Guy Carpenter has identified certain factors that may impact how large medical insurance carriers adapt to the needs of their insureds and employees in the United States amid COVID-19.
End of National Emergency: Although sources have floated the possibility of ending the national emergency, no definitive timeline has been announced. The recent uptick in cases will likely delay this decision.
Impact of Future Regulatory Changes in Specific States: As states grapple with increasing case counts, additional Departments of Insurance (DOIs) may decide to amend or extend their current regulations and guidelines.
Price Transparency Regulation: Although the Healthcare Price Transparency order was issued on November 1, 2019, a lawsuit brought by the American Hospital Association and a consortium of hospitals challenging the order has been working its way through the court system. The U.S. District Court in Washington, D.C. dismissed the lawsuit on June 24, 2020, but plaintiffs are appealing the decision. The regulations are scheduled to take effect on January 1, 2021. The order requires price transparency on 300 services. Centers for Medicare and Medicaid Services (CMS) will choose 70 services that require the publication of pricing, and hospitals will chose the remaining 230. Senators Chuck Grassley (R – Iowa) and Mike Braun (R – Indiana) introduced the Healthcare Price Transparency Act on June 30. There has also been discussion of adding price transparency provisions to the next Coronavirus Aid, Relief and Economic Security (CARES) Act. The deadline for implementation is less than six months away.
ACA Lawsuit – Maine Community Health Options v. United States: This case revolves around the reimbursements for the risk corridors under the Affordable Care Act (ACA). This decision stems from a consolidation of three cases brought by four insurers over whether insurers are entitled to almost USD 12 billion in unpaid risk corridor payments due between 2014 and 2016. The court voted eight to one that the government is obligated to reimburse the carriers. The court remanded the cases to the Court of Federal Claims for adjudication under the Tucker Act. The Court of Federal Claims will issue a judgment for each carrier against the Department of Health & Human Services (HHS) and HHS will then have to approach the Financial Management Service department within the DOJ to certify payment. There are many more cases pending, including a class-action lawsuit. The process of reimbursement will be lengthy due to the number of cases and COVID-19.
ACA Lawsuit – Texas v. United States: The ACA is headed for another review by the Supreme Court during the upcoming fall session. The original case, Texas v. United States, was filed by the Republican Attorney General’s (AG) office in Texas and 20 other states, now 18. When the DOJ declined to defend the ACA, California and a coalition of 21 Democratic AGs intervened to defend it. Texas, the Department of Justice (DOJ) and the two original plaintiffs filed opening briefs with the court on June 25, 2020. The briefs argue that the individual mandate is unconstitutional, that the mandate is an inextricable part of the ACA and that the entire ACA should thus be declared unconstitutional. Oral arguments were presented on November 10, 2020. A decision will likely be issued in spring 2021. The hearings and ultimate Supreme Court decision in spring 2021 will be final regardless of the outcome of the election – however, it will still be up to Congress to act on the decision and make any changes. If and how that happens will depend on the results of the Congressional races.
Election Results: Even though the presidential race has been decided, the future of healthcare and specifically the Affordable Care Act still remain uncertain. Both Georgia senate seats are entering a run-off race in January 2021, and the results could potentially impact the balance of power in the Senate and therefore the legislative agenda. However, regardless of the results of the two congressional run-off races, healthcare in the United States will likely change. How it changes and any impacts to the Affordable Care Act will vary widely depending on the results. The varying degrees to which the Affordable Care Act could change range from a complete end and subsequent replacement, to minimal adjustments. Democrats generally argue for government involvement in healthcare insurance, while republicans tend to believe the government should play a smaller role in healthcare insurance.