AHIP's 'State of the Industry' for 2023: 7 takeaways

AHIP is focused on Medicaid redeterminations and promoting competition in the marketplace for 2023. 

The trade association representing health insurers held its "State of the Industry" discussion on Jan. 9. AHIP President and CEO Matt Eyles and other executives laid out their legislative priorities at the federal and state level for 2023. 

Here are seven key takeaways from the discussion: 

  1. Many Medicaid recipients aren't aware of the redetermination process set to begin April 1, Mr. Eyles said. He urged states to communicate with enrollees about administrative requirements, and ensure a smooth transition to other forms of insurance for those who are no longer eligible.

    "Our industry is committed to working with all stakeholders to ensure as many Americans remain covered as possible," Mr. Eyles said. 

  1. AHIP will push policies to promote competition in the marketplace, Mr. Eyles said during the call.

    "As we look to 2023, we'll continue to prioritize reforms that remove some of the incentives and opportunities for [private equity] firms and others to exploit patients for profit."

    Jeanette Thornton, AHIP's executive vice president for policy and strategy, said competition has driven more choices and more enrollment in ACA exchange plans for 2023.

    "We'll be looking in 2023 to see a continued stable regulatory environment so this market can continue to be available for the millions of Americans who are really depending on it for their health coverage," Ms. Thornton said. 

  1. AHIP members' plans are continuing to expand mental health networks and adding in-home and virtual behavioral healthcare resources, Mr. Eyles said.

    "We are committed to improving affordability, access, quality  and results for everyone seeking mental health support," he said. 

  1. State legislatures are likely to focus efforts on reforming prior authorization in 2023, Miranda Motter, senior vice president for state affairs and politics, said.

    "We're seeing pressure in the states to limit the use of prior authorization and other important utilization management tools that we know employers use today to ensure the care patients receive is safe, effective and affordable," Ms. Motter said.

    Ms. Motter said health insurance providers are working at the state level to communicate the value of prior authorization to lawmakers and sharing reforms in progress. 

  1. The trade association is also focused on improving health equity outcomes, Mr. Eyles said. The association finalized new demographic data collection standards last year. 

  1. Another priority for the trade association in 2023 is addressing the cost of prescription drugs.

    In his remarks, Mr. Eyles said pharmaceutical companies are driving up the costs of drugs by blocking generic biosimilars or pushing brand-name drugs to patients.

    "Federal and state policymakers can fix this system by holding Big Pharma accountable," Mr. Eyles said. 

  1. State legislatures will also be looking at regulations for prescription drug prices in 2023, Ms. Motter said.

    Pharmaceutical companies are looking to keep copay coupons in place at the state level. Ms. Motter said these coupons can manipulate prices in the drug market.

    "These coupons are illegal kickbacks in public programs like Medicaid and Medicare, which is why Big Pharma is focused on other markets and really encouraging patients to use coupons to drive them to higher cost, brand-name drugs," Ms. Motter said. 

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