Seven More Reasons Why Employers Want Out Of the Health Insurance Business

With the passage of the Affordable Care Act (ACA) effectively turning private health insurance plans into a de facto government utility managed by bureaucrats in far away places, plan sponsors have become increasingly subjected to freedom robbing government mandates and punishing sanctions.

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America’s Leading Writer of Innovative Insurance Programs

McGowan Program Administrators (MPA) is America’s leading writer of innovative insurance programs. MPA is a Managing General Underwriter and Program Manager. MPA designs, administers and markets highly-specialized programs of insurance. These programs are available exclusively through MPA. They are offered on “A” Rated, Admitted Paper and are available in all 50 states.

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Stay Tuned… FTC Seeks to Breathe Life Back Into Non-Compete Ban

Sean R. GallagherJason T. Weber and Ross T. Weimer

October 25, 2024

This past week, the FTC appealed a Texas federal court’s August ruling that blocked nationwide enforcement of the non-compete ban. The non-compete ban will remain blocked during the pendency of the appeal process. However, the outcome of the appeal will determine: (1) whether the non-compete ban remains blocked; and (2) the future scope of the FTC’s regulatory authority. There are three court challenges to the non-compete ban. The status of those challenges (including appeals) is detailed below:

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Cutting Waste In Government Controlled Healthcare

SOURCE: Efficiency Commission Would ‘Unburden’ Us from a Federal Healthcare Nightmare

“The American healthcare system is increasingly falling behind as critical funds are funneled into bureaucratic red tape rather than innovation. Administrative costs have exploded, diverting resources that could otherwise fuel groundbreaking medical advancements. Instead of prioritizing cutting-edge research and life-saving treatments, far too much healthcare spending is consumed by paperwork, compliance protocols, and outdated systems. This misallocation of funds stifles research, patient care, and global competitiveness.”

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Here’s The Company Who Decides Whether To Pay For Health Care for 100,000,000 Humans

Every day, patients across America crack open envelopes with bad news. Yet another health insurer has decided not to pay for a treatment that their doctor has recommended. Sometimes it’s a no for an MRI for a high school wrestler with a strained back. Sometimes for a cancer procedure that will help a grandmother with a throat tumor. Sometimes for a heart scan for a truck driver feeling short of breath.

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Aldeen’s Sunday Morning Bathroom Read

Send Lawyers, Guns and Money Part III

The American Medical Association recently oined the fray and sued Multiplan earlier this week in federal district court in Chicago. At issue is MultiPlan’s business model. Instead of determining their own out-of-network rates, insurers can outsource that function to MultiPlan, which promises to save them money on those claims. In many cases, MultiPlan uses an algorithm-based tool to recommend a payment level — and receives a portion of the difference between the recommendation and the original out-of-network bill, giving the company a financial incentive to recommend lower rates. The majority of U.S. insurers, including the 15 largest in the country, use MultiPlan to determine out-of-network payments.

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BCBS To Remove Houston’s MD Anderson From Medicare, Medicaid Networks

Blue Cross and Blue Shield of Texas to remove Houston’s MD Anderson Cancer Center from Medicare, Medicaid networks

HOUSTON – Blue Cross and Blue Shield of Texas announced it has made the decision to remove MD Anderson Cancer Center in Houston from its Medicare Advantage PPO, Blue Cross Medicare Advantage HMO, and Medicaid networks effective Nov. 1, 2024.

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Frontier Acquistion of Asserta Health Valued At $10,000,000

September 25, 2024

Bell Nunnally Represents Primary Care Network Frontier Direct Care in $10M Acquisition of Health Plan Provider Asserta Health

SOURCE: Bell Nunnally & Martin LLP

Bell Nunnally, led by Partner Ray A. Balestri and Senior Associate Joshua T. Smith, represented Harlingen, Texas-based primary care provider network Frontier Network, Inc. (d/b/a Frontier Direct Care) in its acquisition of Salt Lake City, Utah-based Asserta Health Inc. Asserta offers employers access to a cash-driven health plan, enabling self-insured and level funded employers to deliver health care benefits to their plan members. The deal, executed through stock-for-stock exchange, had an estimated value of $10 million.

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Seattle Hotel Owners Must Provide Employees With Families $20,232 Per Year In Health Care Benefit Access

2025 Seattle Hotel Employees Ordinance Expenditure Rates

SOURCE: 2025 Seattle Hotel Employees Ordinance Expenditure Rates

The Seattle Office of Labor Standards (“OLS”) announced the adjusted rates for 2025 health care expenditures required by the Improving Access to Medical Care Hotel Employees Ordinance, Seattle Municipal Code (SMC) 14.28.

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A Common Sense Alternative To TRS ActiveCare For Region One School Districts?

Most Texas school districts are unaware of a new health plan option that’s quickly fulfilling market demand across the country. “Why haven’t we heard about this? is a common question we get from district officials. “What is it and how does it work?” they ask. Dr. Eric Bricker explains it best in this short informative video.

