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COVID-Related Profits Were Largely a One-Year Phenomenon Across U.S. Health Insurers

"[T]he first year of the pandemic was historic not only for COVID, but for a surprising side effect -- the health system known for inexorable growth actually provided less care in most categories.... Health insurers were huge financial beneficiaries of this surprise. Their profits increased 52% as they continued collecting insurance premiums while fewer patients went to the doctor.... Fast forward past the end of the pandemic, and the health care finance story has changed dramatically -- premiums are rising much faster now, amid a health care cost surge that includes costly new GLP-1 medications for diabetes and weight loss."

ACA Insurers Denied Nearly 1 Out of Every 5 Claims for In-Network Services

"[KFF] found significant variation between companies, with denial rates ranging from as low as 1% to as high as 54%. Among insurers with a high volume of claims, Blue Cross and Blue Shield of Alabama had the highest denial rate for in-network claims at 35%, followed by UnitedHealth Group at 33%. Illinois-based Health Care Service Corp., which runs nonprofit Blue Cross plans in five states, had the third-highest denial rate at 29%."

Most Patients Quit GLP-1 Drugs in Two Years

"Four in five people taking GLP-1 medications for weight loss quit them in two years, even though the drugs are supposed to be taken much longer to maintain their benefits, according to a new report ... [M]any people regain all their weight after discontinuing the injectable drugs such as Wegovy and put themselves back at risk for costly chronic diseases[.]"

States Support U.S. Supreme Court Review of Decision Limiting State Regulation of PBMs

"Minnesota Attorney General Keith Ellison is leading a bipartisan group of 32 attorneys general asking the U.S. Supreme Court to review a case that could otherwise limit state regulation of pharmacy benefit managers (PBMs).... Minnesota, Oklahoma and other states say PBM practices, in some cases, have enriched insurance companies, hurt independent pharmacies and made it harder for patients to afford and access their medicines." [PCMA v. Mulready, No. 22-6074 (10th Cir. Aug. 15, 2023; cert pet. filed May 10, 2024, No. 23-1213)]

Lawsuit Accuses UnitedHealth Group of Using Faulty AI to Deny Claims

"A class-action lawsuit ... [alleges] UnitedHealth Group is using a faulty artificial intelligence algorithm to wrongly deny coverage for Medicare patients who need rehabilitation care following hospitalizations.... The litigation comes amid signs of growing consumer and government suspicion that health insurers are frequently denying payment for medically necessary services." [Estate of Lokeken v. UnitedHealth Group, Inc., No. 23-03514 (D. Minn. complaint filed Nov. 14, 2023)]

Walgreens to Shutter Many In-Store Clinics, Add Jenny Craig Sites

"Walgreens will shutter nearly 40% of the clinics in its stores ... The company ... will close 150 Walgreens-run clinics by the end of the year, but it will keep open more than 200 that are run in partnership with health care providers.... [T]he chains have struggled to make money off the clinics, which face growing competition from telemedicine services[.]"

Amid Rocky Market, 401(k) Savers Eked Out Gains in Q2

"The average 401(k) plan balance rose 2% to $106,000 in the second quarter versus a year earlier ... Most of the gains came from employees setting aside more of their pay for their retirement plans. The average employee contribution rate rose to 8.8% in the second quarter, a record level. That's up from 8% a decade ago, "

UnitedHealthcare Will Stay on Just Three Exchanges

"Currently, United competes on the exchanges for 34 states, but is retreating due to large financial losses.... [A] United spokesman confirmed the insurer plans to compete again next year only on the exchanges in Nevada, New York and Virginia, meaning the company won't be back in 31 other states.... United's actions point to broader problems with the exchanges ... including financial losses for carriers, rising premiums for consumers and many potential subscribers opting out of coverage."

There's No 'Tooth Fairy' for Pension Fund Bailout

"Anger predictably ensued when Central States administrators proposed cuts for 270,000 drivers and retirees as part of their rescue plan.... But the Treasury Department rejected the Central States restructuring and benefit cuts.... The reality, however, is that rejecting the least bad option simply means that the other solutions are worse. The plan's dire finances have not changed. And without reform, pensioners' cuts eventually may be even deeper.... The debate going forward needs to honestly acknowledge the long odds of a congressional bailout for the Central States fund and what can realistically be done to preserve pensions."

Tax Season Brings New Health Law Paperwork, Some Confusion

"Large employers and insurers in Minnesota are distributing for the first time this winter more than a million tax documents that show who had health insurance last year, a seemingly straightforward task that has nonetheless created some clerical headaches.... Forms can be complicated for workers who've moved between full-time and part-time status during the year, or for those who retired or left employment. There's also been confusion among employers about how exactly to use codes that describe the coverage offered to workers."