If you’re a small business owner and you’ve spent some time shopping for health insurance for your employees, you’ve likely encountered the terms “Group Health” and “Blanket Health.” Here’s an overview to help you understand how each type of coverage works and how they apply to your business.
What is a Group Health Insurance Policy?
A Group Health Insurance policy offers health benefits to your employees as well as spouses or other eligible dependents. It provides employees with medical benefits when they visit a health care provider like a doctor, urgent care facility, or hospital. A Group Health Insurance policy may also include coverage for prescription drugs and other health and wellness benefits – like discounts on Vision, Dental, or the option to purchase Life Insurance.
What is a Blanket Health Insurance Policy?
Despite its name, a Blanket Health insurance policy is less comprehensive than a Group Health policy. In fact, it is most often an accident-only policy issued to cover a group of individuals engaged in a specific activity. For example, school districts, colleges and universities, and sports teams can purchase Blanket Health coverage to provide health benefits to athletes and cheerleaders. These policies may also be issued to civic, non-profit, or religious organizations for participants in (or employees of) ongoing or one-time events or camps. Volunteer firefighters may be covered by a Blanket Health policy for medical treatment in connection with accidental injury related to their fire-fighting roles.
Most importantly, a Blanket Health insurance policy typically has limits on the types of covered tests, procedures, and services. There may also be a maximum covered benefit – ranging from $5,000 to $50,000 of eligible expenses – for treatment of individuals under this type of policy.
More on How the Policies Differ
In contrast to a Blanket Health insurance policy, a Group Health insurance policy – particularly one that includes the Essential Health Benefits (EHBs) mandated by the Affordable Care Act (ACA) – does not have a dollar limit on what it will pay for care received by you and your employees while you are insured. The ACA actually prohibits health insurers from limiting your annual or lifetime coverage expenses for EHBs under a Group Health plan.
In addition, a Group Health policy typically covers you for a full plan year (12 months). If you want coverage long-term, a Group Health policy may be a better choice for you, since a Blanket Health policy may have a limited term duration.
Choosing What’s Right for You
Taking the time to educate yourself on the differences between Group Health insurance and Blanket Health insurance policies is an important step in choosing coverage that’s right for you. To find out if your business qualifies for Group Health insurance, click here or talk with your employee benefits agent. To explore this subject further, consider reading 7 Things to Know About Offering Group Health Insurance.
Your employee benefits agent can also provide you with a quote for health insurance for your employees. If you’re not currently working with an agent, go here to find a licensed expert in your area.
A new year is here and with it come several changes to health care, insurance requirements, and costs. Here’s what you need to know for 2019.
The State of the ACA
In December 2018, a Texas judge ruled that the Affordable Care Act (ACA) is unconstitutional. However, it will still take time for the case to play out. It is now being considered by the Fifth U.S. Circuit Court of Appeals in New Orleans. Even after that court rules, further appeals are expected, and the case could wind up before the U.S. Supreme Court in 2020.
New for 2019, the U.S. Department of Health & Human Services (HHS) – the federal agency that administers the ACA – announced updated payment and cost-sharing provisions, risk adjustment program changes, and increased flexibility in the operation of the federal and state-based exchanges. The latter includes Small Business Health Options Program (SHOP) exchanges, such as Covered California for Small Business.
In proposed rules, the ACA’s risk adjustment program, which mitigates potential adverse selection for participating insurers, would be updated. The goals are to reduce regulatory requirements and empower both consumers and employers. Among the measures designed to grant states increased flexibility is the ability to modify Essential Health Benefits (EHBs), which could increase affordability of coverage for individuals and small businesses.
Large Employer Mandate
The federal employer mandate, which affects businesses with 50 or more full-time or full-time equivalent employees, continues in 2019. It requires Applicable Large Employers (ALEs) to offer “affordable” health insurance that provides minimum value to 95% of full-time employees and their children up to age 26, or to face penalties. For help determining whether your business is an ALE, ask your employee benefits agent, or visit the IRS ALE web page.
