What We’re Reading: Unauthorized ACA Plan Switching; Private Equity in Emergency Care; MA Payments Cut

Author(s):

Insurance plan members find themselves involuntarily switched between plans; the Senate investigates patient safety concerns resulting from private equity practices; base payments to Medicare Advantage (MA) plans will decrease in 2025.

ACA Enrollees Encounter Unauthorized Plan Switching

Affordable Care Act (ACA) enrollees are experiencing unauthorized plan-switching disruptions to their coverage, driven by rogue agents exploiting vulnerabilities in federal marketplace security, according to Kaiser Health News. Despite record enrollment, complaints have surged, prompting regulatory actions from CMS, yet the efficacy of these measures remains uncertain. Additionally, brokers have reported ongoing concerns amidst new consent rules, highlighting the urgent need for enhanced safeguards to protect consumers and maintain ACA integrity.

Senate Committee Probes Private-Equity Firms' Impact on ED Care

Senator Gary Peters (D, Michigan) is heading a Senate inquiry into private-equity firms' management of hospital emergency departments, prompted by reports of patient safety and care issues, according to NBC News. Requests for information targeted Apollo Global Management, the Blackstone Group, and KKR, along with affiliated companies, aiming to assess the impact of private-equity practices on health care quality and physician autonomy. As private-equity firms increasingly dominate the health care sector, concerns continue to mount over cost-saving measures that potentially compromise patient safety, which have prompted calls for transparency and accountability from industry stakeholders.

Biden Administration Cuts MA Payments

The Biden administration's decision to reduce base payments to Medicare Advantage (MA) plans by an average of 0.16% has triggered a market downturn for major insurers like UnitedHealth, CVS Health, Humana, and Centene, amidst fears of ongoing financial challenges, according to Axios. While risk-adjusted payments may mitigate the impact, insurers expressed worries over continued pressure on seniors' benefits and potential benefit reductions due to rising costs and policy changes. With MA enrollment surging, concerns persist over overpayment and cost escalation.