- A federal judge Friday dismissed Oscar Health's antitrust lawsuit against the state's Blue Cross Blue Shield affiliate. Oscar sued Florida Blue late last year over broker arrangements the New York-based payer maintained were implemented to keep its plans out of Florida's lucrative Affordable Care Act exchanges.
- However, "Florida Blue's contract with its brokers requiring them to sell insurance only for Florida Blue at the risk of losing access to all of Florida Blue's product lines is lawful, and Florida Blue has the right to enforce the agreement," Judge Paul Byron of the Middle District of Florida wrote in his opinion.
- Oscar said 190 brokers backed out of deals to sell its coverage after hearing of Florida's policy. A company spokesperson told Healthcare Dive the payer is "disappointed" in last week's decision but will maintain its presence in Florida.
Oscar sued the BCBS affiliate in November for its alleged "exclusive broker policy" prohibiting insurance brokers who sell Florida Blue individual plans from also offering coverage from their competitors. The seven-year-old payer argued Florida Blue implemented the policy after hearing Oscar planned to peddle plans in the exchanges for the first time in 2019.
Florida, with the highest exchange enrollment in the nation, is common battleground for payers looking to snap up a slice of the ACA market. Last year, more than 1.7 million Floridians enrolled in exchange plans. Florida Blue covered a little more than 1 million of those.
Oscar, which was co-founded by Jared Kushner's brother, skewered Florida Blue as a "monopolist" in its compliant filed in the U.S. District Court in Orlando. Oscar has been bullish on expanding in the ACA marketplace as some larger insurers eschew their exchange presence due in part to regulatory instability.
Florida is one of three additional states the Manhattan-based insurer expanded into this year, now selling to individuals and small businesses in nine states.
The Department of Justice weighed in on the ongoing litigation in April and sided with Oscar, asking the federal judge not to dismiss the case as the McCarran-Ferguson Act, a statute exempting insurers from many federal regulations, doesn't cover Florida Blue's actions. However, Byron then denied Oscar an injunction to block the payer from reaching exclusive agreements with brokers, citing lack of proof Florida Blue's policy was preventing it from growing its business.
Byron reiterated that stance in the opinion filed last week, writing it is "hard to imagine a relationship more squarely at the core of the business of insurance than the one described by Oscar as existing between Florida Blue's brokers and ACA consumers." The Florida judge noted the exclusive broker policy allowed Florida Blue to create a broad risk pool and nixing it would cause Florida Blue to assume more risk, stopping consumers from getting their plan at the most affordable price.
"The lawsuit never distracted our teams from supporting our contracted general agents across the state to deliver on our mission of helping people and communities achieve better health," a Florida Blue spokesperson told Healthcare Dive.