GOP plan leaves ACA subsidies behind

By Peter Sullivan – The outlines of a Senate Republican health care plan are coming into focus, and it wouldn't extend enhanced Affordable Care Act subsidies — increasing the likelihood that the assistance will expire in less than a month. Why it matters: An expiration would expose millions of Americans to sharp increases in out-of-pocket premium costs that could lead some to go without insurance. Read Full Article...

HVBA Article Summary

1. Republican Alternatives to ACA Subsidy Extension Face Internal Divisions: Multiple Republican senators have proposed alternatives to simply extending the ACA (Affordable Care Act) subsidies, such as providing health savings account (HSA) funds or phasing out subsidies with new eligibility restrictions. However, the GOP is split on which path to take, making it unclear whether any of these plans will advance or even come to a vote.

2. Democrats and Republicans Remain at an Impasse: Democrats are pushing for a three-year extension of ACA subsidies, which is expected to fail due to strong Republican opposition. Conversely, GOP-backed alternatives are unlikely to gain traction amid Democratic resistance. This partisan gridlock makes it unlikely that any proposal will pass before the current subsidies expire at year’s end.

3. Outlook for Compromise Is Uncertain, Especially in an Election Year: Although some hope remains for a potential bipartisan health care compromise tied to the January 30 government funding deadline, political polarization—especially around issues like abortion coverage and subsidy spending—makes a deal challenging in an election year. Both parties are using the debate to bolster their respective affordability narratives.

Health Care Cost Control to Take Center Stage in 2026

By Emily Boyle - Employers have bumped health benefit cost-containment to the top of their strategic priorities list, according to Brown & Brown Inc.’s Employer Health and Benefits Strategy Survey, 2026, released Monday. Going into next year, 42% of employers cited health care cost control for both the organization and its employees as their No. 1 objective, moving last year’s top goal, “attracting and retaining a competitive workforce,” down to third. Read Full Article…

HVBA Article Summary

1. Employers Brace for Major Healthcare Cost Increases in 2026: According to the Business Group on Health, 2026 is expected to be “one of the most challenging affordability and cost management years in recent history,” with U.S. employers anticipating a median 9% increase in healthcare costs—only reduced to 7.6% after plan design changes. This marks a continuation of a trend where actual costs have exceeded employer forecasts for the past two years. Additionally, 56% of employers surveyed by Brown & Brown said inflation and economic volatility have substantially impacted their health and welfare strategies.

2. Cost-Control Tactics Focus on Plan Redesign, Vendor Oversight, and Digital Tools: Employers are expected to take more aggressive action to manage rising costs. 81% plan to evaluate medical stop-loss designs, and 79% will conduct audits of claims, pharmacy, or clinics within the next two years. Key strategies include partnerships with digital health or wellness solution providers (80% adoption rate) and implementation or enhancement of cost transparency tools (79%). Evaluations may also lead to cutting underperforming vendors and reconsidering future benefit enhancements or arrangements with high-cost service partners.

3. GLP-1 Medications Drive Pharmacy Benefit Challenges and Supply Chain Shifts: Managing the cost of GLP-1 medications—used for diabetes and weight loss—has become a top priority, with 77% of employers naming it as their primary pharmacy benefit concern (per Mercer). While 48% of employers currently cover GLP-1s for weight loss, 89% plan to continue coverage over the next 1–2 years. Among those offering coverage, 63% have usage restrictions, 49% require clinical criteria beyond FDA guidelines, 38% mandate participation in lifestyle programs, and 25% limit prescriber access. To reduce costs, employers are exploring direct-from-manufacturer purchasing models—bypassing traditional pharmacy benefit managers—and this model is likely to expand to other drug classes by 2026.

Cassidy Wants a New Path on ACA Affordability. HSAs Won’t Get Us There.

By Wendell Potter – The Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing this week on one of the few issues that has summoned rare bipartisan concern in Washington and elsewhere: the crushing cost of health care. As POLITICO reported, lawmakers from both parties signaled they want a deal to prevent Affordable Care Act subsidies from expiring. But judging by the exchanges at the hearing — especially between Committee Chair Bill Cassidy and Ranking Member Bernie Sanders — the question is what kind of solution Congress can live with. Read Full Article...

