Biden’s proposal for government GLP-1 coverage could raise federal spending by billions

By Maia Anderson - The popularity of GLP-1s has skyrocketed in recent years, and a November 26 proposal from President Joe Biden’s administration to allow Medicare and Medicaid to cover the medications could make them even more prominent. Read Full Article… 

HVBA Article Summary

1. Coverage and Costs Debate: Medicare and Medicaid are limited in covering GLP-1 medications primarily for diabetes and cardiovascular disease, leaving most weight-loss treatments uncovered. Expanding coverage could provide affordable access to approximately 7.4 million enrollees but would significantly increase federal spending—an estimated $36 billion for Medicare and $15 billion for Medicaid over the next decade.

2. Potential Savings vs. Projected Costs: While some experts, like those at the Dedham Group, argue that covering GLP-1s could lead to long-term savings by reducing chronic illnesses, the CBO projects only modest health-related savings, far outweighed by the costs. Meanwhile, alternative estimates from the University of Southern California suggest much larger savings if private insurers also cover the medications, with a potential $245 billion saved over 10 years.

3. Political and Policy Uncertainty: The decision on Medicare's coverage of weight-loss drugs depends on the incoming Trump administration's stance. Leaders nominated for key healthcare roles have expressed mixed views on the medications, citing concerns about addressing obesity's root causes. With a 60-day public comment period ending soon, there is mounting pressure on policymakers to act, given the popularity of such coverage among seniors and its potential implications for Medicare expansion.

More Than 70 Organizations Urge Congress to Extend Enhanced Premium Tax Credits

By Marissa Plescia - More than 70 organizations, led by Families USA, sent a letter to Congress on Monday calling on them to extend the enhanced premium tax credits that are set to expire at the end of 2025. The enhanced premium tax credits, introduced in 2021, reduced health insurance premiums for millions of individuals purchasing coverage through the marketplace. Read Full Article… 

HVBA Article Summary

1. Impact of Expiring Premium Tax Credits: Advocacy organizations, including Families USA, emphasize that the expiration of enhanced premium tax credits in 2025 would disproportionately affect older adults, rural households, small business owners, and self-employed individuals. Without an extension, premiums are projected to double for many, millions could lose coverage, and uninsured rates may rise by 2.2 million, according to the Congressional Budget Office.

2. Public and Congressional Action Needed: A survey revealed that 86% of voters in 2024 support extending the enhanced tax credits. Advocacy groups urge Congress to act promptly to prevent "premium shock" for 2026 plans, as insurers will start setting rates as early as spring 2025. The letter stresses that constituents' demand for action should be met with legislative commitment to extending the credits.

3. Real-Life Implications of the Tax Credits: The letter highlights personal stories, such as Dean, a self-employed designer who relied on tax credits to afford life-saving cancer treatment, and Jenny, a 64-year-old stroke survivor whose coverage prevented financial ruin. These examples underscore the critical role premium tax credits play in protecting Americans from severe financial and health crises.

Hollywood Firefighters’ Pension sues UnitedHealth execs, including slain CEO, alleging insider trading

By Lynn Cavanaugh - A class action lawsuit brought by the City of Hollywood Firefighters’ Pension Fund alleges that UnitedHealthcare CEO Brian Thompson, who was slain in New York City last week, as well as two other company executives, were involved in insider trading in 2023.  Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Allegations of Insider Trading and Non-Disclosure: The lawsuit filed by the Hollywood Firefighters’ Pension Fund accuses UnitedHealth executives, including Chairman Stephen Hemsley, CEO Andrew Witty, and UnitedHealthcare CEO Brian Thompson, of selling over $120 million in UnitedHealth stock. The suit alleges the sales occurred with knowledge of an active DOJ antitrust investigation into the company’s acquisition of Change Healthcare, which was not disclosed to investors or the public.

2. DOJ Investigation and Court Ruling on the Acquisition: UnitedHealth’s DOJ-related antitrust scrutiny began with its January 2021 announcement to acquire Change Healthcare and integrate it into its Optum unit. While the acquisition was approved by the District of Columbia court in September 2022, the DOJ later reopened its investigation, focusing on allegations of improper firewalls between UnitedHealthcare and Optum, contrary to UnitedHealth's representations.

3. Impact on Investors and Class Action Scope: The lawsuit, representing UnitedHealth stock purchasers between March 14, 2022, and February 27, 2024, claims the pension fund suffered financial damages due to artificially inflated stock prices. It highlights significant stock sales by Hemsley and Thompson during the four-month period following their awareness of the DOJ investigation in October 2023, further alleging violations of federal securities laws.

With or Without ACA Repeal, ACA and Medicaid Cuts Are Looming

By Larry Levitt, MPP - Unlike in many previous national elections, the 2024 presidential election was not one in which health reform was front and center. The Affordable Care Act (ACA) received some attention—most notably when President-elect Donald Trump said he had “concepts of a plan” to replace the ACA, but it never became a focal point of the campaign. Medicaid was hardly mentioned. Read Full Article…

HVBA Article Summary

1. Potential Impact on ACA and Medicaid: With a Republican-led Congress and Trump potentially returning to the White House, significant changes to the ACA and Medicaid could arise. These changes may involve reduced federal spending, increased financial responsibility for states, and a rise in uninsured individuals due to cuts or policy shifts.

