This is Jacob Emerson with the Becker's peer
issues podcast.
Here's your biweekly industry news briefing for September
11th.
Well, immigration and the economy emerged as major
topics during the 90 minutes presidential debate on
September 10th between former president Donald Trump and
vice president Kamala Harris. But the 2 candidates
did spend some of their time on 2
health care topics, abortion and the Affordable Care
Act.
The a ACA surface surface as a topic
near the end of the debate. 1 of
the moderators asked mister Trump if he still
intended to replace the health care law, and
if so, what his plan would be. When
pressed by the moderator, mister Trump said he
has concepts of a plan and that he,
quote, would change it if we come up
with something better and less expensive.
And there are concepts and options we have
to do that, and you'll be hearing about
it in the not too distant future, end
quote. The Republican Party has shifted away from
its longstanding campaign to repeal the ACA passed
under president Barack Obama in 2010.
The health care law reemerged in this election
cycle when mister Trump in November used Truth
Social to identify health care as a key
issue in his 2024
campaign,
promising to replace the ACA if reelected.
According to a tracking poll conducted by KFF,
43% of adults supported the health care law
in November of 2016.
The latest survey conducted in this April showed
62% of Americans hold a favorable opinion of
the ACA, while 37%
view it unfavorably.
In 2021, the Biden administration enacted the American
Rescue Plan Act, which temporarily enhanced subsidies for
individuals purchasing health coverage through ACA marketplaces,
was set to expire at the end of
2025 without congressional action.
The Biden administration has also released new data
on September 10th showing that 1 in 7
US residents have been covered through marketplace coverage
since January of 2014.
During the debate, miss Harris emphasized her commitment
to maintaining and growing the ACA, highlighting that
the law prevents insurance companies from denying coverage
to those with preexisting
conditions.
Well, coming mid October, the Medicare Advantage Program
will enter its annual enrollment period marked by
significant changes for older adults.
Among these changes are increased government scrutiny, tighter
CMS regulations, reduced base payments, and rising health
care costs.
The CEO of 1 Insurance Marketplace also wrote
online that in addition, the presidential election will
distract beneficiaries during the early weeks of the
enrollment period, and the late Thanksgiving holiday will
cause many beneficiaries to delay their decision making
until the final week, adding more stress to
an already difficult situation.
We also know that the health insurance industry
is launching a 7 figure lobbying blitz in
Washington, which includes a national digital and social
media campaign
to reach seniors and counter mounting challenges and
highlight the benefits that Medicare Advantage Plans can
offer to that population.
In response to these market shifts, MA carriers
are prioritizing their margins over membership
by reducing certain benefits and exiting unprofitable
markets. As margins tighten and negotiations with providers
become more strained, some, usually smaller health systems,
are choosing to no longer accept some or
all MA plans
usually from larger carriers.
Sachin Jain, the CEO of Scan Group, a
nonprofit Medicare managed carrier with more than 285,000
members, he wrote on LinkedIn earlier in September
calling all of this, quote, the great disruption,
and he outlined 5 key observations about the
evolving landscape,
saying that benefit stability will win out among
beneficiaries over innovation,
that MA organizations will need to improve care
management
abilities, that competition in the industry will increasingly
focus on plan effectiveness and the quality of
service. The brokers are becoming more important than
ever, and the stronger relationships will prevail will
prevail over partnering with everyone.
Well, Aetna and HCA hospitals in Florida will
go out of network if the two sides
do not reach a new contract agreement before
September 15th.
HCA and 48 of its hospitals in Florida
will be out of network if a new
contract agreement
is not reached. HCA's contract with Aetna's commercial
and individual plans expires September 15th.
HCA's Florida hospitals will remain in network with
Aetna Medicare Advantage through October 2025.
The contract negotiations do not affect ASC's urgent
care facilities or other facilities according to HCA,
and both sides are working to avoid a
split.
Well, speaking of contract negotiations,
Mercy Health in St. Louis has notified Anthem
Blue Cross Blue Shield that it will go
out of network with the insurer in Missouri
if a new agreement is not reached by
January 1st. That contract includes all commercial, Medicare
Advantage, ACA, Managed Medicaid,
and Health Link.
Mercy's retail pharmacy services would not be affected
by any potential split. The health system said
it wants to remove the, quote, red tape
that makes it difficult for patients to navigate
Anthem's system and acts as a, quote, barrier
for patients to receive
medically necessary care.
Both of those organizations are continuing to negotiate.
And finally, Centene expects rising Medicaid pressures to
hurt its 3rd quarter earnings.
In documents filed with the SEC on September
10th, Centene said it expects Q3 earnings per
share to decline by 20 to 30¢. Those
earnings will shift to the Q4.
The company is maintaining its full year earnings
guidance of at least $6.80
cents per share.
Its CFO, sir Drew Asher, on September 4th,
said the company expected medical expenses in Medicaid
to be higher in the Q3 than in
the Q2.
The company's medical loss ratio in the Q2
was 87.6%.
They said that Medicaid redeterminations
have been the main driver of increasing costs.
Centene lowered its Medicaid membership guidance for 2024
from 13,600,000
to 13,000,000.
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