House GOP healthcare bill eschews subsidy extension, HSAs

By Paige Minemyer - Republicans in the House of Representatives have unveiled their plan to tackle healthcare costs, though the bill does not address the soon-to-expire enhanced Affordable Care Act subsidies. Under the bill, unveiled on Friday, lawmakers would lean on association health plans, which allow employers to pool resources to purchase coverage, and individual coverage health reimbursement arrangements, or ICHRA, to offer additional options for enrollees. In the latter case, an employer offers individuals a stipend to purchase coverage of their choosing on the ACA's exchanges. Read Full Article…

HVBA Article Summary

1. Expansion of Stop-Loss Coverage and Cost Transparency: The bill proposes redefining stop-loss insurance so that it is not considered standard health coverage. This change is intended to make it easier for small and mid-sized employers to access this form of financial protection, helping them manage unexpected, high-cost medical claims. Additionally, the legislation seeks to increase transparency in pharmacy benefit structures, aiming to provide employers with more tools to control and reduce prescription drug spending.

2. Reintroduction of Cost-Sharing Reduction Subsidies: The legislation includes a provision to resume cost-sharing reduction (CSR) payments beginning in 2027, which are designed to help lower-income individuals reduce their out-of-pocket healthcare expenses such as copays and deductibles. However, it does not address the looming expiration of enhanced subsidies at the end of this year—an issue that experts warn could result in substantial premium hikes and changes in risk pools for exchange-based health plans starting January 1.

3. Political Dynamics and Legislative Path: Framed by Republican leadership as a responsible and practical alternative to current healthcare policies, the bill emphasizes premium reduction and expanded access to health care options. Notably, it omits the inclusion of health savings accounts (HSAs), despite these being a key component of previous GOP health reform efforts. A related Senate proposal centered around HSAs recently failed, and while House leaders are pushing for a vote before the end of the week, the bill’s path forward remains uncertain given the tight timeline and lack of immediate relief for 2024 enrollees.

Goliath v. Goliath

By Rebecca Pifer – Medicare Advantage network dispute between Optum and Humana in Washington state is pushing seniors into rival Medicare plans — including those owned by Optum’s corporate parent UnitedHealth — in what antitrust experts say could be one of the first high-profile instances of a provider making a network determination to harm a competitor of its insurance parent company. In November, Washington seniors in Humana MA plans began receiving notices that Optum would no longer be in-network effective Jan. 1. The impending split has thrown certain markets in the Evergreen State into disarray. Read Full Article... 

HVBA Article Summary

1. Optum-Humana Split Disrupts Care for Thousands of Seniors in Washington: A contract dispute between Optum and Humana means that starting in 2026, Optum providers will go out of network for Humana Medicare Advantage (MA) members. This affects 63 of Optum’s 1,600 clinics in Washington, where Humana insures nearly 120,000 seniors, making it the second-largest MA provider in the state after UnitedHealthcare. Medicare brokers report widespread plan switching, with affected patients moving to UnitedHealthcare, the only other MA plan in the area that includes Optum providers. The shift has been called "disruptive" by brokers trying to keep patients with their trusted doctors.

2. Market Consolidation Fuels Antitrust Concerns and Patient Access Issues: The dispute underscores concerns about vertical integration in healthcare. Optum, which is owned by UnitedHealth Group, shares corporate ties with UnitedHealthcare, one of the largest insurers in the country, covering over 50 million Americans. UnitedHealth Group’s total annual revenue exceeds $400 billion. Experts warn that when a provider like Optum exclusively partners with its corporate sibling insurer, it can foreclose competitors like Humana from accessing key provider networks — a scenario that regulators fear may reduce competition and limit patient choice in Medicare Advantage.

3. Surge in Medicare Advantage Contract Disputes Highlights Systemic Tensions: This is not an isolated case: contract disputes in the MA space are accelerating rapidly. In the first three quarters of 2025 alone, there were 46 such disputes, according to FTI Consulting, marking a sharp increase compared to earlier in the decade. These conflicts are driven by providers pushing back on below-market rates and insurers seeking to control rising healthcare spending. While such negotiations are common, this high-profile Optum-Humana rift is seen as a real-world example of how consolidation may now be directly impacting patient access and coverage stability.

Economic pressure, consumer behavior will push providers to speed up AI adoption in 2026

By Heather Landi – In the past few years, AI adoption to tackle administrative work in healthcare has surged, with AI scribes and tools to handle billing and paperwork leading the charge. These "high-frequency, low-stakes use cases" are a logical starting point for health systems, with a tangible return on value for those investments, Shiv Rao, M.D., CEO and co-founder of Abridge, said during the recent 2025 Forbes Healthcare Summit in New York City. Read Full Article...

