Fewer companies are selling group health insurance: Congressional watchdog

By Allison Bell - Fewer health insurers are selling U.S. employers coverage, according to a new U.S. Government Accountability Office report. The GAO is an arm of Congress that helps lawmakers oversee government programs and spending. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Decline in Market Competition: Between 2011 and 2022, the number of issuers operating in the large-group market dropped significantly, with the average state seeing a decline from 12 to 8 issuers. Similarly, the small-group market experienced a sharper decline, from 13 to 6 issuers on average per state, indicating reduced competition.

2. Increased Market Concentration: The number of states with highly concentrated markets—where a single issuer controlled over 80% of enrollment—doubled in the large-group market (from 6 to 12 states) and quintupled in the small-group market (from 3 to 15 states), signaling a trend toward monopolistic market structures.

3. Impact on Consumer Choices and Costs: According to the GAO, these high levels of market concentration may limit consumer choice and potentially drive up premiums, contrary to the Affordable Care Act’s original goal of fostering competition in private health insurance markets.

Leadership Shift at CVS/Aetna: Familiar Faces, Familiar Tactics, and Why Patients Will Pay the Price

By Wendell Potter - When I saw that CVS Health had replaced Karen Lynch with David Joyner as CEO and brought in Steve Nelson — a former UnitedHealthcare executive — to lead its Aetna subsidiary, I felt a mix of familiarity and concern. Read Full Article…

HVBA Article Summary

1. The Rise of Consumer-Directed Health Plans (CDHPs): During their time at Cigna, the author, Karen, and other leaders, including current Cigna CEO David Cordani, witnessed the emergence of high-deductible health plans. Marketed as empowering consumers to make prudent healthcare decisions, these plans often led to patients delaying or foregoing care, accruing debt, and facing financial hardship, while insurers reduced claim liabilities and increased profits.

2. Strategic Shifts at CVS Health: CVS’s recent leadership changes, including the appointment of Nelson at Aetna and the promotion of Joyner as CEO, signal a continuation of cost-cutting strategies aimed at boosting shareholder value. Nelson's experience at UnitedHealth and the influence of activist investors like Glenview Capital Management underscore a focus on integrating services and reducing medical loss ratios, potentially at the expense of patient care.

3. Impact on Aetna Policyholders: Under the new leadership’s mandate to improve financial performance, Aetna’s Medicare and Medicaid enrollees could face higher deductibles, narrower networks, and stricter prior authorization processes. These measures, designed to control expenses and satisfy Wall Street expectations, risk putting essential healthcare services out of reach for vulnerable populations.

Insurer Blue Cross accused of ‘phantom tax’ in antitrust lawsuit in Michigan

By Mike Scarcella - Blue Cross Blue Shield of Michigan has been hit with a proposed class action accusing it of hindering competition for insurance that some employers buy to protect against large medical claims, causing them to pay excessive fees. Read Full Article… 

HVBA Article Summary

1. Antitrust Allegations Against Blue Cross Blue Shield of Michigan: Privately-owned gas station chain Wesco and the Utility Workers Union of America benefits fund filed a federal lawsuit alleging that Blue Cross Blue Shield of Michigan violated antitrust laws by charging self-funded customers a fee for using a rival's stop-loss insurance. The plaintiffs claim this "phantom tax" unfairly drives up costs and stifles competition in Michigan's stop-loss insurance market.

2. Impact on Employers and Stop-Loss Insurance Costs: The lawsuit highlights the financial burden on Michigan employers, who reportedly pay some of the nation's highest premiums for stop-loss coverage. Blue Cross Blue Shield of Michigan, which serves over 6 million people and earned $36 billion in revenue last year, is accused of leveraging its dominant position to make its stop-loss insurance business exceptionally profitable, earning $354 million in premiums in 2023.

3. Legal Action and Potential Class-Action Scope: The plaintiffs are seeking class-action certification to represent hundreds of Michigan employers affected by the alleged penalty fees. They aim to prohibit Blue Cross Blue Shield of Michigan from imposing such fees and are pursuing triple damages under federal antitrust law. The lawsuit underscores broader concerns about anticompetitive practices in the health insurance sector.

DOJ sues to block UnitedHealth's $3.3B acquisition of Amedisys

By Paige Minemyer - The Department of Justice (DOJ) filed suit Tuesday to block UnitedHealth's $3.3 billion acquisition of home health company Amedisys, arguing the deal would stifle competition in this space. Read Full Article… 

HVBA Article Summary

1. Elimination of Competition and Market Consolidation: The DOJ argues that the merger between UnitedHealth (UHG) and Amedisys would eliminate direct competition in the home health and hospice care market, reducing patient choice and increasing UnitedHealth's control over 30% or more of these services in eight states. The complaint highlights the importance of maintaining competition to benefit patients and avoid market monopolization.

