After ACA subsidy lapse, consumers opt for low-cost Marketplace plans

By Sara Heath – Silver plans are out and Bronze plans are in, according to new CMS data about the 2026 Open Enrollment Period for the Affordable Care Act Marketplace Exchanges, signaling growing consumer preference for low-cost health plans with potential for higher deductibles. This trend could be a harbinger of what's to come, as consumers contend with higher health plan premiums and rising costs after the agency's elimination of ACA tax subsidies. Read Full Article...

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1. Silver Plan Enrollment Declines but Remains Most Common: Silver plans, which typically cover a larger share of healthcare costs and have moderate deductibles, have historically been the most popular option on the ACA Marketplace. In 2026, they remained the most selected plan type but experienced a notable drop in enrollment. Silver plan participation fell from 56% of Marketplace enrollees in 2025 to 43% in 2026, indicating a shift in consumer plan selection.

2. Bronze Plan Selection Increases as Consumers Seek Lower Premiums: Bronze plans generally offer lower monthly premiums but require higher deductibles, meaning patients may face greater out-of-pocket costs when they receive care. In 2026, 40% of Marketplace consumers chose Bronze plans, up 10 percentage points from the prior year. The increase suggests more consumers are prioritizing lower upfront monthly costs when selecting coverage.

   Subsidy Changes and Rising Costs May Influence Enrollment Trends: The 2026 Open Enrollment Period followed the expiration of enhanced tax subsidies that previously reduced premium costs for qualifying consumers. Policymakers cited concerns about taxpayer spending and fraud, while other analyses suggested the subsidy lapse would increase plan costs for millions of people. Marketplace enrollment declined slightly from 24.3 million in 2025 to 23 million in 2026, though it still represents the second-highest enrollment level in the program’s history.

States prepare to tackle eye care provider protections

By Allison Bell – States could be about to consider a wave of tough, broad vision benefit plan regulation bills. The National Council of Insurance Legislators — a group for state legislators with an interest in insurance — is preparing to discuss a vision benefit plan model act draft. Any state that passed the model act and implemented it as written could end up with a sweeping law that regulates everything from how a vision plan could pay eye care providers, to how eye care providers could choose their own suppliers, to how vision benefit plans should communicate with eye care providers over the telephone. Read Full Article... ^{_{(Subscription required)}}

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1. Vision Benefits Model Bill Introduced: A proposed model bill would require vision insurers and vision benefit managers to provide disclosure statements to eye care providers. These disclosures would identify the company’s parent organizations and list all federal and state litigation involving the company within the past five years. The proposal is intended to increase transparency about the entities administering vision benefit plans.

2. Provider Payment and Operational Requirements: The draft model outlines several standards for how vision benefit plans interact with eye care providers. It calls for equal reimbursement for ophthalmologists and optometrists when they provide the same service and would allow providers to use any labs or suppliers. The proposal also establishes communication requirements, including having representatives available during normal business hours and returning provider voicemails within one business day.

3. Legislative Review and Broader Policy Context: The model bill was sponsored by Kentucky State Representative Deanna Gordon and is under review by the National Council of Insurance Legislators (NCOIL). NCOIL’s Health Insurance & Long Term Issues Committee plans to discuss the draft at its upcoming April 17 meeting in Louisville, Kentucky. The effort follows a broader trend of state and federal proposals aimed at strengthening protections for eye care providers within vision benefit plan systems.

Trump's obesity drug plan for Medicare would cost insurers billions

By Rachel Cohrs Zhang – President Donald Trump's plan to cover weight-loss medications for some people in the Medicare program for the elderly would cost the health insurers billions in its first year, a new analysis found. The Trump administration has argued that the lower prices it negotiated with drugmakers last year would offset the cost of adding coverage for millions of new patients. The plan will "expand access and lower prices for obesity GLP-1 medication without passing the bill to taxpayers," Mehmet Oz, director of the Centers for Medicare and Medicaid Services, said in a video promoting the plan. Read Full Article... ^{_{(Subscription required)}}

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1. Medicare Weight-Loss Drug Coverage Proposal Faces Cost Concerns: A new analysis led by Vanderbilt University health policy professor Stacie Dusetzina estimates that projected first-year savings of more than $900 million would only cover the costs for about 4.4% of patients who would become newly eligible for weight-loss drugs under the proposed program. The findings, published in the Journal of the American Medical Association, challenge claims that the initiative could substantially expand access to these medications for Medicare beneficiaries. The analysis suggests that the anticipated savings may not be sufficient to support broad coverage expansion.

