Health Plan Weekly
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Insurers, Brokers Decry Think Tank’s ACA, Employer Plan Proposals
With two recent papers, a right-leaning think tank has managed to draw the ire of a wide array of health benefits stakeholders — including the top insurer trade group, a major health insurer, employers, unions, agents and brokers.
Both papers come at a time when health care industry stakeholders are increasingly trying to read the tea leaves to determine what policies President Joe Biden or former President Donald Trump would embrace if reelected.
In a paper published in May, the Paragon Health Institute argues that not only should federal policymakers end the enhanced Affordable Care Act subsidies that have been in place since 2021, but they should also cap the current open-ended tax exclusion for employer-sponsored health insurance.
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With Site-Neutral Payment Efforts Stalled, Debate Over Policy’s Merits Continue
Politicians from both parties have been pushing for site-neutral payment reforms, a concept that says payers should reimburse the same amount for outpatient services regardless of whether the service is performed in a hospital, ambulatory surgical center or physician’s office. But getting such a policy passed by Congress has proven elusive. And as Larry Levitt, KFF’s executive vice president for health policy, said during a June 17 KFF webinar: “It’s anybody’s guess what Congress might do in this divisive and chaotic political environment.”
Advocates for site neutrality came close to notching an incremental win last December when the House of Representatives passed the Lower Costs, More Transparency2 Act, which included a provision for Medicare site-neutral payments applying to drugs administered in an outpatient setting. However, the legislation has since stalled.
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Key Financial Data for Leading Health Plans — First Quarter 2024
Here’s how major U.S. health insurers performed financially in the first quarter of 2024. Health Plan Weekly subscribers can access more health plan financial data — including year-over-year comparisons of leading health plans’ net income, premium revenue, medical loss ratios and net margins. Just email support@aishealth.com to request spreadsheets for current and past quarters.
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News Briefs: Supreme Court Hobbles Federal Regulators’ Authority
The U.S. Supreme Court on June 28 issued rulings that will overturn the so-called Chevron doctrine, which gave federal agencies broad authority to interpret laws through their regulations. Writing for the majority in a pair of related cases — Loper Bright Enterprises v. Raimondo and Relentless Inc. v. Dept. of Commerce — Chief Justice John Roberts wrote unambiguously that “Chevron is overruled. Courts must exercise their independent judgment in deciding whether an agency has acted within its statutory authority, as the [Administrative Procedure Act] requires.” The phrase Chevron doctrine refers to a 1984 case, Chevron v. National Resources Defense Council, which created a framework in which courts largely defer to interpretations of the law made by agencies like HHS or the Environmental Protection Agency, as long as that interpretation is reasonable. Overturning that doctrine is expected to have significant implications for highly regulated industries, including the health insurance sector.
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ICHRAs: Poised for Major Growth or Overhyped ‘Niche Market’?
During Oscar Health, Inc.’s recent Investor Day presentation, CEO Mark Bertolini declared that “ICHRA’s time has come,” referring to Individual Coverage Health Reimbursement Arrangements, which the insurer said it believes is the key to expanding its presence in the individual insurance market. However, some industry experts and two much larger health insurers aren’t convinced that these alternatives to traditional employer-sponsored plans are poised for their big break.
“They’ve done a really good job getting a lot of attention on something that’s really a non-issue,” Ari Gottlieb, principal of health care consulting firm A2 Strategies, says of Oscar’s ability to generate headlines about the ICHRA’s market potential.
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