More 2024 Insurance Financial Results
A number of additional health plans announced financial results for 2025.
Clover Health’s stock dipped Feb. 28 after the company announced an earnings per share loss and a 2% miss on quarterly revenue. But the company reported a full-year 2024 adjusted EBITDA of $70 million, a huge year-over-year increase of $112 million.
Alignment Healthcare achieved its first year of positive adjusted EBITDA as a company. It also reported a huge surge in enrollment.
Blue Cross Blue Shield of Massachusetts reported a $400 million operating loss in 2024, driven by spending on GLP-1 medications and other rising medical costs. The company posted a -4.3% operating margin in 2024, compared to a 0.4% margin in 2023.
In other news, Becker’s reports on Blues’ MA enrollment as well as insurers who gained and lost membership for 2025 in MA.
Additional articles: https://www.fiercehealthcare.com/payers/clover-health-nets-70-million-adjusted-ebitda-misses-revenue-goals and https://www.fiercehealthcare.com/payers/alignment-healthcare-posts-701-million-quarterly-revenue-beats-expectations and https://www.beckerspayer.com/payer/bcbs-massachusetts-reports-400m-loss-driven-by-glp-1-spending.html and https://www.beckerspayer.com/payer/bcbs-plans-ranked-by-medicare-advantage-members-2025.html
#healthplans #medicareadvantage #employercoverage
HHS Sends Out Regulatory Memo On Public Comments
Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. sent out a memo yesterday to be published in the Federal Register next week that purports to end mandatory public comment periods for department activities related to “agency management or personnel or to public property, loans, grants, benefits or contracts.”
Many healthcare outlets have characterized this as a far-reaching revision of public comment in general. I could be wrong, but I do not see it that way. I believe that HHS intends to stop public comment on areas it was not truly obliged to seek input on, such as how the agency is managed, personnel decisions, entering into contracts and grants, and other administrative transactions.
I think the general requirement to issue draft rules and seek public comment before finalization would remain for rate-setting, rule enactment or changes, etc. But I admit the word “benefits” causes some worry. I think it is not referring to policy changes in programs but the individual award of benefits.
Again, I could be wrong, but time will tell and I think HHS needs to clarify this. We are in the arcane rule of government regulation here.
Additional articles: https://www.fiercehealthcare.com/regulatory/rfk-jr-orders-hhs-end-notice-public-comment-process-rulemaking and https://www.modernhealthcare.com/policy/hhs-public-comment-rfk and https://thehill.com/policy/healthcare/5170090-rfk-jr-hhs-public-comment-rulemaking-ends/?tbref=hp and https://www.beckershospitalreview.com/legal-regulatory-issues/hhs-aims-to-rescind-public-comments.html
(Some articles may require a subscription.)
#regulations #hhs #cms #healthcare
Judge Says Probationary Worker Firings Illegal But Does Not Stop Them
A federal judge characterized the mass layoff of workers as illegal. He took issues with the memo by the Office of Personnel Management directing agencies to layoff probationary employees. He directed the rescission of the memo. But he said he has no authority to cause the layoffs to be undone.
Another federal judge similarly did not intervene to stop the layoffs. Some agencies have begun to rescind some layoffs given worries about staffing of agencies.
#layoffs #doge #trump #budgetreconciliation
Hospitals Could Cost Shift To Commercial Coverage If Medicaid Cut
Hospitals are warning they could seek higher rates in the commercial world if Medicaid is cut. There is a cost-shift to employer and other coverage today due to losses on services for those covered on government programs, such as Medicare and Medicaid.
But hospitals’ warning here goes beyond that. They would charge employer and commercial coverage more now because of a loss of revenue from a program rather than a loss on a given government program members’ services. This is because they continue to provide services to people (now uninsured) and receive little or no revenue on them.
Large employers are pushing back and saying they would not agree to higher rates. Because health plans negotiate such rates on an administrative (not risk) basis, would most employers even know?
(Article may require a subscription.)
#employercoverage #commercial #medicaid #healthplans #rates #hospitals
https://www.modernhealthcare.com/insurance/medicaid-cuts-hospital-rates
Budget Hawks Say Medicare Should Be On Table
Conservative budget hawks in Congress are saying that Medicare reductions must be on the table to achieve a level of spending cuts to find the extension of the 2017 tax cuts. They say it would be irresponsible to ignore a $1 trillion program. Among the Medicare cuts they target include instituting site neutrality and addressing Medicare Advantage (MA) overpayments.
I have long argued that site neutrality should be adopted in Medicare. It would reduce costs in the commercial world too. In addition, I said that I expect some changes to MA rates and risk adjustment.
(Article may require a subscription.)
#medicareadvantage #hospitals #siteneutral #medicare #spending #budgetreconciliation
https://insidehealthpolicy.com/daily-news/budget-hawks-say-congress-shouldn-t-ignore-medicare
Medicaid Provider Tax Debated
House Republicans say they will not fundamentally cut Medicaid coverage in the budget reconciliation bill and focus instead on what they say is fraud, waste, and abuse (FWA). But on their list of FWA cuts are reforming and reining in provider taxes. Proponents for Medicaid argue provider taxes are a way for states to legitimately raise revenue for their state share of matches in the program. Others argue that provider tax schemes have gone way too far and essentially absolve states of putting in dollars. As such, they say that it is an abuse that drives spending in the program.
The use of provider taxes has been reined in over the years. States are allowed to charge certain providers up to 6% in taxes. On the table is lowering the threshold to 5% to save $48 billion for the federal government over a 10-year period. Dropping the threshold to 2.5% would save $241 billion. Banning the practice would save $612 billion. But states would have to find other dollars to match on their end or cut services or populations.
Some Republicans are also arguing that the enhanced federal match largely covering adults in Medicaid discriminates against traditional program enrollees. They want to see reforms here as well.
(Article may require a subscription.)
#medicaid #providers #budgetreconciliation #fwa
https://insidehealthpolicy.com/daily-news/advocates-slam-gop-view-medicaid-financing-reforms
Outrageous Surprise Bill
Kaiser Health News has reported on the latest outrageous surprise bill. It finds that a 6-mile ambulance ride between hospitals cost $12,872.99. Of course, many ambulances refuse to contract with health plans so they can be out-of-network and charge these outrageous fees. Land ambulances should be included in the No Surprises Act to protect patients and bring sanity to the industry. Right now just air ambulances are in the act.
#surprisebilling #nosurprisesact #medicaldebt
Republican Voters Want Government To Step In On Healthcare
More evidence that the American public is demanding change in healthcare and they don’t mind government regulating and protecting consumers. A poll finds that Republican voters strongly back federal limits on the prices charged by drug companies and hospitals, caps on patients’ medical bills, and restrictions on how healthcare providers can pursue people over medical debt.
#healthcare #coverage #medicaldebt #drugpricing #hospitals #providers #healthplans
https://kffhealthnews.org/news/article/republican-trump-voters-health-care-government-role/
— Marc S. Ryan
