What Humana's employer coverage exit shows about government programs' allure

While other large health insurers are not expected to join Humana's exit from the commercial market in the short term, the government market may be increasingly attractive, Bloomberg Law reported Feb. 27. 

4 things to know:

1. Health insurers are seeing increased pressure as employers look to quell rising healthcare costs by demanding access to claims data and, in some cases, suing to get it, according to the report. 

"As that data becomes more available, it’s easier to discern what’s going on in the marketplace, and it’s easier to contemplate a universe where the health plans become less essential or required to get a good deal," Michael Thompson, president and CEO of the National Alliance of Healthcare Purchaser Coalitions, told Bloomberg Law. The alliance represents groups that work with employer health plans.

2. In addition to Medicare and Medicaid, there are growth and expansion opportunities in the ACA marketplace, said Duane Wright, a senior health-care policy analyst with Bloomberg Intelligence.

3. Humana's commercial market is much smaller than other large payers. Humana had slightly less than 1 million commercial plan members in 2022, representing 6 percent of its total medical membership. Cigna, in comparison, had 14.8 million commercial members. Nationwide, about 159 Americans had employer-sponsored plans in 2022. 

4. Glen Losev, senior equity analyst for health care for Bloomberg Intelligence, said Humana is "probably one of the best and most knowledgeable in the Medicare space." But if there are changes to the program and profitability suffers, "what do they have to fall back on?" asked David Muhlestein, chief research and innovation officer of Health Management Associates, a healthcare consulting firm. 

"There have been proposals time and again to reform Medicare Advantage, and doing so could really hurt them," Mr. Muhlestein said. 

Editor's note: This article was updated March 3 at 7:26 a.m. CT.

Copyright © 2023 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.


Featured Webinars

Featured Whitepapers

Top 40 articles from the past 6 months