Health Plan Weekly

CMS on July 19 took new steps to protect Affordable Care Act marketplace enrollees from unauthorized plan switching — moves that were applauded by the independent broker industry. One policy expert says the new policies are welcome and should help with unauthorized plan switching, but she suggests that more must be done to prevent unauthorized plan signups. Meanwhile, a new Senate bill and industry efforts could make a difference in unauthorized signups. 

In a July 19 press release, CMS said it would make notable changes in the way it processes plan switches on HealthCare.gov, including: 

Legal experts during a recent panel discussion said federal agencies and lawmakers have new uncertainty around health care regulation in the aftermath of the Supreme Court’s decision to end a legal concept that gave agencies broad leeway when they issued rules.  

In its rulings in Relentless v. Department of Commerce and Loper Bright Enterprises v. Raimondo, the Supreme Court effectively repealed Chevron deference, a legal precedent that is more than 40 years old. The idea behind it is that agency staff have subject matter expertise that Congress is unlikely to share, and Congress couldn’t be expected to continually update statutes to address every emerging issue of importance to a specific sector of the economy. 

States have been pursuing reforms that would limit hospitals’ ability to charge facility fees for routine medical services delivered in outpatient settings, which drove up enrollees’ premiums and out-of-pocket health care costs, according to a study by Georgetown University’s Center on Health Insurance Reforms.

Facility fees are charges from hospitals and other institutional health care providers that ostensibly cover their operational expenses for providing care. When hospitals acquire or affiliate with physician practices and other outpatient health care providers — a trend seen in the U.S. in recent years — ambulatory services provided at outpatient practices often generate a second bill for the facility fee on top of the professional fees the practitioners charge.

Despite reporting a strong balance sheet for the second quarter of 2024, Elevance Health, Inc. faced a selloff that seemed to be prompted by higher-than-expected utilization in the insurer’s Medicaid book of business. On July 17, the day that Elevance reported its results, its stock price dropped by $32.21 over the full day of trading, a 5.82% decrease, to settle at $520.93 — despite year-over-year increases in operating gain and operating margin, as well as better-than-expected medical loss ratio (MLR) performance. 

Elevance took in $43.2 billion in operating revenue in the quarter, down $200 million year over year. Its operating gain increased by $200 million year over year to $2.8 billion, and operating margin increased by 0.3% year over year to 6.4%. Elevance posted an MLR of 86.3%, below the Wall Street consensus of 86.4%.