US Supreme Court sides with HHS in Medicare DSH payments case

By Anastassia Gliadkovskaya - The Supreme Court has sided with the Department of Health and Human Services (HHS) in a dispute over the formula used for calculating disproportionate share hospital (DSH) payments. The justices affirmed the lower court's 2023 decision, 7 to 2, that a person is considered entitled to Supplemental Security Income (SSI) benefits only when they are eligible to receive a cash payment during the month of their hospitalization. The ruling implies that HHS did not ultimately underfund those hospitals from 2006 to 2009, as the plaintiffs have argued. Read Full Article…

HVBA Article Summary

1. Supreme Court upholds HHS’s narrower DSH payment formula: In Advocate Christ Medical Center v. Becerra, the Court ruled in favor of the Department of Health and Human Services (HHS), affirming that only patients eligible for a Supplemental Security Income (SSI) cash payment during the specific month of hospitalization count toward disproportionate share hospital (DSH) payment calculations.

2. Hospitals argued for broader SSI inclusion to increase funding: Over 200 hospitals claimed the HHS approach undercounts low-income patients by excluding those receiving noncash SSI benefits, like Medicaid continuation or vocational rehabilitation. They argued this narrower interpretation costs hospitals $1.5 billion annually.

3. Dissent warns of harm to safety-net hospitals: Justice Ketanji Brown Jackson, joined by Justice Sotomayor, dissented, asserting the majority misunderstood the SSI program and that the ruling risks depriving hospitals serving the poorest populations of crucial federal funding, potentially threatening their ability to remain open.

Senate HELP Committee Chair Recommends Reforms to Drug-Pricing Program 

By James Van Bramer - U.S. Senator Bill Cassidy, R-Louisiana, chair of the U.S. Senate Committee on Health, Education, Labor and Pensions, is calling for major reforms to what is known as the 340B Drug Pricing Program following a years-long investigation which questions whether it truly benefits low-income patients. The 340B Program, created in 1992, requires drug manufacturers to offer discounts to certain hospitals and clinics that serve vulnerable populations. The program grew to $66.3 billion in drug purchases in 2023, according to the 195-page report. Read Full Article…

HVBA Article Summary

1. Cassidy’s investigation highlights misuse of 340B funds: Hospitals and health centers, including Bon Secours Mercy Health and Sun River Health, reportedly generated substantial revenue from 340B drug discounts but often failed to pass savings directly to patients, instead using funds for unrelated capital or community projects without adequate transparency.

2. Contract pharmacy practices raise cost and oversight concerns: Pharmacies like CVS and Walgreens, contracted under the 340B program, charge increasingly complex and costly fees for drug dispensing and administrative tasks, potentially diverting resources from patient care while complicating efforts to ensure discounts reach those eligible.

3. Calls for legislative reform intensify: Cassidy and employer groups are urging Congress to restore the original intent of the 340B program by mandating detailed reporting of 340B revenues, increasing transparency of pharmacy fees, and ensuring that drug discounts directly benefit low-income patients rather than subsidizing health system profits.

As autism rates rise, employers evolve benefits to support caregivers

By Stephanie Shields - Raising a child with autism presents profound emotional and financial challenges. According to the CDC, families can spend an average of $60,000 annually on autism-related therapies, specialized education, and support services. While autism is a covered condition under many health insurance plans, coverage levels vary widely, leaving many families burdened with significant out-of-pocket costs. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Autism caregiving responsibilities significantly affect workforce participation: With 43% of parents of children with autism reducing work hours or leaving their jobs due to caregiving demands, employers face rising absenteeism, higher turnover, and decreased productivity. As autism diagnoses increase, it’s essential for organizations to address these challenges through inclusive, caregiver-focused workplace policies.

2. Supplemental health benefits are evolving to meet autism-related needs: Insurers are redesigning supplemental health plans to include autism-specific riders in critical illness policies, offering lump-sum payouts that can be used flexibly for expenses like therapies, specialized education, home modifications, and respite care. These enhancements provide essential financial relief to employees navigating the complexities of autism care.

3. Comprehensive benefits strategies enhance employee wellbeing and retention: Employers that pair expanded supplemental health benefits with improved paid family leave, access to specialized financial planning, and autism-specific EAPs can offer holistic support to caregivers. These integrated strategies not only improve employee wellbeing and resilience but also strengthen morale, reduce burnout, and boost long-term workforce stability.

Pharmacy Benefit Trends For Self-Funded Employers To Watch In 2025

By Yasser Almuaala - As the healthcare landscape accelerates into 2025, many self-funded employers find themselves at a crossroads. Pharmacy benefits, once a manageable line item, now represent a seismic force in the battle to control costs while ensuring employees receive the care they need. The stakes are high: Prescription drug spending continues its relentless climb, projected to grow at an average rate of 5% from 2021 to 2030. For businesses with self-insured plans, where every dollar saved is a dollar reinvested, it’s especially important to stay ahead of emerging trends. Read Full Article…

HVBA Article Summary

1. Biosimilars offer cost-saving potential—but require proactive adoption: As more biosimilars enter the market, especially alternatives to expensive biologics like Humira, employers have a significant opportunity to reduce pharmacy spend. However, to benefit, they must invest in prescriber and employee education and be willing to challenge traditional formularies and prescribing habits.

2. PBM transparency is no longer optional—employers must act: Federal and state initiatives are pushing for greater disclosure from pharmacy benefit managers. Employers can use this moment to uncover hidden costs, renegotiate contracts, and consider alternatives like direct contracting—but they must be ready to move beyond transparency toward true accountability.

