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

By Allison Bell  - A longtime supporter of association health plan proposals has reintroduced his AHP bill — and he's now in a better position to get that bill through Congress. Rep. Tim Walberg, R-Mich., brought back the Association Health Plans Act bill Tuesday. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Expanded Access to AHPs: The new bill introduced by Rep. Tim Walberg is designed to make it easier for small employers and self-employed individuals to join Association Health Plans (AHPs). Under the bill, an AHP could be treated as a single large employer health plan if it has existed for at least two years, was not formed solely to offer health insurance, and meets U.S. Labor Department standards—potentially broadening access to more affordable coverage options.

2. Consumer Protections and Market Impact: The legislation includes rules to ensure AHPs cannot deny coverage or discriminate against individuals with pre-existing health conditions. Supporters argue that AHPs can help small businesses and individuals access better benefits and lower premiums by pooling resources. However, critics—including some insurers and regulators—warn that expanded AHPs could disrupt the traditional insurance market and make oversight more difficult.

3. Renewed Momentum with Leadership Role: Having recently become chair of the House Education and the Workforce Committee, Walberg is in a stronger position to advance the bill, which mirrors efforts he has introduced since 2018. The bill is drawing support from industry groups like the Council for Affordable Health Coverage, which argue it could ease the burden of rising healthcare costs for small businesses that are struggling to provide affordable employee coverage.

How PBMs Took Over the Prescription Drug Chain — And Left Patients and Pharmacists Paying the Price

By Luke Sullivan - Americans spent a record $464 billion last year on prescription drugs, according to recent numbers from the Centers for Medicare & Medicaid Services. Five years ago that number was $335 billion and a decade ago $298 billion. The dramatic increase is not matched by the number of prescriptions filled by pharmacists during that same span.” Read Full Article… 

HVBA Article Summary

1. Prescription drug prices are rising fast: The average cost of a prescription has climbed from $69 in 2014 to $95 in 2024, a nearly 40% increase over a decade. This sharp rise has caught the attention of lawmakers, who are now pushing for reforms aimed at increasing transparency and accountability in the drug pricing system — particularly targeting the role of pharmacy benefit managers (PBMs).

2. PBMs operate with little oversight and massive influence: PBMs, which are owned by major health insurers, act as powerful middlemen in the drug supply chain. They determine which drugs are covered, negotiate rebates with manufacturers, and dictate how much pharmacists are reimbursed — often in ways that are hidden from the public and even doctors. Their practices have drawn criticism for prioritizing profits over patient care and for contributing to the closure of thousands of independent pharmacies.

3. Consolidation in the healthcare system fuels PBM power: Health giants like UnitedHealth and CVS have created vertically integrated empires that span insurance, PBMs, and even medical providers and retail pharmacies. This consolidation gives them control over nearly every step of a patient's prescription journey — from drug approval to pricing at the pharmacy counter — raising serious concerns about competition, access, and affordability in the healthcare system.

Removal of ACA Tax Credits May Cause Millions to Lose Health Coverage

By Remy Samuels - Since Congress approved tax credits for people buying health insurance on the Affordable Care Act marketplaces in 2021, enrollment in ACA policies has doubled to a record 24 million and individuals’ monthly premiums have dropped by hundreds of dollars. While the Inflation Reduction Act of 2022 extended the subsidies through the end of this year, the ACA tax credits may not be renewed under some budget proposals being considered in the House of Representatives, according to the Center for Retirement Research at Boston College. Read Full Article…

HVBA Article Summary

1. Expiration of ACA Tax Credits Could Cause Major Coverage Losses: The potential expiration of Affordable Care Act (ACA) tax credits poses a serious risk of more than 7 million people losing their health insurance coverage. This would hit hardest among lower-income families, middle-class workers, self-employed individuals, and older adults under 65 who rely heavily on these subsidies to make insurance affordable.

2. Proposed Rule Changes May Add Administrative Barriers and Limit Access: The Trump administration’s proposed changes to the ACA include stricter regulations, such as denying coverage to individuals with unpaid past premiums and requiring more rigorous income verification for tax credit eligibility. These changes could create significant administrative hurdles and delay access to health coverage for many applicants.

3. Rising Costs Threaten Affordability and Market Stability: Without continued tax credits, insurance premiums could spike—by as much as $1,500 per month for some older, middle-income couples—putting coverage out of reach for many. If younger and healthier adults opt out due to higher costs, it could undermine the risk pool and destabilize the insurance market overall.

