Schumer introduces bill to reverse ‘OBBB’ healthcare cuts, permanently extend ACA subsidies

By Andrew Cass - Senate Minority Leader Chuck Schumer, D-N.Y., has introduced a bill aimed at repealing the healthcare cuts in the One Big Beautiful Bill Act and permanently extending ACA premium tax credits. Mr. Schumer’s legislation would reverse all the cuts in the budget bill that President Donald Trump signed in early July, according to an Aug. 5 news release from his office. Read Full Article…

HVBA Article Summary

1. Projected Medicaid Cuts and Coverage Impact: The legislation is projected to reduce federal Medicaid spending by approximately $1 trillion by the year 2034. This reduction in funding is expected to result in about 10 million more individuals becoming uninsured, according to estimates from the Congressional Budget Office.

2. Extension of ACA Tax Credits: The bill includes a provision to permanently extend the enhanced premium tax credits under the Affordable Care Act (ACA), which were initially expanded through the American Rescue Plan Act during the COVID-19 pandemic. These credits are currently scheduled to expire at the end of 2025.

3. Impact on ACA Enrollment and Political Support: Since the introduction of the enhanced tax credits, ACA marketplace enrollment has more than doubled—from 11.4 million in 2020 to 24.3 million projected in 2025—indicating a significant increase in access to affordable health coverage. The legislation has full support from the Democratic caucus, with all members listed as co-sponsors.

Nearly half of Americans say they put off health care due to barriers of cost

By Lucy Peterson - A new study by Madaket Health found that insured Americans delay or skip essential health care due to rising costs and complexity of coverage. Many younger Americans are actually going out of their way to pay for care themselves. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Cost and Network Barriers Are Major Obstacles to Care: Nearly half of Americans (47%) have delayed seeking health care due to cost concerns. Millennials are the most impacted, with 78% admitting to postponing care, compared to 56% of Generation X and just 30% of baby boomers. Additionally, 74% of all respondents said they would delay care if their preferred provider is out-of-network, showing how both affordability and insurance network limitations significantly influence care decisions.

2. Preventative and Specialist Care Is Frequently Delayed: Preventative medical care and regular screenings are not happening as recommended for many Americans. Nearly one in four respondents (24%) said they have delayed visits to routine specialists like dermatologists or eye doctors. This highlights a broader issue within the health care system, where even non-urgent but essential services are being deprioritized due to access and cost-related barriers.

3. Patients Are Paying Out-of-Pocket and Turning to Digital Care: Beyond delaying care, a significant number of Americans are choosing to pay for services themselves when insurance falls short—38% reported paying out-of-pocket for services that were out-of-network or not covered. This trend is especially strong among millennials (68%), compared to 44% of Gen X and 21% of boomers. Simultaneously, digital health solutions are gaining popularity, with 60% of all respondents using online or app-based services. The most used tools include online prescriptions (28%) and virtual primary care visits (24%).

Elevated Medicare Advantage, ACA marketplace costs sting insurers in mixed Q2

By Paige Minemyer - Major payers faced another mixed quarter financially amid ongoing cost pressures in Medicare Advantage (MA) and new challenges emerging on the Affordable Care Act's (ACA's) exchanges. While Wall Street may be souring on industry bellwether UnitedHealth Group, the company still led the pack on profits in the second quarter with $3.4 billion. The next-highest earner was Elevance Health, at $1.7 billion in profit, followed by the Cigna Group with $1.5 billion. Read Full Article… 

HVBA Article Summary

1. Mounting Financial Pressure on Major Insurers: UnitedHealth led the quarter in revenue with $111.6 billion but missed profit expectations due to $6.5 billion in unexpected medical costs, mainly from Medicare Advantage (MA) plans. The company is adjusting by repricing products for 2026 and exiting underperforming MA plans, impacting up to 600,000 members. CVS and Humana are also responding to rising MA costs but showed early signs of stabilization.

2. ACA Market Becomes a New Pain Point: Insurers heavily involved in the ACA exchanges—like Centene, Molina, and Elevance—are seeing sharp cost increases driven by higher morbidity, aggressive provider coding, and fewer healthy enrollees. This has led to lowered earnings guidance, profit losses (e.g., Centene’s $253 million loss), and accelerated efforts to reprice 2026 plans in response to deteriorating market dynamics.

3. Strategic Shifts Based on Market Exposure: Insurers are taking divergent paths based on their risk profiles. Cigna, less exposed due to its focus on the commercial market and MA exit, maintained its outlook and reported $67.2 billion in revenue. Meanwhile, companies still entrenched in MA or ACA plans are emphasizing long-term strategy shifts—including repricing, exiting unprofitable segments, and investing in structural changes—to navigate ongoing headwinds.

GLP-1s to become key part of health care infrastructure, expert predicts

By Allison Bell - Today, some employers might be able to avoid offering obese employees coverage for GLP-1 agonists like Wegovy and GLP-1/GIP agonists like Zepbound. But Dr. Tim Church, a public health specialist who now serves as chief medical officer at Wondr Health, predicted recently that GLP-1 agonists, GLP-1 /GIP agonists and similar prescription drugs will soon be as much a part of the medication infrastructure as statins or thyroid pills. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Potential Health Benefits of GLP-1 Agonists: Research suggests that GLP-1 and GLP-1/GIP agonist medications may provide a wide range of health benefits beyond managing type 2 diabetes and weight. These include significantly lowering the risk of chronic conditions such as cardiovascular disease, liver and kidney disorders, sleep apnea, musculoskeletal issues, and possibly even Alzheimer’s disease. Emerging studies also indicate potential positive effects on mental health, such as reducing anxiety-related medical visits.

