Health Plan Weekly
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Blues Plans Dominate Marketplaces; Medicaid Plans Increase Presence
Between 2016 and 2018, Medicaid-focused insurers expanded their footprint into the Affordable Care Act (ACA) marketplaces by offering lower premiums for silver plans, according to a recent analysis by the Robert Wood Johnson Foundation. Blue Cross Blue Shield plans remained the dominant players, accounting for almost half of marketplace enrollment nationally in 2018. In 20 states, Blues plans had all or the majority of enrollment, yet some Medicaid insurers have increased their share of the market in some of these states. In another eight states, Medicaid plans enrolled most of the marketplace consumers.
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Cigna Taps Priority Health, Oscar to Bolster Offerings
Cigna Corp. has now partnered with two smaller insurers, Priority Health in Grand Rapids, Mich., and New York-based Oscar, in an effort to increase its share of commercial group business, particularly small groups.
The alliances, which take effect next year and later this year, respectively, widen available offerings for both Cigna and its partners: Cigna gets access to stronger provider networks and more advanced online tools than it has in-house, while Priority Health and Oscar get access to Cigna’s national platform.
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House Committee Paints Damning Picture of Short-Term Plans
More than a year after they began probing health insurers and brokers for information to fuel an investigation of short-term, limited-duration insurance (STLDI) plans, Democratic leaders of the House Energy & Commerce Committee released a report concluding that this market’s growth has come at the expense of consumers who are often duped into purchasing bare-bones coverage.
Policy experts, however, disagree about what conclusions can actually be drawn from the latest salvo in an ongoing debate over alternatives to Affordable Care Act (ACA) exchange plans.
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Payers Are Poised to See Changes From Hospital Transparency
In another blow to an industry already beleaguered by the COVID-19 pandemic, a federal judge recently upheld a federal rule that requires hospitals to engage in unprecedented price transparency measures. Health systems are likely preparing to comply with the new requirements even as they await the outcome of an appeal — but health insurers, too, are poised to feel an impact if the regulations go into effect.
The rule, which the administration proposed in July 2019 and finalized in November, would require hospitals to disclose the rates they negotiate with payers for all items and services they offer (HPW 8/5/19, p. 1). That comprehensive set of rates must be available in a machine-readable file online, and hospitals also must display payer-specific negotiated charges for a limited set of “shoppable” services in a consumer-friendly format. The rule is slated to go into effect on Jan. 1, 2021, but the American Hospital Association (AHA) and other trade groups and health systems sued to block it.
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