Exchange Enrollment Expected To Drop
While actual enrollment during the open enrollment season in the Exchanges did not drop a great deal, the cost of not extended enhanced subsidies is now appearing to take hold. State Exchanges as well as health plans are reporting cancellations as well as lack of premium payments, which could send rolls dropping dramatically throughout the year. As one example, the biggest Exchange plan nationwide, Centene, says it expects its rolls to drop over one-third this quarter. Cigna, Elevance Health, Molina Healthcare, and UnitedHealthcare anticipate collectively losing approximately 3.4 million exchange members by the end of 2026.
(Article may require a subscription.)
#exchanges #enrollment #healthplans #coverage
https://www.modernhealthcare.com/insurance/mh-aca-exchanges-membership-premium-payments
No Suprises Battles
A Modern Healthcare article covers the ongoing battle between insurers and providers regarding the No Surprises Act arbitration process. Physician groups, hospitals, and air ambulance companies have filed millions of claims seeking higher reimbursement from insurers for out-of-network care. Providers, the article says, argue insurers’ flawed reimbursement methodology is decreasing payment and forcing them to go to the dispute resolution process. Insurers say providers are filing false cases in huge numbers.
Capitol Hill thus far has shown no appetite to truly reform what has been passed. The administration is tinkering at the fringes of reform. The article spends more time than it should trashing plans on favor of providers. Providers are clearly abusing a process that was already heavily slanted toward them.
(Article may require a subscription.)
#nsa #nosurprisesact #transparency
https://www.modernhealthcare.com/providers/mh-no-surprises-act-independent-dispute-resolution
DOJ Sues Provider Over Contracting Behavior
In a sign that the administration is beginning to look at anti-competitive behavior in healthcare, the Justice Department (DOJ) is suing OhioHealth for allegedly forcing insurers into inflated contracts and driving up costs in the state. The DOJ says the regional nonprofit system leverages its market power to force insurers to include its providers in their networks. It says the behavior hampers price transparency and disadvantages regional rivals.
Additional articles: https://www.healthcaredive.com/news/justice-department-sues-ohiohealth-anticompetitive-insurer-contracts/812753/ and https://www.modernhealthcare.com/legal/mh-justice-department-ohiohealth-anticompetitive-lawsuit/
(Some articles may require a subscription.)
#antitrust #healthcare #hospitals
States Move On Wage Garnishment Due To Medical Debt
Lawmakers in at least eight states are aiming to stop or lessen wage garnishment for unpaid medical bills. The legislation is under consideration after Kaiser Health News reported that courts approved wage garnishment requests in an estimated 14,000 medical debt cases a year in Colorado.
#medicaldebt #hospitals #providers #healthcare
KFF Analyze MA Enrollment
Healthcare policy think tank KFF published an assessment of the 2026 open enrollment season in Medicare Advantage (MA) and growth from 2025 to 2026. KFF’s number are slightly different than mine but we arrive at most of the same conclusions. My blog is here: https://www.healthcarelabyrinth.com/2026-medicare-advantage-enrollment-season-good-news-bad-news/
#medicareadvantage #enrollment
KFF Analyzes 2024 Insurance Margins
Healthcare policy think tank KFF published a briefer on health insurance margins for 2024. It finds that per enrollee gross margins are highest in Medicare Advantage ($1,655) and lowest in Medicaid managed care ($608). Medical loss ratios were noticeably high in all lines of business.
#healthplans #margins
Take KFF’s Health Insurance Knowledge Quiz
Healthcare policy group KFF published the “How Well Do You Understand Your Health Insurance?” quiz. Take it below. I got a 100! If you are looking to learn more about health insurance and reform, check out my book: https://www.amazon.com/Healthcare-Labyrinth-Navigating-American-Insurance/dp/1645439933
#healthcare #healthplans #insurers
https://www.kff.org/private-insurance/quiz-how-well-do-you-understand-your-health-insurance/?
— Marc S. Ryan