2. Expansion of Market Dominance: If the merger is approved, UHG’s Optum division would add 500 locations to its existing network across 32 states and expand its footprint to five additional states. The DOJ contends this is part of a broader strategy by UnitedHealth to acquire competitors rather than compete with them, citing its previous acquisition of LHC Group as evidence of this approach.

3. Impact on Patients and Healthcare Workers: The DOJ warns that the merger would harm vulnerable patients by reducing access to home health and hospice services. Additionally, it would impact healthcare workers, particularly nurses, by eliminating a competitor that provides leverage for negotiating better pay and benefits. The DOJ underscores that the merger prioritizes market control over the welfare of patients and employees.

BCBS Michigan ordered to pay former employee $13M in COVID vaccine lawsuit

By Rylee Wilson - A federal jury has ordered Blue Cross Blue Shield of Michigan to pay nearly $13 million in damages to a former employee who said she was wrongfully terminated for refusing to receive the COVID-19 vaccine. Read Full Article…

HVBA Article Summary

1. Significant Jury Verdict: On November 8, Lisa Domski, a former IT specialist at BCBS Michigan, was awarded $10 million in punitive damages, along with $315,000 in back pay, $1.3 million in front pay, and $1 million for noneconomic damages. This verdict highlights the legal and financial implications of employer policies regarding COVID-19 vaccination mandates.

2. Religious Exemption Denied: Ms. Domski, a devout Catholic, sought a religious exemption from BCBS Michigan’s COVID-19 vaccine mandate, providing a written statement and her priest's contact information to support her request. Her exemption was denied, leading to allegations that the company failed to reasonably accommodate her sincerely held religious beliefs.

3. Broader Legal Implications: The case against BCBS Michigan is part of a growing trend of legal challenges over vaccination mandates. Similar cases have emerged, including a $700,000 jury award for a former BCBS Tennessee employee in 2021 and ongoing litigation involving the Equal Employment Opportunity Commission suing UnitedHealthcare for alleged discrimination related to vaccine exemptions.

Vets' private health program puts patients on hold

By Adriel Bettelheim - A federal program serving 2.8 million veterans isn't delivering on key promises. The big picture: The Veterans Community Care Program was set up to help veterans secure appointments with providers near their homes when they can't receive care from a Department of Veterans Affairs facility. Read Full Article…

HVBA Article Summary

1. Rising Costs and Delayed Access: The VA's community care program, established to bypass long wait times for veterans, has faced criticism for exacerbating delays and increasing costs. Referral expenses reached nearly $30 billion in fiscal 2023, with veterans waiting over two weeks on average to schedule appointments, far exceeding the 30-day goal for mental health services.

2. Audits and Congressional Concerns: Federal audits reveal that VA in-house care appointments are often scheduled more promptly than those through community care. Lawmakers have spotlighted alarming cases of veterans losing access to critical treatments, including cancer therapies and non-narcotic pain management options, raising broader concerns about care quality.

3. Funding Challenges and Future Implications: Reports indicate that escalating community care costs are straining the VA’s budget, potentially reducing resources for its in-house care system. While the VA plans to expand staffing in key specialties like mental health and cardiology, experts warn of potential service cutbacks without additional funding, leaving the program's future in question.

Obesity-Linked Heart Deaths Nearly Tripled in U.S. Over Past Two Decades

By Dennis Thompson - Lives lost to obesity-related heart disease have nearly tripled over the past twenty years, a new study reports. Heart disease deaths linked to obesity increased 2.8-fold between 1999 and 2020, according to findings presented…at the American Heart Association’s annual meeting in Chicago. Read Full Article… 

HVBA Article Summary

1. Alarming Rise in Obesity-Related Heart Disease Deaths: Researchers documented a significant 5% annual increase in obesity-related heart disease deaths over two decades, with the rate among men rising 243% and among women 131% between 1999 and 2020. Middle-aged men experienced a particularly sharp increase of 165%, while disparities were observed among Black adults and rural residents who faced higher death rates compared to other groups.

2. Contributing Factors to Increased Risk: Obesity elevates the risk of ischemic heart disease by increasing cholesterol levels, high blood pressure, type 2 diabetes, and poor sleep quality. These factors combine to clog arteries, reducing blood flow and oxygen to the heart, which significantly raises the likelihood of heart attacks.

3. Call for Preventive Action: Experts emphasize the importance of lifestyle changes such as healthier eating, regular exercise, and routine monitoring of heart health. Addressing social and environmental disparities, particularly among high-risk groups like Black adults and rural residents, is critical to mitigating this alarming trend.