New Bill Offers Real Relief on Drug Costs

By Wendell Potter and Rachel Madley, PhD - Millions of Americans are staring down a storm of health care uncertainty with the expiration of the enhanced Affordable Care Act (ACA) subsidies two weeks from today. Starting January 1, they’ll face such sharp premium hikes that many will have no choice but to drop their coverage because they simply won’t be able to afford it. Those who can’t afford not to have insurance because of health issues will be hit with premium increases of up to 400% or even more in some cases. For patients already stretched thin financially, it will mean more hurdles to care and more out-of-pocket costs. Read Full Article…

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1. Proposed Legislation to Cap Prescription Costs: Representative Jake Auchincloss has introduced the ACA Copay Cost and Affordability for Patients (CAP) Act, which proposes a national cap on annual out-of-pocket prescription drug expenses—$2,000 for individuals and $4,000 for families enrolled in Affordable Care Act (ACA) plans. These caps would include gradual, predictable increases tied to premium growth, aiming to improve affordability for patients while maintaining flexibility in plan design and preserving access to necessary medications.

2. Addressing PBMs and Insurance Industry Practices: A core focus of the legislation is to curb the influence of pharmacy benefit managers (PBMs)—often subsidiaries of large insurance companies—who are accused of driving up patient costs through opaque pricing practices. By limiting how much patients are required to pay, the bill seeks to reduce the financial burden imposed by insurers and PBMs, who are criticized for extracting profit from the healthcare system while patients struggle to afford life-saving drugs.

3. Broad Support and Underlying Public Health Concerns: The CAP Act is endorsed by over dozens of patient advocacy groups within the Lower Out-of-Pockets NOW (LOOP NOW) coalition, which highlights how high out-of-pocket costs contribute to widespread medical debt and medication non-adherence, especially among patients with chronic illnesses. Supporters argue that the bill would alleviate financial stress, reduce bankruptcy risks due to medical expenses, and ensure that insurance coverage provides real, tangible access to essential prescriptions.

Wyden pushes EHR vendors to adopt data privacy features

By Emily Olsen – Interoperability — a long-term challenge for the healthcare industry — is key to ensuring patients receive coordinated and quality care, regardless of provider, Wyden wrote in the letter, which was sent to companies like Athenahealth, Oracle Health and Meditech. But healthcare data is often sensitive and coveted by cybercriminals, who have increasingly targeted healthcare organizations in recent years. Read Full Article... 

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1. Record-Breaking Healthcare Data Breach in 2024: A cyberattack on Change Healthcare, a payment processor owned by UnitedHealth, led to the exposure of data belonging to nearly 193 million individuals, marking the largest healthcare data breach ever reported to U.S. federal regulators. Other significant breaches also occurred in 2024, impacting organizations like Yale New Haven Health and DaVita.

2. Concerns Over Unrestricted Health Data Access: Senator Ron Wyden raised concerns about the broad access to sensitive health information by healthcare providers nationwide, regardless of their direct involvement in a patient’s care. He warned that this widespread accessibility increases the risk of unauthorized access, data theft, and leaks, with potential implications for national security, particularly involving military and intelligence personnel.

3. Push for Stronger Patient Control and Vendor Accountability: Wyden highlighted the need for tools that enhance patient control over their health records, citing features implemented by Epic that notify patients about data access and allow them to limit sharing. He requested that other electronic health record (EHR) vendors clarify whether they offer similar privacy protections. Several companies, including Netsmart, Meditech, and Athenahealth, acknowledged receipt of Wyden’s letter and expressed support for improved data governance and patient empowerment.

AMA: 97% of health insurance markets are highly concentrated

By Jakob Emerson – Commercial health insurance markets are continuing to become more concentrated, according to the AMA’s 2025 “Competition in health insurance” report published Dec. 16. The 24th annual report analyzed insurer market concentration across 384 metropolitan areas and all 50 states and D.C. Read Full Article...

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1. Health Insurance Market Concentration Remains High: In 2024, 97% of metropolitan commercial health insurance markets were classified as highly concentrated, an increase from 95% in 2014. This means that in nearly all metro areas, a few insurers dominate the market. Notably, 47% of these areas had a single insurer with more than half the market share, and in 91% of areas, at least one insurer controlled 30% or more, indicating limited competition across much of the country.

