Health Plan Weekly

Across the country, conservative state officials are going further than ever to thwart Medicaid expansion, taking steps to reverse successful ballot initiatives, reforming processes to block ballot measures before they reach voters — and erecting barriers to Medicaid enrollment for some residents who are already eligible. That’s all potentially bad news for Medicaid-focused insurers, experts say.

In Missouri, voters in August 2020 approved an amendment to the state constitution that expands Medicaid. However, the Republican-controlled state legislature refused to fund the new program. Though Republican Gov. Mike Parson had promised to implement the expansion program as recently as January, on May 13 he reversed his position and sent a letter to CMS withdrawing the State Plan Amendments required to launch the program. In response, a Missouri legal aid group filed a lawsuit against the state.

Three startup health insurers that became public companies this year — Oscar Health, Inc., Clover Health Investments, Corp. and Alignment Healthcare, Inc. — recently unveiled their first-quarter 2021 financial results, with all posting substantial net losses. While such results are not unexpected from still-growing companies, the details contained in the firms’ earnings reports suggest that they may not all be equally capable of eventually turning a profit, industry experts say.

“The overall takeaway from the quarter is that when you look across the board at all of the startup health plans, they all have materially underperformed the established, major health plans out there — the publicly traded ones that have reported their quarters so far. And the question is, what’s the degree of underperformance?” says Ari Gottlieb, a principal with the health care consulting firm A2 Strategy Group and a longtime critic of Oscar’s business model.

✦ Centene Corp. has appointed Drew Asher as its new chief financial officer (CFO) and executive vice president, replacing Jeffrey Schwaneke, who is rotating to manage the firm’s HealthCare Enterprises venture capital division. Asher joined Centene in early 2020 when the company acquired WellCare, where Asher was CFO for six years. In the year since, Asher has managed Centene’s Specialty division. Schwaneke will help manage “a portfolio of high growth companies independent of Centene health plans, designing differentiated platform capabilities and delivering industry-leading products and services to third-party customers.” Read more at https://bit.ly/2SFFzxg.

✦ Amazon.com Inc.’s Amazon Care subsidiary closed its first deal to offer app-based care services to an employer, according to press reports. The contract is with fitness equipment firm Peloton Interactive, Inc.’s recently acquired subsidiary Precor. The tech and e-commerce giant revealed in March that it would make Amazon Care available to enterprise clients which, like Precor, are based near Amazon’s Seattle headquarters, and said it will eventually roll out employer offerings nationwide. Press releases from Amazon have positioned the employer-facing offering as an in-network, virtual primary and urgent care provider for self-insured employers. Read more at https://bit.ly/33G6ewb.

California’s individual health exchange successfully used inexpensive email and letters to encourage consumers to switch to lower-cost coverage that provided them with better benefits, according to new research. The 2019 program from Covered California potentially could be duplicated in other states to help consumers save on coverage, according to the study, which was published in Health Affairs.

During the 2019 open enrollment period for California’s Affordable Care Act (ACA) marketplace, Covered California used a randomized intervention to see if low-income beneficiaries, particularly those who earn less than 200% of the federal poverty level, could be encouraged to enroll in silver plans with cost-sharing reduction (CSR) subsidies, which made more sense for them.