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Health insurance is staggeringly uncompetitive in America, and is poised to get even worse for everybody

Published on August 28, 2015 by in News

By: Max Niesen

08/26/2015

qz.com

With two major health insurance mergers pending, the US may be headed for a healthcare market with only three major private health insurers, down from the five that exist now.

 Critics argue that the pending mergers of Anthem with Cigna and Aetna with Humana will further reduce competition. But when it comes to private Medicare plans— the national social insurance called Medicare Advantage (MA) that uses private health insurers—the lack of competition is already awful. Ninety-seven percent of American counties have little or no plan competition, according to a new reportby The Commonwealth Fund, a US healthcare research foundation.
Many of the counties are sparsely populated rural areas. But even within the 100 largest counties by number of Medicare beneficiaries, 81% aren’t competitive, according to the report. Seventy-seven percent of seniors enrolled in MA live in noncompetitive counties.

The report measured competitiveness based on the Herfindahl-Hirschman Index, which classifies markets as non-concentrated, moderately concentrated, or highly concentrated based on the the number of firms within the area and their market share. The Federal Trade Commission uses the index to classify markets for antitrust purposes.

 
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Status Conference held in MDL 2406: In Re: Blue Cross Blue Shield Antitrust Litigation

Published on August 20, 2015 by in News

Judge David Proctor of the Northern District of Alabama held a status conference on August 19, 2015 in MDL 2406: In Re: Blue Cross Blue Shield Antitrust Litigation. The Court heard suggestions from the parties on streamlining the case.

Joe Whatley co-lead counsel for the provider plaintiffs noted ”While we continue to push to move this important case forward efficiently and as quickly as possible, the Blues continue to try to delay the case to protect their excess reserves and profits that they reap by imposing artificial lines on competition. We look forward to a ruling from the court on our proposal to streamline the proceedings to accomplish these goals.”

 
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Lane Regional files antitrust lawsuit against Blue Cross associations, except in Louisiana

Published on August 17, 2015 by in News

By: Ted GriggsBaton-Rouge-Advocate-Logo-590x144

The Advocate.com

08/15/2015

Lane Regional Medical Center has filed a federal lawsuit against all of the Blue Cross plans outside Louisiana, alleging the Zachary hospital received lower payments because the health plans illegally conspired to fix prices at artificially low levels.

 Lane Regional said the lawsuit, filed Friday in Baton Rouge, is intended to force the Blue Cross plans outside the state to compete with Blue Cross and Blue Shield of Louisiana. Lane expects its lawsuit will be combined with antitrust lawsuits filed in Alabama against all of the Blue Cross plans. Those lawsuits claim the Blues acted as an illegal cartel, driving up prices for consumers while lowering payments to doctors and hospitals.

The Blues have denied those allegations. The national Blue Cross association says its members are independent, community-based and locally operated health plans. A number of courts and regulatory agencies have validated the Blues’ business model.

However, Joe Whatley, lead attorney for the Alabama multidistrict litigation, and co-counsel Lance Unglesby say the Blues’ anticompetitive behavior meant Lane was paid less for its services than it should have been.

Lane’s lawsuit was prompted in part by worries that increasing consolidation among health insurers will mean less choice for consumers and less bargaining power for health care providers. Anthem, the largest of the Blues, recently struck a $48 billion deal to purchase Cigna.

Whatley said he did not have an estimate of the Blues’ anti competitive impact on Lane but the damage to hospitals nationwide amounted to billions of dollars.

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Blue Cross Blue Shield accused of stifling competition

Published on August 6, 2015 by in News

By: Patrick Springer

June 8, 2015

Inforum.com

FARGO – The Red River is a border the Blue Cross Blue Shield plans in North Dakota and Minnesota agree not to cross in selling health insurance to customers.

Those exclusive territorial agreements form a hallmark of Blue Cross Blue Shield plans nationwide—which collectively insure one of every three Americans—and are at the heart of a pair of federal lawsuits alleging civil antitrust.

The lawsuits, pending in U.S. District Court in Alabama, were brought separately by providers as well as by individual and small group purchasers of health insurance, and seek class-action status.

Most of the 37 Blue Cross Blue Shield plans in the United States limit their operations to a single state, including those in North Dakota and Minnesota.

 The only reason for the self-imposed geographical marketing restrictions, the providers’ lawsuit contends, is to protect the insurers from competition. The restrictions are maintained by an illegal “market allocation conspiracy,” the doctors and clinics argue

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Bigger May Be Better for Health Insurers, but Doubts Remain for Consumers

Published on August 3, 2015 by in News

the-new-york-times-logoBy: Reed Abelson

08/02/2015

The New York Times

Bigger May Be Better for Health Insurers, but Doubts Remain for Consumers – The New York Times

Deals among the nation’s largest health insurers in recent weeks have been almost head-spinning. But whatever the details, if the combinations are finalized, the result will be an industry dominated by three colossal insurers.

Consumer advocates, policy experts and former regulators say that what may be good for the insurers may not be good for consumers, especially in the wake of a similar frenzy of deal-making among hospitals and doctors’ groups.

“The consolidation in both of these industries has been shown to have an adverse impact on consumers,” said Leemore S. Dafny, a former official at the Federal Trade Commission who is now a professor at Northwestern University’s Kellogg School of Management.

Anthem, which operates for-profit Blue Cross plans in 14 states, merging with Cigna, another large for-profit carrier, along with the planned deal for Aetna to join Humana, a smaller rival known for its private Medicare plans, would create two behemoths.

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Anthem-Cigna Deal is Bad For Doctors on Obamacare Networks

Published on July 31, 2015 by in News

Wall Street National

News that Anthem (ANTM) will buy Cigna (CI) for $54 billion– a deal that closely follows the proposed merger of Aetna (AET) and Humana (HUM) — will intensify regulators’ focus on antitrust issues in the health insurance industry.