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Oscar Health Announces 2025 Market Expansion to Put Health Insurance in the Hands of More Americans

NEW YORK–(BUSINESS WIRE)–Oscar Health, Inc. (“Oscar”) (NYSE: OSCR), a leading healthcare technology company, today announced it will bring the Oscar experience to more individuals, families, and businesses through the ACA marketplace in 2025. Oscar is introducing affordable health insurance products that empower people to pursue a healthy life on their terms with:

  • Services built around personal health needs and preferences.
  • Established networks providing multiple paths to high-value clinical care.
  • Technology solutions to help members manage their health and make informed choices.
Continue reading Oscar Health Announces 2025 Market Expansion to Put Health Insurance in the Hands of More Americans

Anatomy of Public Entity Insurance Corruption

“The only way that we would be able to get into any school district was to be able to directly have a relationship with the decisionmakers — the school board, the trustees. We wouldn’t waste time on people where we couldn’t make money. We would contribute to the opponent of those (board members) who did not vote for us.” – Criminal Turned FBI Informant

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MONUMENTAL SETTLEMENT ANNOUNCED IN PROVIDER BLUE CROSS BLUE SHIELD ANTITRUST CASE

My Moma always said “Lawyers Have More Fun!”

SOURCE: Whatley Kallas

October 14, 2024 

FOR IMMEDIATE RELEASE: October 14, 2024

BIRMINGHAM, AL – Today a monumental settlement was announced by Whatley Kallas, LLP, Co-Lead Counsel, in a long-running antitrust lawsuit filed on behalf of healthcare providers across the nation. The settlement with all the Blue Cross and Blue Shield entities in the country, as well as the Blue Cross and Blue Shield Association, provides billions of dollars for healthcare providers and is the largest antitrust settlement in the history of the United States healthcare industry. The settlement includes a $2.8 billion cash payment into a settlement fund, as well as investments by the Blues of hundreds of millions of dollars in system improvements for the benefit of providers. Provider Plaintiffs have asked the court to preliminarily approve the settlement, which would resolve their claims that the Blues violated the antitrust laws by, among other things, agreeing to allocate markets through the use of exclusive service areas and to fix the prices paid to providers through the BlueCard Program.

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What’s The Difference Between Pre-Tax and Post-Tax?

SOURCE: Pre-Tax Versus Post-Tax

The hidden impact of taxes: 35% or more

Let’s say you decide to give your employees an extra $200 each month (totaling $2,400 per year) to help with their health insurance premiums. The amount they can actually use is a lot less, thanks to those pesky payroll and income taxes. How much so?

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Large Employer Adoption of ICHRA Is Growing Exponentially

ICHRA BLITZKREIG DEFEATS LEGACY GROUP HEALTH PLANS

“Entering their fifth year as a tax-advantaged solution for employer-sponsored insurance, Individual Coverage Health Reimbursement Arrangements (ICHRAs) had nearly 30% year over-year growth from 2023 to 2024, with Applicable Large Employers (ALEs) as the fastest growing cohort.”

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Thatch

Holy Smoke! Another ICHRA Administrator Shows Up In The Market! We are beginning to lose count……………..

“Getting healthcare for your business is a pain. Talking to brokers, picking a plan and benefits, managing issues that arise, open enrollment — it’s a lot of work. And as your team grows, it only gets harder and more time-consuming.”

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KFF Releases 2024 Employer Health Benefits Survey


GLP-1 Coverage, Family Annual Cost Exceeds $25,000, More

Source: Survey Report

This is the 26th annual Employer Health Benefits Survey. As in years past, the survey examines trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, offer rates, wellness programs, and employer practices.

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Excess Re’s Underwriting Performance Earns “Excellent” Rating

AM Best affirms PA-2 rating for Excess Re, outlook stable

Source:  Reinsurance Business,

AM Best has affirmed the PA-2 (Excellent) Performance Assessment of Excess Reinsurance Underwriters Inc. (Excess Re), based in Woodbury, N.J. The outlook for the assessment remains stable.

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The Trap of Employer-Sponsored Health Insurance: Time to Empower Patients

Congress should shift the tax advantage from employers to employees to empower patients.

“The system has ballooned into an inefficient approach that inflates costs and reduces consumer choice. If the tax advantage were transferred from employer to employee, this would expand the usefulness of these funds to pay for medical expenses.”

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Glenview Capital Seeks To Revive Aetna/CVS Stock Price

Health Care Is A Profit Driven Business

  • CVS Health’s board has engaged advisors to conduct a strategic review of its business, according to people familiar with the matter.
  • The review has been ongoing for some time, said the people, but there is no certainty on what actions, if any, the company will take.
Continue reading Glenview Capital Seeks To Revive Aetna/CVS Stock Price