Hospitals tell court price transparency laws violate 1st Amendment

Thursday's hearing was the first step in what's likely to be a drawn out legal fight. Negotiated rates between hospitals and insurers have long been private, and hospitals want to keep it that way. 

By Hailey Mensik • May 7, 2020

Despite the pandemic, insurers seem cautiously optimistic about 2020. Here's why.

The nation's largest private payers stuck by their earnings outlooks for the full year, raising questions about why executives are confident about their prospects despite being in the middle of a public health crisis.

By Samantha Liss • May 7, 2020

With new estimate, ICER sets terms of debate on pricing Gilead's COVID-19 drug

The influential watchdog group judged Gilead's remdesivir would be cost effective at $4,500 per treatment course, setting the stage for what's likely to be a controversial decision by the company. 

By Ned Pagliarulo • May 6, 2020

CVS profit rockets up 41%, but warns April COVID-19 hit could persist

The company reported a significant jump in use of digital and at-home offerings in the quarter, including MinuteClinic virtual visits up 600% and retail prescription home delivery up more than 1,000%.

By Rebecca Pifer Parduhn • May 6, 2020

Paying private insurers Medicare rates would tank hospital revenue by 35%, study finds

Policy action is needed to lower out-of-control healthcare prices, Health Affairs researchers determined, but any moves from Washington to tie reimbursement to Medicare rates could send hospital revenues flatlining.

By Rebecca Pifer Parduhn • May 5, 2020

7 states team up to buy $5B in medical equipment, supplies for COVID-19

New York, New Jersey, Connecticut, Pennsylvania, Delaware, Rhode Island and Massachusetts are aiming to use their combined purchasing power to drive down prices for in-demand items like ventilators and PPE.

By Rebecca Pifer Parduhn • May 4, 2020

Molina readies for 'significant' Medicaid member bump as more lose jobs

The payer also announced its acquisition of Magellan Complete Care for $820 million, giving it access to three new states and about 155,000 new members.

By Samantha Liss • May 1, 2020

Cigna tops Q1 expectations, reaffirms earnings targets despite pandemic

The payer's executives went as far as to say they expect to reach previously stated profit guidance for next year as well.

By Samantha Liss • April 30, 2020

Humana Q1 largely unscathed by COVID-19, expects headwinds for small group segment

Humana beat Wall Street expectations for earnings, revenue and medical loss ratio. Analysts with Jefferies said it had the strongest first quarter results of any managed care organization reporting so far.

By Samantha Liss • April 29, 2020

Anthem braces for shift to Medicaid, exchange plans amid record unemployment

The payer reported operating revenue up nearly 21% in the first quarter, beating Wall Street expectations. Executives said the reporting period was "largely unaffected by the current crisis."

By Shannon Muchmore • April 29, 2020

Payers, providers urge Congress to expand coverage options as COVID-19-spurred job losses soar

Relying on the $100 billion from the CARES Act "will quickly deplete the Emergency Fund and not provide the benefits of comprehensive coverage," the healthcare groups and U.S. Chamber of Commerce wrote.

By Hailey Mensik • April 28, 2020

Pandemic prompts insurance carriers to change employee benefits eligibility requirements

Preliminary estimates indicate the pandemic could take a considerable toll on employee benefit plans.

By Ryan Golden • April 28, 2020

5 key pillars of Biden's healthcare plan

As the coronavirus pandemic highlights shortcomings of the U.S. health system and millions lose coverage, here are the main tenets of the presumptive Democratic nominee's health agenda.

By Rebecca Pifer Parduhn • April 28, 2020

Reimbursement portal opens for providers that test, treat uninsured COVID-19 patients

To take part in the program run by UnitedHealth Group, hospitals and doctor's offices must agree not to balance bill the patient for medical treatment.

By Rebecca Pifer Parduhn • April 28, 2020

Centene warns of 'choppy' performance as it navigates pandemic

While the payer beat Wall Street expectations on earnings and revenue for the first quarter, its medical loss ratio missed, coming in at 88%.

By Samantha Liss • April 28, 2020

Supreme Court rules for payers in $12B risk corridors case

The 8-1 decision, with only Justice Samuel Alito dissenting, found the Affordable Care Act "established a money-mandating obligation, that Congress did not repeal."

By Shannon Muchmore • April 27, 2020

CMS hits pause on speeding Medicare payments to docs as COVID-19 funding reaches $175B

Health policy experts and provider groups called the move premature as the financial concerns plaguing doctor's offices and hospitals are unlikely to go away any time soon.

By Rebecca Pifer Parduhn • April 27, 2020

Inpatient COVID-19 cases estimated to cost $14K per patient

Health Affairs researchers also found patients with coronavirus generated costs that dwarfed other infectious diseases, like the flu.

By Hailey Mensik • April 23, 2020

Medicare still expected to grow to 6% of GDP by 2026, but COVID-19 could speed insolvency

The Medicare Board of Trustees predicts the trust fund that finances Medicare Part A will run out by 2026 — the same estimate as 2018 and 2019's reports due to policy inaction. But the pandemic could worsen the situation.

By Rebecca Pifer Parduhn • April 22, 2020

Oklahoma 1st to seek waiver to block grant Medicaid, despite pandemic

The request, which includes a work requirement and asks beneficiaries to pay premiums for coverage, hinges on Republican Gov. Kevin Stitt's controversial plan for Medicaid expansion.

By Rebecca Pifer Parduhn • April 21, 2020

Obamacare insurers on hook for $2.7B in MLR-based refunds this year, KFF says

The expected owed refunds estimated by the Kaiser Family Foundation come amid a scramble to calculate 2021 rates in the midst of the COVID-19 pandemic and uncertain costs.

By Ron Shinkman • April 20, 2020

Majority of commercial patients may receive surprise bill following ambulance ride

The amount billed to a patient was substantially higher for air ambulance services at a median of nearly $21,700, but ground ambulance rides were more likely to invoke a possible surprise bill, according to a Health Affairs study.

By Shannon Muchmore • April 16, 2020

After largely exiting ACA exchanges, UnitedHealthcare mulls jumping back in

The admission comes as the nation's largest private health insurer said more members are struggling to pay their monthly premiums as workers are laid off or forced to take furloughs in the economic fallout of the novel coronavirus.

By Samantha Liss • April 16, 2020

Could coronavirus derail the decades-long shift to value-based care?

"This is not about managing a population. This is about doing everything you can to keep these people alive," Dean Ungar, vice president of Moody's Investors Service, said.

By Rebecca Pifer Parduhn • April 15, 2020

UnitedHealth marks uptick in members struggling to pay premiums

As employers try to keep their businesses afloat, the payer said it's "deeply committed" to providing premium relief to clients as it benefits from not having to pay for halted elective surgeries, which may outweigh COVID-19 costs.

By Samantha Liss • April 15, 2020