2. A Few Insurers Hold Dominant Positions Nationally and Locally: The commercial insurance landscape is led by a small group of large insurers. UnitedHealth Group, Elevance Health, CVS/Aetna, and Cigna are among the top companies by market share. Collectively, Blue Cross Blue Shield (BCBS) companies account for 43% of the national commercial market and are the largest insurers in 43 states and 84% of metropolitan areas. This widespread dominance suggests a strong regional presence and influence by these major players.

3. Limited Competition Extends to Medicare Advantage and ACA Markets: The pattern of market concentration extends beyond commercial insurance. Medicare Advantage markets remain highly concentrated at 97%, with UnitedHealth Group leading nationally with a 30% share, followed by Humana and CVS/Aetna. Similarly, in the ACA exchanges, Centene has seen notable growth, moving from the 76th largest insurer in 2014 to the top exchange insurer in 2024 with a 20% market share. These trends reflect consolidation and limited insurer diversity across multiple segments of the health insurance industry.

Republican senator accuses CVS of 'driving up health care costs'

By Allison Bell – A member of the Senate Finance Committee is making a public effort to accuse CVS Health of using its Caremark pharmacy benefit manager and Aetna health insurance operations to hurt independent and community pharmacies and drive up health care costs. Sen. Marsha Blackburn, R-Tenn., said earlier this week that she has sent a letter to David Joyner, the chief executive officer of CVS, "pressing him on the company's lengthy record of fraud and regulatory violations at taxpayers' expense and the role the company has played in driving up health care costs." Read Full Article... ^{_{(Subscription required)}}

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1. Concerns Over CVS and Aetna’s Role in Rising Costs: Senator Blackburn raised concerns that CVS and its pharmacy benefit manager (PBM), Caremark, along with Aetna, may be contributing to rising health insurance premiums, which in turn increases federal spending on Affordable Care Act (ACA) premium subsidies. CVS's revenue from federal sources rose significantly from 18% in 2022 to 24% in 2024, indicating growing reliance on government funds.

2. Policy Debate Surrounding PBMs and ACA Subsidies: Legislative efforts, such as the Lower Health Care Premiums for All Act, aim to increase transparency in PBM operations, support small employers, and provide new options for health reimbursement arrangements. At the same time, there is bipartisan concern in Congress about preserving high ACA subsidy levels to avoid the so-called "ACA subsidy cliff," which could drastically increase out-of-pocket costs for many consumers after December 31, 2025.

3. Ongoing Political and Regulatory Tensions: Lawmakers are increasingly scrutinizing the relationship between health insurers and PBMs, with some, like Rep. Austin Scott, calling for the Federal Trade Commission to prevent insurers from owning PBMs altogether. These tensions could influence the fate of current healthcare bills and the broader regulation of insurance and pharmacy benefit structures in the U.S. health system.

Key trends that will shape healthcare M&A activity in 2026: PwC

By Heather Landi - Healthcare deal activity cooled off in 2025, but the sector is poised to bounce back next year, driven by investments in artificial intelligence, an improved exit environment and policy shifts driving buyers to move quickly. Healthcare merger and acquisition deal value hit an estimated $46 billion in 2025, according to a yearly PwC report published Tuesday, citing LevinPro data. That's down from $62 billion in M&A activity in 2024. Read Full Article… ^{_{(Subscription required)}}

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1. Deal Value Rebounded Sharply in Q4 2025 Despite Overall Volume Dip: After a quieter third quarter, the total value of health services M&A surged to $22 billion in Q4 2025, up from $7 billion in Q3. This spike was driven by large transactions such as Qualtrics’ $6.75B acquisition of Press Ganey Forsta and Patient Square Capital’s $2.6B deal for Premier Inc. However, the total number of deals (910 year-to-date) remains lower than in prior years, reflecting a modest cooling in overall activity.

