Health Plan Weekly

In a July 10 letter, America’s Health Insurance Plans (AHIP) criticized a Trump administration proposal that would effectively require hospitals to reveal median rates they negotiate with Medicare Advantage insurers. In the letter, AHIP CEO Matthew Eyles said that the group supports price transparency in general, but the proposed rule would in fact impede that goal.

“We have several serious concerns with the proposal and believe it would fail to advance the Administration’s stated goals for increased consumer transparency and market-based FFS [fee for service] rates on multiple fronts,” Eyles wrote. “As a result, AHIP and its member plans cannot support CMS’ proposed data collection and publication of median payer-specific negotiated rates.”

With COVID-19 cases and deaths surging in some U.S. states, it has become clear that the nation won’t be back to normal anytime soon. Still, the country’s largest health insurer is betting that health care utilization, and the costs associated with it, will return to something close to typical levels in the second half of the year.

At its lowest point in April, inpatient care volume — including care for COVID-19 patients — was about three quarters less than normal, UnitedHealth Group Chief Financial Officer John Rex pointed out during a July 15 conference call to discuss the company’s second-quarter earnings. At that same low point, utilization of outpatient and physician services fell to roughly 60% of normal levels. But in June, UnitedHealth saw inpatient volume recover to nearly 95% of baseline, and as June turned to July, outpatient and physician services were “tracking above 90%,” Rex said. “These national trends have continued thus far in July, even as certain states are seeing short-term deferral of services where there are elevated levels of infection and hospitalization.”

In June, when the Supreme Court ruled in Bostock v. Clayton County, Georgia that transgender people are protected by the Civil Rights Act of 1964 in matters of employment, it was just the latest of a decade-long wave of legal and political victories for the LGBTQ+ movement.

Those changes in the law have only begun to play out in the health care industry, which has a fraught history with LGBTQ+ patients. Experts say health plans must address a legacy of discrimination in collaboration with LGBTQ+ community groups in order to better serve this population.

Weeks after the Trump administration released guidance saying private health insurers don’t have to pay for COVID-19 testing conducted for the purposes of workplace safety or public health surveillance, questions and controversy are still simmering about the implications of that edict.

The guidance sought to clarify provisions of the Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act, which state that insurers must pay for COVID-19 testing and associated services with no cost sharing for consumers or “medical management requirements” such as prior authorization. In a document issued jointly by HHS, the Dept. of Labor and the Treasury Dept. (HPW 6/29/20, p. 1), the agencies clarified that insurers must only pay for diagnostic or antibody testing conducted for “individualized diagnosis or treatment” that takes place “when medically appropriate for the individual, as determined by the individual’s attending health care provider in accordance with accepted standards of current medical practice.”