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Morning Briefing

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Wednesday, Apr 29 2015

Full Issue

Aetna May Reconsider 2016 Obamacare Rates If High Court Rejects Subsidies

Nonetheless, the nation's third largest insurer has increased its 2015 earnings forecast. Also in insurance company news, Anthem touts its effort to change how it pays primary care doctors as it delivers stronger-than-expected earnings. And Humana is helping members boost their health -- and hold down medical costs -- by developing health apps for mobile phones.

Aetna Inc, the third-largest U.S. health insurer, is submitting 2016 individual insurance rates to state regulators but said it might need to reexamine them after the U.S. Supreme Court rules on the legality of most Obamacare exchange subsidies. The nation's top court is expected to announce a decision in June on whether federal subsidies can stand in three dozen states where the U.S. government runs an enrollment website. Opponents of the law say the Affordable Care Act, or Obamacare, allows for subsidies only in states that run their own exchanges. (Humer, 4/28)

Aetna has hiked its 2015 forecast beyond analyst expectations after booking a 17-percent jump in first-quarter earnings, as enrollment gains and moderate medical cost growth helped the nation's third-largest health insurer. (4/28)

Aetna beat earnings estimates and recorded $777.5 million of profit in the first quarter of this year, prompting the Hartford, Conn.-based health insurer to raise profit predictions for the rest of the year. Aetna's overall medical-loss ratio declined year over year, from 80.4% to 79.1%. That shows Aetna paid about 79 cents in medical claims for every premium dollar it collected. Utilization of healthcare services did not increase as much as economists or insurance executives have predicted, and Aetna said it was able to build higher profits into its commercial and Medicare and Medicaid health plans. (Herman, 4/28)

Anthem Inc. said a major effort to overhaul how it pays primary-care doctors appears to be lowering overall health-care costs, as patients spend less time in the hospital. The second-biggest U.S. health insurer unveiled a high-profile program in 2012 that provided doctors with additional payments and an opportunity to earn more if they lowered the cost of patients’ care and met quality requirements. (Wilde Mathews, 4/28)

Anthem Inc., the second-biggest U.S. health insurer by market value, posted earnings that topped estimates as membership climbed. First-quarter operating earnings were $3.14 a share, beating the $2.68 average of 19 estimates surveyed by Bloomberg. ... Anthem, which changed its name from WellPoint last year, is among health insurers that are adjusting to new taxes and regulations under the Affordable Care Act. The health-care law also creates new customers for the firms, since it requires almost all Americans to carry health insurance. (Tracer, 4/29)

Insurance giant Humana Inc., whose earnings are under pressure from rising medical costs, has a prescription it hopes will bring it relief: helping its 13.8 million members improve their own health. That isn’t easy, given that people aren’t likely to stop smoking, eat better or get more exercise simply because a big company says they should. Humana is tackling these tough behavioral issues by reaching out to its customers where many of them more or less live—on their mobile phones. ... Across the street from its headquarters here, the insurer has set up a mobile-apps lab that designs tools like HumanaVitality, which lets people set personal health targets and challenge themselves or one another to fitness goals. (Loftus, 4/28)

Meanwhile, several drugmakers and health-related companies also reported first quarter results -

Cost-cutting and sales of new drugs helped Pfizer overcome a strong dollar and patent expirations to beat Wall Street projections for the first quarter, though it cut its outlook for the year, citing the unfavorable currency exchange rates. The world's second-biggest drugmaker on Tuesday said its 2015 profit forecast includes a negative impact of $3.3 billion from currency exchange, and another $3.5 billion from generic competition. Most major drugmakers have overcome multibillion-dollar revenue hits from the unprecedented wave of patent expirations that began in 2011, but Pfizer isn't out of the woods yet. One of its top sellers, pain and arthritis treatment Celebrex, just got much cheaper generic competition in the U.S. (Johnson, 4/28)

Genworth Financial Inc., which has been hurt recently by charges related to its long-term care business, reported lower first-quarter operating income but said it made progress in its review of strategic options. The goals of Genworth’s review include strengthening its mortgage-insurance businesses and its long-term care insurance capital, earnings and sales. (Beckerman, 4/28)

Boston Scientific Corp. swung to a loss in its first quarter, hurt by litigation costs and currency rate fluctuations. The medical-device maker on Tuesday also said it would pay $119 million to settle nearly 3,000 product liability lawsuits and claims related to its transvaginal surgical mesh products. More than 25,000 claims or suits over the devices have been made against Boston Scientific, the company has said in regulatory filings. (Walker and Beilfuss, 4/28)

As a measles outbreak that started in California grew from seven cases on Jan. 7 to more than 100 a month later, sales of Merck & Co.’s measles vaccine surged as well. From the first week the measles outbreak was in the news to a month later when cases neared their peak, the use of Merck’s M-M-R II vaccine more than quadruped to more than 4,000 a week, according to data compiled by Bloomberg. (Armstrong and Koons, 4/28)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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