Health Plan Weekly

UnitedHealth Group faces a crisis as the fallout from the hack of its Change Healthcare subsidiary continues to spread. The firm is rumored to have paid $22 million to the hackers who may have caused the breach, even as it faces falling stock prices, federal actions to stabilize provider reimbursement, payer operations disrupted by the hack, and legal risk.  

A civil suit has already been filed against UnitedHealth due to the cyberattack, and the scale of the disruption may strengthen enforcement action resulting from a newly revealed federal antitrust investigation into UnitedHealth. Because of the cyberattack, payments to thousands of providers have stalled, causing a liquidity crisis for some practices. The hack also may have exposed thousands of other health care entities to data breaches. UnitedHealth’s stock price dropped from $521.97 on Feb. 21 (the day the breach was disclosed) to $478.78 at the close of business on March 7.  

While reinsurance programs have become popular among states hoping to stabilize their individual insurance markets, a new study makes a compelling case that the premium reductions attributed to such programs may not be as helpful as they seem. 

States can apply for and implement reinsurance programs via Section 1332 waivers, which allow them to waive certain Affordable Care Act rules in order to test marketplace innovations — provided they adhere to strict guardrails. Reinsurance works by subsidizing insurers’ highest-cost claims, allowing them to charge lower premiums overall. 

The Federal Trade Commission, Dept. of Justice and HHS on March 5 released a request for information (RFI) on private equity (PE) and “other corporations’” — including payers’ — ownership of health care providers, citing concerns over patient and worker safety, consolidation, and escalating costs. In a public event held that day, the agencies presented a deeply negative view of providers currently owned by PE and tipped further enforcement actions — including a heightened emphasis on legal coordination with state antitrust regulators. 

The investigation is just the latest in a series of ambitious health care antitrust moves by the Biden administration. The FTC has also launched investigations into PBMs, while the DOJ tried to block notable transactions like UnitedHealth Group’s acquisition of Change Healthcare — and in October launched a broad antitrust investigation into UnitedHealth itself, which became public in recent days. The text of the new RFI said it “complements” CMS’s recent, separate RFI on Medicare Advantage. 

Speaking at two health care investment conferences on March 5, executives at three major health insurance companies noted that they had been affected by the ongoing cyberattack on Change Healthcare, the nation’s leading processor of medical claims. However, they noted that it is still too early to assess how the Change attack will affect their first-quarter results. 

The companies — CVS Health Corp., Elevance Health, Inc. and Humana Inc. — each reaffirmed their financial guidance for the year while addressing investors. They admitted, though, that they do not have as much information on claims and utilization as usual due to the Change outage that was discovered on Feb. 21.  

Privately insured enrollees are generally satisfied with their health plan selection process and benefits, according to recently released data from the Employee Benefit Research Institute (EBRI) and Greenwald Research.

The Consumer Engagement in Health Care Survey found that the majority of adults surveyed obtained their health insurance coverage through their job or a spouse’s job. Most individuals said they were satisfied with various aspects of their health plan coverage. Over half of enrollees were extremely or very satisfied with their open enrollment process.