2. Expiration of ACA Enhanced Subsidies: The enhanced premium subsidies under the ACA, introduced during the COVID-19 pandemic, are set to expire at the end of 2025. Without renewal, ACA enrollment could decrease by nearly 7 million, with a projected $705 annual increase in premiums for enrollees. This expiration would likely have the most significant impact on Southern states, where ACA enrollment has surged the most.

3. Proposed Medicaid Spending Reductions: Proposals from conservative think tanks and Trump’s prior administration suggest capping Medicaid spending or reducing federal match rates for ACA expansion enrollees. Such changes could reduce the federal deficit but shift financial burdens to states, potentially leaving millions uninsured, particularly those covered under the ACA Medicaid expansion.

Family Forced by Cigna's PBM to Make a 9-Hour Drive for a Child’s Life-Saving Medication

By Wendell Potter - Cristi Waltz’s 12-year-old grandson Isaac went several days without telling his mom about the strange color of his urine – bright yellow, then dark purple – until it triggered a frantic, hour-plus drive from their community in rural western Pennsylvania to the emergency room at Children’s Hospital in Pittsburgh. Read Full Article…

HVBA Article Summary

1. The Struggles of Patients in the PBM System: The Waltz family’s ordeal highlights the challenges faced by patients navigating the complex U.S. healthcare bureaucracy. From repeated long trips to Philadelphia to obtain life-saving medication to the inefficiency of mail-order prescriptions, their story underscores how PBMs often prioritize profits over patient care, creating unnecessary barriers to essential treatments.

2. The Bipartisan Push for Reform: Lawmakers from both sides of the aisle, driven by stories like Cristi Waltz’s, are rallying to pass legislation targeting PBM practices. The proposed Lower Costs, More Transparency Act and the Telehealth Modernization Act aim to increase transparency, reduce costs, and protect local pharmacies from exploitative PBM practices, ensuring better access to medications for all patients.

3. The Fight for Transparency and Accountability: Activists like Cristi Waltz are calling for greater transparency in PBM operations, advocating for rebates to benefit patients rather than enriching corporate executives. Her activism, fueled by personal struggles, demonstrates the critical need for systemic reform to prevent such hardships for other families and improve healthcare equity nationwide.

Drug Cost Planning Is About More Than Choosing Plans

By Ron Mastrogiovanni - With the 2025 Medicare open enrollment season wrapped up, it may be tempting to put health care and prescription drug-related costs on the back burner. But, as with all retirement expenses, monitoring and planning for future drug costs should be an ongoing process. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Medicare Part D Trends: While basic Medicare Part D premiums are down 4% for 2025 due to government underwriting and stabilization efforts, premiums for mid-level and high-end plans are increasing significantly—by 4% and 23%, respectively, compared to 2024. Over two years, premiums for broader-coverage plans have risen by over 50%, highlighting a growing cost disparity across policy tiers.

2. Coverage Erosion and Shrinkflation: Deductibles are rising, with low-end plans requiring around $600 in spending before coverage begins in 2025. Simultaneously, Medicare Part D Star ratings have declined for three consecutive years, dropping from 3.70 in 2022 to 3.06 in 2025. Shrinkflation is eroding the perceived benefits of these plans, with some even losing a full Medicare star despite premium hikes.

3. Future Uncertainty Around the Inflation Reduction Act and Rising Costs: Potential changes or repeal of the Inflation Reduction Act under President-elect Trump could significantly affect drug pricing and out-of-pocket caps for retirees. Meanwhile, the cost of drugs and health care in retirement continues to outpace inflation, raising financial challenges for clients, especially younger retirees, who will face even higher lifetime health care costs under current trends.

   

3 factors to consider when funding voluntary benefits

By Shelby Gartner - Offering a range of voluntary benefits is an effective, modern way to elevate the employee experience and make a company more attractive to prospective hires. Yet, when it comes to voluntary benefits, the question remains: Should the employer foot the bill? Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Cost Considerations: Employers must evaluate the financial impact of offering employer-paid voluntary benefits by assessing whether they align with employee needs, organizational goals, and potential tax advantages. A thoughtful approach ensures that these benefits enhance the overall package without detracting from core offerings. Additionally, benefits like identity theft protection can provide dual advantages, bolstering both employee satisfaction and organizational cybersecurity.

2. Benefits Utilization: The success of voluntary benefits depends on how well they align with employees' needs and preferences. Employers can use reporting tools to track engagement and usage, ensuring their investment is impactful. Benefits that remain unused fail to attract or retain employees, while those that offer ongoing value — such as identity theft protection plans with remediation options — can create lasting satisfaction.

3. Experience and Impact: A comprehensive benefits package improves employee experience and supports organizational goals like morale, retention, and productivity. Employers can make a greater impact by addressing holistic well-being, as shown by companies offering financial wellness and identity protection benefits, which often see strong engagement and satisfaction. Ultimately, strategically chosen benefits foster a positive workplace culture and enhance overall organizational performance.