Health Plan Weekly

Florida’s health insurers remain highly profitable as the overall market has grown significantly more concentrated, with companies such as Anthem, Inc. and Florida Blue snapping up numerous smaller HMOs over the past several years, particularly in the Medicare Advantage (MA) space, says the author of a new report on the Florida market.

Independent analyst and consultant Allan Baumgarten, who studies state health care markets, tells AIS Health that he expects consolidation to continue.

Organizations representing health insurers are blasting the Trump administration’s proposed insurer price transparency regulations, saying the rule is anti-competitive and could even force prices higher.

In written comments on the rule to CMS Administrator Seema Verma, health insurer trade groups said they agreed in principle that transparency is good, but the administration’s approach — released in its proposed rule last fall (HPW 11/25/19, p. 1) — is too heavy-handed. “The plans are not opposed to getting consumers the information that they need to make decisions about benefits,” says Dan Mendelson, Avalere founder and former CEO. “But there are a couple of issues here that are causing the plans to oppose this particular rule.”

New rules that allow immigration officials to consider use of Medicaid coverage and other non-cash benefits in considering whether to approve applications for legal residence are likely to cause a chilling effect on Medicaid enrollment, with the impact spilling over to utilization of other health programs and services, even among family members not directly affected by the rules. Medicaid health plans’ front-line staff members can help with messaging — but the nuances are tricky and communications must be carefully managed, experts say.

The Inadmissibility on Public Charge Grounds final rule was issued by the Department of Homeland Security (DHS) on Aug. 14, 2019. But after several states sued the Trump administration over the rule, preliminary injunctions prevented the regulation from taking effect last year. The Supreme Court on Jan. 27 ruled that the rule could take effect on Feb. 24 in every state but Illinois while litigation works its way through the courts.

✦ The legal dispute between Cigna Corp. and Anthem, Inc. — concerning the $1.85 billion breakup fee tied to their failed attempt to combine — is not going to be resolved as soon as anticipated. Cigna Corp. CEO David Cordani said during the company’s recent fourth-quarter earnings call that he expected a court ruling by the end of February, but a Feb. 14 Securities and Exchange Commission filing from Cigna revealed that the court issued a letter requesting that the parties in the case submit supplemental briefings. “As a result, Cigna Corporation no longer expects the court to issue its post-trial decision in this litigation before the end of February 2020,” the filing states. It did not reveal when a decision now might be expected. View the filing at https://bit.ly/2V7qLXI.

✦ While many employers are interested in taking advantage of the new federal rule that gives them more freedom to offer pretax reimbursement to employees who buy their own health coverage, uptake has been slow. Such is the conclusion of a Modern Healthcare article, which included input from third-party administrators, brokers and health insurers about health reimbursement arrangements (HRAs). Meanwhile, a new report on qualified small employer HRAs (which existed before the new regulations) found that the allowance caps set by the Internal Revenue Service for QSHRAs appear to be at a reasonable level. The report, from the software company PeopleKeep, found just 18% of single employees used up their total allowed funds in 2019 and 19% of families used their allowed funds, according to an article from Benefits Pro. Visit https://bit.ly/39G0Ha2 and https://bit.ly/2P7EXMo.