Smaller employers – those with fewer than 50 full-time equivalent employees – are not subject to the ACA employer mandate and are not required to provide employees with health insurance coverage. Those businesses that elect to offer employee health insurance may qualify for a Small Business Health Care Tax Credit, subject to certain federal qualification guidelines.
Health Insurance Reform in California
California Gov. Gavin Newsom announced in his inaugural address on January 7, 2019, that he wants the state to adopt its own individual mandate. He also called for new state-funded subsidies to help middle-class Californians afford health insurance. Whether Congress will act to give the state greater authority to implement its own health care programs, while still receiving federal funding, remains uncertain.
Premium and Deductible Forecasts
Experts at HR consultant Mercer expect an average group health insurance premium increase per employee of 4.1 percent in 2019 for employers making plan changes. For those not making plan changes, the expected increase is 5.3 percent. Over the past decade, health care cost increases have ranged from 2.1 percent (in 2013) to 6.9 percent (in 2010) for employers making plan changes, based on research by the Society for Human Resource Management (SHRM).
In 2018, employees paid nearly a quarter of their premium for single coverage (23 percent) and one-third (31 percent) of their family coverage premium. Those amounts are up less than one percent from the previous four years, according to a report by the International Foundation of Employee Benefit Plans (IFEBP). A similar trend is expected in 2019. Mercer research last year found the average cost of employee health coverage was $12,666 for all employers, $12,148 for employers with 10-499 employees, and $13,018 for employers with 500 or more employees.
For workers with employer-sponsored health plans, deductibles have gone up, too. Those with individual health coverage, nearly half (46 percent), now have a deductible between $1,000 and $2,999. For employees with family coverage, roughly one-third (29 percent) have a similar deductible, while 26 percent have a deductible of $3,000 to $4,999, and nearly a quarter (23 percent) have a deductible of $5,000 or more.
What Does It Mean for Your Business?
To understand what these changes mean for you and your business, it’s important to consult an expert. Your employee benefits agent can walk you through your options and provide a health insurance quote based on your budget and needs. If you’re not currently working with an agent, you can search here for one in your area.
If you’re shopping for insurance for your small business, you may have come across the term “health insurance package.” While the term may be foreign, the concept should be familiar.
Think of a health insurance package in the same way you can “bundle” your phone, cable, and wi-fi services. Three different services in one package that make it easier for you to manage.
Health insurance packages are similar. They bundle a variety of health insurance and other employee benefits into a single program. The goal is to help you meet your employees’ individual and family health care needs, while also minimizing administration for your business.
Health Insurance + More
The core insurance offered is typically Health Insurance and may include HMOs (Health Maintenance Organization), PPO (Preferred Provider Organization), EPOs (Exclusive Provider Organization), or HSA (Health Savings Account) compatible plans.
Besides Health Insurance, what really makes it a “package” is the additional coverage you have access to, such as:
- Acupuncture and Chiropractic Care
- Life Insurance
- (Accidental Death & Dismemberment) protection
- And more!
Your Health Insurance package may be further enhanced by value-added benefits like the following:
- Discounts on Dental, Vision, Hearing, or other health care-related services
- A Premium Only Plan, which allows your employees to pay for some of their employee benefits on a pre-tax basis
- Online human resources support services (for you and your employees)
- Employee discounts on travel, entertainment, and other services
- Prescription drug discounts
- Cal-COBRA or Federal COBRA billing services
- Added tools and resources, such as online health plan comparison services, HSA information, online enrollment, online provider search, online Rx search, and more
Advantages of a Small Business Health Insurance Package
Like with telecommunications services, one of the biggest advantages of packaging your employee health care with other benefits is convenience. When you bundle your services, you have just one contact for your benefits – your agent. You also have one administrator responsible for billing all of your organization’s benefits for employees. That way, you only have to write one check each month for all of your employees’ coverage – and you have one website and one toll-free number for service-related questions.
It’s Easy to Learn More
Your employee benefits agent can provide more information on a Health Insurance Package to suit the needs of your business and employees. If you do not already have an agent, you can search for one in your area here
Good News for Groups!