2. Barriers to Widespread Use: Despite their potential, these medications are not yet accessible to all who could benefit. High costs remain a major obstacle, along with a lack of thoroughly tested clinical guidelines to help providers determine the most appropriate medication and dosage for each patient. More comprehensive support systems are needed to ensure individualized and effective treatment plans.

3. Mechanism and Long-Term Strategy: GLP-1-based drugs function through several biological pathways, including slowing stomach emptying, decreasing hunger hormone activity (like ghrelin), and reducing systemic inflammation. These mechanisms may contribute to benefits for conditions like osteoarthritis. However, for long-term success and sustained health improvement, these medications should be paired with structured behavior-change programs that promote balanced nutrition, regular physical activity, and other sustainable healthy lifestyle habits.

44 health system-owned health plans

By Allie Woldenberg - Health systems across the U.S. are increasingly launching or expanding their own health plans to enhance care coordination, improve patient outcomes and reduce costs. Becker’s has curated a list of health system-owned and -affiliated health plans from across the country. Read Full Article…

HVBA Article Summary

1. Health System-Affiliated Plans Are Expanding Nationwide: Across the U.S., a wide range of health systems are launching or scaling up their own insurance plans, either independently or in partnership with national insurers. Examples include Allina Health Aetna (Minnesota), Banner Aetna (Arizona), Jefferson Health Plans (Pennsylvania), Sanford Health Plan (Midwest), Sutter Health Plus(California), and Memorial Hermann Health Plan (Texas). These plans are designed to integrate care delivery and financing, enabling health systems to manage population health, improve outcomes, and control costs more effectively.

2. Medicare Advantage Is a Central Focus: Many of these health plans are increasingly targeting Medicare Advantage (MA) members as a strategic priority. Health systems like UMass Memorial Health (Mass Advantage), Cone Health (HealthTeam Advantage), Ochsner Health, Trinity Health (MediGold), and Johns Hopkins Health Plans have developed MA-specific products with enhanced benefits tailored for older adults. These benefits often include dental, hearing, fitness programs, transportation, and chronic care coordination—positioning these systems to compete with national MA insurers.

3. Integration and Localized Care Drive Value: A key strength of these system-owned plans lies in their integration with local providers and hospitals. Systems like Kaiser Permanente, Geisinger, UPMC, Sharp HealthCare, and Intermountain Health (Select Health) offer plans that leverage their own hospitals, clinics, and physician networks. This integration supports better care coordination, streamlined referrals, access to virtual care, and use of in-house services like telehealth and care navigation tools—ultimately delivering more patient-centered, cost-effective care within their communities.

Healthcare’s Poor Data Infrastructure Is Hindering AI Innovation in the Field, CEO Says

By Katie Adams - The hype around AI in healthcare is undeniable. AI startups are dominating the digital health investment market, companies like Abridge and Ambience Healthcare are surpassing unicorn status, and the White House recently issued an action plan to advance AI’s use in critical sectors like healthcare. However, one digital health executive thinks AI progress in the field could stall soon unless one key problem is fixed. Read Full Article…

HVBA Article Summary

1. AI in Healthcare Depends on Better Data Infrastructure: For AI to scale effectively in healthcare, it must be built on a foundation of expansive, diverse, and interoperable data. However, current systems are fragmented and lack standardized formats, making it difficult for developers to access the quality data needed for advanced AI models.

2. Incumbent Vendors Resist Data Sharing: Large electronic health record vendors like Epic and Cerner have little motivation to support data interoperability, as it threatens their competitive advantage. While initiatives like CMS's new interoperability push are a step in the right direction, they lack the enforcement or incentives needed to drive real change among these incumbents.

3. Advanced AI is Hindered by Locked Data: The most successful AI applications in healthcare today focus on easily accessible data, such as billing or documentation. More clinically impactful AI tools remain limited by restricted access to proprietary patient data, underscoring the need to invest in foundational data infrastructure before pursuing ambitious AI innovations.

Markup Madness 2025: Hospitals, Insurers, and the Broken Buy-and-Bill Market for Biosimilars

By Jakob Emerson - After multiple years of mandated disclosure of negotiated hospital-insurer rates, those of us who follow the buy-and-bill channel might have expected transparency to reduce drug price variability, lower hospital markups, and accelerate adoption of lower-cost biosimilars. Read Full Article…

HVBA Article Summary

1. Persistent Hospital Markups and Price Variation: Analysis of Avastin and its biosimilars (Mvasi and Zirabev) shows that hospitals—especially 340B hospitals—continue to receive high markups, often more than 200% of a drug’s Average Sales Price (ASP). Commercial insurers reimburse hospitals at widely varying rates for the same drug, with some hospitals earning thousands of dollars more than others for identical treatments.

2. Biosimilar Pricing Not Always Lower: Although biosimilars are priced lower at the wholesale level than their reference products, insurers sometimes pay more for them. In several instances, hospital reimbursement for biosimilars exceeded the ASP by over 400%, and in about 10% of cases, biosimilar payments even surpassed the list price of the original brand-name drug.

3. Transparency Efforts Falling Short: Despite federal transparency regulations and growing adoption of biosimilars, significant inefficiencies and unexplained price disparities persist in the buy-and-bill system. Dominant hospitals can still command higher payments, and insurers tolerate wide pricing gaps—leaving plan sponsors and patients exposed to unnecessarily high costs.