With Threats to Payors' Market Power, Trade Group Hires High-Ranking Antitrust Regulator

With insurers nervous about possible loosened antitrust regulations for providers and stronger enforcement against payors, the industry's trade group has hired a high-ranking attorney in the Antitrust Division of the U.S. Department of Justice to be its new general counsel, according to a report by The Hill.

Joseph Miller, the new general counsel of America's Health Insurance Plans, has been the assistant chief of the litigating section of the Antitrust Division and has responsibility over healthcare and health insurance.

Concerns about ACO market power
Payors are very nervous that ACOs will have overwhelming negotiating clout. In a September letter to CMS, AHIP cautioned federal regulators against loosening antitrust and fraud regulations to accommodate ACOs. The letter said ACOs should not be developed "for the primary purpose of joint negotiation or amassing market power to raise prices." A new white paper released by AHIP recommends an ACO should cover no more than 20 percent of providers in its market to prevent it from driving up costs.

AHIP's warnings do not appear to be having an effect. Officials close to CMS planning for ACOs have said the Federal Trade Commission and Justice Department are now committed to making ACOs work and that the FTC has even sent a senior attorney to work within CMS on ACO planning.

Payor mergers face more scrutiny
Meanwhile, payors are facing a more scrutiny of their own mergers. In a speech before members of the American Bar Association delivered in May, Christine A. Varney, assistant attorney general for the Justice Department's Antitrust Division, warned her office would step up scrutiny of mergers of large payors. She also repeated the Obama Administration's aim to repeal the McCarran-Ferguson Act, which partially exempts insurance companies from antitrust laws and leaves regulation of payors with the states. Bills have also been introduced in the House and Senate to repeal the act.

"The rhetoric surrounding repeal of McCarran-Ferguson does not match the reality of the situation," AHIP President and CEO Karen Ignagni said in a February statement. "The Act is extremely limited in scope and has nothing to do with competition within the health insurance industry. In fact, a wide range of insurer activities, including mergers and many types of business practices, are and always have been subject to federal antitrust laws and to enforcement by the Department of Justice."

Read The Hill report on payors.

Read other coverage about accountable care organizations:

- Payors: ACOs Should Cover No More Than 20% of Providers

- FTC Committed to Making ACOs Work

- 5 Things to Know About the DOJ's Healthcare Antitrust Enforcement and Competition Policy

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