Because Anthem’s proposed acquisition of Cigna creates the nation’s largest health insurer with 53 million customers, it’s already being met with a healthy dose of criticism from doctors and hospitals who say insurers are already squeezing them.

In particular, doctors and hospitals say insurers are narrowing their networks for customers who buy coverage on public exchanges under the Affordable Care Act. Though insurers say narrow provider lists allow them to keep costs low and ensure high quality doctors are on the menu of preferred providers and bad physicians are not, providers say they will be in greater danger of being shut out of a network if consumer choices dwindle.

“One of the main goals of the Affordable Care Act was to restore competition in the health insurance sector,” said David Balto, a former policy director at the Federal Trade Commission who is now in private practice in Washington. “This consolidation will reverse these gains of the Affordable Care Act.”

The deal would reduce the number of publicly-traded health insurance companies from five to three, assuming Aetna’s $37 billion purchase of Humana is approved. UnitedHealth Group (UNH) is currently the nation’s largest health insurer.

In Anthem’s case, the plan already is a defendant in a major antitrust lawsuit against Blue Cross and Blue Shield plans that has been consolidated into a class action wending its way through a federal court in Alabama. Anthem operates most of its commercial health insurance business under the Anthem Blue Cross Blue Shield brand.

The suit accuses the Blues plans of conspiring to fix what they pay doctors and other medical-care providers across the country. The Blues plans have denied the allegations.

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Anthem-Cigna Deal is Bad For Doctors on Obamacare Networks

Published on July 31, 2015 by in News

Great Today News.com

07/25/15

Information that Anthem Anthem (ANTM) will buy Cigna Cigna (CI) for $54 billion– a deal that carefully follows the proposed merger of Aetna Aetna (AET) and HumanaHumana (HUM) — will intensify regulators’ center of attention on antitrust issues in the Well Being insurance coverage business.

As A Result Of Anthem’s proposed acquisition of Cigna creates the nation’s largest Well Being insurer with Fifty Three million buyers, it’s already being met with a healthy dose of criticism from Medical Doctors and hospitals who say insurers are already squeezing them.

Particularly, Medical Doctors and hospitals say insurers are narrowing their networks for patrons who purchase coverage on public exchanges beneath the Affordable Care Act. Though insurers say slender provider lists enable them to keep costs low and make sure that top of the range Doctors are on the menu of most well-liked providers and Dangerous physicians are not, suppliers say they’re going to be in better danger of being shut out of a Community if client picks dwindle.

“One Of The major targets of the Reasonably Priced Care Act Was to restore competition within the health insurance sector,” mentioned David Balto, a former policy director on the Federal Exchange Fee who’s now in private follow in Washington. “This consolidation will reverse these beneficial properties of the Reasonably Priced Care Act.”

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Anthem Agrees to Buy Cigna for $48.4 Billion

Published on July 24, 2015 by in News

Deal, which needs regulatory approval, would help reshape health insurance industry

wsjBy: Dana Mattioli, Liz Hoffman and Chelsey Dulaney

Wall Street Journal

07/24/2015

Anthem Inc. agreed to buy Cigna Corp. for $48.4 billion in a transaction that, along with a previously proposed combination of rivals, could reshape the U.S. health-insurance industry.

The deal, which follows months of speculation and at-times contentious talks, combines the second- and fifth-largest health insurers by revenue and merges two companies with a huge footprint in commercial insurance, the type of coverage provided to employers and consumers.

The merged company is projected to have around $115 billion in annual revenue and cover about 53.2 million people. The deal and its price was first reported by The Wall Street Journal earlier this week.

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Anthem Nears Deal to Buy Cigna for $48 Billion

Published on July 23, 2015 by in News

By: Dana Mattioli, Liz Hoffman and Anna Wilde Mathewswsj

July 22, 2015

The Wall Street Journal

Anthem Inc. is nearing a deal to buy Cigna Corp. for more than $48 billion in a transaction that along with a previously proposed combination of rivals would shrink the five largest U.S. health insurers to just three.

Anthem, based in Indianapolis, is expected to pay about $188 a share for Cigna, of Bloomfield, Conn., according to people familiar with the matter. A deal between the two companies could be announced as soon as Thursday afternoon, one of the people said. The agreement hasn’t been signed, and it is possible that the timing could be delayed or deal terms changed.

The tie-up of Anthem and Cigna would accelerate the rapid-fire reconfiguration at the top of the U.S. managed-care industry. The biggest companies are seeking more cost efficiency and scale as the health-care landscape changes because of the Affordable Care Act and other factors.

The expected deal follows by about three weeks Aetna Inc.’s agreement to buy Humana Inc. for $34 billion. In a sign of the takeover frenzy among big health insurers, Cigna also vied for Humana but failed to arrange a cash-heavy offer that Humana had requested, people familiar with the matter said.

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Oxendine lawsuit says Blue Cross overcharges for insurance

Published on July 22, 2015 by in News

LogoAtlantaJournalConstitutionBy: James Salzer

The Atlanta Journal-Constitution

07/21/2015

Suit alleges: Blue Cross overcharges customers, underpays doctors | www.myajc.com

Blue Cross and Blue Shield of Georgia has overcharged customers for health insurance while at the same time cutting payments to doctors outside of their coverage “network,” according to a lawsuit filed this week that seeks class-action status.

Former Georgia Insurance Commissioner John Oxendine filed the lawsuit on behalf of 11 surgical centers, their patients and a claims filing service. It argues that the state’s largest health insurer cut payments to doctors but continued charging consumers a premium rate as if they were still making the higher provider payments.

Oxendine, who said hundreds of millions of dollars may be at stake, has also asked his successor to investigate.

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