Health Plan Weekly

✦ The Supreme Court will hear oral arguments on Nov. 10 in a case seeking to dissolve the Affordable Care Act. Many health care policy watchers noted the timing of the arguments, as they are scheduled one week after the presidential election is set to take place. In California v. Texas, previously known as Texas v. United States, a coalition of Republican-led states is arguing that the ACA’s individual mandate is unconstitutional now that the tax penalty has been repealed. Thus, they contend, the entire law should be thrown out. Visit https://bit.ly/3aJdvy6.

✦ Anthem, Inc. and Quest Diagnostics said on Aug. 17 that they’re entering a new “strategic relationship.” The insurer and lab company plan to leverage “a broad range of tools and programs to drive operational improvements, create pricing transparency, and enhance health care consumer engagement and outcomes.” Visit https://prn.to/32aaa7d to learn more.

CVS Health Corp.’s Aetna division — having recently rolled out two new plan designs that aim to ease customers’ cost-sharing burden — is now presenting employers with “a cost-effective offering beyond Aetna’s typical broad network plans” that requires members to receive care from a select group of Cleveland Clinic-affiliated providers.

The co-branded Aetna Whole Health – Cleveland Clinic plans will be available to fully insured and self-insured employers in 10 northeast Ohio counties this fall, according to an Aug. 19 press release. Employers could save as much as 10% in health care spending by choosing the new plan over a current Aetna broad network plan, but the catch is that members must receive care from the “Cleveland Clinic Quality Alliance network of employed and independent physicians” or at any Cleveland Clinic facility. Cleveland Clinic, meanwhile, will be rewarded for achieving quality and cost targets.

While the COVID-19 pandemic has not caused employers to significantly alter their health care cost estimates for the coming year, it has unquestionably intensified their interest in embracing virtual care. Those are just a couple of the major findings from the Business Group on Health’s 2021 Large Employers’ Health Care Strategy and Plan Design Survey, which highlighted the variety of ways that the current public health crisis is — and isn’t — affecting how self-insured companies view the health care system.

Notably, 80% of respondents said they believe virtual health will play a significant role in how care is delivered in the future, up considerably from 64% last year and 52% in 2018. Further, when asked about actions they were taking to ease the burdens of COVID-19 for employees, the largest share of respondents — 76% — said they “made changes to allow for better access to virtual care solutions.”

Health insurers are conducting outreach to people who may have been left without coverage as a result of the COVID-19 crisis, but experts say they may be partially stymied in their efforts to get people enrolled in new plans by the difficulties of operating within a pandemic environment.

AmeriHealth Caritas, which is run by Independence Blue Cross in partnership with Blue Cross Blue Shield of Michigan, says it has launched a series of videos designed to help potential Medicaid enrollees learn how they can apply.

Health insurers that sued to recoup halted cost-sharing reduction (CSR) payments scored a key victory on Aug. 14 when a federal appeals court confirmed that the government must reimburse them for providing subsidies to low-income Affordable Care Act exchange enrollees. But that win came with a significant catch, as the three-judge panel said insurers can collect only the monetary damages that they didn’t already recoup from silver loading — the process by which they raise benchmark silver-plan premiums to compensate for lost CSR payments.

Health policy experts who spoke to AIS Health say they don’t expect the court’s decisions will cause much to change about CSRs or silver loading, as the current setup is working well for nearly all stakeholders. Still, insurers probably won’t file any more lawsuits seeking CSR reimbursement from the 2018 plan years and beyond, since they aren’t likely to collect any damages.