By: John Kennedy

Law 360

10/12/2016

Law360, New York (October 12, 2016, 4:24 PM EDT) — Three months after the Sixth Circuit vacated a $30 million federal class action settlement resolving antitrust claims against Blue Cross Blue Shield of Michigan, the parties on Tuesday unveiled a new settlement agreement for the same amount of money.

Under the amended deal, BCBS Michigan denies all claims and says it decided to settle the six-year-old case to avoid further expenses and the burden of litigation. The plaintiffs — direct purchasers of allegedly overpriced health care services — said that a settlement is in the best interest of the class.

The Sixth Circuit remanded the case in early July, vacating the Michigan federal court’s approval of the settlement after 26 self-insured companies whose health care claims had been administered by BCBS Michigan objected to the process under which the previous settlement was reached.

They’d claimed that hundreds of documents had been kept sealed and out of public view and that the settlement itself provided only meager relief to about 8 million potential class members. In its July ruling, the Sixth Circuit also vacated the district court’s orders sealing the documents in question.

In August, U.S. District Judge Denise Page Hood denied the 26 companies’ request to intervene in the suit as it proceeded on remand, finding that the Sixth Circuit’s opinion hadn’t addressed their right to intervene, only the unsealing of court records.

The Sixth Circuit didn’t indicate that the parties had to renegotiate the settlement or conduct further discovery to present a new settlement proposal. Instead, the panel told the district court to start the approval process anew, the judge said.

The case dates back to 2010 and was one of several actions challenging the insurer’s use of “most favored nation” clauses, which require hospitals to charge BCBS’ rival insurers at least as much as they charged BCBS Michigan. In exchange for the clauses, the insurer agreed to pay the hospitals higher rates, the suit said.

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By: Michael Hiltzik

LA TIMES

1/23/17

Aetna claimed this summer that it was pulling out of all but four of the 15 states where it was providing Obamacare individual insurance because of a business decision — it was simply losing too much money on the Obamacare exchanges.

Now a federal judge has ruled that that was a rank falsehood. In fact, says Judge John D. Bates, Aetna made its decision at least partially in response to a federal antitrust lawsuit blocking its proposed $37-billion merger with Humana. Aetna threatened federal officials with the pullout before the lawsuit was filed, and followed through on its threat once it was filed. Bates made the observations in the course of a ruling he issued Monday blocking the merger.

Aetna executives had moved heaven and earth to conceal their decision-making process from the court, in part by discussing the matter on the phone rather than in emails, and by shielding what did get put in writing with the cloak of attorney-client privilege, a practice Bates found came close to “malfeasance.”

The judge’s conclusions about Aetna’s real reasons for pulling out of Obamacare — as opposed to the rationalization the company made in public — are crucial for the debate over the fate of the Affordable Care Act. That’s because the company’s withdrawal has been exploited by Republicans to justify repealing the act. Just last week, House Speaker Paul Ryan (R-Wis.) cited Aetna’s action on the “Charlie Rose” show, saying that it proved how shaky the exchanges were.

Bates found that this rationalization was largely untrue. In fact, he noted, Aetna pulled out of some states and counties that were actually profitable to make a point in its lawsuit defense — and then misled the public about its motivations. Bates’ analysis relies in part on a “smoking gun” letter to the Justice Department in which Chief Executive Mark Bertolini explicitly ties Aetna’s participation in Obamacare to the DOJ’s actions on the merger, which we reported in August. But it goes much further.

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By: James F. Peltz

1/23/2017

LA Time

The proposed $34-billion merger of Aetna Inc. and Humana Inc. to form one of the nation’s largest health insurers was blocked Monday by a federal judge on antitrust grounds.

The ruling by U.S. District Judge John Bates in the District of Columbia was a victory for the Justice Department, which under the Obama administration sued to stop the deal.

In his decision, Bates agreed with the agency’s assertion that the deal would threaten competition, especially in the market for seniors who buy privately operated Medicare health plans called Medicare Advantage.

“Federal regulation would likely be insufficient to prevent the merged firm from raising prices or reducing benefits,” and there is “valuable head-to-head competition between Aetna and Humana which the merger would eliminate,” Bates wrote.

His decision raises questions about whether another huge health-insurance merger, Anthem Inc.’s proposed $48-billion purchase of Cigna Corp., might be in peril as well. The Justice Department also sued to block that deal for antitrust reasons; the case is being heard by a different judge.

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Judge rules that proposed health-insurance merger is anticompetitive

By: BRENT KENDALL and ANNA WILDE MATHEWS

Updated Jan. 23, 2017 12:08 p.m. ET

Wall Street Journal

WASHINGTON—A federal judge Monday blocked the proposed merger of health insurers Aetna Inc. and Humana Inc. on antitrust grounds, a potentially fatal blow to the $34 billion deal and a capstone victory for Justice Department antitrust officials under former President Barack Obama.

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By: Josh Kosman

January 19,2017

A federal judge is expected to block a proposed mega-merger between Anthem and Cigna — a $54 billion deal that would create the nation’s biggest health insurer — as soon as Thursday, sources told The Post.

In what looked like a bid to get ahead of the judge’s smackdown, Anthem said in a public filing early Thursday it is extending the expiration of the merger agreement from Jan. 31 to April 30.

Indeed, sources said Anthem can appeal any ruling that doesn’t go its way. Insiders expect that US District of Columbia Judge Amy Berman Jackson will rule against it on antitrust concerns.

President Obama’s Department of Justice sued Anthem in July, alleging the merger would stifle competition in the US health care industry. The case went to trial in November.

A ruling by Jackson against the tie-up will likely spark a fight between the corporate giants. Cigna is looking to fight any merger extension as it looks to wiggle out of the deal and collect a $1.85 billion breakup fee from Anthem, according to insiders.

Cigna said in a statement that it had received notice of Anthem’s extension and that it would evaluate its options after the court ruling.

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By: Anna Claire Vollers

Al.com

1/12/2017

The political divide between most Alabamians and most San Francisco Bay Area residents is stark.

So is the difference in their average cost of health insurance.

During the Alabama/California Conversation Project, it came as no surprise to the women in the group that the Trump voters among them overwhelmingly opposed the Affordable Care Act – the health insurance overhaul also known as Obamacare – while the Clinton voters supported it.

But what did surprise them was the difference in how they personally experienced the health insurance system.

“I had no idea your insurance rates were worse than ours,” said Lisa Ann, a retired police officer from Sonoma County, north of San Francisco.

In general, health insurance costs are higher in Alabama, they’re rising more rapidly, and they account for a bigger chunk of household income than in California.

Some Alabamians in the group were surprised, too, that the Californians hadn’t experienced the kinds of premium and deductible increases they have in the past year. They told stories about friends and family who were paying more per month for insurance than they did for their mortgages, and about learning their premiums would rise again for 2017.

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By: Leada Gore

Al.com

CVS is no longer part of Blue Cross/Blue Shield of Alabama’s preferred pharmacy network.

Hundreds of thousands of Blue Cross and Blue Shield customers in Alabama who use CVS Pharmacy must find another place to fill prescriptions or face paying higher costs for their medications.

Starting Jan. 1, the preferred pharmacy network of Prime Therapeutics, the benefit manager owned by Blue Cross of Alabama and 13 other BC/BS groups, does not include CVS. The change means a portion of Blue Cross insurance customers who use CVS pharmacies may pay a higher co-pay amount – or even the entire cost of the prescription.

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