Insurers

Legislature Holds Informational Hearings on MCO Tax

Today, the Legislature’s special session Committees on Public Health and Developmental Services each held informational hearings on the Administration’s proposed Managed Care Organization (MCO) tax. The hearings were held to help legislators and the public understand the proposal and no votes were taken today. The Administration’s MCO tax proposal is reflected in AB 2x-20 (Bonta) and SB 2x-15 (Hernandez), which have identical language. Jennifer Kent, Director of the Department of Health Care Services (DHCS), presented the Administration’s proposal at both hearings. California must overhaul the current MCO tax or lose $1.1B in funding for the Medi-Cal program. The proposed MCO tax proposal has broad support from health plans, consumers groups like Health Access and Western Center on Law and Poverty, […] Read More

Centene/Health Net Executives Answer to Regulators, Consumer Advocates and the Public

Consumer advocates are still skeptical about the proposed merger between Centene and Health Net after a six-hour long hearing about the transaction, where insurance company executives provided vague explanations of how consumers would benefit for the merger, but were unwilling to make any specific commitments to protect consumers. On Friday, January 22, California Department of Insurance (CDI) heard over six hours of testimony from insurance executives, consumer advocates and the public during an official hearing held at the Capitol. This hearing took place a month after a public meeting held by the Department of Managed Health Care (DMHC) on December 7, 2015. During the hearing, California Department of Insurance Commissioner Dave Jones, department officials, and the public heard from Centene […] Read More

Consumer Groups Question Aetna-Humana Proposed Merger at DMHC Public Meeting

On January 4, 2016, the Department of Managed Health Care (DMHC) held a public meeting on the proposed merger of Aetna and Humana. The public meeting was requested by consumer groups including Health Access, Consumers Union, and others to raise questions about the structure of the deal, its potential impact on California’s patients and health care systems, and ensure proper oversight as insurance companies merge and become larger. The proposed Aetna-Humana merger is one of three pending insurer mergers being reviewed by DMHC. Earlier this year, the DMHC approved a merger between Blue Shield and Care1st, following Health Access’s and other consumer groups’ request for strong conditions to address potential negative impacts. Health Access is also monitoring the proposed Anthem […] Read More

At DMHC Public Meeting, Consumer Groups Question Proposed Centene-Health Net Merger

On December 7, 2015, the Department of Managed Health Care (DMHC) held a public meeting on the proposed merger of Centene and Health Net. The public meeting was requested by consumer groups including Health Access, Consumers Union, and others, to raise questions about the structure of the deal, its potential impact on California’s patients and health care systems, and ensure proper oversight as insurance companies merge and become larger. (State of Reform wrote up the meeting as well.) The proposed Centene-Health Net merger is one of three pending insurer mergers being reviewed by DMHC. Earlier this year, the DMHC approved a merger between Blue Shield and Care1st, following Health Access’s and other consumer groups’ request for strong conditions to address […] Read More

Blue Shield Tries To Back Out Of $140 Million Commitment to California Communities

When nonprofit insurer Blue Shield California made a $1.2 billion bid to acquire Care1st, a Medi-Cal managed care plan serving 500,000 Southern California patients, it agreed to conditions set forth by DMHC (Department of Managed Health Care), including a commitment to increase its investment in the state’s safety net by an additional $140 million over 10 years. But this week Blue Shield disavowed this commitment, stating that it sees the $14 million requirement as a “floor” for its annual giving to the safety net. Given the nonprofit insurer’s usual giving levels of about $35 million a year, Health Access California has raised concerns with DMHC that the insurer might actually do less for the safety net if its interpretation of the […] Read More

Covered California Open Enrollment Started Sunday!

Yesterday marked the official start of Covered CA open enrollment, which will run through January 31, 2016. For coverage effective January 1, people must enroll by December 31, 2015. As always, Medi-Cal enrollment is open year-round and individuals experiencing any life transitions (losing a job or moving, among many qualifying events for Special Enrollment) may enroll anytime, even after January 31, 2016. For health care advocates and other consumer groups, it’s worth clicking around the much improved Covered CA website to explore the various tools available to maximize enrollment and target those eligible but not yet enrolled. Here are a few highlights:  The Shop and Compare Tool is more useful than ever—showing options for plans by county with estimates of consumer […] Read More

UCLA Forum tonight: Is Merger Mania Healthy?

“Is Merger Mania Healthy?” The Affordable Care Act (ACA) has inspired many providers to consolidate and major payers have now joined this trend. Anthem has announced that it is merging with Cigna, and Aetna announced it is merging with Humana. If these mega mergers are approved by the government, the health insurance industry will consolidate the top five payers into just three companies, each with annual revenue over $100 billion. Providers, regulators, and consumer advocates are concerned that the payer consolidation will limit the negotiating power of private and government health programs. In this Health Forum, our speakers will present the provider, consumer, and government perspective on whether merger mania is healthy. Our executive director Anthony Wright is one of […] Read More

Q & A with the California Office of the Patient Advocate OPA: 2015-16 Report Cards Release

Background Last week the California Office of the Patient Advocate released the newest edition of its 2015/16 Quality Report Cards. The Report Cards provide a tool to assist Californians in comparing quality scores for health plans and medical groups in order to make fully informed health care decisions based on the latest quality data and not just costs.  The information includes more than 2,000 clinical data points and patient experience information to help inform their choices. It is available on their website (www.opa.ca.gov) in English, Spanish, and Chinese, and as a downloadable app for smartphone, IPAD, and tablets:  (http://www.opa.ca.gov/Pages/MobileApplications.aspx) The Report Card ratings are based on care that more than 16 million commercially insured consumers received from the state’s ten largest […] Read More

Covered California Board Meeting Highlights from October 8, 2015

With less than one month before open enrollment (November 1 – January 31), the Board focused mainly on this year’s research-driven “no wrong door” approach to maximizing enrollment and facilitating thoughtful plan selection using shop and compare tools, quality ratings, and reaching out to enrollees who look like they could benefit from enhanced silver plans with lower cost sharing. A press conference held earlier in the day provided a glimpse of the data on current or recent enrollees and what they tell us about Covered CA’s place in the insurance landscape. Most of the individuals surveyed (85%) are staying insured, even if they move into job-based coverage or Medi-Cal. As a source of quality affordable coverage for 1.3 million currently enrolled […] Read More

Blue Shield – Care1st Merger Approved With Conditions

Yesterday, the Department of Managed Health Care announced that it approved Blue Shield of California’s acquisition of Care1st, a Medi-Cal (Medicaid) managed care plan with 500,000 Southern California patients–the largest health plan transaction in nearly a decade. In the months leading up to yesterday’s approval, Health Access and other health care consumer groups, including Consumers Union, and others, questioned key elements about the structure of the deal, its potential impact on Care1st’s patients and California’s health care system, and the disposition and use of Blue Shield’s charitable assets for this transaction. Given the track record of these insurers, our stance was that if Blue Shield or any other insurer wants to get bigger, they will need to get better. According […] Read More