Health Plan Weekly

More than a year after they began probing health insurers and brokers for information to fuel an investigation of short-term, limited-duration insurance (STLDI) plans, Democratic leaders of the House Energy & Commerce Committee released a report concluding that this market’s growth has come at the expense of consumers who are often duped into purchasing bare-bones coverage.

Policy experts, however, disagree about what conclusions can actually be drawn from the latest salvo in an ongoing debate over alternatives to Affordable Care Act (ACA) exchange plans.

In another blow to an industry already beleaguered by the COVID-19 pandemic, a federal judge recently upheld a federal rule that requires hospitals to engage in unprecedented price transparency measures. Health systems are likely preparing to comply with the new requirements even as they await the outcome of an appeal — but health insurers, too, are poised to feel an impact if the regulations go into effect.

The rule, which the administration proposed in July 2019 and finalized in November, would require hospitals to disclose the rates they negotiate with payers for all items and services they offer (HPW 8/5/19, p. 1). That comprehensive set of rates must be available in a machine-readable file online, and hospitals also must display payer-specific negotiated charges for a limited set of “shoppable” services in a consumer-friendly format. The rule is slated to go into effect on Jan. 1, 2021, but the American Hospital Association (AHA) and other trade groups and health systems sued to block it.

✦ A federal district judge upheld the Trump administration’s proposed rule to force hospital systems to reveal the prices they negotiate with insurers. The American Hospital Association (AHA), which brought a suit against HHS over the rule, said it would appeal the decision. The judge, Carl Nichols, who was appointed by President Trump, said that HHS fulfilled all of its statutory obligations in issuing the rule and criticized the AHA’s evidence, writing that HHS’s case was “more persuasive than a decades-old case study involving Danish ready-mixed concrete contracts and research predating the transparency measures promulgated at the state level.” Read more at https://bit.ly/2Yt6YmI.

✦ Cigna Corp. and Oscar Insurance Corp. said they will launch their joint venture to offer fully insured small group plans in Atlanta, the San Francisco Bay Area and Tennessee’s largest cities starting in the fourth quarter of 2020. The new plans will follow Oscar’s telehealth-focused blueprint, and feature “no charge, 24/7 virtual doctor visits,” according to a June 23 Cigna press release. The release also touted $3 prescription drug copays, behavioral health “coaching” programs and access to “multiple Cigna networks” of providers. “Cigna + Oscar was created with the purpose of addressing small businesses’ unique challenges through solutions tailored to their budgets and care designed to prioritize their employees’ health needs. Their top priority is our top priority, and right now that’s recovery,” said Chelsea Cooper, senior vice president of small group business at Oscar. Read more at https://bit.ly/3fXLF2i.

Two recent reports found that Medicaid managed care plans now enroll most Medicaid members, help keep costs and premiums low in the markets where they participate, and are competitive with commercial plans at the low end of the individual market in areas including network quality and benefit design.

One white paper was prepared by consultancy The Menges Group for America’s Health Insurance Plans (AHIP) and released on June 23, and the other was authored by researchers at the Robert Wood Johnson Foundation (RWJF) and Urban Institute and released on June 17. The Menges Group-AHIP study focused primarily on measuring the scale of Medicaid MCO market share nationally, while the RWJF-Urban Institute report surveyed Medicaid stakeholders about MCO quality and effectiveness.