Health insurance CEO admits to spying on claimants, legislators, journalist

By Emily Cousins  - Texas Attorney General Ken Paxton launched an investigation into Superior HealthPlan, one of the state's Medicaid providers, after the CEO admitted during a public hearing that the company had spied on Texans. Tae Andrews, senior counsel at Calfee, Halter & Griswold said "underhanded maneuvers" like this reinforce some people's distrust of insurance companies, seen on full display when many Americans celebrated the killing of UnitedHealthcare CEO Brian Thompson. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Allegations of Surveillance and Misconduct: During a public hearing, Texas lawmakers confronted Superior HealthPlan CEO Mark Sanders over emails suggesting he authorized private investigators to surveil state representatives, a journalist, and private citizens who were seeking healthcare coverage—potentially misusing taxpayer-funded resources in the process.

2. Company Fallout and Investigation: Sanders acknowledged conducting "general research" using publicly available information but denied that surveillance is an ongoing practice. He was fired the following day, and Texas Attorney General Ken Paxton announced a formal investigation into the company, citing concerns about potential blackmail and deliberate efforts to avoid legitimate claim payments.

3. Public Outcry and Legal Concerns: Legal experts, including insurance recovery attorney Tae Andrews, condemned the alleged surveillance as an outrageous abuse of power and an alarming escalation in insurance industry tactics. He called for strict accountability if the claims are verified, warning that such behavior undermines trust in both the healthcare system and democratic institutions.

NFIB: Employer-provided health coverage becoming ‘unsustainable'

By David Krechevsky - A new report from the National Federation of Independent Businesses (NFIB) states that the rapidly increasing cost of health insurance is crippling small businesses in the United States, and that the small-group insurance market faces “an inevitable collapse.” Read Full Article… 

HVBA Article Summary

1. Small-Group Market in Crisis: The small-group health insurance market, which most small businesses rely on, is rapidly shrinking—dropping from nearly 15 million participants in 2014 to 8.5 million in 2023. In Connecticut, enrollment in these plans has declined by over 50%, with major insurers exiting the market.

2. Soaring Costs and Limited Options: Health insurance costs for small businesses have skyrocketed, with individual plan premiums up 120% and family premiums up 129% over the past two decades. Small firms now pay nearly twice as much for coverage as large businesses, despite having fewer options.

3. Urgent Policy Recommendations: The NFIB calls for legislative action to support small businesses, including protecting access to stop-loss insurance, expanding tax credits, encouraging competitive insurance markets, and allowing employer pooling arrangements to lower costs and improve accessibility.

DOJ unveils deregulation taskforce, names healthcare among early targets

By Dave Muoio - The Department of Justice (DOJ) has announced the launch of an Anticompetitive Regulations Task Force to identify and work toward unwinding government regulations it determines to be stifling market competition. The effort will be run by the DOJ’s Antitrust Division, which the department said can provide the “market expertise on regulations that pose the greatest barriers to economic growth.” The task force also intends to invite public comment and “surge resources” toward repealing state- and federal-level laws and regulations as deemed necessary. Read Full Article…

HVBA Article Summary

1. DOJ Launches Task Force to Eliminate Anticompetitive Regulations: In response to executive orders by President Trump, the Department of Justice has created a task force aimed at identifying and rolling back regulations that hinder market competition—particularly those that disadvantage smaller businesses while benefiting larger, established players.

2. Healthcare Among Key Focus Areas: The task force highlights the healthcare sector as a prime example of regulatory capture, criticizing laws that promote consolidation and overbilling while discouraging affordable, high-quality care. Other target industries include housing, agriculture, transportation, and energy.

3. 60-Day Public Inquiry and Multi-Agency Collaboration: The task force will begin with a 60-day inquiry to gather public input on burdensome regulations and will collaborate with attorneys, economists, and other agencies to recommend reforms. It may also engage through legal advocacy, including amicus briefs and legislative commentary.

Lack of family care costs employers $1T annually in lost productivity

By Alan Goforth - Lack of access to family costs employers an estimated $1 trillion annually in absenteeism and voluntary turnover, the 2025 Blueprint for Better Care Benefits Report from Helpr found. “There’s a care crisis in this country, and it’s putting incredible pressure on families and straining business operations,” said Kasey Edwards, CEO of the benefits provider. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Caregiving Challenges Affect Employment: Nearly half of employees take time off for caregiving, and over half consider quitting due to care responsibilities. Families often spend 20% of their income per child on care, and 51% of the U.S. lives in child care deserts, driving many—especially mothers—out of the workforce.