CaliforniaChoice recently made two big announcements, both of which are a net positive for California small business owners and employees.
Oscar Health is now available to small groups in Los Angeles County and Orange County for coverage beginning December 1, 2018, or later. That means, CaliforniaChoice now offers eight different network options.
The Oscar provider network offers employees access to more than 3,500 physicians across 140 medical specialties and sub-specialties. It gives employees access to many of the region’s top hospitals and medical centers, including:
- • Ronald Reagan UCLA Medical Center
- • Children’s Hospital Los Angeles
- • Providence St. Joseph Health (including Hoag Memorial, Saint John’s Health Center, and Providence St. Joseph Medical Center)
- • Huntington Memorial Hospital
- • And others across Los Angeles and Orange counties
Oscar brings a consumer-centric approach to health insurance with nine affordable Exclusive Provider Organization (EPO) plans across all four Affordable Care Act metal tiers. While many health plans require members to visit a primary care physician before seeing a specialist, Oscar does not have such a requirement. Your employees enrolled in Oscar have the freedom to go directly to any in-network specialist – saving them time and money.
The Oscar “Doctor on Call” program lets insured employees and their dependents talk to a board-certified doctor free and get a prescription over the phone. No copay is required and no office visit is needed.
Oscar also offers a no-cost Concierge Service, which gives members access to a personalized care team with a comprehensive knowledge of their health history. The Oscar mobile app makes it easy for participating employees and dependents to manage benefits, look up doctors, view lab results, send messages to their Concierge team, and access a digital ID card.
No More Late Fees
In other news, effective 10/1/18, CaliforniaChoice is no longer charging a late fee if a small business is late on its monthly payment.
If you are interested in learning more about Oscar Health for your small business employees, or if you want to get a quote for any of the eight health plans available through CaliforniaChoice, call or email your employee benefits agent. If you do not already have an agent, we can help you find one.
As an employer considering health insurance for your employees, you have multiple options available to you. You can look for coverage on your own. Or, you can shop for coverage with assistance from an employee benefits broker. You may choose to go directly to an insurance company to purchase coverage. Alternatively, you can shop for health coverage via a public or private health insurance exchange.
So, you may be wondering, what’s a health insurance exchange? A health insurance exchange offers you and your employees access to multiple health insurance plans through a single program. There are both “public” health insurance exchanges and “private” health insurance exchanges. In California, the public health insurance exchange is known as Covered California, which was established as part of the Affordable Care Act (ACA) signed into law by President Barack Obama in 2010. One example of a private health insurance exchange is CaliforniaChoice, which has been serving small businesses in California since 1996.
What Are the Similarities?
Both the state exchange (Covered California) and a private exchange (like CaliforniaChoice) offer you the option to choose from multiple health insurers in a single program. Some of your employees may choose one type of coverage – like a Health Maintenance Organization (HMO) health plan – while others may want to be able to access a certain doctor, medical group, or hospital that is only available through a Preferred Provider Organization (PPO) health plan.
Other health plan options may also be available like an Exclusive Provider Organization (EPO) plan, Health Care Service Plan (HSP), and Health Savings Account (HSA) qualified plan.
Both a public exchange and a private exchange give you choices and allow you and your employees to shop and compare health plans – so you find the coverage that is right for your specific health care needs.
What Are the Differences?
As you might expect, a public health insurance exchange is one administered by the government – at either the state or national level. California was the first U.S. state to establish its own state health insurance marketplace as part of the ACA. Covered California offers medical and dental coverage to individuals and small businesses statewide.
As required by the ACA, Covered California also offers pediatric dental and vision benefits, but vision coverage for adults is not an option on the state exchange.
As of 2018, a dozen states and the District of Columbia operated their own public health insurance exchanges. All other states used the federal marketplace, HealthCare.gov, to offer ACA compliant health coverage to their residents.
