About health insurance
Oscar Health Announces Results for Third Quarter 2021: Disturbing trends, especially compared to other insurers’ financials reported here last week. Despite increased membership and premiums, the MLR and net loss increased.
“Membership as of September 30, 2021 of 594,284, a 41% increase YoY
For the quarter ended September 30, 2021:
Direct policy premiums of $895.4 million, a 53.1% increase YoY
Premiums earned of $441.7 million, a 345.6% increase YoY
Medical Loss Ratio of 99.7%, increased 920 bps YoY
InsuranceCo Administrative Expense Ratio of 23.1%, increased 70 bps YoY
InsuranceCo Combined Ratio of 122.8%, increased 990 bps YoY
Net loss of $212.7 million, an increase of $133.6 million YoY; Adjusted EBITDA loss of $188.7 million, an increase of $117.7 million YoY”
2022 Medicare Parts A & B Premiums and Deductibles/2022 Medicare Part D Income-Related Monthly Adjustment Amounts: CMS says Part B increases will be more than offset by the increased Social Security payments (as if healthcare is the only increased expense facing seniors). One unique item in this year’s explanation of why rates are increasing: “Additional contingency reserves due to the uncertainty regarding the potential use of the Alzheimer’s drug, Aduhelm™…” At $56k per year, the drug’s sales have been slow, but future unknown costs forced CMS to be prepared for huge future expenses. Some estimate that about half of the 14.5% increase in Part B premiums are due to this cost uncertainty. See, also: Alzheimer’s drug cited as Medicare premium jumps by $21.60
Healthcare Affordability: Majority of Adults Support Significant Changes to the Health System: From the RWJ Foundation:
Some highlights:
- “Put limits on what drug companies can charge for specific drugs that save lives or that millions of people use to treat life-long health conditions like diabetes. (89%)
- Prevent drug companies from blocking cheaper generic drugs from being sold in the US. (86%)
- Put limits on the prices that hospitals can charge for services. (85%)
- Allow the government to negotiate lower drug prices for employers and consumers. (84%)
- Put limits on the prices that doctors can charge for services. (81%)
- Eliminate health insurance deductibles and copayments so that people don't have to pay more to use their health insurance. (80%)” One question not asked was whether respondents would rather higher premiums or narrower networks in exchange for a reduction in out-of-pocket expenses.
Former UnitedHealth exec says company would only pay surprise bills after complaints: “The former head of UnitedHealthcare's Shared Savings Program alleged during testimony that the insurer was willing to pay for its members' surprise medical bills, but only if they filed a complaint to the company.
The testimony is part of the ongoing legal battles between UnitedHealthcare and TeamHealth. John Haben, the former UnitedHealthcare executive, has been testifying in Nevada over a TeamHealth lawsuit that alleges the insurer's Shared Savings Program resulted in millions of dollars in clinician underpayments.”
About Covid-19
U.S. appeals court affirms hold on Biden COVID-19 vaccine mandate: “A U.S. appeals court on Friday upheld its decision to put on hold an order by President Joe Biden for companies with 100 workers or more to require COVID-19 vaccines, rejecting a challenge by his administration.”
About pharma
CVS withdraws Supreme Court case on disability rights, announces new partnership: “The CVS pharmacy chain has reached an agreement with a coalition of disability rights organizations and dropped a legal case that had made it all the way to the U.S. Supreme Court. The court was scheduled to hear arguments in the dispute next month, and the ruling could have had far-reaching effects on disability rights…
The case, CVS Pharmacy, Inc. vs. Doe, stemmed from a lawsuit filed against CVS by multiple people who take prescription drugs for HIV/AIDS. The plaintiffs objected to changes to the company's terms that meant they could not opt out of mail-only delivery or utilize another pharmacy with experience handling their special medication needs. They argued it had a discriminatory impact on them, even if that wasn't the company's intent.”
Since the Supreme Court did not have a chance to rule in this case, the issue of the ability of an insurance company to impose a narrow network is unresolved.
About healthcare devices
FDA flags safety issue in replacement material for recalled Philips ventilators: “Months after Philips received the FDA’s go-ahead to begin repairing and replacing the ventilators affected by the Class I recall the company initiated in mid-June, the regulator identified a potential safety risk with a replacement component, according to a Nov. 12 statement.
The recall was sparked by an issue Philips identified with the polyester-based polyurethane foam used to muffle sound and vibrations in its continuous and non-continuous ventilators. Over time, the company found, that foam could break down, potentially sending specks of black debris and other dangerous toxins into the air pathway.”