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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'> <img width=623 height=151 id="Picture_x0020_1" src="cid:image009.jpg@01D19402.9FC1F8F0" alt="Description: Description: Description: Description: CAL/AAEM: California Chapter of the American Academy of Emergency Medicine"><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><div style='margin-left:15.0pt;margin-top:7.5pt;margin-right:15.0pt;margin-bottom:7.5pt' id=content><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal><b><span style='font-size:11.0pt;font-family:"Arial",sans-serif;color:#7F7F7F'>March 30, 2016<o:p></o:p></span></b></p></div><div style='margin-top:11.25pt;margin-bottom:11.25pt'><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'><o:p> </o:p></span></b></p><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'>Anthem-Cigna Merger Proposal Takes A Grilling<o:p></o:p></span></b></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0000CC'><a href="http://californiahealthline.org/news/anthem-cigna-merger-proposal-takes-a-grilling/?utm_campaign=CHL%3A+Daily+Edition&utm_source=hs_email&utm_medium=email&utm_content=27849839&_hsenc=p2ANqtz--edBS_BVFc6AL6EQ1T7PIee0DdWPcK20sqox1owwkb54l90qQf3v0GKvWoEgnrU1go-iiayN6K1qA_ToqCF7q97kzdXwppBHmUfIs6PxhsitAXBNM&_hsmi=27849839"><span style='color:#0000CC'>California Healthline</span></a></span><span class=MsoHyperlink><span style='color:#0000CC'><o:p></o:p></span></span></p><p class=MsoNormal style='margin-right:15.7pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>By Ana B. Ibarra<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>SAN FRANCISCO — State insurance commissioner Dave Jones continued to make his skepticism clear regarding Anthem Inc.’s proposed $54.2 billion acquisition of Cigna Corp. during a hearing here on Tuesday.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Company executives faced Jones and a panel of physicians and consumer advocates who questioned the benefits the companies say the acquisition will bring.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The Department of Insurance hearing took a more pressing tone than a related hearing held by the Department of Managed Health Care earlier this month.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>According to Anthem and Cigna, the merger will result in easier access to medical providers for patients and lead to more affordable health insurance policies.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Jay Wagner, Anthem’s vice president and counsel, and Tom Richards, Cigna’s global leader for strategy and business development, said the purchase would cut costs by $2 billion annually.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>They told Jones they were “quite confident” in that estimate. But Wagner and Richards said they could not commit to guaranteeing savings for consumers because of factors out of their control, such as the rising prices of specialty drugs.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Brent Fulton, a professor of health economics and policy at UC Berkeley, presented an analysis on the Anthem and Cigna merger at the request of the Department of Insurance.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Theoretically, Fulton said, consolidation could lead to stronger negotiating leverage with hospitals, physician organizations and other providers of health care services that now hold market power, resulting in lower costs for health insurance customers.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>“However, we are not aware of any peer-reviewed studies that have found that higher insurer market concentration has led to lower health insurance premiums,” Fulton said.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Consumer advocates said the acquisition would make existing problems with health insurance worse. Anthem, they claimed, has already struggled with inaccuracies in provider directories, low quality ratings and poor management of grievances.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>“We don’t have any proof from Anthem on concrete benefits to consumers,” said Carmen Balber, executive director of Consumer Watchdog.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>“Consumers are already hurting in cost,” she said, stating that about 20 percent of consumers can’t afford the prices even with insurance.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Anthem is part of the four insurance titans that dominate the health insurance market in California, along with Kaiser Permanente, Blue Shield and Health Net. If approved, the Anthem and Cigna merger would result in the largest insurer by enrollment in the state, with an approximate 8.2 million policyholders, surpassing current leader Kaiser. (Cigna now is in fifth place.)<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Even without the merger, the top four insurance companies control more than 80 percent of the market. The Anthem-Cigna union is one of two pending mergers still under review by state regulators.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Last week, Centene’s $7 billion purchase of Health Net was approved. Regulators are also examining the planned $37 billion combination of Aetna Inc. and Humana Inc.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The Anthem-Cigna merger also needs the green light from 23 other states. Nationally, the combination would cover some 53 million policyholders, overtaking UnitedHealth Group Inc., which has close to 46 million members, according to 2013 estimates.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The Department of Managed Health Care, which held a hearing on this same merger earlier this month, is expected to impose certain conditions on the Anthem-Cigna deal to address consumer worries about the potential impact of large-scale consolidation. Those conditions are not yet clear.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Jones said he’s asked the two companies for more information and he expects to make a recommendation in the coming week.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>“I am considering what is best for consumers and the overall marketplace,” Jones said in a prepared statement. “Anthem and Cigna bear the burden of demonstrating this proposed merger is in the best interest of the California consumers and health care marketplace.”<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Jones said he plans to make a recommendation to the Federal Trade Commission and Department of Justice, who ultimately have the final say on the merger nationwide.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:30.