Health Plan Weekly

If enhanced subsidies for Affordable Care Act exchange plans expire at the end of the year and aren’t renewed by Congress, it could upend a market that has seen massive growth in the past four years, according to two health policy experts who spoke during a KFF webinar on Feb. 10. However, Brian Blase, a former adviser to President Donald Trump, argued that the subsidies are too high and oversight of the exchanges in many states is lax, contributing to inflated costs for insurance and fraud among brokers and enrollees. 

Blase’s comments come amid speculation about a rule currently pending at the Office of Management and Budget that concerns ACA “program integrity.” While it’s not clear yet what that rule will entail, it could be focused on rolling back ACA-related regulations that increase federal spending.  

The Dept. of Justice (DOJ) under Donald Trump’s administration will defend the Affordable Care Act’s preventive services coverage mandate from a legal challenge that has reached the Supreme Court. The DOJ wrote in a Feb. 18 filing that it will maintain the position of Joe Biden’s administration, which held that agencies — the U.S. Preventive Services Task Force (USPSTF), the Advisory Committee on Immunization Practices, and the Health Resources and Services Administration — are within their rights to recommend which preventive services must be fully covered by private health insurers. In June 2024, the Fifth Circuit Court of Appeals agreed with a lower court ruling that the government should stop enforcing the mandated coverage of USPSTF-recommended services, although the ruling only applies to the plaintiffs.  

For two years in a row, the CEO of the nonprofit Health Care Service Corp. (HCSC) received compensation that outstripped the chief executives of all the major publicly traded health insurance companies, including Centene Corp., CVS Health Corp.’s Aetna, Elevance Health, Inc., Molina Healthcare, Inc., The Cigna Group and UnitedHealth Group. 

HCSC, which owns Blue Cross Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma, and Texas, has been led by CEO Maurice Smith since 2020. In 2023, Smith outearned every health insurance CEO except for Oscar Health, Inc.’s Mark Bertolini, whose total compensation was $44.5 million, according to AIS Health’s latest analysis of executive compensation data from the country’s largest health insurers. Smith also outearned every other CEO in 2022 except John Kao, the CEO of another newly public insurtech company, Alignment Healthcare, Inc.  

The CEOs of seven major publicly traded health insurance companies together received more than $144 million in total compensation in 2023, AIS Health’s Executive Compensation Database shows. The database includes major health insurers’ executive compensation from 2019 to 2023 — collected from individual companies, state insurance documents and U.S. Securities and Exchange Commission filings — and their national membership information as of the third quarter of 2024, per AIS’s Directory of Health Plans. The database will be updated annually.

Several states do not disclose compensation data for specific executives at health insurance companies or do not collect compensation data. Some insurance companies made leadership changes over the years.

House Republicans released a 2025 budget resolution on Feb. 12 calling for deep Medicaid funding cuts that could impact millions of people. While the Association for Community Affiliated Plans (ACAP) and other advocacy groups warn of major disruptions to Medicaid, Wall Street analysts indicated they are uncertain whether the proposals will pass because of the program’s popularity among voters. 

As Republicans look for ways to pay for President Donald Trump’s proposed tax cuts, their budget resolution calls for the House Energy and Commerce Committee to cut federal spending by at least $880 billion from fiscal years 2025 through 2034, a large portion of which could come from Medicaid. The Energy and Commerce Committee oversees Medicaid, which covers more than 79 million Americans, per KFF.