Lawmakers to probe health insurer profits

House lawmakers said Aug. 6 that they will launch an investigation into the business practices of health and dental insurance companies after many posted high profits in the second quarter of this year.

The profits were largely fueled by deferred medical care during the COVID-19 pandemic. Many elective surgeries and procedures that were set to take place in late March through April of this year, and again in July in some areas, were delayed or canceled.

Energy and Commerce Chairman Frank Pallone, Jr., D-N.J., cited a report from The New York Times that looked into how the pandemic-fueled deferments helped insurers' second quarter profits. UnitedHealth Group, Anthem and Cigna were among large commercial health insurers that recorded over $1 billion in profits during the second quarter.

Some of the profits may be going back to members. The ACA requires health insurers who spend less than 80 cents of every dollar on medical care to issue refunds — and some insurers already have. Still, Mr. Pallone said he believes "insurers should be doing more to help enrollees and providers immediately. This assistance could be through premium reductions, extending policies to eliminate cost-sharing for COVID-19 treatment through the end of the public health emergency and extending low or zero interest loans to community providers." 

In a response to The New York Times article and Mr. Pallone's announcement, America's Health Insurance Plans published a blog post comparing the pandemic to "a marathon, not a sprint." The trade group said treatment costs for growing COVID-19 cases continue to rise and future expenses related to vaccines "are not going to simply disappear." They added that many insurers have already waived cost-sharing for COVID-19 testing and treatment and expanded telehealth and mental health benefits.

The Energy and Commerce Committee said it is sending oversight letters to health and dental insurers in coming days. The letters include questions around compliance with statutes that require all cost-sharing for COVID-19 testing to be waived.

More articles on payers:
Fraudulent coding led CMS to overpay Cigna $1.4B, Justice Department says
UnitedHealth: 7 steps to the 'next-generation health system'
Which states haven't expanded Medicaid?

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