HVBA Article Summary

1. AI Adoption in Healthcare Is Accelerating Across Use Cases: Healthcare systems are moving beyond low-stakes applications of AI, such as documentation and credentialing, into higher-stakes workflows like clinical decision support and patient triage. Dr. Shiv Rao, CEO of Abridge, uses AI in his own cardiology practice and highlights that AI is already deeply embedded in real clinical environments. Abridge's platform is currently used in over 200 health systems, supporting nearly 100 million clinical encounters annually. This growth reflects increasing provider confidence in AI’s ability to support and improve real-time medical decision-making.

2. Widespread Consumer and Clinician Adoption Is Driving Integration: AI tools are rapidly gaining traction among both patients and clinicians, pushing health systems to keep pace. As of this year, 34% of U.S. consumers have used ChatGPT—58% among those under 30—and 10% of adults worldwide have used it. A recent survey found 35% of Americans and nearly 50% of 16- to 34-year-olds have used AI to research a health concern, while over 40% of healthcare providers have used medical AI platforms like OpenEvidence. This dual-side adoption shows AI is no longer experimental—it is becoming an expectation in care delivery.

3. Balancing Speed, Accuracy, and Safety Is Essential for Scalable AI Use: While AI enables faster workflows and new capabilities, maintaining high accuracy—especially in clinical contexts—is critical. For example, Abridge’s system detects 97% of hallucinated content, outperforming GPT-4o’s 82%, and Medallion highlights that even a single character error in provider data can block patient access. AI is being designed with quality-control mechanisms, such as feedback loops and deterministic automation, to reduce risk. Experts stress that although caution is warranted, delaying AI adoption can also cause harm—especially when the real-world alternative is often no care at all.

2026 healthcare trends: How access to better data can redefine benefits

By Paola Peralta - Using real data and insights to guide benefit decisions can help employees get the right care sooner — while improving health outcomes and controlling costs, too. Recent data indicates a significant gap between the benefits employers offer and what employees actually need. In fact, only 12% of employees reported feeling truly satisfied with their benefit packages, according to a recent survey from employee benefits and financial services firm Drewberry. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Data-Driven Tools Personalize Employee Support: Utilizing employee data allows organizations to create highly personalized health and wellness benefits that better meet individual needs. These tools can analyze patterns related to stress, workload, or financial pressure, and then trigger timely, automated interventions such as mental health coaching or workload adjustments. For example, platforms may detect early signs of burnout and alert managers or suggest proactive solutions. This personalization ensures support is delivered when it's most needed, increasing effectiveness and engagement.

2. Improved Insights Guide Strategy and Investment: Organizations that implement data-driven well-being programs receive comprehensive usage reports, showing which resources are most accessed and where engagement gaps persist. These insights allow leaders to move beyond assumptions, using real-time data to evolve strategies, better target investments, and refine benefit offerings. According to HR expert Amanda Martell, such reporting helps surface unmet needs earlier and reduces overreliance on expensive reactive care, making benefits more impactful and aligned with employee realities.

3. Preventive Care Reduces Long-Term Costs: Addressing health and wellness challenges early—before they escalate into more serious medical issues—can significantly reduce long-term costs. Untreated burnout, anxiety, or chronic conditions often lead to expensive interventions like emergency room visits and contribute to increased insurance premiums and employee turnover. By focusing on proactive care through data insights, companies can lower healthcare utilization rates, reduce absenteeism, and preserve workforce productivity. Martell emphasizes that shifting toward tailored, preventive healthcare is essential in avoiding the rising costs tied to delayed support.

Nearly 1 in 4 Americans believe US healthcare is in ‘crisis’: Gallup

By Kristin Kuchno - More Americans than ever believe the U.S. healthcare system is in crisis, according to a Dec. 15 article from Gallup. The West Health-Gallup Health and Healthcare Survey was conducted Nov. 3-25 and included responses from 1,321 U.S. adults. Read Full Article…

HVBA Article Summary

1. Perception of a Healthcare Crisis Has Reached Record Levels: In 2025, 23% of Americans believe the U.S. healthcare system is “in a state of crisis,” marking the highest level ever recorded. Additionally, 47% say the system has “major problems,” bringing the combined total of critical views to 70%. In contrast, only 26% believe the problems are minor, and a mere 3% think the system is free of problems. The perception of crisis has grown significantly, rising from 16% in 2024 and far above the historical low of 5% recorded in 2001.