A private health insurance exchange – like CaliforniaChoice – is an insurance marketplace established by a private organization such as a Third Party Administrator (TPA). CHOICE Administrators is the TPA that operates CaliforniaChoice, and all plans offered through CaliforniaChoice are ACA compliant. Through the CaliforniaChoice private exchange, small businesses in California can access dozens of health plan options from eight different health insurers that operate in the state. Businesses can also add options for employee and dependent dental and vision benefits as well as other coverage.
While a public exchange generally offers only medical and dental insurance, a private exchange may offer more. For example, CaliforniaChoice offers employers and their employees a variety of discounts (including dental, vision, and hearing services) as well as resources that could help you and your employees save time and money.
These include a free Premium Only Plan (POP), access to HRAnswerLink (human resources support), employee discounts through the Cal Perks program, a no-cost California Rx prescription-drug discount card, an online Health Savings Account (HSA) Resource Center, a free Flexible Spending Account (FSA) for groups of 15 or more employees, COBRA billing services, and other benefits.
Optional services, including payroll, 401(k) integration, and access to other types of insurance, are also often available through a private exchange.
Because Covered California was launched in connection with the ACA, it has been in operation for about 10 years. The CaliforniaChoice private exchange opened in 1996, so it has more than 22 years of experience and expertise in delivering employee choice and multi-carrier exchange services to small businesses in California.
What’s Right for You and Your Business?
If you are interested in learning more about what’s available from a public or private exchange, talk with your employee benefits broker. He or she can help you decide what might work best for your business and your employees’ individual or family health care needs. If you do not have a broker, we can help you find one who will meet with you and provide you with a custom quote for health and other coverage for your employees (and dependents, if you choose).
You might also want to read our posts on Health Insurance Can Help You Better Compete for Employees and 7 Reasons to Use a Broker and a Private Exchange for Your Small Business Employees’ Health Insurance in 2018.
Offering group health insurance to employees – no matter what size your organization – is important. That’s because, more than at any other time in recent history, current and potential employees are seeking a better work and benefits experience. That’s what MetLife reports in its 2018 U.S. Employee Benefit Trends Study. Even if your business is not “required” to offer health benefits, it might still be something to consider – as you compete for workers in an increasingly competitive talent marketplace.
How to Qualify for Group Health Insurance
Let’s start by discussing what group health insurance is, and the rules concerning who qualifies for coverage? A group health insurance policy is one issued to an employer to provide coverage for eligible full-time employees. At the discretion of the employer, it may also include benefits for part-time employees (those working fewer than 30 hours per week) and/or the qualified dependents of employees.
If an employer offers any full-time or part-time employees health coverage, it must offer insurance to all employees, regardless of any pre-existing medical conditions.
Health insurers will write groups with as few as two covered persons (the business owner and an employee). However, some carriers will not write a policy for a husband and wife group if both are owners of the business, or if it is a sole proprietorship. Other business types such as an LLC, S-Corp, C-Corp, and Partnerships where the spouse is a W-2 employee are acceptable.
ACA Requirements for Small Businesses
The Affordable Care Act (ACA) employer mandate (still in force despite the House of Representatives’ effort to change it) requires employers with 50 or more full-time and full-time equivalent employees to offer health insurance. (Link here to the Healthcare.gov website for a calculator to determine your group size.)
Fifty-plus employers who do not offer eligible employees affordable coverage that includes what the ACA defines as “essential health benefits” are subject to a penalty. However, employers with fewer than 50 employees are not required to offer health benefits, and are not subject to a penalty – although many choose to offer benefits as part of their recruitment and retention strategy.
Group Health Coverage Costs
If you decide to purchase group health insurance for your employees, whether you pay the full cost of coverage or you share the cost with employees, what you pay is based on the ages of those individuals insured under your plan (including any dependents).
You will be able to choose from four ACA metal tiers: Bronze, Silver, Gold, and Platinum, each offering a different shared health care cost percentage, as shown in the graphic below:
Some programs – including the CaliforniaChoice multi-carrier private exchange – allow you to choose more than one metal tier for your employees’ coverage. This gives you and your workers greater access to doctors, hospitals, and other providers offered by the eight plans available from CaliforniaChoice, so you can find the plan that’s right for your individual or family health care needs.
