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Health Insurance Markets Remain Highly Concentrated

The health insurance market was highly concentrated in 42 of the 50 states in 2019 and 2020 – the continuation of a trend identified in 2010 that has persisted ever since, according to a new report by the U.S. Government Accountability Office.

The GAO considers a market concentrated if three or fewer insurers in a state have 80 percent of that market.  Using Centers for Medicare & Medicaid Services health insurance enrollment data, the GAO looked at three distinct aspects of markets – individual policies, small group policies, and large group coverage – and found that

  • Each of the three markets in 2020 was concentrated in at least 42 states (including the District of Columbia).
  • The individual and small group markets generally became more concentrated in recent years. The median market share of the top three issuers in each market increased by 12 and 10 percentage points, respectively, from 2011 through 2020. With these increases, their median market share was at least 97 percent in both markets in 2020.

Learn more about the study’s origins in the Affordable Care Act and why its findings matter in the GAO report “Private Health Insurance:   Markets Remained Concentrated through 2020, with Increases

Feds Taking the Long View on Monkeypox

Federal health officials are increasingly looking at monkeypox as a long-term challenge that may periodically create short-term crises.

The number of monkeypox cases is not increasing exponentially and appears large confined to limited, defined communities and may eventually spread more like a sexually transmitted disease than a pandemic-style threat.  In addition, as time passes more at-risk individuals are likely to receive vaccines to gain protection against the infection.  Meanwhile, efforts continue to find more effective ways to treat the disease.  Monkeypox has long been common in some countries and its presence in the U.S. suggests that it is likely to be so here as well.

Lean more about a monkeypox and how the federal response to it is evolving in the Roll Call article “Monkeypox response looks to long term.”…

Feds Pursue Next Regs for Surprise Billing Law

In their continuing effort to implement the complex No Surprises Act, the 2020 law that seeks to prevent consumers from receiving surprise medical bills, federal regulators are now turning their attention to how providers and payers should inform insured individuals about the costs they may incur for procedures and purchases.

Specifically, the federal agencies with jurisdiction over the law and its implementation – the Department of Health and Human Services, the federal Office of Personnel Management, the Internal Revenue Service, the Department of the Treasury, the Department of Labor, and the Employee Benefits Security Administration – have issued a request for information (RFI) seeking stakeholder comment on how to implement the No Surprises Act’s requirement that health care providers and payers give explanations of benefits and good-faith estimates of costs for services and items that are scheduled at least three days in advance to individuals who have health insurance.

Previous regulations have focused on the delivery of this information to uninsured and self-pay patients and those obtaining services from out-of-network providers.  At the time those regulations were proposed, providers and payers asked regulators to delay implementation of the law’s requirements for the provision of such information to insured patients so …

Hospital Financial Woes Continue and Will Persist

The immediate financial future for many hospitals is bleak, according to a new study.

The study, by the health care management consulting company Kaufman Hall, concludes that

  • “Margins remain depressed relative to pre-pandemic levels.”
  • “More than half of hospitals are projected to have negative
    margins through 2022.”
  • “Expenses are significantly elevated from pre-pandemic levels.”
  • “Hospitals have faced a profound financial toll.”
  • “Ultimately, U.S. hospitals are likely to face billions of dollars
    in losses in 2022 under both optimistic and pessimistic.”

The study cites the COVID-19 pandemic and inflation among the leading causes of hospitals’ financial distress.

Learn more from the Kaufman Hall report “The Current State of Hospital Finances:  Fall 2022 Update.”…

DeBrunner Partner Recognized by Publication

City and State Pennsylvania has named DeBrunner & Associates’ Michael Chirieleison one of its “2022 Health Care Power 100.”

Since taking over the reins of DeBrunner & Associates’ Pennsylvania health care consulting, government relations, and advocacy practice, Mike has pushed the firm in new directions.  From a mostly hospital-oriented practice, Mike and his team of policy, data, and lobbying professionals have moved boldly into biopharmaceuticals, long-term care, substance use services, and more.  In recent years the firm has scored a number of successes, including the successful pursuit of legislation to increase state funding for skilled nursing facilities that care for ventilator-dependent patients; improving access to pharmaceutical treatments for rare diseases; and developing innovative methodologies to improve Medicaid payments to safety-net hospitals.

Congratulations, Mike!…