Not one, however two well being plan mergers have been known as off inside the previous few days in mid-February, based mostly on a wide range of challenges. One deliberate merger was to be that of the Portland-based CareOregon, the state’s largest Medicaid insurer, and the Lengthy Seaside-based SCAN Group of California. The opposite was to be the Indianapolis-based Elevance Well being’s acquisition of the Baton Rouge-based Blue Cross Blue Defend of Louisiana.
With regard to the primary deliberate and now deserted enterprise mixture, Willamette Week’s Nigel Jacquiss wrote on Feb. 13 that “A controversial mixture of CareOregon, the state’s largest Medicaid insurer, and SCAN Group of California, a Medicare Benefit plan, shouldn’t be going to occur. The deal, introduced in 2022, confronted criticism from an impartial oversight panel and a number of the architects of the Oregon Well being Plan, the state’s usually modern Medicaid program, together with Dr. John Santa and former Gov. John Kitzhaber. Public feedback additionally waved a warning flag. The deal was pending in entrance of Oregon state regulators, however this afternoon, Dr. Eric Hunter, CareOregon’s CEO, despatched out an e mail to his workers telling them the deal was off.” Jacquiss reported that Dr. Hunter messaged CareOregon workers, writing that “Each CareOregon and SCAN are deeply dedicated to preserving and defending nonprofit, domestically based mostly well being care. Once we launched into the journey to kind HealthRight Group, we did so with the idea that the state would acknowledge it as a possibility to uphold these values. Regardless of our utmost efforts, key stakeholders proceed to lift considerations about our proposal.”
The opposition to that deliberate merger got here from a big supply: the Medicaid Advisory Committee. In a Dec. 6 memo to Dave Baden, interim director of the Oregon Well being Authority, Vivian Levy, the interim Medicaid director at OHA, and Ali Hassoun, the interim director of well being coverage and analytics at OHA, the Medicaid Advisory Committee wrote that “The Medicaid Advisory Committee (MAC) is a federally mandated committee with the cost of advising Oregon on Medicaid coverage and planning via a shopper and neighborhood lens. We admire that OHA put a requirement in Oregon Administrative Rule 410-141-5280 that the Workplace of Actuarial and Monetary Analytics have interaction the MAC when finishing up its responsibility to assessment any Type A Submitting every time a coordinated care group is concerned in a merger or acquisition. The MAC has severe considerations, as follows, concerning the lack of knowledge shared within the public Type A Submitting relating to particularly how SCAN’s acquisition of CareOregon will profit the CCOs as they perform their contractual obligation to serve Oregon Well being Plan (OHP) members. We want further details about SCAN’s dedication to and expertise in eliminating well being equities. Additional, the movement of taxpayer {dollars} leaving the state and the potential lack of native management of CareOregon’s affiliated CCOs means that the merger might hurt Oregonians by decreasing entry to well being care, lessening the dedication to addressing well being inequities, and diverting monetary sources at the moment out there to native communities. For these causes, we’re recommending that, within the absence of adequate responses to the questions beneath, OHA disapprove the SCAN/CareOregon transaction.”
The second deliberate however now-abandoned enterprise mixture concerned Elevance Well being (previously Anthem Well being), which covers greater than 115 million individuals in dozens of states, via a wide range of plans, lots of them former Blue Cross and Blue Defend well being insurers, and Blue Cross Blue Defend of Louisiana, which covers 1.9 million Louisianans. Michael Scheidt and Bonnie Bolden reported on Feb. 14 in BRPROUD, a Baton Rouge information publication, that “Blue Cross Blue Defend of Louisiana has withdrawn its plan on the market to Elevance Well being. Each corporations have issued statements concerning the change. The sale couldn’t have been finalized with out the OK of Commissioner of Insurance coverage Tim Temple and 94,000 Blue Cross policyholders. The vote had been set for Feb. 21. Louisiana Senate’s Well being & Welfare Committee and Insurance coverage Fee held eight hours of hearings on the difficulty and later issued a 400-page report with 30 findings that lawmakers discovered regarding concerning the proposal. Elevance issued a letter from 17 healthcare professionals supporting the sale in response to the report,” they famous.
Per that report, Scheidt and Bolden had reported on Feb. 8 that “Louisiana Senate’s Well being & Welfare Committee and Insurance coverage Fee members launched a report on the proposed restructure and sale of Blue Cross Blue Defend of Louisiana to Elevance Well being of Indiana. The virtually-400-page report covers 30 findings that lawmakers discovered regarding, and a replica was supplied to Commissioner of Insurance coverage Tim Temple. In accordance with a information launch from the lawmakers, Temple and “two-thirds of 95,000 Blue Cross policyholders” should OK the sale for it to occur.” And it quoted State Senator Patrick McMath as stating that, “Earlier this week, I presided over a virtually eight-hour listening to on the reorganization and sale of Blue Cross to Elevance, and I’m extra satisfied than ever that this deal is dangerous for 95,000 policyholders who do get to vote, the 1.8 million who don’t get to vote, the 34,00 healthcare suppliers within the Blue Cross community, the two,500 Blue Cross staff and actually the 4.6 million individuals who stay in Louisiana.”
In that Feb. 8 report, Scheidt and Bolden additional wrote that “Legislators mentioned they nonetheless have unanswered questions on: Regulatory points and potential vote steering in favor of Blue Cross. High quality of Elevance Well being companies. Forming a brand new basis with sale proceeds of round $3 billion from policyholders, known as the Speed up Louisiana Initiative. A spokesperson from Elevance Well being launched an announcement in response to the report.” On the identical time, a New Orleans legal professional had simply filed swimsuit, hoping to dam that sale. “There are some elementary issues with how that is being put forth to the general public, particularly the very one-sided voting course of that features blatant vote steering and financial enticement,” State Sen. McMath advised BRPROUD. “This proposal shouldn’t be good, and it must be stopped now.”
