Health Plan Weekly

Legislation to protect patients against surprise medical bills is once again gaining momentum in Congress, with two key House committees voting to advance proposals. However, passage of competing bills by the House Education and Labor Committee and the House Ways and Means Committee also emphasized the policy divide between lawmakers and stakeholders on the main sticking point: how to decide rates for out-of-network providers.

Education and Labor, which approved its bill on Feb. 11 with a bipartisan majority, would set payments for providers by basing them on regional benchmarks, while still giving providers the option of going to arbitration for bills higher than $750. Ways and Means, meanwhile, backed mediation between insurers and providers to set rates, again on a bipartisan vote. That panel also threw in a new twist: a provision designed to rein in private equity firms that have purchased physician practices.

As the concept of a public insurance option gains increasing visibility in the 2020 presidential race, the spotlight is also trained on Washington and Colorado — states that are at different stages of setting up their own versions of a public option yet are facing similar challenges.

While they can vary considerably, public option programs generally aim to offer individual market customers a more affordable choice for health coverage than existing commercial plans by means such as capping administrative expenses and provider reimbursement rates. A public option provision was infamously eliminated from the Affordable Care Act (ACA) during the push to get it through Congress.

✦ CVS Health Corp. said on Feb. 3 that former Aetna Inc. CEO Mark Bertolini, who led the health insurer when it was acquired by the pharmacy chain, will leave the CVS board once integration is complete. But in an interview with the Wall Street Journal, Bertolini claimed he was forced out, and implied that he lost a power struggle with CVS CEO Larry Merlo. “There’s always going to be a natural tension between the current CEO and the former CEO in any discussions regarding how you move the strategy forward,” Bertolini told the publication. Read more at https://on.wsj.com/2GTNAFV and https://bit.ly/2SpwYuT.

✦ Humana Inc. continues to expand in the health care provider space, announcing that its Partners in Primary Care brand will partner with Welsh, Carson, Anderson & Stowe (WCAS) to expand operations. “This joint venture will further allow Partners in Primary Care to scale its core operations to facilitate the continued expansion of its care model,” said a Humana press release. The venture will target seniors in “underserved areas throughout the nation,” and WCAS will invest about $600 million in the venture, the release said. WCAS owns a majority stake in MMIT, AIS Health’s parent company. Visit https://huma.na/380IX8J.

by Jinghong Chen

The cost of the lowest-priced silver plan in the Affordable Care Act exchanges fell by an average of 3.5% from 2019 to 2020, according to a new analysis from the Robert Wood Johnson Foundation. The report also examined premiums in major urban and rural areas in select states, finding that rural premiums were higher than urban premiums in Arizona, California, North Carolina, Ohio and Oregon. However, Alabama, Georgia and Indiana showed a different picture.

Nevada — which is the proverbial guinea pig among a host of states aiming to shift from the federal Affordable Care Act (ACA) exchange platform to their own state-run exchange — now has completed its first full open enrollment period independent from HealthCare.gov.

Heather Korbulic, the executive director of the Silver State Health Insurance Exchange, told AIS Health before open enrollment kicked off that to her, a successful transition would look like “we landed the plane — we got all of our consumers successfully migrated, we were able to work with enrollment professionals and the technology worked, and we could at least retain the enrollment that we had from previous years” (HPW 9/30/19, p. 1).