Millions were removed from 医疗补助计划, but insurers gained 医疗补助计划 revenue anyway

Private 医疗补助计划 health plans lost millions of members in the past year as pandemic protections that prohibited states from dropping anyone from the government program expired. 

但是，尽管医疗补助计划正在撤销, 众所周知, at least two of the five largest publicly traded companies selling plans have continued to increase revenue from the program, 根据他们最新的收益报告. 

医疗补助计划, the state-federal health program for low-income and disabled people, 是由各州管理的. But most people enrolled in the program get their health care through insurers contracted by states, 包括UnitedHealthcare, Centene和Molina. 

The companies persuaded states to pay them more money per 医疗补助计划 enrollee under the assumption that younger and healthier people were dropping out — presumably for ACA coverage or employer-based health insurance, or because they didn’t see the need to get coverage — leaving behind an older and sicker population to cover, 他们的高管告诉投资者. 

Several of the companies reported that states have made midyear and retrospective changes in their payments to plans to account for the worsening health status of members. 

In an earnings call with analysts on April 25, Molina Healthcare CEO Joe Zubretsky said 19 states increased their payment rates this year to adjust for sicker 医疗补助计划 enrollees. “States have been very responsive,” Zubretsky said. “We couldn’t be more pleased with the way our state customers have responded to having rates be commensurate with normal cost trends and trends that have been influenced by the acuity shift.” 

Health plans have faced much uncertainty during the 医疗补助计划 unwinding, as states began reassessing enrollees’ eligibility and dropping those deemed no longer qualified or who lost coverage because of procedural errors. 展开之前, plans said they expected the overall risk profile of their members to go up because those remaining in the program would be sicker. 

UnitedHealthcare, Centene和Molina had 医疗补助计划 revenue increases ranging from 3% to 18% in 2023, 根据KFF. 另外两家大型医疗补助保险公司, 相关性和CVS运行状况, 不列出医疗补助专项收入. 

The 医疗补助计划 enrollment of the five companies collectively declined by about 10% from the end of March 2023 through the end of December 2023, 从44.从200万到39万.KFF的数据显示，这一数字为900万. 

In the first quarter of 2024, UnitedHealth’s 医疗补助计划 revenue rose to $20.50亿美元，高于去年的180亿美元.2023年同一季度将达到80亿美元. 

Molina在4月24日公布了近7美元.5 billion in 医疗补助计划 revenue in the first quarter of 2024, up from $6.去年同一季度的销售额为30亿美元. 

On April 26, Centene reported that its 医疗补助计划 enrollment fell 18.5% to 13.3 million in the first quarter of 2024 compared with the same period a year ago. The company’s 医疗补助计划 revenue dipped 3% to $22.20亿年. 

Unlike UnitedHealthcare, whose 医疗补助计划 enrollment fell to 7.2024年3月从800万美元降至700万美元.4 million a year prior, Molina’s 医疗补助计划 enrollment rose in the first quarter of 2024 to 5.从4到100万.2023年3月将达到800万美元. Molina’s enrollment jump last year was partly a result of its having bought a 医疗补助计划 plan in Wisconsin and gained a new 医疗补助计划 contract in Iowa, the company said in its earnings news release. 

Molina added 1 million members because states were prohibited from terminating 医疗补助计划 coverage during the pandemic. 该公司损失了550人,000 of those people during the unwinding and expects to lose an additional 50,到6月为止. 

关于 90% of Molina 医疗补助计划 members have gone through the redetermination process, Zubretsky said. 

The corporate giants also offset the enrollment losses by getting more 医疗补助计划 money from states, which they use to pass on higher payments to certain facilities or providers, 施耐德说. By holding the money temporarily, the companies can count these “directed payments” as revenue. 

医疗补助计划 health plans were big winners during the pandemic after the federal government prohibited states from dropping people from the program, leading to a surge in enrollment to about 93 million Americans. 

States made efforts to limit health plans’ profits by clawing back some payments above certain thresholds, 伊丽莎白·辛顿说, KFF的副主任. 

But once the prohibition on dropping 医疗补助计划 enrollees was lifted last spring, 这些计划面临着不确定性. It was unclear how many people would lose coverage or when it would happen. Since the unwinding began, more than 20 million people have been dropped from the rolls. 

医疗补助计划 enrollees’ health care costs were lower during the pandemic, and some states decided to exclude pandemic-era cost data as they considered how to set payment rates for 2024. That provided yet another win for the 医疗补助计划 health plans. 

Most states are expected to complete their 医疗补助计划 unwinding processes this year. 

来源:凯