ACA rates approved to increase for next year, new carrier added to marketplace

By Angela Roberts - Premium rates for individual health insurance plans under the Affordable Care Act will increase by about 6% on average next year, but the Maryland Insurance Administration said this week that opportunities for savings remain. Read Full Article… 

HVBA Article Summary

1. Slight Increase in Rates: Individual market insurance rates in Maryland will see an average increase of about 4% in 2025. However, the state will continue to offer some of the most affordable rates nationwide, partly due to federal and state subsidies and a reinsurance program that has successfully stabilized the market.

2. New Carrier and More Choices: Wellpoint Maryland has been approved to sell 10 new plans on and off the Affordable Care Act marketplace, increasing the total number of insurance carriers in the state to five. This expansion ensures that Marylanders will have access to at least four insurance carriers, regardless of their location within the state.

3. Savings and Rate Adjustments: The insurance administration approved rates that are roughly 0.5% lower than initially requested by carriers, resulting in an estimated $6.4 million in savings for state residents. Despite overall cost increases in prescription drugs, physician, and hospital services, the reinsurance program has helped keep rates approximately 17% lower than in 2018.

Medicare prescription drug plans a concern for clients as well as agents

By Susan Rupe - Craig Gussin isn’t only hearing from clients going into Medicare open enrollment season; he’s also hearing from his fellow Medicare agents as part of his involvement with several industry associations. Read Full Article…

HVBA Article Summary

1. Challenges for Medicare Clients: Gussin highlights that the upcoming Medicare season will be challenging due to significant changes affecting Medicare Advantage plans and prescription drug costs. Key issues include major hospitals and physician networks in San Diego opting out of Medicare Advantage plans, forcing clients to seek alternative coverage, potentially leading to higher costs or the need to switch doctors.

2. Impact on Agents and Commissions: Agents in the San Diego area face additional difficulties as two carriers have announced they will no longer pay commissions on Medicare prescription drug plans. This raises concerns about the financial viability of selling these plans and the additional time required to find suitable options for clients.

3. Potential Premium Increases: There is apprehension that Medicare prescription drug plans may raise premiums to cover the costs associated with provisions in the Inflation Reduction Act, such as the $2,000 annual cap on out-of-pocket costs and the $35 cap on insulin. Gussin questions whether these potential increases will affect Medicare Advantage plans and stresses the importance of educating clients about their options during the

U.S. Surgeon General calls on employers to better support parents' mental health

By Lucy Peterson - Earlier this week, the U.S. Surgeon General issued an advisory and urgent need to better support the nearly 63 million parents living with children under the age of 18 in the U.S. According to the advisory, 33% of parents reported high levels of stress in the past month compared to 20% of other adults. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Urgent Call for Support: U.S. Surgeon General Dr. Vivek Murthy has issued a strong advisory urging employers to support parents by enhancing access to paid family leave, affordable childcare, mental health care, and community support. The aim is to address the multifaceted stressors faced by parents, including financial strain, time demands, and social pressures.

2. Comprehensive Approach Required: Experts, including Dr. Neha Chaudhary, emphasize the need for a multi-faceted approach to supporting parents. This involves not only employer-led initiatives but also improvements in healthcare systems, policy changes, and community support to effectively address parental stress and enhance mental well-being.

3. Employer's Role in Mental Health: Employers are encouraged to prioritize the mental health of parents and caregivers as a strategic move. By adopting proactive health care models and supportive workplace practices, employers can boost workforce productivity and contribute to overall societal health.

Advocates rush to Congress, White House to extend telehealth prescribing for two years, after DEA's plans leaked

By Emma Beavins - The Drug Enforcement Administration is reaching the final steps of its proposed rulemaking process for the prescription of controlled substances via telehealth, but its plans have been leaked. Read Full Article…

HVBA Article Summary

1. Proposed Rule Restrictions: The DEA's draft rule for telehealth-controlled substance prescribing proposes significant limitations. Specifically, it restricts Schedule II substances like Adderall from being prescribed via telehealth without an in-person visit and limits telehealth prescribing to 50% of the total prescriptions, requiring the other 50% to be done in person.

2. Challenges with Prescription Monitoring: The draft rule necessitates prescribers to check all 50 states' prescription drug monitoring programs (PDMPs) before prescribing controlled substances to new telehealth patients. However, the lack of a national PDMP registry makes this requirement impractical, as no existing state registry can access information from all other states.

3. Advocacy and Legislative Response: In response to the draft rule, telehealth advocates are pushing for a two-year extension of current prescribing flexibilities. They are urging Congress and the White House to act, with some suggesting that a presidential extension might be more feasible than a legislative one. Both political parties have shown support for broader telehealth prescription access.

DOL wins round in lawsuit against BCBS Minnesota over provider tax

By Alan Goforth - The U.S. Department of Labor earlier this year filed a lawsuit accusing Blue Cross and Blue Shield of Minnesota of incorrectly imposing a state provider tax on self-funded health plan customers and violating its fiduciary duties under ERISA. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. District Court's Ruling: A U.S. District Court, led by Judge John Tunheim, has rejected BCBSM's motion to dismiss a lawsuit brought by the Department of Labor. The court's decision highlights that BCBSM's billing practices, which allegedly imposed nearly $67 million in tax liabilities on self-funded health plans without proper authorization, constitute a tangible injury.

