Health Plan Weekly

Avalere Health experts who spoke during an Aug. 11 webinar predicted an “active legislative environment” for health care regardless of which party emerges victorious from the coming election. The selection of Sen. Kamala Harris (D-Calif.) as former vice president Joe Biden’s running mate probably won’t change that or move Biden’s health care agenda further left.

During the webinar, which was recorded before Harris was announced as the presumptive Democratic vice presidential nominee, Avalere founder Dan Mendelson predicted the next president and Congress will confront three major health issues: the COVID-19 pandemic, expanding health insurance coverage and reducing racial disparities in health care access and delivery.

Fresh off winning a Supreme Court case concerning billions of dollars’ worth of payments from the Affordable Care Act risk corridors program, health insurers that operate in the ACA exchanges are racking up lower-court victories and filing new lawsuits over halted cost-sharing reduction (CSR) payment funding.

In mid-July, the U.S. Court of Federal Claims ordered the federal government to pay L.A. Care Health Plan more than $16.7 million in CSR payments that it withheld in 2019. Combined with a summary judgment made last year in L.A. Care’s favor regarding 2017 and 2018 payments, federal courts have ruled that the insurer is owed a total of $35.4 million. Even more recently, Humana Inc. on Aug. 10 filed a complaint in federal claims court arguing that it is owed just under $2 million in CSR payments for 2017.

With health care claims costs reaching ultra-low levels amid lockdowns, canceled elective procedures and consumers’ fear of contracting the novel coronavirus at clinical sites, publicly traded health insurers saw their margins swell significantly in the second quarter of 2020. At the same time, insurers were quick to point out during their earnings conference calls that they have collectively provided billions of dollars’ worth of financial relief to consumers and providers and expect utilization to rebound in the second half of the year.

However, the health insurance industry still found its way into the crosshairs of the House Energy & Commerce Committee, which revealed on Aug. 6 that it will investigate insurers’ business practices “following reports that many of the companies are recording record profit margins during the COVID-19 pandemic.”

✦ CMS said on Aug. 4 that in light of the COVID-19 public health emergency, it will allow insurers operating in the individual and small-group markets to offer one or more months of temporary premium reductions for customers this year. Insurers in those markets are generally prohibited from changing premiums midway through the year. Previously, CMS permitted HealthCare.gov issuers to extend premium payment deadlines and delay cancellation for non-payment of premiums, and it allowed them to prepay to enrollees all or part of the estimated medical loss ratio rebate for the 2019 MLR reporting year. Read more at https://go.cms.gov/2DrEMZF.

✦ Pending regulatory approvals, Oscar Insurance Corp. will offer health insurance in four new states during the upcoming individual market open enrollment period, for a total footprint of 19 states. The company also launched a new $0 Virtual Primary Care product, which offers free telehealth visits “with a dedicated team of Oscar primary care providers,” and free Tier 1 prescriptions, durable medical equipment, labs, diagnostic imaging orders and initial specialist referrals. The new plans also feature $0 “vitals monitoring kits” and in-home lab draws when ordered by an Oscar primary care provider. Read more at http://on.hioscar.com/2C5Hp2L.