Health Plan Weekly

During a keynote session at the AHIP Medicare, Medicaid, Duals & Commercial Markets Forum, health plan leaders offered sobering assessments about the state of health equity in the U.S. Still, they offered concrete steps their organizations have taken with community partners to address systemic inequalities. 

“I would give us a grade of ‘C’ [on health equity]. Probably, before the murder of George Floyd, I would have given us a ‘D,’” said Karen Dale, market president and chief diversity, equity and inclusion officer at AmeriHealth Caritas. Floyd was killed by a white police officer during an arrest made outside a Minneapolis convenience store in May 2020, sparking nationwide protests over police brutality and racial inequality.  

The American Academy of Actuaries has urged the Biden administration to follow through on its proposal to rescind a controversial 2018 rule that granted more regulatory leeway to association health plans (AHPs). Rescinding the 2018 AHP regulations will protect consumers and strengthen the actuarial health of the Affordable Care Act exchanges, according to Academy Senior Health Fellow Cori Uccello and a February public comment letter from the organization.   

The comments by the professional association are in response to a December 2023 regulatory proposal that followed through on long-expected plans to rescind the 2018 rulemaking. Those regulations, put forward by the Trump administration, significantly loosened the requirements that apply to AHPs and their close cousins, multiple employer welfare arrangements (MEWAs). The 2018 rule was never implemented, however, because it was largely blocked by a summary judgment issued as a result of litigation by 11 states and the District of Columbia. 

The typical cost for a patient-provider email messaging claim was $39 in 2021, including both the portion paid by health plans and by patients. Although insurers covered the full cost for 82% of these claims, the patients who need to pay out of pocket typically spent $25 on a typical email message, according to Peterson-KFF Health System Tracker.

Use of electronic health communications has exploded since the COVID pandemic as more patients are seeking medical care remotely. CMS introduced several new billing codes in 2020 to help health care providers bill patients and insurers for a range of digital health services including electronic visits or asynchronous patient portal messages that require medical decision-making and at least five minutes of clinician time over a seven-day period.

More than 21 million people selected or were automatically reenrolled in health plans during the most recent Affordable Care Act open enrollment period (OEP). That’s according to one of four reports issued by HHS on March 22 marking the 10-year anniversary of the ACA. HHS also said that 5.1 million more people signed up for coverage during the 2024 OEP compared to the 2023 OEP, representing a 31% increase. Another report found that over 45 million people now have coverage thanks to the creation of the ACA marketplaces and Medicaid expansion -- “the highest total on record.” 

The Oregon Health Authority (OHA) on March 14 began a review of UnitedHealth Group’s proposed acquisition of Amedisys Inc., a home health provider. Amedisys disclosed the OHA’s review in a March 19 Securities and Exchange Commission filing. UnitedHealth made a $3.26 billion unsolicited offer for Amedisys last June, shortly after Amedisys had agreed to merge with Option Care Health, Inc., a home infusion provider. Amedisys’s shareholders approved the UnitedHealth deal in September, but the transaction is subject to regulatory approval. In a preliminary analysis published this month, the OHA wrote “this transaction has the potential to reduce competition in Oregon’s market for home health and hospice services and other health care markets in the state.” 

Speaking at an AHIP conference in Baltimore on March 13, two states' top Medicaid officials shared frank views about the tensions that arise from working with private managed care plans to run their Medicaid programs — especially as scrutiny of insurer practices like prior authorization is intensifying.  

“We talk a lot internally about the fact that if I were to stand somebody from my agency — the Medicaid agency — next to somebody from a Medicaid managed care company, from a mission perspective, you will not see a single difference between the two,” said Jay Ludlam, deputy secretary of NC Medicaid, during the AHIP Medicare, Medicaid, Duals & Commercial Markets Forum.