U.S. Supreme Court appears likely to uphold ACA preventive care coverage mandate

By Associated Press - The Supreme Court seemed likely to uphold a key preventive-care provision of the Affordable Care Act in a case heard Monday. Conservative justices Brett Kavanaugh and Amy Coney Barrett appeared skeptical of arguments that Obamacare’s process for deciding which services must be fully covered by private insurance is unconstitutional. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Potential rollback of key preventive services: The Supreme Court case could impact coverage requirements for preventive care under the ACA, affecting up to 150 million Americans. Services at risk include statins, lung cancer screenings, PrEP for HIV prevention, and breast cancer risk-reduction drugs—potentially leading to reduced access and higher costs.

2. Constitutional challenge centers on board authority: Plaintiffs argue that the U.S. Preventive Services Task Force lacks constitutional authority because its members weren’t Senate-confirmed. The case, supported by conservative legal advocates, raises questions about the legitimacy of mandates derived from non-appointed experts.

3. Court leans toward upholding coverage mandates: Several justices expressed skepticism about the plaintiffs’ broad claims, suggesting the board doesn’t wield enough power to require Senate approval. However, a remand to the Fifth Circuit could delay clarity, leaving the future of certain preventive services uncertain.

State-By-State, America is Taking on Big Insurance’s Pharmacy Middlemen

By Wendell Potter and Joey Rettino - Last week we published a piece about how lawmakers in states like Alabama, Arkansas and California are fighting back against pharmacy benefit managers (PBMs) — the powerful middlemen owned by giant insurance companies. In that piece, we emphasized something that’s too often missing from national coverage: that PBM reform isn’t just a federal issue. Much of the real progress is happening in state capitals — where lawmakers and attorneys general from both parties are stepping up to protect local pharmacists and patients. Read Full Article…

HVBA Article Summary

1. States push back against PBM practices to protect pharmacies and patients: New laws in Alabama and proposed legislation in Oregon aim to level the playing field for independent pharmacies. Alabama’s SB252 mandates Medicaid-level reimbursement rates, while Oregon’s HB3212 would establish minimum dispensing fees and allow pharmacies to reject unprofitable prescriptions — both measures designed to prevent pharmacy closures and maintain patient access.

2. Bipartisan state-level support grows amid pharmacy access crisis: As pharmacy deserts expand and independents shutter, lawmakers across party lines are stepping up. Alabama’s unified statehouse passage and Oregon’s cross-party coalition reflect a growing consensus that unchecked PBM practices are harming communities and driving up healthcare costs.

3. State attorneys general call for federal PBM reform and structural separation: Over three dozen AGs are urging Congress to dismantle vertically integrated PBM-insurer-pharmacy conglomerates. They argue these entities exploit market dominance to inflate drug prices, undermine competition, and steer patients — calling for federal legislation that restores fairness and protects local access to care.

Workplace life, disability, & supplemental health insurance sales soar

By Kristen Smithberg - Workplace life insurance, disability insurance and supplemental health sales grew in 2024, marking the fourth straight year of new premium growth, according to LIMRA’s 2024 workplace benefits sales survey. Workplace life insurance new premium increased 10% year over year to $925 million in the fourth quarter. That was the fifth consecutive quarter that workplace life insurance new premium increased, according to the report. The number of employer groups that sold life insurance dropped by 1%, while participants increased 9%. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Workplace life insurance hits record growth: New premium for term life products—the dominant segment making up over 80% of workplace life insurance policies—grew 13% in the fourth quarter of 2024. This surge helped drive total workplace life insurance new premium to a record $4.5 billion for the year, marking an 8% increase over 2023. In contrast, new premium for permanent life products declined by 1% during the same period.

2. Disability insurance sees mixed performance with long-term gains: Disability insurance generated $4.2 billion in new premium in 2024, representing a 2% annual increase. Long-term disability premium showed solid growth of 7%, while short-term disability declined by 3% year-over-year. The top 10 carriers, responsible for 75% of total new premium in this category, were key drivers of growth, posting a collective 3% increase.

3. Supplemental health premiums show strong annual growth despite Q4 decline: New premium for supplemental health products—which include critical illness, accident, cancer, and hospital indemnity insurance—dipped 2% in the fourth quarter. However, robust performance across the first three quarters fueled an 8% increase for the full year, bringing total 2024 premium to $3.3 billion. LIMRA noted that three-quarters of carriers in this space experienced year-over-year growth.

Healthcare leaders: Prepare for a very different HIPAA security rule | Viewpoint

By Joe Oleksak - In recent years, many of us in the cybersecurity profession have predicted the end of self-assessed compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the fundamental security practices it mandates. More specifically, some of us – myself included – believed such a shift would reflect the growing acceptance that cyber resilience no longer falls solely on the shoulders of the IT department or security professionals. Read Full Article…

HVBA Article Summary

1. Cybersecurity is now a board-level and fiduciary priority in healthcare: High-impact breaches like the Change Healthcare ransomware attack have elevated cybersecurity from an IT concern to an enterprise-wide, executive-level risk. Healthcare leaders—including boards—face increasing personal accountability, as the proposed HIPAA rule eliminates leniency around “addressable” security controls and requires documentation of executive responsibility in safeguarding health data.

