While outside forces contributed, health plans, especially the big ones, can blame their own mismanagement on the insurer meltdown.

About The Podcast:

Millions of Americans feel confused and frustrated in their search for quality healthcare coverage.

Between out-of-control costs, countless inefficiencies, a lack of affordable universal access, and little focus on wellness and prevention, the system is clearly in dire need of change.

Hosted by healthcare policy and technology expert Marc S. Ryan, the Healthcare Labyrinth Podcast offers accessible, incisive deep dives on the most pressing issues and events in American healthcare.

Marc seeks to help Americans become wiser consumers and navigate the healthcare maze with more confidence and certainty through The Healthcare Labyrinth website and his book of the same name.

Marc is an unconventional Republican who believes that affordable universal access is a wise and prudent investment. He recommends common-sense solutions to reform American healthcare.

Tune in every week as Marc examines the latest developments in the space, offering analysis, insights, and predictions on the changing state of healthcare in America.

About The Episode:

On this episode, Marc discusses the financial crisis of health plans. While outside forces contributed, health plans, especially the big ones, can blame their own mismanagement on the insurer meltdown.

Key Takeaways:

Outside forces contributing to the meltdown were high utilization and government actions that reduced rates and revenue and limited cost-savings opportunities.

But health plans generally and the big plans specifically missed the financial mark.

Big plans were over-zealous and had a severe lack of financial discipline.

In Medicare Advantage, health plans ignored lower rates, lower Star performance, risk adjustment reform demands, and prior authorization limits.

In Medicaid, plans grew too much, ushered on by what were temporary rules expanding growth and reimbursement.

In the Exchanges, insurers did not plan for the eventual phaseout of enhanced premium subsidies.

In the employer and commercial world, health plans did not respond to demands for cost-savings and greater transparency by insurers.

The current trends, including the budget reconciliation bill, likely would have meant further retrenchment in all lines of business.

But it is equally true that the lack of financial discipline by most of these plans in the last several years complicates their recovery.

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The Healthcare Labyrinth: A Guide to Navigating Health Plans and Fixing American Health Insurance