HVBA Article Summary

1. Enhanced ACA Subsidies Are Essential to Prevent Unaffordable Premiums: With ACA subsidies set to expire soon, millions of Americans face a steep rise in premiums they may not be able to afford. In Cassidy’s home state of Louisiana, where the median household income is $60,000, many families would be unable to purchase comprehensive insurance without significant government support. The article warns that removing these subsidies risks destabilizing the ACA marketplace and pushing Americans back into a fragmented, high-cost individual insurance market.

2. HSAs Are Financially Inaccessible for Most and Don't Solve High Out-of-Pocket Costs: The proposed shift to government-seeded Health Savings Accounts (HSAs) linked to cheaper, high-deductible bronze plans would offer little relief for most Americans. Current law requires HSAs to be paired with high-deductible health plans, yet:

   • 51% of HSA accounts hold $500 or less

   • Only 2% have $25,000 or more

   • Meanwhile, the average cost of a family policy has reached $26,993, and some families still face over $20,000 in out-of-pocket costs in a bad health year — costs that a modest HSA cannot realistically offset.

3. HSAs Could Reinforce Big Insurance's Market Power Instead of Reducing Costs: Instead of bypassing insurers, the HSA-based approach may funnel more public dollars into the same industry it aims to reform. For example, UnitedHealth Group, the country’s largest insurer, also owns Optum Bank, the largest HSA custodian — meaning government HSA deposits would still end up supporting these conglomerates. Additionally, HSAs have become a booming market for retail goods, with funds increasingly spent on items like $9,000 ice baths, $2,000 saunas, and gym memberships, rather than essential medical care, raising concerns about their effectiveness in addressing serious health care affordability challenges.

Healthcare cybersecurity bill promises increased guidance, grants for industry

By Emma Beavins - A group of bipartisan senators introduced new healthcare cybersecurity legislation that would change Department of Health and Human Services (HHS) protocols on cybersecurity and offer guidance to the healthcare industry on how to handle cybersecurity attacks. According to data compiled by the HIPAA Journal, the largest number of individuals had their healthcare data exposed in 2024 than any year since 2009, when the HHS’ Office for Civil Rights began collecting data on breaches. The cyberattack on UnitedHealth subsidiary Change Healthcare, which happened in February of that year, is estimated to have impacted more than 190 million individuals. Read Full Article…

HVBA Article Summary

1. Healthcare Sector Faces Escalating Cyber Threats: In 2024, the U.S. healthcare sector experienced the highest volume of ransomware and data theft incidents among all critical infrastructure sectors. This included 592 regulatory filings to the Department of Health and Human Services (HHS), affecting a record 259 million Americans. A significant portion of this impact stemmed from the Change Healthcare ransomware attack, which alone compromised data for approximately 190 million individuals.

2. Bipartisan Legislation Aims to Improve Cyber Resilience: A bipartisan group of senators has reintroduced the Healthcare Cybersecurity and Resiliency Act of 2025, designed to strengthen cybersecurity across the healthcare system. The bill proposes targeted grants, federal guidance, and educational programs to help healthcare providers—especially those in rural and underserved areas—better prepare for and respond to cyberattacks on their IT infrastructure.

3. Proposed Reforms Include Reporting, Education, and Modernization: The legislation outlines several modernization efforts, including updates to HIPAA’s Security Rule to mandate more current cybersecurity practices. It also calls for the creation of a public-facing breach-reporting portal, an HHS incident response plan, and enhanced education and training for the healthcare workforce. These measures aim to improve accountability, boost cybersecurity readiness, and increase transparency in breach responses.

How and Where Can Plan Sponsors Identify ‘Gag Clauses’ in Contracts?

By PlanSponsor Staff – How do you know if there are “gag” clauses in a contract and which contracts would they be in? Jamie Greenleaf, co-founder, Fiduciary in a Box; Julie Selesnick, founder and principal attorney, Health Plan Legal Counsel and of counsel, Berger Montague; Rory Akers, vice president, senior ERISA compliance attorney, Lockton Companies; and Alden Bianchi, of counsel, McDermott Will & Shulte, answer below. Read Full Article...