2. Cost is Increasingly Viewed as the Most Urgent Health Issue: In 2025, 29% of respondents identified cost as the most urgent health issue in the U.S., up from 23% in 2024. This is the highest percentage recorded since 2004 and among the highest since tracking began in 1987. While cost has regained its place as the top concern, access to care — which was the leading issue from 2007 to 2012 — was cited by only 17% in 2025. Obesity followed with 8%, indicating a clear prioritization of financial concerns in public opinion.

3. Satisfaction with Healthcare Costs is at an All-Time Low: Public satisfaction with U.S. healthcare costs declined to 16% in 2025, down from 19% the previous year. This is the lowest satisfaction level Gallup has recorded since it began tracking the trend in 2001. Despite this decline, individual satisfaction with personal healthcare costs remains much higher at 57%, showing a notable contrast between perceptions of the system overall and personal experiences within it.

Merck and Nvidia team up on new drug discovery model

By Patrick Kulp – There’s no shortage of AI models aimed at discovering new drugs these days. Researchers have introduced more than 200 of these foundation models in the last three years, with 40% growth per quarter, according to a new paper published this month in the journal Drug Discovery Today. Pharmaceutical giant Merck and Nvidia recently rolled out a new entry in this growing body with a small-molecule drug model called KERMT. The model is pretrained on more than 11 million molecules, then fine-tuned for various tasks specific to industrial drug discovery workflows, according to Merck. Read Full Article...

HVBA Article Summary

1. AI Models Like KERMT Are Dramatically Accelerating Early Drug Development: Merck’s KERMT model—built on the GROVER neural network and fine-tuned with multitask learning—enhances prediction of ADMET properties (absorption, distribution, metabolism, excretion, and toxicity), helping scientists catch potential failures earlier in the process. Traditionally, these assessments take months of physical and biological testing. With AI, Merck is seeing timelines shortened by 30% or more, alongside improvements in drug candidate quality and cost reductions. This makes early-stage research faster, more efficient, and more likely to succeed.

2. AI Partnerships Are Reshaping the Pharma-Tech Landscape: Merck’s collaboration with Nvidia, which allows them to scale KERMT across multiple processors and improve efficiency, is part of a growing trend across the pharmaceutical industry. Other major players are following suit: Eli Lilly and Nvidia are building a drug discovery supercomputer, Novo Nordisk has partnered with Anthropic and AWS, and Johnson & Johnson is working with Nvidia on medical robotics. These alliances reflect a surge in AI-powered drug discovery efforts aimed at transforming biotech R&D pipelines.

3. AI Tools Show Strong Potential, But No Fully Approved AI-Designed Drugs Yet: Despite three years of development using foundational AI models, including Merck’s KERMT and TEDDY, no AI-generated drug has yet received full regulatory approval. However, the models are already integrated into scientists’ real-time design workflows and are showing promise in therapeutic areas like oncology, cardiovascular, and immunology, where Merck has a robust pipeline. With around 90% of clinical candidates failing traditionally, these tools could help improve success rates. Merck is also expanding the models’ multimodal capabilities and open-sourcing them to foster broader scientific collaboration.

Experts see AI boosting productivity across workplace benefits

By Jimmy Nesbitt – AI is here to stay and companies can utilize it to offer a more engaging workplace benefits experience for employees. A panel of three experts discussed this trend and more during a discussion on Dec. 11 titled "Putting AI to Work: The Opportunities and Risks of AI in Workplace Benefits." The discussion was held as part of the Employee Benefit Research Institute's 2025 Financial Wellbeing Symposium. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. AI Increases Productivity but Still Needs Human Oversight: According to Edwin Jongsma of Financial Finesse, AI serves as a powerful tool to enhance individual productivity within the benefits industry. However, human guidance remains essential to direct and supervise AI outputs. Jongsma noted that while AI can help professionals work more efficiently, the technology is currently plateauing, and a significant leap in AI capabilities is still needed to drive further innovation.

2. Adoption Is High, but Scaling Remains a Major Challenge: Data from the McKinsey 2025 AI Report, presented by Greg Ward, shows that 88% of companies are now using AI. Despite this, 67% remain in "pilot mode"—struggling to deploy AI tools effectively across their organizations. A lack of trust is a major barrier, with 51% of organizations reporting failed AI deployments. While 62% are experimenting with AI agents, only 23% have successfully scaled them, underscoring the implementation gap.

3. AI Tools Offer Personalized Support, but Bias Must Be Monitored: Candidly’s AI assistant "Cait" demonstrates how AI can offer tailored financial guidance, reportedly helping users save an average of $347 per month. Cait can detect emotional distress and escalate users to human coaches when needed. While AI bias remains a concern in financial wellness tools, Candidly conducts extensive testing. One study found that users with the lowest financial literacy had the longest interactions and used the most tools, suggesting the AI responded appropriately by offering more support where needed.