Health Plan Weekly

Insurer and plan sponsor trade groups strongly oppose the Biden administration’s stepped-up mental health parity regulations, according to statements and public comment letters submitted in response to the latest rulemaking on the subject. Insurer groups AHIP, the Blue Cross Blue Shield Association (BCBSA) and the Alliance of Community Health Plans (ACHP) all lined up against the rulemaking, as did the ERISA Industry Committee (ERIC), a plan sponsor group. 

According to the insurer and plan sponsor groups, the proposed rules, which were released in July, are unworkable. They argue that there are simply not enough providers available to meet the more stringent requirements set out in the proposed regulations. The current round of rules, if implemented, would expand the list of conditions covered by parity rules, require additional data reporting and establish stronger network adequacy standards. Both plan sponsors and carriers could be held liable for violations of most provisions in the Biden administration’s proposed regulations. 

While the managed care stock story in the first half of 2023 revolved around care utilization concerns, the company that first fueled those worries — UnitedHealth Group — eased investors’ minds considerably when reporting third-quarter earnings. 

“Care patterns remain consistent with the view we shared during the second quarter, with activity levels still led by outpatient care for seniors and still most notably in the orthopedic and cardiac procedure categories,” Chief Financial Officer John Rex said, addressing the utilization issue head-on before describing UnitedHealth’s financial results during its Oct. 13 earnings call.  

Only 42% of Medicare Advantage Prescription Drug (MA-PD) contracts that will be offered in 2024 achieved an overall rating of 4 stars or higher, compared with approximately 51% of contracts in 2023, according to the latest Medicare Part C and Part D Star Ratings data. Weighted by enrollment, the average MA-PD Star Rating fell from 4.14 for 2023 to 4.04, with approximately 74% of MA-PD enrollees estimated to be enrolled in contracts that achieved 4 or more stars for 2024, compared with 72% for 2023, CMS reported on Oct. 13.

Those changes were largely expected due to the application of the new Tukey outlier deletion methodology, which was used in determining the cut points for measures not directly related to member experience and largely achieved CMS’s stated goal of infusing more “predictability and stability” into the Star Ratings.

Enrollment in managed Medicaid dropped by more than 2.1 million from the first quarter of 2023 to the second quarter, as the Medicaid eligibility redeterminations process resumed after a multi-year pause, according to AIS’s Directory of Health Plans.

Seven of the major national Medicaid insurers saw membership losses, with Centene Corp. losing more than 602,000 HMO members. Its membership declined by more than 100,000 in three states: Florida, Iowa and Texas. At the 2023 Wells Fargo Healthcare Conference on Sept. 6, Centene’s executives said that they expected the number of disenrolled former members to be in the range of 2.3 million to 2.4 million. Elevance Health, Inc. also reported significant membership loss in the second quarter, as nearly 475,000 members left its Medicaid HMO plans.

The average annual premium for employer-sponsored health insurance this year increased by 7% for single coverage and family coverage, reaching $8,435 and $23,968, respectively, according to the KFF Employer Health Benefits Survey. The report, released on Oct. 18, noted that workers’ wages increased by 5.2% and inflation rose by 5.8% in 2023. The average annual increase last year was 2% for single coverage and 1% for family coverage. KFF’s survey, now in its 25th year, includes private and non-federal public employers with three or more workers. 

Customer satisfaction with health insurance increased to a record-high score, according to the American Customer Satisfaction Index (ASCI) Insurance and Health Care Study published on Oct. 17. Humana Inc. had the highest score (82 out of 100), followed by UnitedHealthcare (78) and CVS Health Corp.-owned Aetna (77). ASCI’s report was based on interviews with 12,849 customers between October 2022 and September 2023 on subjects such as the range of plans available, ease of submitting a claim and access to doctors and hospitals. ASCI was founded in 1994 by researchers at the University of Michigan as well as the American Society for Quality in Milwaukee, Wisconsin, and CFI Group in Ann Arbor, Michigan.