Health Plan Weekly

A Sept. 9 report by the nonpartisan health care policy group United States of Care highlights the challenges posed to the government, private firms and health plan members by the country’s reliance on employer-sponsored insurance — and points out that COVID-19 has made existing problems worse.

However, while the report identifies some public policy limitations of the employer-sponsored health system, it stops short of advocating for universal health coverage.

Georgia recently reaffirmed its proposal to make dramatic changes in its individual market, saying it plans to abandon the Affordable Care Act (ACA) marketplace in favor of a new state program despite the widespread disruptions in health care and health insurance brought by the coronavirus pandemic.

In its revised Section 1332 waiver request to CMS, Georgia said it wanted to push back the start date for part of its plan, meaning the proposal’s two parts — the new state marketplace and a new reinsurance program — wouldn’t take effect until 2022.

The Trump administration — which has made price transparency one of its signature health care initiatives — recently finalized a rule that one expert warns is a signal that CMS is serious about requiring hospitals to reveal rates negotiated with health insurers.

Buried deep within the 2021 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital final rule is a provision that would require hospitals to annually report the median rates they negotiate with Medicare Advantage plans, explains Mark Polston, who co-chairs the life sciences and health care industry group at the law firm King & Spalding.