2. The proposed HIPAA Security Rule marks a fundamental shift in compliance expectations: By eliminating the distinction between “addressable” and “required” safeguards, the rule demands that organizations implement core controls like encryption, multi-factor authentication, and network segmentation. Compliance will require significant architectural overhauls, enterprise-wide coordination, and adherence to a tighter 180-day implementation timeline.

3. Every healthcare stakeholder must enhance cybersecurity readiness: Hospitals, device manufacturers, and service vendors must urgently adopt more rigorous cybersecurity practices—from security-by-design protocols and vulnerability management to continuous monitoring and vendor oversight. The new regulatory environment requires not just baseline compliance but a culture of proactive, risk-based security leadership across the healthcare ecosystem.

How much employees pay for healthcare, by industry

By EBN Staff - Healthcare costs are increasing, and it's unlikely that employers alone will absorb those expenses. A recent survey by financial services company Mercer estimates that employees will have to cover an additional 5.8% of their healthcare benefit costs throughout 2025. No industry is immune from rising costs of care, though some end-users suffer higher premiums than others. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Wide variation in healthcare premiums by industry: According to March 2024 data from the U.S. Bureau of Labor Statistics, employee healthcare premium costs vary significantly across sectors. Education and health services employees pay the lowest average monthly premium at $147.11, while those in leisure and hospitality face the highest at $173.79.

2. Employers bear differing premium burdens: Employers in education and health services contribute the most on average at $601.51 per month, compared to just $480.92 in the construction sector. This disparity highlights uneven financial commitments from employers across industries.

3. Rising costs drive a cycle of delayed care and worse outcomes: Experts warn that shifting rising healthcare costs to workers can deter care access, worsening health outcomes and increasing long-term expenses. Employers are urged to explore innovative solutions to contain costs without sacrificing access or quality.

Reference-based pricing: successful characteristics and common traps

By Scott Ray - As a referenced-based pricing (RBP) veteran and founder of a full-service RBP company, I’ve witnessed hundreds of plans take the RBP journey, many with great success and others with disappointment. Successful plans share certain characteristics, while others can fall into common traps. The RBP landscape has changed significantly over the past decade, so I am excited to share my experience to help advisors navigate this complex terrain more effectively. Read Full Article…. ^{_{(Subscription required)}}

HVBA Article Summary

1. Setting realistic expectations is critical for RBP success: While reference-based pricing (RBP) plans can deliver unmatched savings, they also require more coordination and support than traditional network plans. Plans that fail to anticipate challenges—such as access issues or balance billing—often see lower satisfaction and retention rates. Advisors must proactively educate decision-makers and set clear expectations from the outset.

2. Balance billing and access issues are manageable with the right partner: Though rare, balance bills and provider access concerns can frustrate members. These situations are governed by state law and not ERISA, making legal and support strategies essential. Strong RBP vendors mitigate these risks through education, advocacy, and legal defense, while also resolving access problems through direct negotiations or alternative provider arrangements.

3. Employers can lead healthcare cost reform through RBP: Traditional PPO networks drive excessive costs by locking in inflated hospital charges. RBP disrupts this model, allowing employers to pay fairer rates and drive market competition. Though it may involve short-term friction, RBP—when implemented with experienced partners—enables long-term affordability and makes employers a driving force in transforming healthcare pricing.

VA starts search for new health and benefits leaders

By Press Release - The U.S. Department of Veterans Affairs…announced it has established commissions to find candidates to lead the Veterans Health and Veterans Benefits Administrations. VA Deputy Secretary Paul R. Lawrence, Ph.D., will chair both commissions. The commissions will help VA find candidates for its Under Secretary for Health and Under Secretary for Benefits positions and are a prerequisite to the president’s nomination of a candidate, subject to Senate confirmation, for each role. Read Full Article…

HVBA Article Summary

1. VA reform efforts under new leadership: The Department of Veterans Affairs is undergoing significant reforms, including ending DEI programs, phasing out gender dysphoria treatments to redirect funds toward paralyzed Veterans and amputees, and reversing telework policies—efforts the administration claims prioritize direct support and mission-critical services for Veterans.

2. Operational milestones and service enhancements: The VA reports record progress, having processed over one million disability claims for FY25 by February 20—the fastest pace in its history—and has accelerated the deployment of its integrated electronic health record system, previously stalled.

3. Key leadership roles open for recruitment: The VA is seeking candidates for the Under Secretary for Health and Under Secretary for Benefits roles. These positions oversee the nation’s largest healthcare system and a wide range of Veterans’ benefits programs, respectively—both critical to sustaining and advancing the department’s reform agenda.

To learn more about the Under Secretary for Benefits role, view the job description.