Uninsured Rate Remains Steady
Healthcare policy group KFF finds that the uninsured rate held steady at 8.0% in 2024 and remains near a historic low. The analysis uses new data from the Census Bureau and matches other findings. While Medicaid redeterminations meant losses there, private sector and Exchange coverage did pick up most of the losses. As the Medicaid continuous enrollment policy came to an end, states resumed Medicaid redeterminations. Medicaid coverage dropped by 1.3 percentage points from 2023 to 2024 while private coverage increased by 0.7 percentage points, including a 0.5 percentage point increase in direct purchase coverage.
In another analysis of Exchange coverage, KFF also found that 48% of adults under age 65 enrolled in individual market (direct purchase) coverage are either employed by a small business with fewer than 25 workers, self-employed entrepreneurs, or small business owners.
KFF also published key facts about Medicaid, including that over 70% of Medicaid spending pays for hospital services and long-term care.
Additional article: https://www.kff.org/medicaid/5-key-facts-about-medicaids-share-of-national-health-spending/ and https://www.kff.org/quick-take/2024-uninsured-rate-held-steady-as-aca-marketplace-enrollment-offset-medicaid-declines/
#uninsured #coverage #employercoverage #exchanges #medicaid
Hospitals Leverage Lawmakers On 340B
A bipartisan group of 163 lawmakers signed on to a letter urging the Department of Health and Human Services (HHS) to cancel or give assurances about a 340B drug discount program pilot that would switch from an upfront discount to a retrospective rebate. There are a number of studies that conclude hospitals and safety net providers abuse the system. They receive the discount but do not pass through savings to the intended low-income beneficiaries. Some studies show that drug costs are higher at 340B providers than those who do not get the benefit. Program costs have spiraled in the last decade. Of course, lawmakers are carrying hospitals’ water as they have been bought off in numerous ways over the years. Their letter touted long-standing hospital positions and was devoid of any balance.
#340b #hospitals #drugpricing #branddrugmakers
Health Plan Developments
A number of health plan developments today:
- Cigna Chief Operating Officer Brian Evanko believes the Big 3 pharmacy benefits manager (PBM) model will be durable although it will evolve somewhat. Its PBM, Express Scripts, will focus on affordability, clinical programs that promote safety, and benefits administration services. Evanko said that Cigna is working with Capitol Hill on reasonable reforms.
- The U.S. Bankruptcy Court for the Middle District of Florida approved a bid from Humana’s CenterWell, a provider entity, to acquire the assets of The Villages Health, the health system serving The Villages retirement community in Florida.
- A federal judge in Minnesota denied UnitedHealth Group’s request to narrow the scope of discovery in an ongoing lawsuit on the use of artificial intelligence (AI). Plaintiffs contend that United uses AI to wrongfully deny Medicare Advantage members’ post-acute care.
- UnitedHealth’s Rocky Mountain HMO and Elevance Health’s Anthem HMO Colorado have withdrawn their plans to exit the state’s Exchange program. Both companies will continue services in all counties they cover now. The discontinuances of plans between the two insurers would have affected 96,000 residents. In August, state lawmakers passed a law that will mitigate the impact of the expiring enhanced premium subsidies under federal law. Up to $100 million in state funds will be provided to stabilize the individual market.
Additional articles: https://www.fiercehealthcare.com/payers/cigna-execs-say-evernorth-poised-weather-eventual-pbm-reform and https://www.beckerspayer.com/m-and-a/court-approves-humana-bid-to-buy-the-villages-health/ and https://www.beckerspayer.com/payer/medicare-advantage/judge-denies-unitedhealths-bid-to-limit-discovery-in-ai-coverage-denial-case/
#healthplans #medicareadvantage #exchanges #ai #priorauthorization #claimsdenials #providers #primarycare #pbms
https://www.beckerspayer.com/payer/aca/unitedhealth-elevance-reverse-course-on-colorado-aca-pullback
— Marc S. Ryan