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p></div><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal><b><span style='font-size:11.0pt;font-family:"Arial",sans-serif;color:#7F7F7F'>March 28, 2016<o:p></o:p></span></b></p></div><div style='margin-top:11.25pt;margin-bottom:11.25pt'><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'><o:p> </o:p></span></b></p></div><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'>California physicians oppose health plan mega-mergers, citing reduced access to affordable high-quality health care<o:p></o:p></span></b></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0000CC'><a href="http://www.cmanet.org/news/press-detail/?article=california-physicians-oppose-health-plan-mega"><span style='color:#0000CC'>California Medical Association</span></a></span><span style='color:#0070C0'><o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>SACRAMENTO — Eighty-five percent of California’s physicians are opposed to the merger of health insurance giants Anthem and Cigna, according to a new analysis released by the California Medical Association (CMA) on Monday.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The CMA survey, conducted in collaboration with the American Medical Association (AMA), sought to gauge California physicians’ perspective on the proposed Anthem-Cigna and Aetna-Humana mergers, as well as gather insight into the tactics undertaken by insurance companies’ in their negotiations with physicians.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>“California’s doctors could not be more clear: these mergers are bad for patients and bad for medicine,” said CMA President Steven E. Larson, M.D. “These two mergers would give insurance companies near monopsony at the expense of patients’ access to providers and physicians’ ability to provide fundamental care. In the end, patients will suffer.”<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The survey results were released on the eve of a California Department of Insurance hearing on the implications of the proposed Anthem-Cigna merger. Both CMA and AMA will be testifying in opposition to the merger at the hearing.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Concerns over consequences of this type of market consolidation included narrower physician networks that make it more difficult for patients to find care from in-network physicians (82.2%), reduced ability for physicians to advocate on behalf of their patients (81.9%), and a reduction in the quantity or quality of services that physicians can offer their patients (88.8%). Physicians expressed similar concerns over the Aetna-Humana merger.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>“If these mergers go through, the impact on everyday people trying to receive medical care in a timely and affordable manner would be devastating,” said CMA General Counsel and Senior Vice President Francisco Silva. “The result would be less competition with only the health insurers coming out winners.”<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>CMA has long been concerned with the consolidation of health plans and health insurers and the reduction of competition. When market power is consolidated among just a few plans, insurers contract with fewer physicians, limiting choice for patients, increasing wait times for referrals, and sometimes forcing them to pay more to see out-of-network doctors. Physicians across the country worry that the hardball tactics undertaken by these plans demonstrate that they put profits before patients.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The survey gathered data from 989 practices in 47 California counties, representing physicians from a range of specialties and practice sizes.<o:p></o:p></span></p><p class=MsoNormal style='margin-right:15.75pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:15.75pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:15.75pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><strong><span style='font-family:"Arial",sans-serif'>Jeff Wells</span></strong><span style='font-family:"Arial",sans-serif'><br>Deputy Editor, CAL/AAEM News Service<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-bottom:12.0pt'><strong><span style='font-family:"Arial",sans-serif'>Brian Potts</span></strong><b><span style='font-family:"Arial",sans-serif'> MD, MBA</span></b><span style='font-family:"Arial",sans-serif'><br>Managing Editor, CAL/AAEM News Service</span><o:p></o:p></p></div><p class=MsoNormal style='margin-bottom:12.0pt;background:#D9D9D9'><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>Contact us at: <span style='color:#0000CC'><a href="mailto:calaaem.news.service1@gmail.com"><span style='color:#0000CC'>calaaem.news.service1@gmail.com</span></a></span><br><br>For more articles, visit our <span style='color:blue'><a href="http://www.calaaem.org/news_archives.php"><span style='color:blue'>archives</span></a></span>. <br><br></span><span style='font-size:9.0pt;font-family:"Arial",sans-serif'><a href="mailto:somcaaem@uci.edu"><span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:black;text-decoration:none'>To</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:#0070C0'><a href="https://maillists.uci.edu/mailman/listinfo/calaaem"><span style='color:#0070C0;text-decoration:none'> </span><span style='color:blue'>unsubscribe</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'> from this list, visit our mail server.<br><br>Copyright (C) 2015. The California Chapter of the American Academy of Emergency Medicine (CAL/AAEM).</span> <span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:#0000CC'><a href="http://www.calaaem.org"><span style='color:#0000CC'>http://www.calaaem.org</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>. All rights reserved.<br><br>CAL/AAEM, a nonprofit professional organization for emergency physicians, operates the CAL/AAEM News Service solely as an educational resource for physicians. Dissemination of an article by CAL/AAEM News Service does not imply endorsement, agreement, or recommendation by CAL/AAEM News Service, CAL/AAEM, or AAEM.<o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><b><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>Follow CAL/AAEM on Facebook and Twitter:<o:p></o:p></span></b></p><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><a href="http://www.facebook.com/pages/CalAAEM/172577489479442?sk=wall&filter=12" target="_blank"><span style='color:black;text-decoration:none'><img border=0 width=28 height=28 id="Picture_x0020_6" src="cid:image010.jpg@01D19402.9FC1F8F0"></span></a> <a href="https://twitter.com/#!/CALAAEM"><span style='color:windowtext;text-decoration:none'><img border=0 width=30 height=30 id="Picture_x0020_7" src="cid:image011.jpg@01D19402.9FC1F8F0"></span></a> <a href="http://escholarship.org/uc/uciem_westjem"><span style='color:windowtext;text-decoration:none'><img border=0 width=112 height=30 id="Picture_x0020_4" src="cid:image012.jpg@01D19402.9FC1F8F0"></span></a><o:p></o:p></p><p class=MsoNormal style='background:#D9D9D9'><span style='color:black'><o:p> </o:p></span></p></div>
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