This is Jacob Emerson with the Becker payers
issues podcast.
Here is your bi weekly industry news briefing
4 June 20 fourth.
A federal court has kept the Ach aca
preventive care mandate in place for now, but
is raising questions about its constitutional.
The fifth Us Court of Appeals issued a
decision in Braid Management versus Ba on June
20 first.
Judges there called their decision a, quote mixed
bag, and the case is likely to be
lit in higher courts.
Braid Management to Texas company. Sued Hhs back
in 20 21.
The company argued that the requirement to cover
prep for Hiv prevention, violated the company's religious
freedoms.
The Appeals court ruled Braid wood cannot be
compelled to pay for prep for its employees,
but reversed a lower court decision that prevented
the federal government from enforcing requirements. To cover
preventive services.
Of course, the Aca requires payers to cover
more than 100 preventive services with no c
pays and more than a hundred million people
use those services every year.
In March, of last year, Us district Judge,
R O'connor ruled, that recommendations made by the
Us Preventive Services task force made after 20
10 do not need to be comp with
and blocked the federal government from enforcing its
recommendations.
Hhs later struck a deal to preserve the
mandate while the case was appealed. The appeals
court agreed with mister O'connor ruling that because
the members of the task force are not
confirmed by the Senate. Their authority to mandate
coverage of services is
unconstitutional. They did say though, we think it
was air however for the court to have
also vacated all agency actions taken to enforce
to preventive care mandates and to universally enjoying
the defendants from enforcing them. The The decision
in the case will therefore apply only to
Braid wood management. The appeals court will send
the issue of the authority of the task
force back to a lower court. To decide,
and the case is likely to make its
way to the Supreme Court.
Will rise ant Health, a non nonprofit formed
under Kaiser Permanente has signed a definitive agreement
to acquire Cone health, which is based out
of Greens, North Carolina.
The news comes less than 3 month after
R acquired its first health system, Dan, Pennsylvania
based Ge health.
Cohen health includes 4 acute care hospitals, a
behavioral health facility, 3 ambulatory surgery centers, 8
urgent care centers, and more than a hundred
and 20 physician practices.
It has more than 13000 employees in over
700
physicians.
It also
more Is the majority owner of health team
advantage, a health insurance subsidiary founded in 20
15.
Winston, Salem of North Carolina based, Nova Health
holds a minority stake and health team advantage,
which has
about 17000
members and offers M plans and eligible... 2
eligible Medicare beneficiaries in certain North Carolina counties.
We'll change health has started informing healthcare
organizations into insurers and other entities, whose data
was breached in the February ransom attack. Change
a subsidiary of United Health group has reviewed
more than 90 percent of the affected files.
Information potentially exposed in the attack includes names,
addresses, health insurance information and search security numbers.
To date, there is no evidence that medical
charts or full medical histories were leaked in
the breach. The company said it is still
investigating and they may identify more customers who
data whose data was compromised.
In late April, the company said data stolen
buy hackers likely covers a substantial proportion of
people in America. Customers Change will start notifying
individual patients affected by the breach in late
July.
While some of the nation's largest health insurers
have signaled significant headwind in recent. And months
with their Medicaid businesses, Mass costs rise in
the effect of red
takes hold. But fit analysts expect those headwind
to be short lived. And in a June
brief shared with Becker, Fit wrote that regardless
of the core drivers of the higher utilization
rates, we expect the resulting Medicaid margin pressure
to be relatively short lived as rates setting
discussions with states should incorporate the higher levels
of acuity. For most companies,
diversification, particularly in commercial group and individual exchange
markets will also continue to be beneficial in
helping to offset the temporary margin pressure in
Medicaid.
Additionally, higher interest rates continue to more heavily
benefit the investment income generated by the large
high quality bond portfolios of publicly held health
insurers.
We As of June fourteenth, more than 23000000
people have lost Medicaid coverage. That's a direct
hit to private insurers enrollments. If Medicaid managed
organizations continue to lose members, but the enroll
that keep retain use health care at a
higher rate. Profits could suffer.
Fit is analyst wrote that the morbidity of
the risk has deteriorated. What's precise causes of
higher acuity within remaining medicaid medicaid
beneficiaries. Is currently unclear. However, we believe that
1 potential factor is adverse selection driven in
part by the high level of dis enrollment
for procedural reasons.
Well, priority Health is planning to purchase physicians
health plan of Northern Indiana, a Fort Wayne
based payer with more than 52000 members in
Indiana, and Ohio,
pending regulatory approvals, that acquisition is is expected
to close by the end of this year.
Financial terms of the deal were not disclosed.
Priority health is the payer arm of Grand
Rapids Michigan based core health, which serves more
than 1300000.0
people across commercial Medicare and Medicaid plans.
Finally, the Us uninsured rate is projected to
increase to 8.9
percent by 20 34.
That's according to new estimates published by the
congressional budget office in June.
According to the Cb, the nation's on uninsured
rates in 20 23 hit a record low
of 7.2
percent. A preliminary survey published in June by
these Cdc found the 20 23 short rate
was 7.6
percent. That's about 25000000 people nationwide.
The Cb, which attributes the expected on uninsured
increase over the next decade to medicaid red
determinations and the expiration of Aca premium subs.
Cities after 20 25.
A recent increase in immigration will also contribute
to that rate. The largest increase in the
uninsured population between 20 24 and over the
next decade will be among adults, ages 19
to 44.
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