Repeal of health insurance tax could bolster Medicare Advantage insurers' earnings, enrollment

Just in time for the holidays, Congress appears ready to give health insurers several gifts in its year-end spending deal, unveiled Monday and passed by the U.S. House of Representatives Tuesday. One of those includes a permanent repeal of a loathed industry tax that insurers have been lobbying to kill for years.

Commercial health insurers serving employers and individuals generally passed that tax, known as the HIT, along to their members in the form of higher premiums. Medicaid managed-care insurers are reimbursed for the tax by the states they contract with.

But in the fiercely competitive, fast-growing Medicare Advantage market, insurers have historically absorbed at least part of the tax to keep their policies attractive enough to enroll more seniors.

Repealing the HIT for 2021 and beyond could boost Medicare Advantage enrollment as insurers keep premiums flat and reinvest into supplemental benefits, insurance industry analysts said. The tax repeal could also bolster Advantage insurers' bottom lines.

"They are going to be able to stabilize the price of their products … and I think in general seniors would appreciate that. It will help more people choose to go with Medicare Advantage as opposed to being in fee-for-service" Medicare, said Sarah James, a senior research analyst with financial services firm Piper Jaffray.

About a third of Medicare beneficiaries, or 22 million people, are enrolled in Medicare Advantage plans. Many have been taking advantage of CMS flexibility to give seniors benefits that address their social needs. Deep Banerjee, an analyst at S&P Global Ratings, said it's possible insurers will ramp up those benefits even further if the tax disappears.

The health insurance tax, which was meant to help pay for the Affordable Care Act, was in effect in 2018 but suspended by Congress in 2019 after intense industry lobbying. The budget deal, which still must be approved by the U.S. Senate and signed by the president, would leave the tax in place for 2020 but repeal it for the years after. The Internal Revenue Service estimated the tax would bring in about $15.5 billion total next year, up from $14.3 billion in 2018.

The share of the tax that each health insurer pays depends on its premium revenue. UnitedHealth Group, parent company of the largest health insurer, reported a HIT liability of $2.6 billion in 2018, while Anthem reported paying $1.5 billion, according to company filings with the Securities and Exchange Commission. Combined, the eight largest publicly traded health insurers paid nearly half of the fees owed in 2018 at a little more than $7 billion.

Health insurers, including Medicare Advantage plans, raise premiums about 2% on average to recoup the cost of the tax, according to a 2018 analysis by Oliver Wyman Actuarial Consulting commissioned by UnitedHealth Group.

Unlike insurers in other business lines, Medicare Advantage plans do not pass along the cost of the federal income taxes related to the nondeductible HIT, opting instead to absorb those costs for competitive reasons. In all, the HIT amounts to a 10% drag on Medicare earnings among for-profit insurers, said Michael Newshel, analyst at Evercore ISI.

If the tax is repealed, "the bulk of the benefit will accrue to seniors in the form of better benefits, but a portion will also presumably accrue to margins for for-profit insurers," he said.

Given its big Medicare Advantage footprint, Humana, which paid a fee of a little more than $1 billion under the HIT in 2018, would benefit the most from a repeal, James and Newshel said. James estimated the repeal would boost Humana's earnings by 10%; Humana reported $1.2 billion in net income in 2018. UnitedHealth's earnings, meanwhile, would boost UnitedHealth's earnings by about 4%. UnitedHealth reported net income of $12.4 billion in 2018.