3. Personalized medicine challenges traditional cost containment strategies: Genomic and targeted therapies are revolutionizing treatment but come with high price tags, raising tough questions around equity, fiduciary responsibility, and long-term sustainability. Employers may need to adopt innovative financial models like stop-loss insurance or risk-sharing agreements to manage these costs effectively.

Top pet insurance claims of 2025

By Brittney Meredith-Miller - Around 66% of households in the United States own a pet — up from 56% in 1988 — and while these companions certainly contribute to the household in their own way, caring for them can get pricey. According to Forbes Advisor, the average annual cost of owning a dog is around $1,400 and the cost of owning a cat is around $1,150. However, that number can grow exponentially if a pet is in need of emergency care. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Pet insurance can protect employees from rising veterinary costs: With premiums averaging $53/month for dogs and $32/month for cats, pet insurance is increasingly seen as a practical benefit—not a luxury. As vet bills soar, with some claims exceeding $60,000, offering pet insurance through the workplace can help employees manage financial stress tied to their pets' health.

2. Even common pet conditions can create financial strain: Many routine diagnoses—like dental disease ($1,284), trauma ($708), or intestinal issues ($702)—can cost hundreds within the first month of treatment. Providing pet insurance as a voluntary benefit can help employees avoid difficult financial decisions when their pets need care.

3. High-frequency claims show the need for everyday coverage: According to Nationwide’s 2025 data, top insurance claims include skin allergies ($265), diarrhea/intestinal upset ($702), and ear infections ($304). These recurring conditions demonstrate why pet insurance is a meaningful way for employers to support employees’ broader well-being.

RFK Jr. is the real wild card in protecting Obamacare

By Frank Vinluan - The U.S. Supreme Court ap-pears likely to preserve a key component of the Affordable Care Act (Obamacare) that requires insurers to fully cover preventive care such as colon and lung cancer screenings. That's a huge relief. The case, Kennedy v. Braidwood Management, has enormous consequences for the health of millions of Americans. Read Full Article…

HVBA Article Summary

1. Preventive care coverage is at risk due to legal challenges: A Supreme Court case questions whether the independent task force that mandates insurers cover preventive services—like birth control, PrEP, mammograms, and colonoscopies—can legally operate without presidential appointment and Senate confirmation, potentially jeopardizing no-cost coverage for over 100 million Americans.

2. Shift in authority raises concerns about future coverage decisions: If the Court sides with the government, it would give HHS Secretary Robert F. Kennedy Jr. expanded control over which services remain covered, sparking fears that evidence-backed services like PrEP and HIV screenings could be removed due to his controversial health views and past cuts to HIV-related programs.

3. Millions stand to lose essential services despite cost-saving benefits: While many insurers may voluntarily continue covering preventive services, a KFF analysis estimates 10 million people could lose access under a policy change—despite research showing that preventive care reduces long-term costs and significantly improves public health outcomes.

House Debates SHRM-Backed Bill on Caregiving Benefits

By Rachel Zheliabovskii - On April 9, the House Committee on Education and Workforce held a full committee markup that included a discussion of H.R. 2270, which would impact workers across the country. The Empowering Employer Child Care and Elder Solutions Act “would add child and dependent care to the FLSA’s [Fair Labor Standards Act’s] list of exclusions and therefore allow employers to freely offer these benefits to workers with young children,” explained Rep. Mark Messmer, R-Ind., the bill’s sponsor. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. H.R. 2270 aims to promote caregiving benefits by adjusting overtime rules: The bill would exclude employer-provided child and elder care services from the “regular rate” used to calculate overtime, reducing financial barriers for employers—especially those with hourly workers—to offer dependent care support.

2. SHRM backs the bill, citing labor market needs and growing caregiving demands: SHRM’s recent research shows caregiving is a long-term concern for over 80% of working caregivers, with 14% of employees expecting to assume new adult care responsibilities and 18% anticipating expanded elder care duties in the next five years. SHRM argues H.R. 2270 supports talent attraction and retention in a competitive job market.

3. Critics warn of unintended consequences for workers and families: Lawmakers like Rep. Bobby Scott argue the bill may lead to longer work hours and greater caregiving needs without providing real support. A second bill, H.R. 2262, also drew criticism for potentially allowing employers to require off-the-clock job training under the guise of voluntary development.

Virtual mental health provider Charlie Health launches substance use disorder program

By Heather Landi - Charlie Health, a company that offers virtual high-acuity mental health care services, launched a dedicated virtual treatment program for individuals with primary substance use disorders (SUDs). The new treatment program builds on years of experience supporting individuals with co-occurring substance use and mental health conditions, noted Carter Barnhart, CEO and co-founder of Charlie Health, in an interview. Read Full Article…

HVBA Article Summary

1. Charlie Health Launches Dedicated Virtual SUD Program: Building on years of treating clients with co-occurring disorders, Charlie Health has launched a dedicated virtual intensive outpatient program specifically for individuals whose primary need is substance use disorder (SUD) treatment. The program offers group, individual, and family therapy, along with medication-assisted treatment (MAT), all within a fully virtual, curated peer-cohort model.

2. Strong Outcomes and Comprehensive Care Model: The company reports significant success among SUD clients, including a 94% rate of avoiding higher levels of care within three months post-discharge and dramatic reductions in opioid and alcohol use. Clients also experienced improved mental health outcomes, including reduced depression, anxiety, self-harm, and suicidal ideation—underscoring the effectiveness of Charlie Health’s evidence-based, measurement-driven approach.

3. National Growth Backed by Community Integration: Now operating in 37 states and serving over 50,000 patients, Charlie Health continues to expand based on treatment outcomes rather than market size. The company maintains strong community ties through 300 on-the-ground liaisons and strategic partnerships, ensuring continuity of care post-treatment. Its sustainable, outcomes-focused model has allowed it to grow without relying on additional venture funding.