I’m hosting a free webinar on Thursday. Here’s why you should tune in and how to register.

The webinar, "Safeguarding Health Care's Runaway Train: A Rescue Plan for Americans" is on Thursday, March 21, 2024 at 2:00 PM EST

About a year before I left Cigna, I was in a leadership meeting with the CEO. I remember that meeting for a single question a colleague asked our CEO: “Ed, what keeps you up at night?”

Without hesitation, Ed Hanway answered with one word: disintermediation.

He said he worried that the company’s employer customers would eventually come to view big health insurance companies as unnecessary middlemen. They would begin to question the industry’s “value proposition” and look for ways to push insurers aside.

He did not mention what might happen in Washington, even though at the time there was growing talk on the campaign trail about the need to pass sweeping health care reform. This was in 2008 and all the Democrats and even some Republicans were calling for big changes in health care, health insurance in particular. 

Two years after that meeting, major reforms did indeed begin to ripple through the industry when President Obama signed the Affordable Care Act into law, on March 23, 2010. That was 14 years ago this week. I would argue that the ACA has helped a lot of folks. It banned or restricted some common industry practices, like refusing to sell coverage to people with preexisting conditions. But–and it’s a very big but–it also incentivized big insurers to get even bigger and much more in control of our access to care. 

Today, a handful of investor-owned corporations, including Cigna, have bulked up to the point that I’m often asked if they’ve become too big to fail. Cigna and two of its rivals, UnitedHealth Group and CVS, which owns Aetna, now control 80% of the pharmacy benefit marketplace. Big insurers have become the biggest employers of doctors and have been on a buying spree of clinics and many other facilities in recent years. 

And along the way, few companies have rewarded shareholders as handsomely as big insurers have. A share of stock in UnitedHealth when the ACA was signed into law was valued at $26.82. As of last Friday, it was $490.82. The other companies have done almost as well, if not better, for their shareholders.

So are health insurers’ CEOs sleeping better at night? 

I’m not so sure–and not just because Washington, after a 14-year reprieve, is once again setting its sights on Big Insurance. A growing number of Democrats in Congress support legislation that would improve and expand traditional Medicare to cover all of us. But interesting things are happening in the private sector, too. Over the past year or so, I’ve seen growing evidence that disintermediation is, at long last, beginning to happen. Some employers and unions are waking up and realizing they can ditch the Cigna’s of the world and offer better benefits at less cost to their workers. Is it a private-sector trend that can be scaled and sustained enough to truly transform how we pay for and access health care in this country, or are the skids greased so well for insurers that nothing can derail their ambitions? 

This Thursday, HEALTH CARE un-covered, with support from the Validation Institute, will host an hourlong webinar to explore all that. I’ll be moderating a panel of experts who are as up to speed on what’s happening in the world of health insurance and health care delivery as anybody I’ve come across. Chris Deacon, Jeff Hogan, and Brian Klepper have many decades of experience among them working, as I did, inside the beast or in close proximity to it and are now trying to get employers, unions and health care providers to take steps to remove the shackles big corporations have put all of us in.

Regardless of whether you support Medicare for All or more of a “free market” approach to reform, you need to stay abreast of what’s happening behind the scenes on all fronts.

If all goes as planned, this will be the first of an ongoing series of webinars with experts in every facet of U.S. health care. I see it as an extension of the kind of insightful journalism we’ve been producing through HEALTH CARE un-covered over the past several months. I hope you’ll join us!