2. Insurer Participation Will Determine Program Launch: Health insurers must decide by April 20 whether to participate in the optional program for the following year. The Trump administration has said the initiative will move forward only if insurers covering at least 80% of the Medicare population opt in. Reaching that threshold would likely require participation from all major insurers currently involved in Medicare’s prescription drug benefit program.

3. Financial Trade-Offs and Industry Considerations: Researchers note that expanding access to weight-loss drugs through Medicare could create financial pressure for insurers and potentially lead to higher premiums. Dusetzina stated that expanding coverage would likely affect premiums “pretty dramatically.” At the same time, insurance industry representatives say plans generally support seniors having access to these medications and are currently evaluating whether to participate in the pilot program.

Healthcare workers face rising workplace violence as Congress debates solutions

By Adrian Thomas and InvestigateTV Staff – Healthcare workers across the country face violent acts while trying to help patients heal, including being punched, kicked, bitten and even stabbed. According to a May 2024 study by the CDC, healthcare workers make up 10% of the American workforce but experience 48% of non-fatal injuries resulting from workplace violence. The issue has become severe enough that Congress is trying to pass laws to help curb it, but there are two different bills being considered and disagreement on which one is best. Read Full Article...

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1. Two Legislative Approaches to Workplace Safety: Lawmakers are considering two different federal proposals to address violence against healthcare workers. The Workplace Violence Prevention Act would require healthcare employers to create comprehensive prevention plans, with supporters emphasizing safe staffing levels as a key factor in recognizing and managing escalating patient behavior. The Save Healthcare Workers Act, supported by the American Hospital Association, instead focuses on deterrence by increasing criminal penalties for people who assault healthcare staff.

2. Oregon Enacts Comprehensive Workplace Violence Law: In January 2026, Oregon implemented a new law aimed at reducing violence in healthcare settings through a range of safety measures. The law requires hospitals to provide annual workplace safety training, establish committees that include both administrators and healthcare workers, and collect and report data on violent incidents to a state agency. Additional provisions allow nurses to display only their first name on identification badges and require protective measures such as bulletproof glass in emergency rooms.

3. Healthcare Workers Highlight Risks and Need for Culture Change: Nurses shared experiences of verbal abuse, threats, and physical assaults while working in hospitals and home healthcare environments. The new law also requires documentation of patients’ violent histories and sharing that information with other healthcare organizations when care is transferred. Supporters say these measures, along with broader awareness, are intended to address what many workers describe as the normalization of violence in healthcare settings.

Elevance Health 'ghost network' class action lawsuit allowed to proceed

By Noah Tong – A lawsuit alleging Elevance Health business Carelon Behavioral Health misled beneficiaries about the scope of its provider network will move forward after a federal judge ruled against the insurer's motion to dismiss. Judge Edgardo Ramos of the Southern District of New York denied Carelon’s motion to dismiss the plaintiff’s case alleging deceptive business practices, deceptive advertising, claims for fraudulent and negligent misrepresentation and unjust enrichment claims, according to a court ruling on Tuesday. Read Full Article...

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1. Lawsuit Centers on Alleged Misrepresentation of Provider Networks: The class action lawsuit claims that Carelon Behavioral Health, an Elevance Health business, misled beneficiaries by overstating the size and accuracy of its mental health provider network. Plaintiffs argue that these so-called "ghost networks"—directories with inaccurate or outdated provider information—caused members to struggle to access mental health services. The case alleges that this practice influenced enrollees’ decisions and gave Carelon an unfair advantage over competitors.