In addition, with CaliforniaChoice, you can more easily manage your employee benefits budget using Defined Contribution. You select your preferred plan and decide how much you want to spend on employees’ health insurance. You can choose a Fixed Percentage of the costs (from 50% to 100%) or a Fixed Dollar Amount. The choice is yours – and your cost per employee is locked-in for a year. At renewal, you can adjust your contribution (up or down) and lock it in for another 12 months.
If you’re a small employer (with two to 50 full-time employees) and you want to offer health insurance to your employees, federal law guarantees your access to it. To learn more, contact your employee benefits broker. If you don’t already have a broker, we can help you find a CaliforniaChoice broker, who will work with you to build an affordable health plan quote that meets your employees’ needs.
Pro Tip: Broker services are typically available at no cost.
- Short-term health plans that do not comply with the Affordable Care Act would be prohibited in California effective in 2019.
- California’s action mirrors short-term plan limitations or prohibitions taken by other states.
- Governor Jerry Brown has until September 30, 2018, to sign or veto the proposed legislation.
The California Assembly and State Senate both took action this month to ban the sale of short-term health insurance plans in 2019. The Senate approved S.B. 910, authored by State Sen. Ed Hernandez (D-West Covina), on August 21 after the Assembly approved the measure on August 16. The legislation now heads to the governor.
The Trump administration has been working to expand the availability – and the coverage period – for short-term health insurance plans. Recently released federal guidelines would expand short-term plans from 90 days to 12 months. Insurers would have the option to allow individuals covered by these plans to renew them for up to 36 months. States have the option to regulate the sale of such plans, which California is doing.
Under the Affordable Care Act (ACA), short-term health plans do not have to include all of the “essential health benefits” of ACA-compliant plans. For example, short-term plans can exclude maternity care and prescription drug coverage, among other benefits. They can also deny an applicant coverage if he or she has a pre-existing health condition.
For years California limited the length of time an individual can be covered by a short-term health plan to six months. The Obama administration reduced the coverage period to three months. Under S.B. 910, the sale of non-ACA compliant short-term health plans in California is no longer permitted effective January 1, 2019.
The impact of the change could be minimal, although it’s not known how many residents might have been attracted to the plans under the broader federal rules. According to the California Department of Insurance, fewer than 10,000 short-term health insurance policies were in force at the end of 2017.
If Governor Jerry Brown signs the bill, California would join a handful of other states, including Massachusetts, New Jersey, and New York, which have severely restricted or banned short-term health plans. Beginning in 2019, Californians could still purchase limited-term health policies; however, they would have to comply with the ACA’s consumer protections and essential health benefits.
Talk with your employee benefits broker about short-term coverage options for your employees if they leave your group health plan. If your group has 20 or more employees on more than 50 percent of your typical business days in the calendar year, you are subject to COBRA (the Consolidated Omnibus Budget Reconciliation Act), and you may be required to offer coverage continuation to employees, spouses, and dependent children who lose coverage due to certain events. These include death, employment termination, reduction of hours (and qualification for benefits), eligibility for Medicare, divorce, or legal separation.
The country’s leading health insurers reported mixed financial results for the first quarter of 2018. Among the publicly traded insurers that offer coverage through the CaliforniaChoice small business, multi-carrier private exchange, it was a positive start to the year.
Anthem: Increased Income on Similar Revenue
Anthem, Inc., the parent of Blue Cross and Blue Shield plans across the country (including Anthem Blue Cross in California) had high net income for Q1. The company earned $1.3 billion in the quarter on revenue of $22 billion. That compares to $1 billion in income in Q1 2017 on similar revenue. Membership was 2.5 percent lower – 37 million nationwide – during the quarter as compared to 2017. Medicare plan growth increased 16 percent, while other enrollment was lower. Individual major medical coverage fell to 755,000 members nationally as compared to 1.9 million in 2017.
