, states may have to think about waivers very differently than they have under the Trump administration.

Several recent surveys on employer-sponsored health insurance have found that plan sponsors are following three major trends: expanding virtual care and telehealth benefits, narrowing provider networks and emphasizing centers of excellence in their benefit designs. Experts suggest that these trends are driven by the continuing growth in health care costs, which is reflected in growing premiums for firms and employees. Meanwhile, the COVID-19 pandemic has exposed plan sponsors to unforeseeable risk.

According to the 2020 edition of the Kaiser Family Foundation’s (KFF) Employer Health Benefits Survey (see infographic, p. 7), which was published Oct. 8, this year’s annual premium growth (4% for individuals and families) outstripped both wage growth (3.4%) and inflation (2.1%). That is in line with the dramatic growth in premiums in recent years, which have risen 22% in the last five years and 55% in the last 10.

✦ CMS on Oct. 15 approved a Medicaid section 1115 demonstration waiver that it said will allow working-age Georgia adults who are currently ineligible for Medicaid to get such coverage “by participating in qualifying activities like work and education, as well as meeting premium and income requirements.” The “Pathways to Coverage” program will apply to people ages 19 to 64 with income up to and including 100% of the federal poverty level, and will run from July 1, 2021 to Sept. 30, 2025. CMS said it expects that “over 30,000 individuals will receive Medicaid coverage during the first year of the demonstration” and nearly 65,000 Georgians will enroll in Medicaid or receive Medicaid premium assistance for coverage through employer-sponsored insurance during the five-year demonstration. Visit https://go.cms.gov/2IDn7AF.

✦ Health insurers across most markets saw their claims costs fall and their gross margins increase since the start of the COVID-19 pandemic and relative to 2019, according to a new analyst from the Kaiser Family Foundation. In addition, medical loss ratios in the Medicare Advantage market decreased 5 percentage points through the first six months of 2020 relative to the same period in 2019, and group market MLRs decreased by an average of 3 percentage points year over year. In the individual market, though, average MLRs held steady relative to 2019. “Although we cannot measure profits directly, all signs suggest that health insurers in most markets have become more profitable so far during the pandemic,” the report concluded. Read more at https://bit.ly/3lIc9Ie.

To the Trump administration, a recently released report on individual insurance market enrollment demonstrates that “people who do not qualify for subsidies continue to be priced out of the market.” Indeed, between plan years 2016 to 2019, unsubsidized enrollment both on and off the Affordable Care Act exchanges declined by 2.8 million people, representing a 45% drop nationally.

The reason behind those trends — as the administration suggested — is chiefly high costs, according to one policy expert. But the forces that drove individual market premium changes to spike so much are a bit more complicated, and they illustrate just how much change the market has undergone since the ACA’s inception.