House Speaker Unveils Healthcare Plan as Divided GOP Scrambles for an Alternative

By Associated Press – The Senate failed to get anywhere on healthcare last week. Now it's the House's turn to show what it can do. Speaker Mike Johnson (R-La.) unveiled a Republican alternative late Friday, a last-minute sprint as his party refuses to extend the enhanced tax subsidies for those who buy policies through the Affordable Care Act (ACA), also called Obamacare, which are expiring at the end of the year. Those subsidies help lower the cost of coverage. Read Full Article... 

HVBA Article Summary

1. House Republicans' New Healthcare Proposal Focuses on Market-Based Reforms: House Republicans have introduced a healthcare package that centers on traditional GOP priorities, including expanding access to association health plans for small businesses and the self-employed, and increasing data transparency requirements for pharmacy benefit managers (PBMs) to control prescription drug costs. While the proposal includes limited future cost-sharing assistance under the ACA, it notably excludes an extension of the enhanced tax credits that currently help millions afford coverage, which are set to expire at the end of 2025.

2. Democrats and Some Centrists Oppose or Bypass GOP Efforts: Democratic leaders have sharply criticized the Republican proposal, labeling it politically motivated and insufficient to address rising healthcare costs. Meanwhile, some centrist Republicans are joining with Democrats in support of discharge petitions—an uncommon legislative maneuver—to push for temporary extensions of the ACA's enhanced subsidies. These bipartisan efforts reflect concern about the financial impact on constituents if subsidies lapse without a replacement.

3. Congress Faces a Time Crunch with No Bipartisan Deal in Sight: With only days left in the 2025 legislative session, Congress has made little progress toward a bipartisan agreement on healthcare reform or subsidy extension. Recent failures to advance proposals in the Senate—on both Republican and Democratic sides—highlight the gridlock. As political pressure builds, particularly on lawmakers from swing districts, competing bills and discharge petitions offer possible paths forward, but no clear consensus has yet emerged to prevent coverage cost hikes in the new year.

House GOP rolls out bill to boost association health plans and reboot ICHRAs

By Allison Bell - Members of the U.S. House are now considering a package of health care proposals that includes many health benefits provisions, including sections that would: Make it easier for employers to team up to use association health plans to buy health coverage. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Transparency in Pharmacy Benefits and Employer Plan Protections: The bill would require pharmacy benefit managers (PBMs) to provide detailed tracking reports to employer-sponsored health plans, aiming to increase accountability in drug pricing. It would also prevent states from regulating stop-loss insurance, which employers use to protect self-funded health plans from catastrophic claims. These changes are designed to give employers more control and insight into healthcare spending, without additional state-level interference.

2. ICHRA Reform Through CHOICE Arrangement Act: The proposed CHOICE Arrangement Act would rename Individual Coverage Health Reimbursement Arrangements (ICHRAs) to "custom health option and individual care expense" (CHOICE) arrangements, and address existing regulatory obstacles that make ICHRAs difficult for employers to use. This could increase adoption of these plans by simplifying their structure and clarifying legal ambiguities, offering more flexibility in health coverage design.

3. No Extension of ACA Premium Boosts, but Future Cost-Sharing Subsidies Planned: Although the bill does not extend the current enhanced ACA premium subsidies (set to expire Jan. 1, 2026), it would restore funding for cost-sharing reduction subsidies starting January 2027. The looming "ACA subsidy cliff" could cause coverage costs for some typical users to double, and for certain high-income families with heads of household over age 50, premiums could jump from less than $10,000 per year in 2025 to more than $50,000 in 2026. Lawmakers are considering last-minute amendments—such as subsidy extensions or new tax-advantaged account options—before a potential House vote before Christmas.

States take the lead policing AI in health care

By Adriel Bettelheim – While President Trump demands a single national framework on AI policy, states are going their own way with hundreds of proposals aimed at setting guardrails for how the technology is used in health care. Why it matters: That could set up a clash over who determines how AI models and systems can be deployed in insurer reviews, mental health treatment and chatbots that interact with patients. Read Full Article...

