UHG To Give Profits Back To Exchange Enrollees
In an effort to forestall charges against it over healthcare affordability, UnitedHealth Group announced today that it plans to give profits from its Exchange plans back to customers in 2026. Several top executives from the biggest plans will appear before two House committees Thursday as the GOP seeks to insulate itself from the affordability crisis. UnitedHealthcare offers plans on the exchanges in 30 states, and it expanded its service area in 11 of those regions. It is unknown how much money that is or if United will make a profit.
Additional articles: https://www.modernhealthcare.com/insurance/mh-unitedhealth-aca-rebates-congress/ and https://www.fiercehealthcare.com/payers/unitedhealth-ceo-hemsley-says-insurer-will-rebate-aca-profits-consumers and https://www.healthcaredive.com/news/unitedhealth-to-return-aca-profits-to-customers-hemsley/810183/ and https://www.modernhealthcare.com/politics-regulation/mh-stephen-hemsley-david-joyner-congress/
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#unitedthealthcare #healthplans #congress #affordability #exchanges
https://thehill.com/policy/healthcare/5699770-unitedhealth-group-affordable-care-act-profits
Cigna May Settle FTC Insulin Suit
Cigna may settle the administrative Federal Trade Commission (FTC) case over allegations it artificially raised insulin prices. The FTC said it suspended the case to review Cigna PBM Express Scripts’ and other related companies’ settlement offer. The FTC has charged the three biggest pharmacy benefits managers over insulin pricing.
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#drugpricing #pbms #ftc #fwa
President Trump’s “Great Healthcare Plan” Explained
Becker’s Payer Issues gives some additional details on President Trump’s “Great Healthcare Plan,” including what is in it and what is unclear. It also touches on the other bipartisan agreement and the status of the Exchange subsidy extension talks. My blog on Tuesday covers much of this as well. That is at the blog tab.
Politico says prospects for President Trump’s plan are low due to the fact that key parts likely won’t meet the strict Senate rules for the budget reconciliation process. Few if any Democrats would support the plan and many GOP moderates could question it too. Pieces of the plan could get into a reconciliation bill. Another obstacle: while Trump is right to go after most-favored-nation (MHN) drug pricing, many GOP lawmakers oppose it. They have been bought off long ago by Big Pharma.
Additional article: https://www.politico.com/news/2026/01/20/trump-health-plan-congress-00734445
#trump #congress #healthcare #exchanges
MD Will Need To Lower Medicare Advantage Hospital Rates
A new federal policy will mean Maryland will no longer get to set all-payer hospital rates under a federal model. Medicare Advantage (MA) health plans have complained for years that the rate process in Maryland was unfair to MA plans as the rate system did not recognize their true costs given the high all-payer hospital rates in the state.
Plans had lobbied for increased MA rates, but instead the Centers for Medicare and Medicaid Services (CMS) will revoke Maryland’s long-standing rate-setting power for Medicare fee-for-service. CMS will once again control the rates. Commercial rates will increase to make up for the lower Medicare rates. The change will be effective in 2028.
The Maryland Health Services Cost Review Commission confirmed a $435-million cost shift onto commercial payers via hospital rate increases. Commercial hospital rates will increase by $87 million every calendar year from 2028 through 2032 before maintaining the shift in rates. There will also be 11.55% in rate relief for eligible MA plans.
#medicareadvantage #hospitals #rates
— Marc S. Ryan
