ACA premiums set to spike 

By Nathaniel Weixel, Joseph Choi and Alejandra O’Connell-Domenech - People who buy health insurance through the Affordable Care Act (ACA) are set to see a median premium increase of 18 percent, more than double last year’s 7 percent median proposed increase, according to an analysis of preliminary filings by KFF. Read Full Article…

HVBA Article Summary

1. Proposed ACA Marketplace Premium Increases: Preliminary filings from 312 insurers across all 50 states and D.C. show an average proposed premium increase of about 20% for 2026, marking the steepest hike since 2018, when policy uncertainty also drove sharp jumps. Insurers point to rising costs for hospitalizations, physician services, and prescription drugs as key factors, and many are also building in potential impacts from federal policy changes, such as the possible expiration of enhanced premium tax credits.

2. Policy and Economic Influences: Although tariffs on imported goods may add to medical cost pressures, most insurers are not listing them as a primary driver of higher premiums. Instead, they are more concerned with political and legislative uncertainty, particularly the looming expiration of COVID-era subsidies. If Congress does not extend these enhanced premium tax credits, subsidized enrollees could see their premiums rise by more than 75% starting in January 2026, according to KFF’s projections.

3. State-Level Pushback: In response to the proposed rate hikes, some states are taking action to challenge or block the increases. In Arkansas, Governor Sarah Huckabee Sanders criticized proposed hikes of up to 54% from Centene and 25.5% from Blue Cross Blue Shield, calling them “excessive or discriminatory.” She has urged the state’s insurance commissioner to reject the filings under state law and to protect consumers from what she described as unjustified increases.

Trump says pharma tariffs could eventually reach up to 250%

By Annika Kim Constantino - President Donald Trump told CNBC’s “Squawk Box” on Tuesday that planned tariffs on pharmaceuticals imported into the U.S. could eventually reach up to 250%, the highest rate he has threatened so far. He said he will initially impose a “small tariff” on pharmaceuticals, but then in a year to a year and a half “maximum,” he will raise that rate to 150% and then 250%. Read Full Article…

HVBA Article Summary

1. Proposed Pharmaceutical Tariffs: President Trump has suggested tariffs on pharmaceuticals as high as 250%, up from a July threat of 200%, but has a record of reversing course on such proposals, leaving their implementation uncertain. The tariffs follow a Section 232 investigation into the national security impacts of pharmaceutical imports and are intended to incentivize drugmakers to shift production to the U.S., where domestic manufacturing has declined in recent decades.

2. Industry Concerns and Potential Impacts: Pharmaceutical companies warn that steep tariffs could increase drug costs, deter investment in U.S. facilities, and disrupt supply chains, potentially jeopardizing patient access to medicines. These concerns are compounded by other administration drug pricing policies, which the industry argues threaten both profitability and the ability to invest in research and development.

3. Drug Pricing Initiatives: In addition to the tariff discussions, Trump has revived the “most favored nation” policy through an executive order, aiming to link U.S. drug prices to lower prices abroad. While no formal changes from the order have been implemented, Trump has sent letters to 17 drugmakers urging them to cut U.S. prices by September 29, including offering Medicaid patients the lowest price charged in other developed countries.

UnitedHealth's Optum Rx sued over alleged double-billing for patient prescription

By Allison Bell - A new federal lawsuit in California could affect what happens when health-benefits systems accidentally double bill plan participants. Dave Vaccaro, a Los Angeles resident, says Optum Rx, a subsidiary of UnitedHealth, authorized a single debit from his bank account for a prescription purchased Nov. 15, 2024. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Allegations of Unauthorized Bank Debits: Plaintiff Vaccaro alleges that Optum Rx first made an authorized withdrawal of $150.28 on November 18, 2024, but then charged the account a second time on November 19, 2024, without permission. The complaint claims these actions violated the federal Electronic Funds Transfer Act, which regulates electronic withdrawals, and constituted “common law conversion,” meaning the taking of consumers’ funds without legal authorization.

2. Class Action Scope and Timeframe: The lawsuit seeks to establish two nationwide classes of U.S. residents allegedly impacted between August 4, 2024, and August 5, 2025. One class would cover individuals whose bank accounts were subject to recurring electronic fund transfers without a signed or similarly authenticated written authorization. The second class would include those who experienced alleged unauthorized taking of funds under common law during the same period.

3. Relief Sought: Vaccaro’s complaint requests statutory damages of $1,000 for each class member affected by the alleged violations of federal law, as well as actual damages for any direct losses suffered. The suit also seeks attorneys’ fees, court costs, interest, and any additional relief deemed appropriate by the court, with the potential class size estimated to be in the hundreds.

Weight Loss Medication Coverage, Big PBMs Drive Up Cost Concerns for Plan Sponsors

By Emily Boyle - More than half (51%) of large U.S. employers are likely to increase health care benefit cost sharing with their employees next year as the use of new weight-loss drugs surges, according to Mercer’s Survey on Health Benefits Strategies for 2026. Yet when surveyed about their 2025 intentions to add coverage of glucagon-like peptide medications, which have become popular by helping patients lose weight, employers with at least 500 workers were more likely to say they would add coverage in 2025 than drop it. Read Full Article…

HVBA Article Summary

1. Rising GLP-1 and Prescription Costs: Among large employers in 2024, average medical plan costs per employee rose 5%, while prescription drug costs rose 8%. GLP-1 drug use for obesity and overweight grew nearly 600% over six years, with 2% of Americans using them in 2024 despite an estimated 40% obesity rate. Manufacturing complexity, market introduction costs, and auto-injector delivery contribute to high prices, creating significant budget pressures for employers.

