Health Plan Weekly

✦ The Blue Cross Blue Shield Association has signed off on a tentative agreement in a major antitrust lawsuit filed against Blues plans on behalf of customers, the Wall Street Journal reported on Sept. 24, citing people with knowledge of the matter. While the settlement has not yet been authorized by the boards of the 36 Blue Cross Blue Shield insurers or the judge presiding over the case, the WSJ reported that it would “require a payout of around $2.7 billion and curtail practices that allegedly limited competition” among Blues plans. Read more at https://on.wsj.com/3kR9Kut.

✦ In a Sept. 24 campaign speech in Charlotte, N.C., President Donald Trump touted his administration’s record on health care and unveiled an “America First Healthcare Plan.” The plan, which the is detailed in a new executive order, both details past actions the administration has taken to improve the health care system and Trump’s vision for future improvements. For example, it says that “it has been and will continue to be the policy of the United States to give Americans seeking healthcare more choice, lower costs, and better care and to ensure that Americans with pre-existing conditions can obtain the insurance of their choice at affordable rates,” though it doesn’t mention how that would be accomplished. The order also directs HHS to work with Congress to achieve a solution to the problem of surprise medical billing by Dec. 31. View the order at https://bit.ly/3mNWJ6y.

Since at least the 2017 saga when Republicans tried to repeal and replace the Affordable Care Act (ACA), one of the law’s most visible — and politically charged — components has become its protections for people with preexisting conditions. Now, with the makeup of the Supreme Court slated to shift, some experts believe those same provisions are the most at risk from being struck down alongside the law’s now-defunct individual mandate (see story, p. 1).

But that begs the question: Would health insurers actually want to go back to a pre-ACA world?

The rates that providers and laboratories charge for COVID-19 diagnostic and antibody testing — prices that “have important implications for out-of-network plans, uninsured patients, and other payers with little negotiating power” because of provisions in the CARES Act — far exceeded their Medicare reimbursement rates, according to a recent study published in the Society of General Internal Medicine. By analyzing administrative claims data from the COVID-19 Research Database, the study found that independent labs — which performed almost half of all COVID-19 diagnostic tests — charged $140.41 on average, while the Medicare rate was $51.31. Independent labs performed more than 95% of all antibody tests, with an average charge of $62.30, compared to the Medicare rate of $42.13. Across the country, average diagnostic testing fees ranged by state, from a low of $64.98 in Utah to a high of $505.65 in Washington, D.C. For antibody testing, New Mexico providers and labs charged an average of $195.41, more than four times of the average charge in New York ($45.85).

A study published Sept. 11 in the American Journal of Managed Care found that a federal law to rein in surprise medical billing could reduce overall health insurance premiums by 1% to 5%. The study, which was prepared by researchers at the USC-Brookings Schaeffer Initiative for Health Policy, was lauded by health insurance experts for looking at surprise billing’s impact on the insurance system at large, an area that they say has not been studied extensively.

The study is based on 2017 data compiled by the Health Care Cost Institute, which is drawn from claims submitted to UnitedHealthcare, Humana Inc. and CVS Health Corp.’s Aetna. The data is compiled from 568.5 million claims submitted by 44.8 million covered lives.

The COVID-19 pandemic and associated economic crisis have led to steep losses in the number of people with health insurance, and lawmakers should take swift action to provide temporary funding to bolster COBRA so that people can remain on their employer-sponsored plans, says a coalition that includes business groups, employer organizations, insurers and consumer groups.

The coalition, the Alliance to Fight for Health Care, released a report on Sept. 22 indicating that nearly 7.5 million Americans enrolled in commercial health insurance lost their coverage in April and May. This number, which is based on two surveys conducted by America’s Health Insurance Plans (AHIP), is expected to rise substantially by the end of 2020, as layoffs continue to outpace new job openings and temporary job losses turn permanent.