January 24, 2024

Record Enrollment In Exchanges Nationwide

The Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services (HHS) announced something to celebrate.  Driven in part by Medicaid redetermination enrollment losses and enhanced premium subsidies, state and federal exchange enrollment reached a projected 21.3 million for 2024. An amazing achievement. Over 5 million new enrollees joined over 16 million existing members. Nearly 4.2 million people with incomes of less than 250% of the federal poverty level signed up for 2024 coverage.  They receive both premium subsidies and cost-sharing reductions. About 15% of those enrollment previously had Medicaid.  That translates to a little over 3 million – a small amount of those who lost Medicaid coverage. Over 16 million are in the federal Exchange and about 5 million in various state Exchanges.

CMS press release here: https://www.cms.gov/newsroom/press-releases/historic-213-million-people-choose-aca-marketplace-coverage . CMS Snapshot here: https://www.cms.gov/newsroom/fact-sheets/marketplace-2024-open-enrollment-period-report-final-national-snapshot . HHS press release here: https://www.hhs.gov/about/news/2024/01/24/historic-21-million-people-choose-aca-marketplace-coverage.html

Kaiser Family Foundation analysis here: https://www.kff.org/policy-watch/another-year-of-record-aca-marketplace-signups-driven-in-part-by-medicaid-unwinding-and-enhanced-subsidies/

Other articles here: https://www.modernhealthcare.com/insurance/open-enrollment-breaks-21m-2024 and https://thehill.com/homenews/4426408-obamacare-marks-record-enrollment-5-million/ and https://insidehealthpolicy.com/daily-news/cms-touts-medicaid-marketplace-transitions-enrollments-hit-record-213m

(Some articles may require a subscription.)

#exchanges #aca #obamabcare #enrollment #coverage #medicaid #redeterminations

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PBM Reform And Landscape For 2024

A nice Modern Healthcare article on possible PBM reform and how things could evolve in 2024.  Touches on reform in Congress, startup PBMs, and Mark Cuban’s initiatives.  I wrote a blog on this subject here: https://www.healthcarelabyrinth.com/pbm-transparency-and-reform-is-a-big-trend-in-the-american-healthcare-system/ .  Similar themes.

(Article may require a subscription.)

#drugpricing #transparency #pricetransparency #cuban #pbms

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Study Finds Black Medicaid Enrollees At Higher Risk Of Hospitalization

The Urban Institute has found that black Medicaid enrollees were “significantly more likely” to be hospitalized for preventable conditions than white enrollees, including for asthma/chronic obstructive pulmonary disease (COPD), diabetes and heart failure. There clearly are both social determinants of health and health equity issues playing a role here.

#sdoh #socialdeterminants #healthequity #medicaid

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Elevance Health Reports Good Results And Manageable Medical Expense

Unlike United and Humana, Elevance Health for now seems to be avoiding unmanageable medical expense increases. Elevance beat the Street.  It said medical expense met expectations, but it did see pockets of high utilization. Its Carelon business is growing, backed by growth in its PBM.  It now represents more than a quarter of revenue.

Additional articles here: https://www.fiercehealthcare.com/payers/elevance-health-posts-856m-profit-q4-earnings-beat and https://www.modernhealthcare.com/finance/elevance-health-fourth-quarter-earnings-investor-relations-gail-boudreaux

(Some articles may require a subscription.)

#elevancehealth #medicalexpense #mlr

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New Federal Agency For AI Regulation?

Some Senate Finance and Judiciary lawmakers want a new federal agency to regulate artificial intelligence across the federal government, while others are simply calling for enhancement to oversight at certain healthcare agencies. Do we really need yet another federal agency?

(Article may require a subscription.)

#ai #healthcare

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— Marc S. Ryan

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