US Senate Democrats renew bid to extend Obamacare subsidies

By Nolan D. McCaskill and Richard Cowan – Democrats will put a three-year extension of expiring health insurance subsidies to a U.S. Senate vote next week, Minority Leader Chuck Schumer said on Thursday, a late push to revive a proposal Republicans blocked earlier this year. Senate Majority Leader John Thune committed to giving Democrats a vote on healthcare legislation under an agreement last month to end a record 43-day government shutdown. Read Full Article...

HVBA Article Summary

1. Democrats Propose ACA Tax Credit Extension Amid Deadline Pressure: Senate Democrats, led by Majority Leader Chuck Schumer, plan to introduce legislation to extend current Affordable Care Act (ACA) tax credits for three years. These subsidies, used by approximately 24 million people, are set to expire at the end of the year. The vote is scheduled for December 11, with Democrats aiming to frame it as a key healthcare affordability issue ahead of the 2026 midterm elections.

2. Republicans Express Opposition, Cite Need for Broader Reforms: Republican leaders, including Senator John Thune, have criticized the Democratic proposal as politically motivated and unlikely to succeed. While some Republicans support extending subsidies, they have pushed for conditions such as income-based eligibility limits and the inclusion of Hyde Amendment restrictions, which would prevent federal funding for abortion-related coverage.

3. Legislative Uncertainty Amid Tight Timeline: The bill faces steep odds in the Senate, where Democrats would need 13 Republican votes to advance it past a filibuster. House Speaker Mike Johnson has yet to commit to taking up any Senate-passed healthcare legislation. With the ACA open enrollment deadline set for December 15, the narrow legislative window adds urgency and complexity to the debate.

Hospitals sue to block 340B rebate model

By Ron Southwick - Hospitals are going to court to prevent the federal government from making significant changes to the federal 340B drug discount program. The Department of Health & Human Services is launching a new rebate model for several drugs in the program. The 340B program allows hospitals and health systems serving vulnerable populations to buy outpatient drugs at reduced prices. Read Full Article…

HVBA Article Summary

1. Shift to Rebate Model in 340B Program: Starting January 1, the U.S. Department of Health and Human Services plans to overhaul the longstanding 340B Drug Pricing Program by launching a new rebate-based model. Under this system, eligible hospitals and health systems—previously allowed to buy outpatient drugs at discounted rates—would now pay full price up front and receive rebates afterward. This change would apply to approximately 14,600 covered entities across the country, marking a significant shift from the current operational model.

2. Hospitals Challenge Legality and Rollout Process: The American Hospital Association, Maine Hospital Association, and four hospitals have filed a lawsuit seeking to block the program. They argue the government violated administrative law by imposing the new model without sufficient notice, preparation time, or response to public comments. Hospitals claim the new program is not a true "pilot" as labeled, since it is mandatory for all 340B participants and offers no phased or limited implementation. The lawsuit emphasizes that participation is compulsory for hospitals but optional for drug companies, raising concerns over fairness and legal compliance.

3. Stakeholder Disagreement Highlights Broader Policy Tensions: 
   Hospitals argue the rebate model will increase financial strain, especially in states like Maine where hospitals are already struggling. The American Hospital Association cited that 340B hospitals provided nearly $100 billion in community benefits, such as free or discounted medications and care for uninsured patients. Meanwhile, PhRMA, the trade group for pharmaceutical companies, supports the rebate model and is advocating for its rapid expansion. The clash reflects ongoing political and industry disputes over the size, scope, and administration of the 340B program.

Debunked Episode 22: With ACA Subsidies Set to Expire and the Open Enrollment Window Closing, Members of Congress Brainstorm Alternatives

By Stephanie Baum – The deadline for extending the Affordable Care Act subsidies is approaching this month. This is happening even as consumers who depend on the ACA Marketplace are faced with the tough decision. Should they forego health plans that will no longer be affordable for them once the subsidies expire or hope that Congress will reach a bipartisan agreement to extend the subsidies until workable alternatives can be hashed out and approved? Read Full Article...

HVBA Article Summary

1. Impending Expiration of ACA Subsidies Could Affect Millions: With tax credits currently supporting 93% of ACA Marketplace plan members—roughly 22 million people—their scheduled expiration at the end of 2025 presents a significant risk to affordable healthcare access. As open enrollment ends on December 15 and the Senate vote on subsidy extensions was expected by December 9, there is growing urgency among policymakers and enrollees alike to resolve the issue promptly.

2. Political Proposals Reflect Partisan Approaches to Healthcare Reform: In anticipation of the subsidy debate, some Republican senators, notably Rick Scott and Bill Cassidy, have introduced proposals centered on expanding healthcare savings accounts. These plans represent an ideological shift from broad federal subsidies to more individualized financial tools and reflect the broader political calculus ahead of the 2026 election cycle, where healthcare remains a pivotal issue.

3. Efforts to Reduce Drug Costs Face Practical and Behavioral Challenges: There is increasing momentum to lower the cost of expensive GLP-1 drugs, which are seen as a promising tool for combating obesity-related chronic illnesses. These efforts align with initiatives like the MAHA campaign led by HHS Secretary Robert Kennedy Jr. However, the drugs’ long-term success depends on sustained lifestyle changes by patients and a robust pharmaceutical supply chain—both of which present significant hurdles to widespread and effective adoption.

