Health Plan Weekly

Anthem, Inc. reported strong membership growth in its Medicare and Medicaid segments along with a lower-than-expected medical loss ratio (MLR) of 85.6% in its 2021 first-quarter earnings report. The MLR results, which handily beat analysts’ expectations of an 87.7% MLR, reflected lower utilization of non-COVID-19-related medical services, the company said.

The insurer isn’t necessarily expecting utilization to jump as the pandemic winds down, Chief Financial Officer John Gallina said April 21 during the company’s earnings conference call. “We continue to closely monitor our markets as vaccination rates increase,” Gallina said. “The senior population has been vaccinated sooner, and so we are seeing a significant decline in COVID inpatient [costs] associated with seniors, which means that the non-COVID [utilization] can rebound a bit faster. We believe that we’ve totally factored that in.” Members who needed care in 2020 mostly were able to obtain it, Gallina said, and so there likely isn’t “a giant backlog.” But Anthem did see some increased costs associated with COVID-19 testing and vaccine administration in the first quarter, he said.

CMS on Apr. 16 revoked an eleventh-hour Section 1115 waiver the Trump administration had granted to Texas, which makes the shape of the second-most populous state’s Medicaid program after 2022 an open question. Experts say that CMS’s action is an attempt by the Biden administration to push Texas to expand Medicaid — although the state’s legislature recently voted down one such proposal.

CMS had approved Texas’ waiver request on Jan. 15, less than a week before the end of the Trump administration. The waiver would have sent about $11.4 billion to Texas annually in order for the state to compensate providers for unreimbursed care. The Trump administration approved the waiver for 10 years, a term that experts say is unusually long and likely motivated by politics.

Spurred in part by the harsh spotlight that the COVID-19 pandemic has shone on health equity issues, the Blue Cross Blue Shield Association (BCBSA) on April 20 unveiled a vast, ambitious initiative that aims to “change the trajectory of heath disparities and re-imagine a more equitable healthcare system.”

Industry experts say that now is the ideal time for such a project to kick off and that the BCBSA and its 35 member plans are well-positioned to take on such a challenge. To succeed, though, the Blues plans will need to build crucial trust among the populations they’re hoping to help, and they must act as the conduit for grassroots efforts that health insurers can’t handle on their own.

✦ Enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) grew by 10.8% between February and November 2020 to approximately 78 million, according to an issue brief by the Kaiser Family Foundation (KFF). The growth in the safety-net insurance programs follows a two-year trend of declining enrollment. “Increases in enrollment reflect changes in the economy (as more people experience income and job loss and become eligible and enroll in Medicaid and CHIP coverage) and provisions in the Families First Coronavirus Response Act (FFCRA) that require states to ensure continuous coverage to current Medicaid and CHIP enrollees to access a temporary increase in the Medicaid/CHIP match rates,” the brief said. Read more at https://bit.ly/39Lg97F.

✦ Making the expanded Affordable Care Act (ACA) marketplace tax credits included in the American Rescue Plan permanent would lower the national uninsured rate by 4.2 million, according to an analysis by the Robert Wood Johnson Foundation (RWJF) and Urban Institute. Individuals who already qualified for premium tax credits under the ACA will see more generous financial aid, including expanded access to zero- premium plans for lower-income people. In addition, people whose incomes were too high to qualify for subsidies will be eligible for reduced premiums for the first time thanks to a provision that caps marketplace premiums at 8.5% of all enrollees’ income. The subsidies are currently set to expire after 2022. Read more at https://rwjf.ws/3docTB4.