2. Court Decision Allows Core Allegations to Proceed: While the court dismissed breach of contract claims due to the contractual relationship being with New York State rather than individual members, it allowed the main allegations of deceptive practices and unjust enrichment to move forward. This means the lawsuit will continue to address whether Carelon’s actions constituted fraudulent misrepresentation and violated consumer protection laws. The decision keeps the central issues of network accuracy and member impact at the forefront of the case.

3. Broader Implications for Mental Health Access and Industry Practices: The lawsuit highlights a widespread problem of inaccurate provider directories, particularly in mental health care, which can lead to delays, increased costs, and unmet patient needs. Secret shopper studies cited in the article found that only a small fraction of listed providers were actually available to new patients, reinforcing concerns raised by government investigations. The outcome of this case could influence how insurers maintain provider directories and comply with regulations like the No Surprises Act and Mental Health Parity and Addiction Equity Act.

Kill switches, guardrails: The raging debate over healthcare AI agents

By Giles Bruce – Agentic AI is arriving in health systems before anyone has agreed on how to contain it — whether to deploy narrow, task-specific agents or broader autonomous use cases, and how to build meaningful oversight into both. Health system IT leaders told Becker’s they’re experimenting with early frameworks and weighing what needs to happen before they give AI agents — which plan, act and execute without a human initiating the interaction — more autonomy than they do today. Read Full Article...

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1. Guardrails and Oversight Remain Central: Health systems are deploying agentic AI primarily in administrative and operational areas, with strict controls such as audit logs, real-time dashboards, and kill switches. Clinical applications are still limited due to regulatory, liability, and cultural concerns, and human oversight is required for any AI-driven recommendations or actions that impact patient care. This cautious approach reflects the current lack of consensus on how much autonomy AI agents should have in healthcare settings.

2. Collaboration and Best Practices Are Needed: Leaders emphasize the importance of sharing best practices and performance data across health systems to ensure safe and ethical adoption of agentic AI. Initiatives like innovation consortiums allow organizations to collectively address challenges and develop frameworks for responsible AI deployment. Such collaboration is seen as key to building the necessary infrastructure for broader, safer use of autonomous AI agents in healthcare.

3. Barriers to Full Autonomy Include Liability and Readiness: Despite the potential for AI agents to improve efficiency, many health system leaders believe the industry is not yet ready for fully autonomous deployment, especially in clinical contexts. Concerns about immature liability frameworks, risk of patient harm, and insufficient investment in governance and workforce training are major obstacles. Until robust oversight mechanisms and regulatory clarity are established, most organizations are focusing on foundational work rather than widespread agentic AI adoption.

Health care polling as top issue for first time since 2020: Gallup

By Sophie Brams – Americans are more concerned about the availability and cost of health care than any other domestic issue, with it reclaiming the top spot for the first time since 2020, according to a new Gallup poll. The poll, released Tuesday, found that 61 percent of the 1,000 adults surveyed said they worry a “great deal” about accessing and affording health care, while 23 percent expressed a “fair amount” of concern. Read Full Article...

HVBA Article Summary

1. Health Care Surpasses Economy as Top Concern: According to the latest Gallup poll, health care has overtaken the economy and inflation as the primary issue worrying Americans. This marks a return to pre-2020 trends, when health care consistently ranked as the top concern before being eclipsed by economic anxieties. The shift suggests that recent changes in the economic climate have lessened public anxiety about financial issues, allowing health care to regain prominence.

2. Political Affiliation Influences Issue Priorities: The poll reveals significant differences in concern based on political affiliation. While a large majority of Democrats and independents express a high level of worry about health care, a majority of Republicans are more concerned about illegal immigration. This divergence highlights how political identity shapes perceptions of the most pressing national issues.

3. Policy Changes Impacting Health Care Costs: The expiration of enhanced ObamaCare subsidies at the end of 2025 has contributed to rising health care and insurance costs for many Americans. Legislative efforts to extend these subsidies have stalled in the Senate, leaving millions facing higher out-of-pocket expenses and reduced enrollment in coverage. These developments have likely intensified public concern about health care affordability and access.