World Health Organization Recommends GLP-1 Drugs Like Ozempic For Obesity. Here’s What To Know

By Omer Awan – For the first time ever, the World Health Organization has issued global guidance on the use of GLP-1 drugs for the treatment of obesity. Obesity, a chronic, often relapsing condition that affects more than a billion people worldwide, is linked to adverse medical conditions such as heart disease, stroke, high blood pressure and a dozen different cancers. In addition, the use of GLP-1 drugs like Ozempic and Wegovy could be gamechangers in fighting the obesity epidemic since these drugs are highly effective. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Effectiveness and Health Benefits of GLP-1 Drugs: GLP-1 receptor agonists such as semaglutide (found in Ozempic and Wegovy), tirzepatide, and liraglutide have shown the ability to reduce body weight by up to 20%. In addition to weight loss, these drugs can significantly lower the risk of major cardiovascular events—including heart attack, stroke, and death—by 20% after three years of use, benefits that appear to occur regardless of a patient's initial weight or the amount of weight lost during treatment.

2. Concerns Over Safety and the Need for a Holistic Approach: Despite their growing popularity and general tolerability, these medications carry potential risks, including rare but serious side effects like pancreatitis, gallbladder disease, and a possible link to thyroid cancer. Since long-term safety data is still emerging, the WHO has issued only a conditional recommendation. Additionally, the WHO stresses that medication alone is not sufficient to address obesity, a complex and chronic disease. A comprehensive strategy—including proper nutrition, physical activity, behavioral support, and supportive public policies—is essential for meaningful and sustainable outcomes.

3. Equity and Access Limitations
   While effective, GLP-1 drugs remain inaccessible to many who could benefit from them, especially in middle- and low-income countries where 70% of individuals with obesity live. Current projections suggest that fewer than 10% of eligible individuals will have access to these treatments by 2030. The high cost and limited supply could further widen health disparities between higher- and lower-income populations. In response, the WHO is advocating for strategies like tiered pricing models, voluntary licensing agreements, and broader policy reforms to improve global accessibility and promote health equity.

Mark Cuban's Cost Plus Drugs, Humana exploring partnership to tackle employer drug costs

By Heather Landi – Mark Cuban's Cost Plus Drugs and Humana are exploring a potential partnership to help lower the cost of prescription drugs for employers. Cuban, an entrepreneur, businessman and TV personality who co-founded Cost Plus Drugs, said the company is in discussions with Humana to work with its CenterWell healthcare services business to provide a better pharmacy experience for consumers and a direct-to-employer model for prescription drugs. Read Full Article...

HVBA Article Summary

1. Cost Plus Drug Company Aims to Disrupt Traditional Pharmacy Models: Launched in January 2022, Cost Plus Drug Company seeks to lower prescription drug prices by cutting out middlemen and working directly with manufacturers. The company adds a transparent 15% markup and a flat $5 shipping fee, allowing consumers to see the actual cost of medications. With a catalog of over 2,500 drugs, it is now exploring strategic partnerships—such as with CenterWell—to expand access, particularly by reaching consumers through employer-sponsored insurance plans.

2. Direct-to-Employer and Direct-to-Consumer Models are Emerging Alternatives: Cost Plus and Humana’s CenterWell are developing new distribution models that bypass traditional pharmacy benefit managers (PBMs), which they argue contribute to high costs and inefficiencies. These direct approaches aim to deliver medications straight from manufacturers to consumers or employer health plans. By doing so, both companies hope to offer lower prices, improve transparency, and increase access—especially for those in high-deductible plans or without insurance.

3. Industry Leaders Call for Structural Change and Employer Involvement: Mark Cuban and Humana CEO Jim Rechtin emphasized that major reform in the pharmacy sector requires employers to challenge the existing PBM-dominated system. They urged CEOs to demand transparent drug pricing and adopt direct purchasing models that remove unnecessary layers from the supply chain. With employers covering insurance for over 160 million Americans, both leaders believe their active participation is essential to driving systemic cost savings and improving healthcare delivery.

Flexibility and personalization will define benefit needs in 2026

By Alyssa Place - As workplaces evolve and employee expectations accelerate, HR and benefits leaders are being challenged to rethink how they design, deliver and communicate support to their workforce. Rising healthcare costs, generational shifts, mental health needs and the pressure to balance personalization with cost containment are all converging at once. During Employee Benefit News' recent Leaders discussion, leaders from Bartaco and the Child and Family Center shared how these forces are reshaping their strategies for the next three to five years. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Modern Employee Benefits Must Reflect Diverse, Real-Life Needs: The evolving workforce — especially with the rise of Gen Z — expects benefits that go beyond traditional offerings. Employees are looking for flexible, personalized options that address their full lives, including mental health support, financial wellness tools, and opportunities for personal and professional growth. A one-size-fits-all approach is no longer sufficient; employers are encouraged to offer a “menu” of benefits that employees can tailor to their unique circumstances.

2. Effective Communication is Crucial for Benefit Utilization: Even the best-designed benefits can go underused if employees aren’t aware of them or don’t understand how to access them. Organizations are finding success with a multi-channel communication strategy that includes orientations, manager interactions, HR-led sessions, digital platforms, and regular reminders. Repetition and personalization are key to ensuring all generations in the workforce are informed and empowered to take advantage of what’s available.

3. Balancing Cost with Value Requires Strategic Innovation: Rising healthcare costs and tight budgets push employers to find creative ways to provide valuable benefits without overspending. Low-cost options like wellness challenges, mental health apps, and voluntary insurance plans (e.g., disability coverage) can offer meaningful support. Employers are also leveraging wellness funds and partnerships to create flexible, mix-and-match benefits that are both sustainable and impactful for a multigenerational workforce.