Â鶹ŮÓÅ

Cigna and Humana are in talks for a combination that would create a new powerhouse in the health-insurance industry. The companies are discussing a stock-and-cash deal that could be finalized by the end of the year, assuming the talks don’t fall apart, according to people familiar with the matter. While the structure and terms under discussion couldn’t be learned, a merger of the managed-care providers would be huge, and give rise to a company worth some $140 billion given Cigna’s market value Wednesday morning of about $83 billion and Humana’s of roughly $62 billion.  (Thomas, Mathews and Cooper, 11/29)

A proposed transaction would almost certainly prompt a close review from antitrust enforcers at the Department of Justice and the Federal Trade Commission. A merged Cigna-Humana would further consolidate the market for pharmacy benefit managers. PBMs are companies that serve as the controversial middlemen of drug pricing negotiations, and of the four largest, two are owned by Cigna and Humana. (Herman, Bannow and Trang, 11/29)

Reports that Cigna is eyeing a major Medicare Advantage move have provoked speculation about the health insurance company's plans for the lucrative market. Citing sources in the banking sector, Reuters reported this month that Cigna was seeking a buyer for its Medicare Advantage business. Subsequently, an analyst at the investment bank Stephens wrote that such a deal may be a precursor to a bold action: acquiring Humana, the second-largest Medicare Advantage carrier by membership. Medicare makes up a meager portion of Cigna's business. The insurer has about 600,000 Medicare Advantage enrollees this year, which amounts to 2% of the market, according to federal data compiled by Â鶹ŮÓÅ. Humana's 5.5 million members and 18% share are the most behind UnitedHealth Group subsidiary UnitedHealthcare's 8.9 million and 29%. (Berryman, 11/29)

Republican lawmakers may not be thrilled with former President Trump's renewed push to repeal and replace Obamacare — but few are firmly ruling it out. The Affordable Care Act has become more popular and even more entrenched in the health care system since the GOP's failed repeal attempt in 2017 contributed to Democrats' big electoral gains the following year. (Sullivan, 11/30)

The Biden administration is appealing a court ruling against a Trump-era regulation that aimed to protect the way health insurance companies handle some prescription drug costs — a rare moment of harmony between the two administration’s approaches to drug pricing reform. (Wilkerson, 11/29)

UnitedHealth Group has about 90,000 employed or affiliated doctors, approximately 10% of all physicians in the U.S. The number — disclosed Wednesday at the company’s investor day by Amar Desai, the CEO of UnitedHealth’s Optum Health division — means the company acquired or hired 20,000 doctors in the past year alone. (Herman, 11/29)

Â鶹ŮÓÅ Health News: Medicare Advantage Increasingly Popular With Seniors — But Not Hospitals And Doctors

A hospital system in Georgia. Two medical groups in San Diego. Another in Louisville, Kentucky, and nearly one-third of Nebraska hospitals. Across the country, health care providers are refusing to accept some Medicare Advantage plans — even as the coverage offered by commercial insurers increasingly displaces the traditional government program for seniors and people with disabilities. As of this year, commercial insurers have enticed just over half of all Medicare beneficiaries — or nearly 31 million people — to sign up for their plans instead of traditional Medicare. The plans typically include drug coverage as well as extras like vision and dental benefits, many at low or even zero additional monthly premiums compared with traditional Medicare. (Appleby, 11/29)

Â鶹ŮÓÅ Health News: Uncle Sam Wants You ... To Help Stop Insurers’ Bogus Medicare Advantage Sales Tactics

After an unprecedented crackdown on misleading advertising claims by insurers selling private Medicare Advantage and drug plans, the Biden administration hopes to unleash a special weapon to make sure companies follow the new rules: you. Officials at the Centers for Medicare & Medicaid Services are encouraging seniors and other members of the public to become fraud detectives by reporting misleading or deceptive sales tactics to 800-MEDICARE, the agency’s 24-hour information hotline. Suspects include postcards designed to look like they’re from the government and TV ads with celebrities promising benefits and low fees that are available only to some people in certain counties. (Jaffe, 11/30)

Â鶹ŮÓÅ Health News: Â鶹ŮÓÅ Health News' 'An Arm and a Leg': To Get Health Insurance, This Couple Made A Movie 

Last fall, Ellen Haun and Dru Johnston were hustling to get their health insurance sorted out for 2023. The Hollywood couple are members of SAG-AFTRA, the union representing actors and writers. Members have to earn about $26,000 a year on union projects to be eligible for union insurance. And Haun was about $800 short. (11/30)