HVBA Article Summary

1. Widespread State Activity on AI and Health Care Regulation: As of mid-October, over 250 AI-related bills impacting health care were introduced across 47 states, with 33 becoming law. These bills reflect a growing bipartisan effort to address the use of AI in sensitive health-related contexts, including chatbots, insurance claim processing, and health data handling. States like Illinois have enacted specific laws banning AI-driven mental health decision-making.

2. Focus Areas: Chatbots, Insurance, Bias, and Data Use: Legislative efforts cover several major concerns: regulating medical chatbots to prevent harm or misrepresentation, imposing transparency and anti-discrimination requirements on high-risk AI systems, mandating reporting on AI-influenced insurance denials, and preventing misuse of health data in clinical AI applications. Some states, such as Texas, Nevada, and Oregon, have already passed such measures.

3. Federal vs. State Tension and Industry Concerns: The rapid rise in state-level laws has sparked friction with federal initiatives and AI companies. A recent executive order by former President Trump aims to challenge restrictive state laws and push for a unified federal framework. Companies like Anthropic express concern over a fragmented legal landscape, warning that a patchwork of laws could hinder innovation and impose inconsistent compliance burdens.

One year after Thompson murder, industry grapples with reform and security

By Alan Goforth - The debate over U.S. health care policy escalated from heated rhetoric to tragic reality on Dec. 4, 2024. One year later, the shocking murder of UnitedHealthcare CEO Brian Thompson -- in broad daylight and on the streets of the nation’s largest city -- continues to ripple not only through the insurance industry, but corporate America as a whole. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Thompson’s Murder Exposed Deep Public Frustration With the Health Care System: The tragic killing of an insurance executive brought national attention to widespread dissatisfaction with the U.S. health care and insurance systems. Although violence was condemned, many experts acknowledged the attack as a symptom of long-simmering public anger over issues like rising costs, denied claims, and lack of transparency. Industry insiders and legal experts noted that this event forced a more urgent and personal reckoning with how systemic problems affect individuals.

2. The Health and Insurance Industries Are Increasing Security and Rethinking Policies: Thompson's death has prompted heightened security measures across multiple industries, with executive protection now viewed as essential. Meanwhile, insurers such as UnitedHealth have acknowledged the need for reform, focusing on improving transparency, customer service, and internal practices. Industry groups like AHIP and the Blue Cross Blue Shield Association have pledged to streamline prior authorization, ensure continuity of care, and expand real-time responses, signaling a push toward practical policy improvements.

3. Health Care Reform Is Gaining Momentum Across the Political and Corporate Spectrum: The incident reignited political debate over health care reform, with proposals ranging from incremental regulatory changes to broader overhauls like Medicare for All. Stakeholders from both government and private sectors have emphasized the need for clearer communication, more equitable policies, and empathetic customer support. As the 2026 midterms approach, affordability, fairness, and trust in the system are expected to be central to voter concerns and legislative agendas.

Semaglutide Tied to 50% Lower Risk for Epilepsy in Diabetes

By Pauline Anderson - Semaglutide, a GLP-1 receptor agonist (RA), was associated with a significantly lower risk for adult-onset epilepsy in patients with diabetes than other glucose-lowering drugs (GLDs). Notably, this risk reduction appeared largely independent of improvements in glycemic control or weight. Read Full Article…

HVBA Article Summary

1. Semaglutide Linked to Over 50% Reduction in Seizure Risk Among Type 2 Diabetes Patients: In a retrospective analysis using data from 393,596 adults in the NIH All of Us Research Program, researchers identified 10,140 eligible individuals with type 2 diabetes (mean age 63.5 years) and no prior seizure history. Among these, patients who began treatment with semaglutide had a hazard ratio (HR) of 0.40 (95% CI, 0.22–0.73; P = .003) for epilepsy compared to those using other GLDs, and an HR of 0.45 (95% CI, 0.25–0.81; P = .008) compared to those on SGLT2 inhibitors. This indicates a greater than 50% reduction in seizure risk for semaglutide users over a mean follow-up of 2.6 years.