Centene: Dramatic 12-Month Growth
Centene, the parent organization of California-based Health Net and managed care Medicaid plans across the country, reported $338 million in net income on $13 billion in revenue. That is up significantly from $139 million in net income, on revenue of $12 billion, in 2017. At the quarter’s end, the St. Louis-based insurer was providing or managing health care for 13 million people.
UnitedHealth: Greater Earnings, Increased Cash
UnitedHealth Group, Inc., the parent of UnitedHealthcare, had a Q1 2018 profit of $2.84 billion, an increase from $2.17 billion a year earlier. Earnings per share were up sharply to $3.04 a share, from $2.37 per share last year. Revenue for the quarter was up 13 percent, much of it attributable to the health insurance and health services businesses (operating under the Optum brand). Cash flow and earnings were also positively affected by the company’s reduced income tax under the reform signed by President Trump in late 2017.
Although not a publicly traded insurer, the non-profit health plan Kaiser Permanente also released information on its results for the first quarter. The company reported increased Q1 revenue and operating income for its nonprofit hospital and health plan businesses. Operating revenue was up about 12 percent to $20.3 billion, as compared to $18.1 billion during Q1 2017. Kaiser Permanente, California’s largest health plan, saw its membership grow to 12.2 million members nationwide, up 472,000 from the end of 2017.
Oscar Health, which operates in California and five other states nationwide, announced its first-ever profit. Oscar had Q1 2018 premium revenue of $300 million, three times that in the same quarter last year. Net profit was $7.4 million for the quarter. Oscar, which launched in 2012 and entered the California group market this year, will be offering small group coverage through CaliforniaChoice this fall.
Meet Choice Builder: The Only Private Exchange for Optional Employee Insurance Benefits
The Affordable Care Act (ACA) introduced the concept of an insurance exchange to many Americans, but the fact of the matter is that private health insurance exchanges have operated in the U.S. for years. One of the country’s most successful private exchanges, CaliforniaChoice, began operations in 1996. Today, it serves 18k small businesses and more than 320k members across California.
Exchange marketplaces – whether they are public or private – are designed to give consumers easier access to a broad range of Employee Insurance Benefits. With an exchange, you and your employees have a variety of carriers and plan options from which to choose, so you can select the coverage that best matches your individual or family health insurance needs and budget.
If you’re a business owner or mid-career manager, you may have dependents you want to include in your coverage. Maybe you take a prescription drug for an ongoing medical condition, such as diabetes or high cholesterol. You may have a preferred doctor, who is only available through a local PPO. Your 20-something administrative assistant or 30-something supervisor may be single or divorced (without children) and not inclined to visit the doctor, other than for a routine annual check-up. The options available in an exchange allow all three of you to find the PPO, HMO, or other coverage that works best for you.
The same holds true for added benefits, like Dental, Vision, Chiropractic & Acupuncture, and Life Insurance. The Choice Builder insurance benefits exchange, created by the same company that operates the CaliforniaChoice health exchange, has just what you need. Choice Builder can help you expand your employee benefits beyond health care. You can contribute to your employees’ added benefits or you can offer these benefits on a completely voluntary basis. You can even “mix and match” coverage, so your company shares in the cost of some coverage (like one of several Dental plans), while the employee pays the full cost for other coverage (say, perhaps, Vision or Life Insurance). The choice is yours.
Why consider added benefits? There are many reasons. As mentioned above, you can choose whether you share the cost, or your employees pay the full cost. Added benefits are a good way to keep your employees happy, too – and happier employees are up to 20 percent more productive. That affects your bottom line.
Dental, Vision, and other benefits can also help you attract and retain employees. You may be surprised to learn a 2017 study by Aflac found a majority (58 percent) of employees would a take a job with lower pay if it offered better insurance benefits. In fact, 16 percent of those surveyed two years ago by Aflac said they have left a job – or turned down a job offer – due to the available benefits.
Choice Builder offers convenience and a variety of coverage options for you and your employees:
Pick one, or pick them all; the choice is yours. And you’ll receive just one monthly bill for all of your employees’ added Choice Builder benefits. Plus, you can easily manage those benefits through one website.
