Health Plan Weekly

Since states resumed the Medicaid eligibility redetermination process — with the first beginning in April 2023 — almost 14.4 million people have lost coverage. That’s according to KFF’s Medicaid Enrollment and Unwinding Tracker, with data representing all states and the District of Columbia as of Jan. 9. States restarted their routine eligibility checking process this spring and summer after being effectively prohibited from doing so during the COVID-19 pandemic. Among the 14 million-plus people who have lost coverage since redeterminations resumed, 71% lost coverage for procedural reasons, KFF said. 

CMS on Jan. 9 approved an amendment to New York’s section 1115 demonstration, allowing the state to “make large investments in wide-ranging Medicaid initiatives.” Those initiatives include establishing base reimbursement rates for safety net hospitals; connecting people to housing and nutritional support services; enhancing access to coordinated treatment for substance use disorders; and making long-term investments in the state’s health care workforce. As part of the waiver, New York will also “increase and sustain provider payment rates and Medicaid managed care payment rates for obstetrics, primary care, and behavioral health,” CMS said. 

Although 2024 features both a presidential election and a split Congress — limiting any potential policy changes that could affect health insurers — the industry is facing mounting criticism regarding some of its business practices. Therefore, managed care organizations this year will be lobbying, perhaps largely behind the scenes, to not only mitigate that pressure but also to set the stage for future policy battles, industry observers tell AIS Health, a division of MMIT.  

“I don’t think there’s a huge health insurance reform issue in the immediate future, but I do think [insurers] kind of exited 2023 in a hail of bullets,” says Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation.  

UnitedHealth Group will sell its Brazilian subsidiary, Amil, the integrated managed care giant on Dec. 29 revealed in a filing with the Securities and Exchange Commission (SEC). Other publicly traded insurers have similarly divested international health insurance divisions in recent years after a notable trend of international expansion during the early 2010s. 

UnitedHealth said in the SEC filing that its earnings guidance remains unchanged, and it added that the deal is expected to incur a $7 billion charge “which will be excluded from adjusted earnings, the majority of which is non-cash and due to the cumulative impact of foreign currency translation losses.”  

Entering 2024, growing health care costs are the main worry of employer plan sponsors, according to industry experts. To cope with the problem, those experts add, employers may seek novel benefit designs, while also reaching for tried-and-true cost control methodologies like narrower networks. 

Brokerage WTW found in a September survey that 69% of surveyed large employers listed health care costs as a “top health and wellbeing priority” over the next three years, and that health care costs were the most frequently named priority by respondents. 

“I think that the emphasis on cost is actually bigger now than it was a few years ago,” says Jeff Levin-Scherz, M.D., population health lead at WTW and an assistant professor at the Harvard School of Public Health. 

While many people had closed their laptops and were gearing up to open presents, the U.S. District Court for the District of Columbia offered a gift to patient advocates that have been fighting for restrictions on private health plans’ use of copay accumulator programs. 

In September, Judge John Bates ruled in favor of a challenge brought by patient advocates — including the HIV + Hepatitis Policy Institute, the Diabetes Patient Advocacy Coalition and the Diabetes Leadership Council — to provisions in a 2021 rule that allowed group and individual health plans to apply copay accumulators even when drugs have no therapeutic alternative. Such programs prevent enrollees from counting any drug manufacturer discounts, like copay coupons, toward their deductibles and out-of-pocket maximums. Insurers and PBMs argue that copay accumulators are necessary to prevent copay coupons from steering patients to high-cost branded drugs — raising costs for everyone — but patient advocates contend that those coupons are necessary to promote affordability amid benefit designs that force patients to bear the brunt of their prescription drug costs.