2. Effect Independent of Blood Sugar and Weight Improvements: The study showed that the neuroprotective effect of semaglutide was largely independent of metabolic improvements. Changes in hemoglobin A1c and BMI explained less than 5% of the association between semaglutide use and reduced seizure risk. This suggests that mechanisms unrelated to glucose control or weight loss — possibly involving inflammation reduction or epigenetic changes — may be responsible for the observed neuroprotective benefits.

3. Broad Implications for Brain Health and Future Research: Given that patients with type 2 diabetes have a 25% higher risk of developing seizure disorders than the general population, these findings may inform treatment strategies that prioritize brain health in addition to cardiovascular and metabolic outcomes. However, experts caution that while the study's large dataset and rigorous trial-emulation design are strengths, prospective clinical trials and mechanistic studies are needed to validate these findings and explore semaglutide’s potential superiority over both its own drug class and other GLDs in preventing epilepsy.

What payer experts, leaders are thinking about 2026

By Caroline Catherman – Payers had a wild year, and 2026 is shaping up to be just as dramatic, particularly for those offering government plans within Medicare, Medicaid, and the health insurance marketplace. Marketplace insurers hiked up 2026 premiums an average of 26%, per KFF, and are expecting a huge drop in enrollees. Meanwhile, already-high medical costs could rise further, and AI is majorly changing patient, provider, and payer relationships. Read Full Article...

HVBA Article Summary

1. Rising Impact of the Dual-Eligible Population: The dual-eligible population—individuals enrolled in both Medicare and Medicaid—is projected to grow by more than 6% annually through 2028. Although they represent only about 20% of Medicare members, they account for over one-third of Medicare spending, reflecting their complex medical, social, and financial needs. Insurers are prioritizing integrated, person-centered care models to improve outcomes and reduce costs for this high-need group.

2. Payer Consolidation Likely to Accelerate in 2026: Following a challenging 2025, industry leaders anticipate a notable increase in mergers, partnerships, and affiliations among health plans in 2026. Smaller and mid-sized payers may find it too risky to remain independent, while larger organizations are expected to seize opportunities to scale operations, expand capabilities, and enhance affordability in a consolidating market.

3. Systemic Shifts in Infrastructure and Cancer Care Costs: Regulatory pressure is expected to drive the collapse of ghost networks, compelling insurers to replace static, error-prone provider directories with real-time, dynamic systems that support accurate scheduling and patient feedback. Additionally, the cost of cancer care is projected to exceed $240 billion by 2030, increasing the burden on patients and employers. Addressing these challenges will require stronger collaboration across health plans, providers, and the pharmaceutical sector to ensure effective and affordable access to life-saving treatments.

Many Americans would cut healthcare spending without FSAs, new data shows

By Jimmy Nesbitt – Flexible spending accounts remain a popular tool for paying medical expenses, and many people would cut back on health spending without them. That was one of the key findings from new research on FSAs and health spending accounts that was presented Dec. 11 during the Employee Benefit Research Institute's 2025 Financial Wellbeing Symposium by Heather Ruff, senior account executive of healthcare and employee benefits at VISA. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. FSAs (Flexible Spending Accounts) are crucial in influencing healthcare spending: Over half (56%) of FSA users would reduce their spending on medical treatments and medications without access to an FSA, and 32% of purchases would not happen at all. The absence of FSAs would most impact spending on over-the-counter medications, vision care, dental visits, vaccines, and hospital visits—demonstrating the role FSAs play in maintaining routine and preventative health care.

2. HSA (Health Savings Account) adoption and investment remain limited due to confusion and caution: While many HSA users value the sense of financial security the account provides, most invest only about 25% of their balances—largely due to concerns about access and understanding. Many younger users, in particular, are hesitant to use HSAs for long-term investing, often preferring more familiar retirement vehicles like 401(k)s.

3. Education and simplified communication are key to improving HSA engagement, especially among younger generations: Despite knowledge gaps, 96% of respondents expressed interest in learning more about HSAs. The research highlights that websites, employers, and even healthcare providers are essential channels for educating users. To boost adoption—especially among Gen Z and millennials—messages about HSAs need to be more emotionally resonant and easier to understand than current explanations like “triple tax advantage.”