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Health Insurance Mergers

On this week’s episode I continued my monthly series with Medical Association of Georgia. MAG CEO, Donald Palmisano, Jr., and MAG delegate from Bibb County, Dr. John Rogers joined me in studio to talk about the challenges and concerns arising from recently-proposed mergers between large health insurance companies that will significantly reduce amount of competition in the space for Georgians to choose from.

Aetna/Humana and Anthem/Cigna are in the process of merging. At the same time, health insurers are offering insurance policies to the public that do not have adequate coverage resulting in more out of network charges by physicians.

Aetna/Humana and Wellpoint/Cigna have proposed mergers in the health insurance market. If these inadequate policies are being offered in the current environment, MAG is concerned about how patients will be negatively impacted with a further narrowing of the networks and increased physician reliance on out of network charges.

MAG recently sent a letter to the U.S. Department of Justice to call for it to scrutinize the mergers for antitrust violations.

MAG believes the mergers would reduce competition and place physicians and their patients at an even greater disadvantage as a shrinking number of health insurance companies gain increasingly-dominant positions in the marketplace.

The new Aetna (58 percent) and Anthem (30 percent) entities would control nearly 90 percent of the individual market in Georgia. In the small group market, Aetna would control more than 49 percent, while Anthem would control more than 33 percent. Each new company would control about 26 percent of the Medicare Title XVIII marketplace. And for large group market, Aetna would control more than 12 percent while Anthem would control nearly 55 percent.

Physicians have little-to-no leverage to negotiate contract terms with these multi-billion dollar conglomerates – which are imposing take-it-or-leave it agreements and unilateral, mid-term amendments with growing impunity.

Gone unchecked, a few insurers will be in a position to manipulate the marketplace to institute policies that will exacerbate the physician shortage and undermine the economic viability of the practice environment in the state and limit the accessibility of care and individual patient choice.

Georgia Department of Insurance has expressed concerns that the Aetna/Humana merger would violate Georgia’s standards for competition. Specifically, DOI has shared that the Aetna/Humana merger may violate Georgia’s competitive standard in the individual, small group, and Medicare Title XVIII markets while raising concerns of substantially reduced competition in the large group market.

More than 30 percent of the physicians in Georgia who participated in a survey that MAG conducted in the last several months said that they believe that the Aetna/Humana merger would threaten the long-term viability of their practice.

Special Guests:

Donald Palmisano, CEO, Executive Director of Medical Association of Georgia     

• JD Law, Loyola School of Law
• Board of Directors, Physician Advocacy Institute
• Medical Payment Subcommitte Member, State Board of Workers’ Compensation
• Treasurer, Board of Directors, Physicians’ Institute for Excellence in Medicine
• Former Director, Government Relations/General Counsel/Director, GAMPAC

Dr. John Rogers, Co-Medical Director, Coliseum Northside Hospital

• Member, Board of Directors, Bibb County Medical Society
• Vice President, American College of Emergency Physicians
• Doctor of Medicine, University of Iowa Carver College of Medicine
• Residency, Medical Center of Central Georgia