2. Coverage Demand vs. Affordability Challenges: Only 18% of employers with at least 200 employees cover GLP-1s primarily for weight loss, yet 64% of privately insured employees think they should be covered, and 51% are unsure if their plan already does. Employers are weighing long-term adherence—given high drop-off rates and frequent weight regain—against potential healthcare savings and their need to remain competitive in attracting talent.

3. PBM Scrutiny and Market Shifts: The three largest PBMs control 80% of the market and face federal lawsuits and state-level legislation, such as Arkansas’ (currently blocked) ban on PBM-owned pharmacies. In response, 34% of employers are evaluating new or emerging PBMs, more than 50 of which have entered the market in recent years. Additionally, 39% of employers say they are not considering any change in how they manage pharmacy benefits, despite the rapidly shifting landscape.

Employees want to know that leaders approve of AI tools

By Paola Peralta - Organizations' productivity and efficiency strategies rely on employees' willingness to work with new tech tools, but for that to happen, employees need to know that leadership is on board. Despite its growing presence and demand in the workplace, 40% of HR and benefit leaders are still avoiding generative AI, according to a recent report from AI education platform FlexOS. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Leadership hesitation is stalling AI adoption: A significant number of leaders view adapting to AI and automation as their biggest challenge, often due to concerns about fairness, bias, and data privacy, especially in sensitive areas like hiring and promotions. This is compounded by a lack of technical expertise and frustration from years of overpromised, underdelivered “magic bullet” solutions. Such hesitation sends a clear signal to employees, fostering caution and leading to the underutilization of AI tools, ultimately slowing innovation and competitive growth.

2. AI fluency is now a competitive necessity: In today’s market, understanding and effectively using AI is no longer optional but a defining competitive advantage. Companies that fail to educate, equip, and engage their workforce in AI risk lagging behind in both performance and talent retention. Leaders need to demand full transparency from AI providers, ensure systems are explainable and fair, measure workforce skills accurately, and weave AI adoption seamlessly into daily workflows to build trust, confidence, and long-term adoption.

3. HR must lead the transformation through education: The biggest barrier to AI success is not acquiring the technology but enabling people to use it effectively. HR is uniquely positioned to bridge the AI skills gap, instill confidence in employees at all levels, and align talent development with fast-changing business needs. By focusing on continuous upskilling, building AI literacy, and helping employees see a clear growth path, HR can future-proof the workforce, drive innovation, and ensure organizations remain competitive in the AI-driven era.

UnitedHealth to sell off 164 locations to settle US challenge to Amedisys deal

By Jody Godoy - UnitedHealth Group has agreed to sell off 164 hospice and home health locations to resolve U.S. antitrust concerns over its $3.3 billion acquisition of Amedisys (AMED.O), the U.S. Justice Department said on Thursday. The Justice Department and attorneys general from four states sued last year to block the deal, arguing it would reduce competition in the home health services market. Read Full Article…

HVBA Article Summary

1. Merger Approval and Enforcement Context: The Trump administration’s antitrust enforcers approved the Optum–Amedisys merger, signaling a more permissive approach to corporate deal clearances compared to the stricter oversight often associated with the Biden administration. The settlement, according to the Justice Department, is designed to protect competition in both the quality of patient care and the wages of nursing staff, which can have significant implications for healthcare access and labor conditions.

2. Company Perspectives: The Justice Department emphasized that the agreement safeguards hundreds of thousands of vulnerable patients from potential declines in care quality and protects wage competition for thousands of nurses. Optum, for its part, expressed that the acquisition of Amedisys will help it accelerate improvements in home health and hospice services, which it views as essential components of its broader value-based care model aimed at improving patient outcomes and lowering long-term costs.

3. Penalty for Disclosure Lapse: The Justice Department imposed a $1.1 million fine on Amedisys for failing to disclose missing information during the merger review process, underscoring the federal requirement for complete transparency in regulatory submissions. This penalty serves as both a corrective measure and a warning to other companies that incomplete or inaccurate filings can result in significant financial and reputational consequences.

Hospitals struggle to find space as demand for outpatient care outpaces new construction

By Erika Morphy - Medical office building sales continued at a slow pace in the second quarter of 2025, according to preliminary data released by RevistaMed, an Arnold, Maryland-based healthcare real estate research firm. On July 24, RevistaMed hosted a webcast to present its second-quarter findings, led by principal Hilda Martin and research analyst Stephen Lindsey. They reported that MOB sales volume was $1.52 billion for the quarter, the lowest level seen in more than nine years, based on data collected so far. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. MOB Sales & Pricing Trends: Preliminary Q2 medical office building (MOB) sales volume stood at $8.4 billion over the past 12 months, slightly below last year, with higher 2024 numbers partly driven by past M&A activity. While transaction volume remains muted, median pricing rose modestly to $374 per square foot, and the median capitalization rate increased to 6.8%.

2. Strong Demand, Limited Supply: National MOB occupancy in the top 100 U.S. markets reached 92.8%, driven by factors such as an aging population, preventive care growth, and outpatient procedure migration. Demand has outpaced new supply (16 million sq. ft. absorbed vs. 14 million delivered), with new construction starts representing less than 1% of total inventory.

3. Health System Strategies Under Tight Conditions: Health providers like Northwestern Medicine face challenges securing adequate space due to low supply and high costs, often relying on second-generation spaces that require upgrades. Ownership remains preferred for long-term operations, but some hospitals may sell assets to free up capital, potentially increasing the role of benefits brokers in helping redirect savings toward real estate and facility investments.