Health Plan Weekly

With Donald Trump declared the winner of the 2024 presidential election and Republicans controlling at least one chamber of Congress, experts are divided about the myriad ways in which the new balance of power in Washington might affect health insurers. Yet they largely agree on one subject: The Biden administration’s intense scrutiny of health care deals likely won’t be shared by the second Trump regime. 

“The biggest thing is a more permissive antitrust regime, where mergers & acquisitions are going to be allowed,” says Dan Mendelson, CEO of Morgan Health, founder of the consultancy Avalere Health and a former health official in the Clinton administration.  

As legislation to address it languishes in the lame-duck Congress, prior authorization (PA) remains under intense scrutiny. Adding to previous accounts of provider and consumer frustration with PA, two recent reports — one from the Senate and one from ProPublica — offer new evidence of insurers and their contractors denying PA requests to cut costs.  

Physicians have long been wearied of PA battles, noting it negatively affects patient care and contributes to burnout. The continued scrutiny raises the question: What lies ahead for PA reform, especially as the U.S. transitions to a new presidential administration? 

Alignment Healthcare, Inc., Clover Health Investments Corp. and Oscar Health, Inc., which are commonly referred to as “insurtechs” for their focus on technology, each recently posted solid third-quarter financial results, especially compared with previous years.  

Ari Gottlieb, principal of health care consulting firm A2 Strategies and a longtime critic of some of the insurtechs, tells AIS Health that Alignment “has been a well-run business” for some time. He adds that Oscar and Clover “have turned into much better-run businesses” thanks to leadership changes and a narrower focus on where they compete in the market. Oscar last year hired industry veteran Mark Bertolini as CEO, while Clover last year promoted technology executive Andrew Toy to CEO.