Payer Roundup—After advocating for AHPs for years, NFIB says it will not establish one

A signpost with the words Affordable Care Act
After fighting the ACA for years, NFIB says it will not partake in one of the administration's biggest efforts yet to weaken the law. (Getty/kroach)

NFIB abandons decades-long effort to establish AHP

The National Federation of Independent Business (NFIB) lobbied for more expansive association health plan (AHP) policies for 20 years, and last month, the Trump administration finalized a rule to do just that. But NFIB now says it will not establish one.

The new rule, which broadened the scope of employers that can participate in AHPs, doesn’t make it easier for organizations like NFIB to create an AHP, a spokesman for NFIB told Politico on Thursday. And NFIB CEO Juanita Duggan has said AHPs would generate a poor return on investment for the organization, causing some controversy within the organization. Duggan has shifted NFIB’s focus toward tax cuts.

In the health policy realm, NFIB may be most well-known for challenging three key provisions of the Affordable Care Act in the 2012 Supreme Court case NFIB v. Sebelius. (Politico article)


13th Partnering with ACOS & IDNS Summit

This two-day summit taking place on June 10–11, 2019, offers a unique opportunity to have invaluable face-to-face time with key executives from various ACOs and IDNs from the entire nation – totaling over 3.5 million patients served in 2018. Exclusively at this summit, attendees are provided with inside information and data from case studies on how to structure an ACO/IDN pitch, allowing them to gain the tools to position their organization as a “strategic partner” to ACOs and IDNs, rather than a merely a “vendor.”

Proposal targeting PBMs could be a killjoy for CVS and Cigna

The White House’s most recent effort to lower drug prices by targeting pharmacy benefit managers (PBMs) could throw a wrench in two recent megadeals.

Little is known about the proposal so far. But its title – Removal Of Safe Harbor Protection for Rebates to Plans or PBMs Involving Prescription Pharmaceuticals and Creation of New Safe Harbor Protection – signals a move away from the current rebate system, which would make PBMs less profitable.

If the administration follows through on this, CVS's acquisition of Aetna and Cigna’s acquisition of Express Scripts may turn out to be less lucrative than originally thought.

On the other hand, it may end up being a victory for pharmaceutical companies, who could lower list prices without cutting into their bottom line.  (Bloomberg article)

Despite premium hikes, Covered California says it will keep California covered

Premiums on the individual market in California will rise 8.7%, the state’s marketplace, Covered California, announced on Thursday. In 10 of the state’s 19 pricing regions, premiums will rise more than 9%, including 10% in northeast Los Angeles and 16% on the north-central coast.

In the region comprising Mono County, Inyo County and Imperial County, premiums will decrease by 0.5%. This is the only region in California where premiums will drop.

Consumers who receive subsidies to buy coverage, who comprise 88% of enrollees, will see smaller increases than those who do not.

Covered California’s executive director, Peter V. Lee, attributed these increases primarily to the elimination of the individual mandate penalty. However, he says, California’s efforts to reach consumers and cultivate competition will keep rates lower than in other states. (Sacramento Bee article)

Study: State individual mandates would boost the insured rate without tremendous extra costs

If every state in the country enacted its own individual mandate, all 50 would see lower premiums, fewer uninsured people and less uncompensated care, according to a new study from The Urban Institute and The Commonwealth Fund.

The analysis estimates that the number of uninsured Americans would drop by 3.9 million next year, and by 7.5 million in 2022. The average monthly premium in 2019 for a single, 40-year-old adult would be $470, rather than $530, as is currently estimated – an 11.8% difference.

Federal healthcare spending would increase by $28 million – not a small number on the surface, but less than 0.01 percent of current healthcare spending.  

Massachusetts and New Jersey currently have individual mandates in place. Individual mandates have been proposed in Connecticut, Hawaii, Maryland, Vermont, Washington, and the District of Columbia as well. (Report)

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