Key Takeaways from the 2022 Healthcare Insurance Symposium
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Key Takeaways from the 2022 Healthcare Insurance Symposium

The enhanced HIX subsidies implemented last May could be extended, but closing the coverage gap in Medicaid is not expected to pass. Our expert believes that further delays in clinical lab PAMA cuts could be extended for another year as part of an Omnibus 2023 Appropriations bill that could pass in 4Q22 or 1Q23.

During the Medicare Market Session, supplemental benefits (groceries, meals) remained a focus, and the favorable rate update is expected to allow plans to become even more creative with these in 2023. For plan year 2024, a step back for some M.A. plans in their Star ratings is possible as pandemic-related adjustments end.

Our presenter believes brand name recognition may help some providers grow but sees the growth journey as more of a marathon than a sprint. Our presenter sees tech-enabled MCOs eventually drawing some interest from larger MCOs for their proprietary technology rather than their membership.

Our expert suggested during the Medicaid Market session that a mid-single-digit percentage of those currently enrolled on Medicaid have secured other coverage, as the pandemic has dragged on and might be double-counted. He also believes that 5-15% of those on the Medicaid rolls could ultimately be cut from the existing rolls as redeterminations start. A few states could see as much as one-third of members declared ineligible. He agreed that those members rolling off are likely to be somewhat healthier than those who remain covered by Medicaid; however, he also believes states may wait to see how the economic backdrop unfolds before adjusting rates.

Regarding rebate guarantees, our presenter believes most PBM contracts contain language that would allow for adjustments if a biosimilar/generic launches and reduces rebate dollars. Our presenter also discussed the 340B program and its difficulties for a PBM and health plan. He argued that the current dispute between drug manufacturers and health systems/contract pharmacies would not likely be solved via negotiation but rather by regulators and the courts.

@A. J. Rice