2. MinnesotaCare Provider Tax: Since 1994, Minnesota has levied a tax on healthcare providers' gross revenue to fund MinnesotaCare, a program for low-income residents. In 2024, this provider tax rate stands at 1.8%. The Labor Department accuses BCBSM of improperly passing this tax onto self-funded employer health plans without the providers’ authorization or the plans' agreement.

3. Allegations Against BCBSM: The Department of Labor claims that from 2016 to 2020, BCBSM collected approximately $66.8 million from self-funded health plans under the guise of covering the Minnesota provider tax. BCBSM denies these allegations, asserting that their payment rates include all relevant taxes and fees and challenging the lawsuit's interpretation of the tax law.

23 health systems dropping Medicare Advantage plans | 2024

By Jakob Emerson - Medicare Advantage provides health coverage to more than half of the nation's older adults, but some hospitals and health systems are opting to end their contracts with MA plans over administrative challenges. Read Full Article…

HVBA Article Summary

1. Rising Denial Rates and Slow Payments: A primary factor driving hospitals and health systems to drop Medicare Advantage (MA) plans is the increasing frequency of prior authorization denials and delayed payments from insurers. This trend has been a significant burden, prompting many to reevaluate their participation in MA networks.

2. Survey Insights: A recent survey by the Healthcare Financial Management Association, covering 135 health system CFOs, revealed that 16% of systems plan to stop accepting one or more MA plans within the next two years. Additionally, 45% are considering this move but have not yet decided. The survey also highlighted that 62% of CFOs find it "significantly more difficult" to collect payments from MA plans compared to two years ago.

3. Health Systems Dropping MA Plans: A growing number of health systems are discontinuing their Medicare Advantage contracts. Notable examples include Blessing Health, which will limit MA contracts starting in 2025, and Lawrence's LMH Health, which will cease accepting Aetna and Humana MA plans from January 1. This trend reflects broader concerns about the financial and operational challenges associated with MA plans.

The direct primary care model: Health policy analysts propose state solutions

By Allison Bell - Health policy analysts at the Heartland Institute have an idea for a way states could free the market for primary medical care: Pass a law that lets physicians form direct primary care practices, or subscription-based primary care practices, and defines the practices as something other than insurance arrangements. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Direct Primary Care Model: Analysts suggest that a direct primary care model, where physicians manage a smaller panel of around 450 patients paying monthly fees of $80 to $150, can be more effective and financially viable compared to managing a larger panel of 2,500 patients through managed care networks.

2. Heartland Institute's Health Care Plan: The Heartland Institute has included this direct primary care proposal in its "2024 American Health Care Plan: State Solutions" report, which presents various strategies for state lawmakers to improve health care finance, including increasing transparency, verifying Medicaid eligibility, expanding telemedicine, and implementing reference-based pricing.

3. Conservative Health Policy Competition: The Heartland Institute, aligned with conservative and libertarian groups, is competing with other organizations like the Cato Institute and Heritage Foundation to influence Republican health policy post-elections, focusing on state-level reforms given the challenging prospects for federal changes in the near future.

How 'Oatzempic' Stacks up to Ozempic

By Lorraine L. Janeczko, MPH - A so-called "oatzempic" diet has been bouncing around the internet posing as a cheap — and available — weight loss alternative to Ozempic. Read Full Article…

HVBA Article Summary

1. Oatzempic vs. GLP-1 Medications: While oatzempic, a smoothie made from oats, water, lime, and optional flavorings, has gained popularity on social media for weight loss, it is not comparable to prescription GLP-1 medications like Ozempic. GLP-1 drugs are specifically approved for managing type 2 diabetes and have a well-established scientific basis for their effectiveness. In contrast, the benefits of oatzempic are not supported by substantial research, and its effects on weight loss and glucose management are minimal compared to those of GLP-1 medications.

2. Safety Concerns for Diabetics: Nutrition experts warn that the oatzempic diet can be risky for individuals with type 2 diabetes. Unlike GLP-1 agonists, which help regulate blood sugar levels, the oatzempic diet lacks crucial nutrients like protein and healthy fats, potentially leading to unstable blood glucose levels and other health issues. Rapid weight loss from restrictive diets like oatzempic can be harmful, especially for people managing diabetes, where consistent blood sugar control is crucial.

3. Expert Advice on Social Media Diet Trends: Nutritionists emphasize the importance of skepticism towards social media diet trends such as oatzempic and ricezempic. These diets often lack scientific backing and may not provide the health benefits they claim. Clinicians should guide patients towards sustainable and balanced eating patterns that include a variety of nutrients, rather than quick fixes promoted online. For reliable dietary advice, patients should consider consulting registered dietitian nutritionists (RDNs) and trusted nutritional resources.