American Telemedicine Association's lobbying division acquires Digital Therapeutics Alliance

By Emma Beavins - The American Telemedicine Association’s lobbying arm, ATA Action, acquired the Digital Therapeutics Alliance (DTA) in a bid to beef up its digital health presence and advocate for health technology further upstream in the regulatory process. Read Full Article…

HVBA Article Summary

1. Strategic Acquisition to Advance Digital Health Advocacy: ATA Action’s acquisition of the Digital Therapeutics Alliance (DTA) combines complementary strengths—ATA’s robust telehealth policy influence and state-level lobbying power with DTA’s expertise in novel medical devices and international regulatory reach. The merger aims to enhance federal and state advocacy for emerging digital health technologies.

2. Creation of the Advancing Digital Health Coalition: As part of the acquisition, a new advocacy arm—the Advancing Digital Health Coalition—will drive policy efforts on cutting-edge digital health solutions. This includes reintroducing the Prescription Digital Therapeutics Act, supporting regulatory and reimbursement frameworks for digital diagnostics, and advancing coverage for FDA-approved technologies.

3. Broader Membership and Influence: The merger expands ATA Action’s membership to include pharmaceutical and medical device manufacturers, increasing its reach in health tech. It also unifies U.S. and international policy advocacy under one umbrella, offering greater resources and coordination for shaping the future of digital health at both domestic and global levels.

The Workplace Mental Health Crisis of 2025

By Judy Faust Hartnett - A survey of 1,000 full-time U.S. employees, commissioned to assess the state of mental health across America’s workforce at the start of 2025, reveals some alarming trends. Seventy-five percent of respondents reported experiencing some form of low mood, with the majority attributing it to the turbulence of global politics and current events. Read Full Article… 

HVBA Article Summary

1. Here are three key takeaways from the article:

   1. Demand for Mental Health Support Is High: A significant 74% of employees want workplace mental health resources specifically tailored to the stress caused by political and social crises. Leaders like Modern Health CEO Alyson Watson emphasize that unaddressed mental health needs are driving both disengagement and turnover.

   2. Neglecting Mental Health Harms Business Performance: Poor mental health and disengagement are major productivity killers—costing companies billions. Unresolved depression alone leads to a 35% drop in productivity, while global disengagement contributes to an estimated $8.8 trillion in lost productivity annually.

   3. Investment in Mental Health Drives ROI: Prioritizing mental well-being leads to tangible business benefits. Companies that focus on mental health see higher productivity (13% increase), reduced stress (2.3x), and less absenteeism (2.6x). Ignoring this need not only risks burnout and turnover but can severely impact morale, retention, and profitability.

Bill would allow physicians to make prior authorization judgments

By Jeff Lagasse - Lawmakers in the House of Representatives have rolled out a bipartisan bill that would task board-certified specialists with determining the medical need of prior authorization requests. The Reducing Medically Unnecessary Delays in Care Act would reform the practice of prior authorization in Medicare and Medicare Advantage by requiring that board-certified physicians in the same specialty are the ones making those decisions. Read Full Article…

HVBA Article Summary

1. Reforming Prior Authorization in Medicare: A bipartisan bill led by Rep. Dr. Mark Green and other physician-lawmakers aims to ensure that prior authorization decisions in Medicare, Medicare Advantage, and Part D plans are based on medical necessity and transparent, evidence-based clinical criteria.

2. Removing Non-Expert Decision-Makers: The legislation seeks to eliminate insurance company representatives without medical expertise from making care decisions, requiring that only qualified physicians review prior authorization requests, particularly when a treating doctor has already recommended the service.

3. Improving Patient Care and Reducing Administrative Burden: With physicians spending an average of 16 hours per week on prior authorization, the bill is backed by major medical associations and responds to growing concerns that the current system delays care, worsens health outcomes, and contributes to physician burnout and unnecessary healthcare costs.

The Standard Completes Acquisition of Allstate Employer Voluntary Benefits Business

By Business Wire - StanCorp Financial Group, Inc. (The Standard) today announced the closing of the acquisition of Allstate’s Employer Voluntary Benefits business in accordance with the terms of the agreement reported on Aug. 13, 2024. The agreement includes a future distribution partnership through which certain of The Standard’s products and services will be made available to Allstate customers. Read Full Article…

HVBA Article Summary

1. Strategic Growth Opportunity: The Standard's acquisition of Allstate’s Employer Voluntary Benefits business represents a significant step in advancing its long-term growth strategy, enabling the company to offer one of the most comprehensive and competitive workplace benefits portfolios in the market.

2. Shared Commitment to Service: By bringing together two well-established providers known for their deep industry expertise, the transaction reinforces a mutual dedication to high-quality customer service and strengthens their combined market presence.

3. Seamless Brand Integration: The acquired business, primarily consisting of American Heritage Life Insurance Company, will transition to operate under The Standard brand over time, with both organizations focused on ensuring a smooth, disruption-free experience for clients, employees, and partners.