The additional advantage offered by Choice Builder is convenience. You don’t have to go to different insurance companies to offer the coverage your employees want; it’s all available through the Choice Builder program. You get access to a wide variety of Dental options – from Ameritas, Anthem Blue Cross, Delta Dental, and MetLife plus Vision coverage from EyeMed and VSP. Life Insurance is offered by Assurity Life. And Chiropractic & Acupuncture treatments, available as an employer-sponsored benefit, are backed by Landmark Healthplan, a California leader in integrated care since 1985. Best of all, you get one monthly bill for all of your employees’ added benefits – and you can easily manage their benefits through one website. There’s just one toll-free number for assistance, too.
To learn more about Choice Builder – and how the added benefits it offers can help you attract and retain employees and, potentially, increase productivity, too – talk with your employee benefits broker. If you don’t have a current broker, we can help you find one.
|4 Things to Remember:
Proposed Legislation Could Shake Up Health Insurance Mergers
Since President Barrack Obama signed the Affordable Care Act (ACA) into law in March 2010, the health insurance industry has seen a lot of changes. Among them have been mergers and proposed mergers of some major players in the health care and insurance industries. However, some of that could change under proposed legislation making its way through the California legislature.
Not since the 1990s have so many health care management and hospitals initiated talks to discuss a possible consolidation. In fact, as reported by Managed Care magazine in 2016, an analysis by the consulting firm Kaufman Hall found health care-related mergers, acquisitions, joint ventures, and joint operating agreements almost doubled from 2010 to 2015. A 2017 post by Health Standards reported more than 560 hospital mergers since 2010, and there are more affiliations being discussed today by some of the country’s largest medical center and hospital operators.
On the insurance side of the health care industry, several major deals have been proposed, but some have not been completed because of government opposition. Those include the proposed consolidation of Anthem and Cigna, which terminated talks in 2017, and an Aetna-Humana marriage called off last year after 19 months of planning and growing opposition.
Deals – or proposed deals – announced in the past six months include Cigna’s acquisition of pharmacy benefit manager Express Scripts, a hookup of the retailer CVS with insurer Aetna, and discussions between the world’s largest company, Walmart, and America’s fourth-largest health insurer, Humana.
Some of these proposed consolidations could face an uphill battle if legislation now in the California State Senate is approved. Assembly Bill 595, authored by Assembly member Jim Wood (D-Healdsburg), would require health plans that would like to merge with or acquire other health plans to receive approval from the California Department of Managed Health Care (DMHC).
State regulators say they want to consider the impact on cost and quality of care that could result from any proposed merger or acquisition. Under current law, health plans must provide the DMHC with notice of a planned merger; however, the state has limited authority to review any proposed consolidation. Insurers oppose the proposed legislation saying it is too broad and approvals could be unreasonably high. As of mid-March, A.B. 595 is under review by two committees: the State Senate Committee on Health and the State Senate Judiciary Committee.
Another proposed legislative bill that could impact Californians’ health care – and health care costs – is Assembly Bill 3087. The bill would put an independent commission in charge of pricing for hospital stays, doctor visits, and many other medical services covered by commercial health plans. Costs would be based on rates approved for Medicare plans. A similar measure was enacted for Maryland’s all-payer program in 2014.
Proponents of A.B. 3087 – including labor unions and consumer groups – say it is designed to reduce escalating health care costs in the Golden State. According to the California Health Care Foundation, premiums for Californians who get their health insurance through their employer grew by more than 240% from 2002 to 2016. Inflation during the same period was about 40%.
The California Association of Health Plans says it is reviewing the cost control proposal; however, it has opposed previous efforts to regulate pricing. That includes a 2014 ballot initiative that would have empowered the state insurance commissioner to block rate increases considered excessive. Proposition 45, as it was known, was rejected by Californians in a 59 to 41 percent vote during the November 2014 election.
Passage chances for these two bills are not yet known. We will continue to monitor proposed legislation in Sacramento and will share updates.