The year 2015 was undoubtedly one of seismic change for the health insurance industry, with no shortage of game-changing headlines and issues.
The Affordable Care Act, once again, played a major role in shaping the direction of the industry, and the year saw everything from mega-mergers to controversy over wellness programs to the failure of a slew of consumer operated and oriented plans (CO-OPs).
Here’s a look back at a few of the health insurance business news stories that resonated with our readers over the past year:
King v. Burwell ruling sets ACA on more solid ground
The Supreme Court released its long-awaited ruling on the King v. Burwell case in June, when the justices sided with the defendants and refused to eliminate federal subsidies for consumers in states that chose to not establish their own exchange. In its 6-3 ruling, the Court wrote that “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.”
The decision not only prevented a health insurance “death spiral” but also allowed insurers and patients alike to focus on open enrollment for 2016. It also means that the ACA will maintain subsidized health insurance for an estimated 6.4 million Americans who would have otherwise lost their coverage.
The court’s opinion had the immediate impact of sending hospital and health insurer stocks soaring. The ruling also made a splash in politics, as the 2016 presidential campaign aspirants either lauded the decision or promised to undo the ACA altogether if elected.
Mergers and acquisitions rock the industry
Following the King v. Burwell ruling, four of the largest insurance companies announced their intentions to pair off, with Aetna planning to acquire Humana andAnthem making a deal with Cigna.
Aetna and Humana received approval from their shareholders to merge in October, and the companies say that Humana’s strength in the Medicare Advantage sector and Aetna’s experience in the commercial insurance market will make a strong and mutually beneficial partnership.
Anthem and Cigna’s shareholders also approved their deal, though both mergers are facing a thorough review from federal and state regulators.
If the consolidation trend continues, some say it will create a single-payer system in the U.S. And many still have questions about what the large mergers mean, with the provider community issuing continued criticism of what they see as anti-competitive effects of the deals, joined recently by consumer advocates.
Experts and the CEOs and Aetna and Anthem also testified about the mergers in a series of congressional hearings this year.
Insurers experience growing pains on the ACA exchanges
The Affordable Care Act went through some growing pains in 2015, which resulted in failed CO-OPs, premium increases and shrinking provider networks.
More than half of the originally established CO-OPs failed in 2015, and the frustration turned from disappointment to political finger-pointing on Capitol Hill. There hasn’t been any official explanation for why CO-OPs have failed, but sources have said that lack of oversight, inability to compete with larger insurance companies and poor CO-OP design could be major contributing factors.
Premium increases added to frustrations over the ACA in 2015. The government said in October that the average premium for a “benchmark” ACA plan would increase by about 7.5 percent in 2016, though the premium hikes varied considerably from region to region.
A study in October revealed that those who receive subsidized healthcare plans have much easier access to insurance than those who don’t. Still, despite the fact that rates are posed to increase next year, nearly half of Americans will stick with the same health plan in 2016.
There were also rising concerns surrounding narrow-network plans, and theAssociation of Insurance Commissioners proposed new regulations to ensure that the trend doesn’t harm consumers’ access to affordable care. The regulations called for greater oversight, since narrow-network plans have become more common on the federal marketplace. Despite the fact that narrow networks could mean fewer doctors in key specialties, smaller networks could improve care and keep costs low.
One of the bigger surprises in 2015 was the UnitedHealth announcement in November that, due to “continuing deterioration” of how its ACA marketplace products are performing, it has pulled back on its individual exchange product marketing efforts and will decide in 2016 whether or how it will participate in public exchange markets in 2017.
However, at least one expert believes that UnitedHealth aims to call attention to the ACA’s flaws, and that it would be surprising if UnitedHealth actually left the marketplace.
Wellness programs gain popularity, face scrutiny
Wellness programs continued to gain popularity in 2015, but the programs faced increasing concerns about their effectiveness and privacy implications.
Wellness vendors and third parties may not be covered under HIPAA’s privacy law, which means employee privacy could be at even greater risk depending on how outside vendors handle that personal health information.
For example, many women have concerns over the fact that their pregnancy status may somehow get back to their employer, and others worried that detailed health data for individuals could create a caste system, with the healthy reaping the benefits of substantially lower insurance rates than those with measurable illness or genetic conditions.
But in just one year, Aetna proved that employee wellness programs could show a positive return on investment when it saved more than $600,000 with a personalized program that targeted employees at high risk for metabolic syndrome.
In addition, a court’s ruling in favor of New Jersey-based Honeywell means employees can be required to partake in biometric screenings or face financial penalties. Some are calling for health insurers and employers to design programs that are more about rewarding personal responsibility and less about penalizing individuals.
Payers and providers increasingly collaborate to improve care
Another topic that grabbed readers’ attention in 2015 was with the payer-provider relationship and how it has evolved to adapt to an era of value-based care. This year, insurers faced a regulatory environment that required them to make critical decisions–particularly when it comes to merging with and acquiring providers.
Still, as more and more health systems entered the Medicare Advantage marketplace, the lines between payer and provider began to blur. Payers are starting to understand the importance of establishing relationships with providers that will reward them for managing patients’ chronic conditions.
Additionally, it appears more payers and providers are moving to a collaborative future, since payers can provide a wealth of information to providers, making a key contribution to improved healthcare quality and lower costs.