2. Employer Care Benefits Drive Retention and ROI: Care benefits reduce absenteeism by up to 16 days annually and encourage 86% of working parents to stay with their employer. With a potential 425% return on investment, even retaining 1% more staff can cover the cost of these programs.

3. Holistic, Accessible Solutions Are Key: Effective care programs must go beyond child care to include elder care, self-care, and culturally inclusive models. Employers are urged to invest in tech-enabled, subsidized, and globally scalable care benefits that address systemic inequities and meet the needs of diverse, frontline, and hourly workers.

'They won’t help me': Sickest patients face insurance denials despite policy fixes

By Lauren Sausser - Sheldon Ekirch spends a lot of time on hold with her health insurance company. Sometimes, as the minutes tick by and her frustration mounts, Ekirch, 30, opens a meditation app on her phone. It was recommended by her psychologist to help with the depression associated with a stressful and painful medical disorder. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Prior authorization delays are leaving seriously ill patients without timely care: Patients like Ekirch, who lives with painful small fiber neuropathy, are caught in a cycle of repeated insurance denials for treatments recommended by multiple specialists. Despite paying high premiums, she’s been unable to access IVIG therapy, a treatment that could offer relief, because her insurer deems it not medically necessary—highlighting how prior authorization can block access to potentially life-changing care.

2. Public frustration with insurance companies is intensifying: High-profile incidents, such as the fatal shooting of a UnitedHealthcare CEO and viral social media criticism from doctors, have brought renewed attention to the emotional toll and systemic failures of prior authorization. Many patients and families now see the system as not only inefficient but harmful, fueling a growing movement of online advocacy and “unified anger” against opaque insurance practices.

3. Despite reform efforts, systemic issues remain unresolved: While insurers have announced improvements and lawmakers at both the state and federal levels have introduced legislation to streamline or eliminate prior authorization, many reforms are viewed as superficial. Critics argue that changes rarely address high-stakes treatments and fail to protect the most vulnerable patients from delays, denials, and an exhausting appeals process.

Oral GLP-1 Receptor Agonist Reduces CV Risk

By Ted Bosworth - In patients with type 2 diabetes who have established atherosclerotic cardiovascular disease, chronic kidney disease, or both, the oral formulation of semaglutide, a glucagon-like peptide (GLP-1) receptor agonist, reduces the risk for major adverse cardiovascular events, according to SOUL, an international phase 3b placebo-controlled trial. Read Full Article…

HVBA Article Summary

1. Oral semaglutide proves effective in reducing cardiovascular events: The SOUL trial showed a 14% relative reduction in major cardiovascular events (CV death, nonfatal MI, or stroke) among high-risk patients with type 2 diabetes, making oral semaglutide an evidence-based, non-injectable alternative to GLP-1 receptor agonist therapy.

2. Kidney protection benefit was not statistically significant: While the trial hinted at directional consistency with prior studies (like FLOW), the secondary endpoint related to kidney outcomes narrowly missed statistical significance(HR, 0.91; P = .0967), potentially due to participants' better baseline renal function.

3. Effectiveness was independent of SGLT2 inhibitor use: The benefit of oral semaglutide on cardiovascular outcomes held regardless of whether patients were also taking an SGLT2 inhibitor, supporting its use as a standalone or combination therapy option—especially important for patients unwilling to take injections.

Judge dismisses lawsuit against Wells Fargo over prescription drug costs

By Rebecca Pifer - The litigation against Wells Fargo is the second lawsuit accusing a large, self-funded employer of failing to bring down drug costs for their workers and acting as a poor steward of their healthcare dollars in violation of ERISA. Read Full Article…

HVBA Article Summary

1. New Legal Strategy Faces Setbacks: Lawsuits targeting employers like Johnson & Johnson and Wells Fargo for allegedly mismanaging their employee health plans and failing to control drug costs introduced a novel legal approach. However, both cases were dismissed due to lack of standing, dampening hopes for similar future lawsuits.

2. Allegations of Overpayment and Plan Mismanagement: Plaintiffs accused Wells Fargo of paying inflated administrative fees to pharmacy benefit manager (PBM) Express Scripts and agreeing to costlier pharmacy arrangements that led employees to pay significantly more for medications, despite decreasing plan enrollment and unchanged services.

3. Court Finds Claims Too Speculative: Judge Laura Provinzino dismissed the Wells Fargo case, ruling that the alleged financial harm was too speculative and not clearly connected to the employer's decisions. Although acknowledging the plaintiffs’ concerns about high drug costs, the judge found insufficient evidence of individual harm or causation.