2. 2026 Outlook Suggests a Resurgence in M&A Amid Strategic Shifts: Analysts forecast that deal activity will grow in both value and volume in 2026. Investors are expected to focus on high-quality, cash-generating assets with strong reimbursement visibility. Emphasis is shifting toward bolt-on acquisitions and carve-outs, particularly in subsectors like behavioral health, ambulatory care, and tech-enabled services. AI integration, margin scalability, and regulatory predictability are emerging as key decision drivers.

3. Private Equity and Strategic Buyers Adjust to Regulatory Pressures: Heightened regulatory scrutiny is reshaping M&A strategies. Buyers are prioritizing disciplined capital deployment, targeting platforms with reduced reimbursement risk—especially in software, AI-driven care models, and member engagement tools. IPO activity is also reviving, with digital health companies returning to public markets. As mega-funds re-enter the scene, competition for premium assets is intensifying, pushing mid-market players to adapt.

Workplace insurance is a good deal for employers

By Caitlin Owens - Employer-sponsored insurance may be getting costlier, but it still delivers a positive return for firms that cover their workers, according to a new Avalere Health analysis commissioned by the U.S. Chamber of Commerce and provided first to Axios. Read Full Article…

HVBA Article Summary

1. Health Insurance Costs Are Rising Significantly: ACA premiums are set to increase by 26%, driven by rising hospital costs, higher use of expensive drugs like Ozempic, and potential tariffs. Without an extension of Biden-era subsidies, enrollees could face a 114% increase, affecting the 22 million of 24 million who currently receive subsidies. Small group employer premiums are expected to rise by a median of 11%, and large employers anticipate a 6.5% increase in per-employee costs, with many shifting more expenses to workers through higher out-of-pocket costs.

2. Congressional Inaction Leaves Rising Costs Unchecked: Despite intense political debate, no legislative solution is emerging to curb rising premiums. While Democrats favor extending subsidies, Republican opposition remains strong, and no measures address the underlying drivers of cost hikes like medical inflation or drug prices. With no relief in sight, many families and employers face tough choices — including reducing coverage or going uninsured.

3. Healthcare Costs Are a Growing Political and Public Priority: The ACA has reached 57% approval, including over 60% of independents, while only 15% of Republicans support it. Gallup also found that 29% of Americans now identify healthcare costs as the most urgent health issue, up from 23% last year. With healthcare use rising post-pandemic and AI increasing provider capacity, insurance is becoming a key election issue, especially as premium hikes loom for 2026.

What AI means for burnout, benefits and trust at work in 2026

By Jimmy Nesbitt – As AI becomes more integrated in the workplace, benefits will shift from a one-size-fits-all approach to a more employee-centric model. That's just one of the major changes Polina Dimitrova, global head of people at automation platform Make, expects to see in the coming years. From benefits to productivity, AI is upending how employees go about their jobs. And while that revolution may be scary to some, Dimitrova sees a lot of opportunities to improve efficiency and work in tandem with AI programs on repetitive tasks, freeing up employees to become more creative. Read Full Article... ^{_{(Subscription required)}}

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1. AI Integration Requires Thoughtful Design and Training: The successful use of AI in the workplace goes beyond simply implementing new tools. To truly gain productivity and well-being benefits, organizations must invest in redesigning workflows, clearly define how AI should be used, and provide comprehensive training. Without this foundational support, AI may unintentionally increase employee pressure, create confusion, or lead to higher stress levels instead of improving efficiency.

2. AI Enhances, But Does Not Replace, Human Judgment: AI is most valuable when used to streamline repetitive, administrative tasks and provide data-driven insights. This allows employees to redirect their time and energy toward work that requires creativity, strategic thinking, and emotional intelligence. However, to achieve these benefits, companies must present AI as a tool that complements human capabilities rather than as a replacement or a mechanism for pushing employees to do more in less time.

3. Personalized Benefits and Ethical AI Use Are the Future: As AI becomes more sophisticated in analyzing behavior, health data, and work patterns, it will enable highly personalized support for employees in areas like wellness, mental health, and skill development. To prepare for this shift, benefit leaders must focus on ethical implementation, remain transparent about how AI is used, and actively foster trust by showing how AI can enhance — not undermine — the human experience at work.