Health Plan Weekly

✦ A federal district judge upheld the Trump administration’s proposed rule to force hospital systems to reveal the prices they negotiate with insurers. The American Hospital Association (AHA), which brought a suit against HHS over the rule, said it would appeal the decision. The judge, Carl Nichols, who was appointed by President Trump, said that HHS fulfilled all of its statutory obligations in issuing the rule and criticized the AHA’s evidence, writing that HHS’s case was “more persuasive than a decades-old case study involving Danish ready-mixed concrete contracts and research predating the transparency measures promulgated at the state level.” Read more at https://bit.ly/2Yt6YmI.

✦ Cigna Corp. and Oscar Insurance Corp. said they will launch their joint venture to offer fully insured small group plans in Atlanta, the San Francisco Bay Area and Tennessee’s largest cities starting in the fourth quarter of 2020. The new plans will follow Oscar’s telehealth-focused blueprint, and feature “no charge, 24/7 virtual doctor visits,” according to a June 23 Cigna press release. The release also touted $3 prescription drug copays, behavioral health “coaching” programs and access to “multiple Cigna networks” of providers. “Cigna + Oscar was created with the purpose of addressing small businesses’ unique challenges through solutions tailored to their budgets and care designed to prioritize their employees’ health needs. Their top priority is our top priority, and right now that’s recovery,” said Chelsea Cooper, senior vice president of small group business at Oscar. Read more at https://bit.ly/3fXLF2i.

Two recent reports found that Medicaid managed care plans now enroll most Medicaid members, help keep costs and premiums low in the markets where they participate, and are competitive with commercial plans at the low end of the individual market in areas including network quality and benefit design.

One white paper was prepared by consultancy The Menges Group for America’s Health Insurance Plans (AHIP) and released on June 23, and the other was authored by researchers at the Robert Wood Johnson Foundation (RWJF) and Urban Institute and released on June 17. The Menges Group-AHIP study focused primarily on measuring the scale of Medicaid MCO market share nationally, while the RWJF-Urban Institute report surveyed Medicaid stakeholders about MCO quality and effectiveness.

As more employers turn to COVID-19 testing to see if employees are safe to return to the workplace, the Trump administration has clarified that insurers must cover only physician-ordered “medically necessary” diagnostic and antibody tests.

The guidance, released jointly on June 23 by the Department of Health and Human Services, the Department of Labor and the Department of the Treasury, also says self-funded employer plans must pay for COVID-19 testing that’s medically appropriate, and that providers of tests must publicly post retail prices for those tests.

COVID-19 has disproportionately infected and killed people of color, causing many health care leaders to renew their focus on racism’s role in social determinants of health (SDOH). Since George Floyd was killed by Minneapolis police and Black Lives Matter protests took over America’s streets, the conversation about racism in health care has become even more urgent. Experts and policymakers say payers can help battle racism and SDOH by partnering with organizations rooted in communities of color — and improve insurance business outcomes by doing so.

In a June 22 meeting of the House Committee on Education and Labor about the pandemic’s impact on education, health care and the workforce, Rep. Lauren Underwood (D-Ill.) observed that COVID-19’s brutal impact on Black communities is “glaring, but not surprising.” Underwood is a nurse with a master’s degree in public health who worked on Affordable Care Act (ACA) implementation at HHS and taught at Georgetown University before being elected to Congress.