Health Plan Weekly

✦ The average COBRA enrollee spends significantly more on health care services than active workers or dependents with employer-sponsored coverage, according to a new study from the Employee Benefit Research Institute (EBRI). The study, released July 9, found that active, full-time employees with individual coverage in 2018 used an average $6,724 worth of health care services, while COBRA beneficiaries used an average of $18,752. COBRA enrollees are also older than their employed counterparts, on average, and more likely to have certain health conditions such as COPD, diabetes, cancer or mental health conditions. EBRI argued that subsidizing COBRA — as some policymakers have supported in light of the current economic downturn — can help reduce adverse selection against COBRA plans by making that coverage option more attractive for healthier people. Read more at https://bit.ly/322Pz6G.

✦ Five prominent Democratic lawmakers wrote to top Trump administration officials to “express serious concerns” about guidance they issued June 23 stating that health insurers are required to cover only “medically necessary” SARS-CoV-2 diagnostic or antibody tests (HPW 6/29/20, p. 1). Based on that guidance, insurers would not have to pay for “return to work” screening or for public health surveillance testing. “With COVID-19 cases skyrocketing and our testing capacity nowhere near where it needs to be, it is unacceptable that this Administration’s priority seems to be giving insurance companies loopholes instead of getting people the free testing they need,” wrote Frank Pallone Jr. (D-N.Y.), Bobby Scott (D-Va.), Richard Neal (D-Mass.), Patty Murray (D-Wash.) and Ron Wyden (D-Ore.), in a July 7 letter to HHS, the Dept. of Labor and the Dept. of the Treasury. View the letter at https://bit.ly/3gMjQKV.

✦ Employer health care spending could grow anywhere from 4% to 10% in 2021 as costs rebound from a dip in utilization tied to the COVID-19 pandemic, according to a new report from PwC’s Health Research Institute. The two main factors that PwC expects to inflate spending in 2021 are increased mental health services utilization and new and previously approved specialty drugs. Two major potential offsetting factors include the rapid adoption of telehealth and employers increasing their use of narrow networks. Read more at https://pwc.to/2ZCWTTI.

✦ The House of Representatives on June 25 passed a bill that aims to strengthen the Affordable Care Act (ACA), incentivize holdout states to expand Medicaid and lower prescription drug prices. The Patient Protection and Affordable Care Enhancement Act (HR 1425) advanced on a 230-180 vote, though it has little chance of passing in the Republican-controlled Senate. Among other provisions, the bill would expand ACA subsidies, help states develop their own insurance marketplaces and enact measures included in a drug-pricing bill previously passed by the House, HR 3. Read about the bill at https://bit.ly/2ZAze64.

Cigna Corp. has now partnered with two smaller insurers, Priority Health in Grand Rapids, Mich., and New York-based Oscar, in an effort to increase its share of commercial group business, particularly small groups.

The alliances, which take effect next year and later this year, respectively, widen available offerings for both Cigna and its partners: Cigna gets access to stronger provider networks and more advanced online tools than it has in-house, while Priority Health and Oscar get access to Cigna’s national platform.