HVBA Article Summary

1. Gag Clause Prohibitions Enhance Transparency: The gag clause rules prohibit group health plans and insurance issuers from entering into agreements that limit access to provider-specific cost and quality-of-care information. These rules ensure that participants, beneficiaries, enrollees, plan sponsors, and referring providers can access this data, and that de-identified claims and encounter data can be shared in line with privacy laws. This move is aimed at promoting transparency in health care pricing and performance to support informed decision-making.

2. Broad Scope of Application with Specific Exceptions: The prohibition applies to nearly all group health plans and individual coverage types, including self-funded, fully insured, grandfathered, church, and nonfederal governmental plans. All applicable plans must submit an annual attestation of compliance to the federal government. However, the rules exclude certain types of plans such as excepted benefits (e.g., fixed indemnity or disease-specific coverage) and account-based arrangements like health FSAs.

3. Contracts Must Address “Downstream” Agreements: The gag clause rules extend to both direct agreements and "downstream" contracts—such as those between third-party administrators (TPAs) or pharmacy benefit managers (PBMs) and health care providers. Health plans must ensure that no contractual language, even in sub-vendor agreements, restricts the sharing of required cost or quality data. Notably, while these rules improve transparency, they do not automatically grant employers access to their plan’s claims data.

Falling prices might lead 33% of U.S. adults to try GLP-1 weight-loss drugs

By Allison Bell – Roughly 5.1% of U.S. adults may now be using GLP-1 agonists to try to control their weight, according to eHealth. Another 33% of U.S. adults told eHealth that they wanted to try drugs like Wegovy once the price comes down, and 15.4% said they were not sure what they want to do about the drugs. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Growing Interest in Weight-Loss Drugs Amid High Obesity Rates: With 74% of U.S. adults being overweight or obese, there is significant interest in GLP-1 agonists, a newer class of weight-loss drugs. A RAND survey found that 12% of adults have already tried them, and 26% are interested in doing so. This reflects a broader trend toward medical weight management solutions.

2. Potential for Massive Growth in Spending on GLP-1 Agonists: If roughly one-third of U.S. adults begin spending around $200 per month on GLP-1 agonists, annual out-of-pocket spending could reach $220 billion—far exceeding the $45 billion spent in 2024. Some projections, like those from CVS Health's CEO, suggest future total spending could surpass $1.2 trillion annually at current prices.

3. Public Perceptions and Pricing Expectations Are Shifting: Survey data from eHealth indicates a surprising number of Americans are willing to invest heavily in weight-loss medications. While only 19% capped their budget at $50/month, 31% were willing to spend more than $300. Additionally, lower premium costs for 2026 health plans surprised 23% of survey participants, signaling increased consumer sensitivity to health-related costs and options.

How dental benefits can help manage diabetes

By Edward Shellard - Along today's benefits landscape, forward-thinking brokers are partnering with dental insurance companies to highlight the critical connection between oral health and systemic conditions like diabetes. This strategic alliance provides a comprehensive approach to wellness, going beyond basic dental benefits offerings to help employer clients understand how addressing this often-overlooked area can cultivate a healthier, more engaged workforce. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Oral Health and Diabetes Are Interconnected Conditions: Gum disease affects an estimated 22% of individuals with diabetes, and the relationship is bidirectional—high blood sugar worsens gum health, while gum inflammation complicates blood sugar control. Diabetes also raises the risk of oral issues like tooth decay and dry mouth, with broader links to systemic conditions such as heart disease and Alzheimer's, highlighting the need for integrated care approaches.

   The Economic Impact Is Substantial for Both Employers and Employees: Diabetes-related complications lead to an estimated $106.3 billion in annual losses for U.S. businesses due to absenteeism and reduced productivity. Additionally, individuals with diabetes incur 2.6 times higher medical expenses compared to those without, including dental costs. Routine dental care has been shown to reduce out-of-pocket costs significantly, offering an opportunity for long-term savings.

   Dental Benefit Strategies Offer a Competitive Advantage for Brokers: Brokers can add value by promoting preventive-focused dental plans, leveraging educational resources from insurers, and using claims data to identify at-risk populations. Tailored benefits that support diabetes management—such as enhanced coverage for periodontal treatment—can improve employee health outcomes and position brokers as strategic partners in workforce wellness.