Health Plan Weekly

The three insurtechs — Alignment Healthcare, Inc., Clover Health Investments Corp. and Oscar Health, Inc. — each recently reported full-year 2024 earnings reports that continued to show improvements in membership and financial health.  

Ari Gottlieb, principal of health care consulting firm A2 Strategies, is a longtime critic of the companies for touting themselves as technology firms rather than focusing on health insurance. However, Gottlieb says “it was a really good year for all three” companies, each of which achieved profitability on an adjusted earnings before interest, taxes, depreciation and amortization (EBITDA) basis, plus significant gains in membership. 

With Republicans in Congress considering steep cuts to federal Medicaid spending, multiple studies have shown that the proposed policy changes could shift billions in costs to states and leave millions uninsured.

Any major cuts to Medicaid funding could also exacerbate margin pressures for U.S. health insurers, portending potentially lower enrollment and revenue headwinds, Fitch Ratings said in a recent bulletin. As of March, more than 65.6 million people are enrolled in a managed Medicaid health plan, according to AIS’s Directory of Health Plans. Centene Corp. alone accounted for 18.7% of the national market, while Elevance Health, Inc. and UnitedHealthcare ranked the second and the third largest, holding about 11.0% and 8.5% market share, respectively.

HHS Secretary Robert F. Kennedy Jr. recently rescinded a decades-old policy regarding allowing the public — and industry stakeholders like health insurers — to comment on proposed rules. Experts tell AIS Health that while the move is the opposite of “radical transparency” Kennedy promised to bring to HHS, any future rules can be kept in check through other parts of the Administrative Procedure Act (APA). 

“This is surprising when you have an administration, in particular Kennedy, who promised transparency, and this is unequivocally reducing transparency,” says Leonardo Cuello, a research professor at the Georgetown University McCourt School of Public Policy’s Center for Children and Families. 

In late February, President Donald Trump signed an executive order signaling his desire to build upon the health care price transparency regulations issued during his first administration. Those rules required hospitals and health insurers to publish lists of negotiated prices for services, including in- and out-of-network rates. But an expert tells AIS Health that issues persist with the massive amount of complex data being submitted by health care organizations — and with ensuring health plan compliance. 

The executive order directs HHS and the Labor and Treasury departments, in the next 90 days, to “take all necessary and appropriate action to rapidly implement and enforce” the price transparency rules targeting hospitals and insurers issued in Trump’s first term. This includes requiring disclosure of actual prices instead of estimates, issuing guidance to ensure standardization and easy price comparisons, and issuing guidance to update enforcement policies, according to the order. 

Blue Cross Blue Shield of Michigan had a $1.7 billion operating loss in 2024, according to a March 3 Crain’s Detroit Business article. The company paid out $20.7 billion in claims last year, with medical claims increasing $2.1 billion and pharmacy costs increasing $900 million compared with 2023. Crain’s noted it was the fourth consecutive year BCBS of Michigan paid out more in medical claims than it collected in premiums. A BCBS of Michigan spokesperson told AIS Health last month that the company “has weathered significant economic headwinds affecting virtually all health insurers.” The company has passed on double-digit premium increases to fully insured customers and is seeking to reduce administrative costs by $600 million over the next few years. 

Wellvana has acquired CVS Health Corp.’s Medicare Shared Savings Program business, according to a March 4 press release. As part of the deal, CVS Health obtained a minority stake in Wellvana, a value-based care enablement company that serves about 1 million Medicare patients and supports providers in 40 states. CVS Health noted it would continue pursuing value-based care arrangements in its Oak Street Health and MinuteClinic locations, as well as through contracts between Aetna and providers.