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This Week in Managed Care: January 27, 2017


This week, the top managed care stories included Aetna and Humana's merger getting blocked, the first Affordable Care Act replacement proposal was unveiled, and an analysis of regional cancer death trends.

Hello, I’m Laura Joszt with The American Journal of Managed Care. Welcome to This Week in Managed Care from the Managed Markets News Network

Aetna-Humana Deal Blocked

This week, a federal judge blocked the proposed merger of Aetna and Humana, saying there would not be enough competition in some markets to protect consumers.

The Department of Justice (DOJ) filed suit to block this merger and a proposed union of Anthem and Cigna. The two mergers would take the market from five large national insurers to three.

US District Judge John Bates had harsh words for Aetna, which reduced its presence from 778 to 242 counties in 2017. Bates found that consumers were given fewer choices not because Aetna was losing money, but to pursue a litigation strategy: “Aetna tried to leverage its participation in the exchanges for favorable treatment from DOJ regarding the proposed merger.”

For more, read the article.

First ACA Replacement Proposal

President Donald Trump wasted no time keeping his promise to undo the Affordable Care Act (ACA). On his first day in office, he signed an executive order to halt regulatory work on the ACA, which left some health plans wondering if the new administration will enforce the individual mandate while Congress works to replace the health care law.

Senators Susan Collins, R-Maine, and Bill Cassidy, R-Louisiana, introduced the Patient Freedom Act, which would give states the choice of keeping the ACA or using alternatives, including an option that would let states use federal funds to create basic plans funded with health savings accounts.

Collins believes most states will take the option that covers people with a high-deductible plan featuring basic drug coverage and some preventive care. She explained the need to avoid market disruptions: “Significant changes are going to need to be made in order to prevent the individual market from going into a tailspin. Our goal is to increase the number of people who are insured, to help restrain the growth of premiums, and to give consumers more choices.”

Concerns for Future of DPP

The Council for Diabetes Prevention has warned that President Trump’s executive order and plans to repeal the ACA could inadvertently derail Medicare’s plan to pay for the Diabetes Prevention Program starting in 2018.

The Council’s acting president, Brenda Schmidt, warned that Congress should take the following steps to protect the DPP:

  • Grandfather Diabetes Prevention Program services, without cost-sharing for seniors
  • Include the services in Medicare Part B, if CMS no longer can use the ACA’s waiver provision

For more on this issue, click here.

Regional Trends for Cancer Death Rates

An analysis of cancer death records appearing in JAMA has identified counties with unusually high death rates, depending on cancer type.

The study aims to give county-level data to help local public health officials and clinicians give better treatment in their communities. The data cover the years 1980 to 2014. The good news is that cancer death rates fell 20% during the study period.

Managed Care Cast

Finally, the latest Managed Care Cast is available on AJMC.com. In this installment, Mandi Bishop of Aloha Health discusses how health policy is developed with Nicole Fisher, the founder and CEO of HHR Strategies and contributor to Forbes.

iTunes: http://apple.co/2eYWTss

TuneIn: http://bit.ly/2gv7iwj

Stitcher: http://bit.ly/2gCqtFg

You can listen to the Managed Care Cast at these podcast services.

For all of us at the Managed Markets News Network, I’m Laura Joszt. Thanks for joining us.

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