Health Plan Weekly

Congress has now passed three separate bills to address the ever-worsening COVID-19 crisis in the U.S., spending trillions of dollars to lessen the economic impact and support the country’s overtaxed health care system. But for the most part, this legislation has not included measures requested by the health insurance industry aimed at boosting coverage affordability and access.

COVID-19, the disease caused by the new coronavirus that has swept the world, has claimed more than 4,000 lives in the U.S. and caused officials to shut down large portions of the economy as they try to slow the infection rate.

Many of the nation’s largest health insurers have now waived patient cost sharing and prior authorization requirements for treatment of COVID-19, the disease caused by the novel coronavirus. Experts praise payers for making the change, but say the moves could have negative financial impacts for some firms. The same experts believe consolidation is likely if payers and providers struggle with liquidity.

Payers waiving coinsurance include Anthem, Inc., UnitedHealth Group, Cigna Corp., Centene Corp., Humana Inc. and some Blue Cross Blue Shield plans. Companies that have relaxed prior authorization requirements include Anthem, Centene and Humana. (For a more complete list, see p. 5.)

✦ The U.S. Senate on March 25 passed a $2 trillion stimulus package aiming to lessen the economic blow of the COVID-19 pandemic on Americans and businesses — including the health care industry. America’s Health Insurance Plans praised the legislation, which sets aside $100 billion for hospitals, but hinted that more relief is needed for the managed care industry. “Now more than ever, we must ensure that people are able to access the care they need by assuring that their current coverage is — and remains — strong and stable,” AHIP President and CEO Matt Eyles said in a statement. “We are committed to collaborating with policymakers to take action on the solutions necessary to achieve this goal, and we call on Congress to swiftly take additional action to secure and stabilize coverage for families, businesses, and workers.” Read the stimulus bill at https://bit.ly/2JubLw1.

✦ A clinical research team “has demonstrated that a simple, self-collected test is as effective in identifying COVID-19 infections as the current clinician-collected test,” leading the FDA to update COVID-19 testing guidance, according to a UnitedHealth Group press release. The peer-reviewed study, which was conducted jointly by the University of Washington, Bill & Melinda Gates Foundation, Quest Diagnostics Inc., and UnitedHealth researchers, concludes that the new test “accurately detected COVID-19 in more than 90% of positive patients,” a rate in line with a practitioner-administered test, the release said. Read more at https://bwnews.pr/3dGMMn0.

Total U.S. health care spending is projected to increase at an annual average rate of 5.4% over the next decade, reaching $6.2 trillion by 2028, according to CMS. Health expenditures’ share of Gross Domestic Product will rise from 17.8% in 2019 to 19.7% in 2028, as health spending growth will be 1.1 percentage points faster than that of GDP, on average, over the 2019-28 period. According to the forecast, average annual spending growth in Medicare will be the fastest, due to higher projected enrollment growth.

CMS has now approved 29 Medicaid Section 1135 waivers in an effort to give states’ Medicaid programs additional flexibility to augment their COVID-19 response by relaxing certain federal requirements.

Observers say they anticipate more states approaching CMS with similar requests as the crisis progresses, although the waivers may not streamline care very much for managed care organizations operating within state Medicaid programs.