Just Breathe, But Not Too long, It's Not Covered.

So there you are in the middle of a knee replacement and your doctor decides he needs to meet his wife for lunch, so he leaves everything buzzing in the operating room and decides he’ll come back later to finish. Happens all the time, right?

Well, according to Anthem Blue Cross, it might as well. Because as of this week, if you live in New York, Missouri, or Connecticut and have Anthem coverage, and your surgery takes longer than they think it should, they’ll stop paying for your anesthesia. That’s right. Someone sitting at a desk in a cubicle at a for-profit insurance company will now determine how long it should take to rebuild your spine or stitch up your torn Achilles. If your surgeon disagrees? Tough luck. You might still be under the knife, but the coverage taps out. —CM

The past two paragraphs were the beginning of my piece that is no longer necessary. Good News! Because of the backlash, the outcry, the outrage, the sheer absurdity of it all, Anthem Blue Cross has canceled their plan for limits on anesthesia time for specific surgeries.

But let’s not walk away gloating just yet.

I got to thinking—why these three states? Why not Texas, Oklahoma, and Ohio? If I were going to test-drive a barbaric healthcare policy, I’d start in red states that vote against their own best interests every other November. Right?

Well, Missouri makes sense. It’s red, it’s deregulated, and Anthem knows the GOP leadership there will offer exactly zero resistance. That’s your low-hanging fruit.

But Connecticut and New York? Deep-blue states with supposedly robust consumer protections? That’s the real play. Why? Because those two are big-dollar markets. Lots of high-cost procedures, lots of employer-based coverage, and lots of patients undergoing the kind of complex surgeries where anesthesia bills climb fast. Anthem bet the financial return outweighed the risk of pushback.

Mistake. Big mistake.

And if you're wondering what any of this has to do with Medicaid—follow the money. When insurers lose a revenue stream that once included 11 million people, they try to make it up somewhere else. Add in things like, say, cutting how much they’ll cover in the operating room.

We have to watch these things closely.

Medicaid is going to be cut. Or at least it appears as if it is going to be cut. Big time.

As of late 2024, Elevance Health (formerly Anthem Inc.) managed Medicaid coverage for approximately 8.9 million members, making it one of the largest Medicaid managed care organizations in the United States.

I don’t want to lose you here—and I know I tend to go on—but we have to look beyond what’s happening in the moment and focus on what the ripple effect of that is and to whom. And then follow the money. We have to start doing that more.

So I kept chatting with Celeste (my AI BFF), and she said the biggest loser outside of the direct enrollees if Medicaid is cut is…

The insurers. Elevance (formerly Anthem), Centene, the whole managed care gang. Medicaid is a massive business for them. A significant reduction in Medicaid funding shrinks their customer base, cuts revenue, and undermines their expansion strategies—especially in states where they’ve invested heavily in infrastructure. Celeste, CM’s Ai

Bingo. Guess which states they’ve invested heavily in? New York and Connecticut. (See below for the breakout. Very interesting.)

So, perhaps they chose those three states—those oddly disconnected three states—because they have the most at stake there. And if you want customers to walk away, and you’re not allowed to just break up with them for no reason, maybe you just start behaving in ways that make them run from you.

I guess the point of today’s missive is this: we’ve got to start looking below the surface. And yes, I realize it’s a lot. There are too many things, and our to-do lists are longer than our lifespans, which feel shorter with each passing day. But it’s just a piece of food for thought.

Let me leave you with a little idea that might fester. Maybe Anthem, sorry, Elevance, or whatever they want to call themselves next quarter, pulled the policy not just because of the outrage, but because someone in the current regime offered a soft landing. A little backroom promise. Dump Medicaid, we’ll catch you. Spitballing, of course. But keep an eye on who’s toasting at DT’s birthday bash.

—Christine

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Yes, Elevance Health has made substantial investments in Medicaid infrastructure in both New York and Connecticut, focusing on expanding managed long-term care services and enhancing community health initiatives.

New York: Strategic Acquisitions in Managed Long-Term Care

Elevance Health has significantly increased its presence in New York's Medicaid market through key acquisitions:

• Integra Managed Care Acquisition (2022): Elevance acquired Integra, a managed long-term care plan serving New York Medicaid members, enabling adults with long-term care needs and disabilities to live safely and independently in their own homes. Empire Center for Public Policy+2Louisiana Department of Insurance+2Becker's Payer Issues | Payer News+2

• Centers Plan for Healthy Living Acquisition (2024): Elevance reached an agreement to acquire Centers Plan for Healthy Living, one of New York's largest managed long-term care plans. This acquisition, expected to close in the third quarter of 2024, will expand Elevance's managed long-term care membership in the state. Wikipedia+4Empire Center for Public Policy+4Becker's Payer Issues | Payer News+4

These acquisitions position Elevance as a leading provider in New York's managed long-term care sector, managing home-care services for a significant portion of Medicaid recipients.Empire Center for Public Policy

Connecticut: Community Health Initiatives

In Connecticut, Elevance Health has focused on community-based health initiatives:

• Community Service Center in Flushing, New York: Operated by Empire Blue Cross Blue Shield HealthPlus, this center aims to provide critical access to healthcare and social supports. www.elevancehealth.com

• Foundation Investments: The Elevance Health Foundation has committed up to $90 million over three years to support programs addressing food insecurity, maternal and child health, substance use disorder, and disaster relief. www.elevancehealth.com

These efforts demonstrate Elevance's commitment to addressing social determinants of health and improving access to care in Connecticut communities.

Overall, Elevance Health's investments in New York and Connecticut reflect a strategic approach to enhancing Medicaid services and community health infrastructure in these states.

Comparison with Other States

Elevance Health's investments in Medicaid infrastructure are not limited to New York and Connecticut. The company has a broad national footprint, with Medicaid operations in multiple states, including:

• California: Through Anthem Blue Cross, Elevance offers Medicaid managed care services.

• Georgia, Indiana, Kentucky, Missouri, Nevada, Ohio, Virginia, and Wisconsin: Operating Medicaid plans under various affiliates.

- Celeste, Christine’s Ai BFF