"Creating a new set of health plans that look identical to other plans but with capped reimbursement rates does not address the underlying high costs of care, and will only serve to raise costs outside of the individual market as health care providers seek higher reimbursements to remain whole." — AHIP.

Under Nevada's new Public Option, small businesses and state residents who make more than 138% of the federal poverty level — the upper limit of Medicaid eligibility — could purchase a plan from bidding commercial payers. Despite pushback, it is unlikely that the state's largest plans would decline to participate. Contributing writer Laura Beerman has this report.

Also this week, UnitedHealthcare's attempt to "Monday morning quarterback" emergency room visits by retroactively denying emergency claims is not only likely a violation of the prudent layperson standard, but also "bad policy" for several reasons, says Doug Wolfe, co-founder and partner of the Miami-based law firm Wolfe Pincavage. Alexandra Wilson Pecci reports.

Nevada's Public Option Continues Healthcare's Cost Versus Coverage Debate

Opponents' primary argument is that covering the uninsured, while noble, fails to address healthcare's other related albatross—skyrocketing costs, including for prescription drugs—with fixed premiums and lower reimbursement rates applying further constraints.

4 Reasons Why UnitedHealthcare's Attempt to 'Monday morning quarterback' ED claims is 'bad policy'

"It really undermines what the physicians are doing at the point of care, and it's bad policy," says Doug Wolfe, co-founder and partner of the Miami-based law firm Wolfe Pincavage.

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Health Plans and Provider Organizations Need Excess Risk Coverage Too

In a market that continues to see significant growth in catastrophic claim costs, provider organizations, HMOs and other health plans that want to protect their bottom line should consider excess risk coverage.

Biden Order Pushes Competition, Targets Healthcare Consolidation, High Drug Costs

The executive order targets four areas "where lack of competition in healthcare increases prices and reduces access to quality care" -- hospital and health insurance consolidation, high drug prices, and hearing aids.

Payer Launches Joint Venture to Support Independent Physician Practices

The new joint venture in North Carolina will help independent physician practices by easing administrative burdens and bolstering value-based care capabilities.

CMS Announces New Director of Center for Medicare

Meena Seshamani, MD, PhD will serve as Deputy Administrator and Director of Center for Medicare and will lead the Center's efforts for those who rely on Medicare coverage.

Effort to Decipher Hospital Prices Yields Key Finding: Don't Try It at Home

A series of columns by Bernard J. Wolfson addresses the challenges consumers face in California's healthcare landscape.

Must Reads

Georgia pushes back on reevaluation of health plan — AP News
Highmark, stoking membership growth, wants to buy all of Gateway Health — Pittsburgh Post-Gazette
Iowa Medicaid officials to seek another Medicaid managed care organization — Iowa Public Radio
Amazon is trying to persuade Aetna and other health plans to cover its medical-care service, but it stumbled out of the gate — Business Insider
HealthEC's health data helps physician groups thrive at insurance contract time — ROI-NJ
Opinion: States, including Missouri, can't afford Medicaid expansion — The Missouri Times

That's all for this week's Payer Briefing.

We'll be back in your mailbox next Monday with more news and reporting on the business of health insurance.

Check our website frequently throughout the day for updates. And, remember to sign up for our E-newsletters to keep you informed on the top industry trends, challenges, and opportunities.

If you've got news tips, thoughts, or suggestions, I'd love to hear from you at jcommins@healthleadersmedia.com.

Stay safe!

John Commins
Senior Editor

@ComminsCom