Health Plan Weekly

The annual J.P. Morgan Health Care Conference in San Francisco, which took place from Jan. 8-11, has a well-earned reputation as the site of dealmaking. Last year, for example, rumors of CVS Health Corp.’s eventual deal to acquire primary care provider Oak Street began to emerge.  

The 2024 edition proved to be less fruitful for dealmaking as far as managed care firms were concerned — never mind the $6.4 billion in deals announced at the start of the conference by Johnson & Johnson, Merck & Co. Inc. and Boston Scientific Corp.  

Still, CVS and The Cigna Group each faced questions about the aftermath of megadeals, both real and imagined. 

Over 20 million people have enrolled in Affordable Care Act marketplace coverage since the start of the 2024 open enrollment period (OEP), reaching a record for the third consecutive year, according to CMS. Over 3.7 million people who have signed up for ACA plans are new enrollees this year.

More than 15.5 million people have enrolled through HealthCare.gov in the 32 states that use that platform, and another 4.8 million have enrolled across 18 states and the District of Columbia, which use their own marketplaces.

After adjusting enrollment figures to account for the fact that there is one fewer day included in the 2024 OEP data compared to last year’s report, an ACAsignups.net analysis showed that every state except Maine and the District of Columbia saw membership growth in 2024, ranging from 2.8% in Hawaii to 78.8% in West Virginia. A total of 10 states reported signup surges of more than 50%.

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.”