Health Plan Weekly

Trade groups representing employer health plan sponsors have a busy lobbying agenda for 2021 now that Democrats control the presidency and both chambers of Congress. The trade groups, the ERISA Industry Committee (ERIC) and Purchaser Business Group on Health (PBGH), both to some degree support lowering the eligible age for Medicare, aggressive action to lower prescription drug prices and comprehensive telehealth reform.

The common theme for both organizations across all their policy goals is a desire to lower health care costs and, broadly speaking, improve the risk pool for plan sponsors. While those goals are in alignment with the aims of the managed care industry most of the time, there are points where plan sponsors and carriers’ interests deviate — which could mean health insurance trade groups might team up with the plan sponsor lobby on one bill but square off on another.

President Joe Biden on Jan. 28 launched his Affordable Care Act-centric health insurance agenda with an executive order that will reopen the federal health exchange for a special enrollment period. The administration also directed federal agencies to roll back widely criticized changes to Medicaid as part of a broader review of Trump administration regulations.

The new executive order, which the administration framed as a pandemic relief measure, demonstrates the administration’s emphasis on expanding coverage through the ACA. The special enrollment period (SEP) will run from Feb. 15 to May 15 and will be bolstered by a more aggressive effort to promote enrollment through advertising.

✦ Effective July 1, 2021, Humana Inc. will become the fifth Medicaid managed care organization to contract with South Carolina, the insurer said on Jan. 27. Centene Corp., Blue Cross Blue Shield of South Carolina, SelectHealth and UnitedHealthcare are the state’s four other MCOs, Citi analyst Ralph Giacobbe pointed out in a research note. Starting on Jan. 1, 2022, Humana will also begin enrolling new Healthy Connections Prime members, a new “expanded option for South Carolinians who have both Medicare and Medicaid, operating under a joint demonstration contract between the state and the federal government.” Read more at https://bit.ly/3t8BnUq.

✦ During the Trump administration, federal spending on consumer assistance and marketing for the Affordable Care Act exchanges dropped while revenue from exchange user fees held steady. The result, according to a new issue brief from the Kaiser Family Foundation, is that “it appears that more than $1 billion in unspent federal user fee revenue has accumulated and could be used to invest in changes that would make it easier for consumers to enroll in health coverage.” Read more at https://bit.ly/3oAVLuh.

As CMS re-evaluates its priorities under the new Biden administration, it should seriously consider making policy changes that integrate “drivers of health” (DOH) into payment policies for Medicare, Medicaid and the individual market, says a new report from four top independent health care foundations and think tanks.

The recommended changes would make it easier for insurers and providers to implement initiatives that address socioeconomic, environmental and behavioral factors that directly impact health, according to the report, “Investing in Health: A Federal Action Plan.” Manatt Health, The Health Initiative, Blue Shield of California Foundation and the Commonwealth Fund sponsored the report.

✦ Not long after his inauguration on Jan. 20, President Joe Biden issued a “regulatory freeze” memo to the heads of executive departments and agencies — a routine move for new administrations that temporarily halts last-minute regulations issued by the preceding administration pending review. The memo forbids any new rules from being proposed until they are approved by a department head designated by the new president, and it orders those rules not yet published in the Federal Register to be withdrawn for review. For those regulations that have been published but have not yet taken effect, the memo asks the department/agency leaders to consider postponing the rules’ effective dates for 60 days in order to review “any questions of fact, law, and policy the rules may raise.” Read the memo at https://bit.ly/2KA4VZQ.

✦ Also on Jan. 20, Biden unveiled a list of individuals who will serve in acting capacities across his administration until the Senate confirms permanent leaders. Norris Cochran, who previously served as HHS deputy assistant secretary of budget, will be the acting HHS secretary pending the confirmation of Biden’s pick to lead the department, California Attorney General Xavier Becerra. Citing a Democratic aide familiar with Biden’s plans, Bloomberg Law reported that the Senate Finance Committee isn’t expected to take up the Becerra nomination until February. Read more at https://bit.ly/3qE0CvY and https://bit.ly/3ixw9Ng.