KFF: A look at how enrollees are responding to the looming expiry of ACA subsidies

By Paige Minemyer – Individuals enrolled in marketplace plans are bracing for potential massive premium hikes for next year, and a new KFF survey digs into how they're thinking about their options. KFF researchers polled 1,350 adults who are covered through the Affordable Care Act's exchanges between Nov. 7 and Nov. 15, and found that 1 in 3 said they are "very likely" to look instead for a plan with lower premiums, which would almost certainly come with a higher deductible and out-of-pocket costs. Read Full Article...

HVBA Article Summary

1. Impending Expiration of Tax Credits May Lead to Loss of Coverage: The enhanced premium tax credits that currently help approximately 22 million of the 24 million marketplace enrollees afford health insurance are scheduled to expire soon unless Congress intervenes. Without an extension, average premiums could increase by 114%, prompting about one-quarter of current enrollees to consider going without insurance altogether due to rising costs.

2. Affordability Challenges Remain Despite Assistance: Even with the current tax credits in place, many individuals still face significant financial strain when it comes to healthcare. Sixty-one percent report difficulty affording deductibles and out-of-pocket expenses, while 51% struggle with premium payments. Nearly 60% of enrollees say that an additional $300 in annual healthcare costs would negatively impact their household finances, highlighting ongoing affordability concerns.

3. Healthcare Costs Could Influence 2026 Voting Behavior: Support for extending the tax credits is strong, with 84% of surveyed enrollees in favor, including nearly all Democrats and about 70% of Republicans. Furthermore, more than half of respondents say that a $1,000 increase in healthcare costs next year would significantly impact both their likelihood of voting and which party’s candidate they support in the 2026 midterm elections, signaling potential political consequences.

Senate Democrats push ‘last chance’ 3-year ACA tax credit extension

By Elizabeth Casolo – Senate Democrats are introducing legislation to extend enhanced premium ACA tax credits by three years, according to Senate Minority Leader Chuck Schumer. The bill would come to the Senate floor for a vote Dec. 11, “and every single Senate Democrat will support it,” he said. Read Full Article...

HVBA Article Summary

1. Proposed ACA Subsidy Extension Delayed by Republican Opposition: President Trump was reportedly preparing to propose a two-year extension of the enhanced Affordable Care Act (ACA) subsidies, which are scheduled to expire at the end of the year. This proposal also included new restrictions on eligibility. However, the announcement was ultimately postponed due to resistance from within the Republican Party, leaving the future of the subsidies uncertain.

2. Concerns Over ACA Fraud Highlighted Amid Policy Debate: A December 3 report from the U.S. Government Accountability Office cited vulnerabilities to fraud in the ACA system, a point that may strengthen Republican arguments against extending the subsidies without additional safeguards. In contrast, the health insurance industry group AHIP continues to support an extension, while recommending measures such as enhanced income-verification protocols and tighter oversight of insurance agents and brokers to prevent misuse.

3. Urgency as Premium Increases Loom: Senate Majority Leader Chuck Schumer stressed that the current legislative effort may be the final opportunity to prevent significant increases in health insurance premiums set to take effect in January. He warned that failure to pass the bill would leave consumers exposed to sharp cost hikes, with the economic burden likely hitting hardest in Republican-majority areas.

Aetna updates on prior authorization reform

By Rebecca Pifer - Many major insurers pledged to fix some much-maligned business practices after the killing of UnitedHealthcare CEO Brian Thompson unleashed Americans’ pent-up anger over delays and denials of care. The backlash was especially directed at a process called prior authorization, which requires providers to get an insurer’s permission before performing a medical service. Read Full Article…

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1. Aetna Implements Bundled Prior Authorizations and Care Transition Support: Aetna has introduced bundled prior authorization requests for specific medical conditions, allowing healthcare providers to submit one comprehensive request for multiple treatments. These include bundles for musculoskeletal care and cancer-related imaging. Additionally, Aetna expanded its Clinical Collaboration program, placing nurses in 17 hospitals to support patient transitions between care settings.

2. Insurers Reduce Prior Authorization Burden Following Industry Pressure: In response to widespread criticism—and following a high-profile event that prompted renewed scrutiny—major insurers, including Aetna, have committed to streamlining the prior authorization process. This includes reducing the number of treatments that require approval and speeding up patient access to care. However, these efforts remain largely voluntary and without federal enforcement.

3. Skepticism Persists Among Providers and Patients: Despite insurer pledges and new initiatives, many doctors and patients remain doubtful about the effectiveness and longevity of these reforms. Past efforts to ease administrative burdens and improve access have fallen short, and many healthcare professionals report that prior authorization requirements have actually grown more cumbersome in recent years.

New Medicare trial may boost digital care

By Maya Goldman and Erin Brodwin – A new Medicare payment trial will determine whether the federal government can promote digital health applications like remote monitoring to manage chronic illnesses. Why it matters: Traditional Medicare currently pays care providers based on the volume of individually billable services they deliver, which makes digital health adoption difficult. Read Full Article...

HVBA Article Summary

1. New Medicare Model Focuses on Chronic Care Management via Technology: The ACCESS model introduces a fixed payment system for Medicare providers to manage chronic conditions such as hypertension, diabetes, and depression. To receive full payments, providers must meet specified patient outcomes. The model is designed to expand the use of digital health tools—like remote monitoring and hybrid care approaches—to better support patients in managing their health between clinic visits.

2. Long-Term Goals and Financial Requirements: Set to run for a 10-year trial period, the ACCESS initiative must demonstrate either cost savings or budget neutrality in order to be considered for permanent adoption. This condition reflects a strong emphasis on fiscal responsibility, ensuring that any improvements in care delivery do not result in increased taxpayer burden.

3. Policy and Industry Implications: The launch of ACCESS signals a clearer commitment from the federal government—particularly the Trump administration—to promoting health technology and value-based care. It may motivate hospitals and health systems to invest more in digital infrastructure. Additionally, the program arrives amid ongoing uncertainty around key telehealth flexibilities and programs like Hospital at Home, which remain at risk of expiration without further legislative action.

Health insurers face financial headwinds with pressure from GLP-1s, higher utilization

By Allison Bell – Health insurers might still be responding to the recent surge in claim costs by increasing prices, cutting benefits and restructuring operations throughout the next year. That's the view of analysts at AM Best, a company that grades insurance companies' own health for brokers, customers, lenders and others. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Outlook Downgrade Due to Rising Costs: AM Best revised its outlook for U.S. health insurers from "positive" to "neutral" in August and now maintains a "negative" stance. This change reflects widespread cost pressures stemming from a broad-based increase in medical expenditures. Key drivers include higher utilization of specialty drugs, more frequent physician visits and inpatient admissions, increased emergency room use, a rise in behavioral health claims, and more intensive coding practices that reflect sicker patient populations.

2. Profitability Pressures Across Insurance Segments: Despite strong capital reserves and access to liquidity, U.S. health insurers are facing a notable decline in earnings across multiple segments. The commercial group market, which has historically helped offset narrower margins in other areas, saw significant earnings deterioration in 2024, a trend continuing into 2025. Cost increases are now affecting nearly all lines of business, including Medicare, Medicaid, and individual plans, highlighting systemic profitability challenges across the industry.

3. Limited Pricing Power and Long-Term Challenges: Insurers are attempting to manage escalating costs by raising premiums, but their ability to do so is constrained by the risk of losing members—especially among fully insured small-group plans. The report notes that it may take several pricing cycles, potentially extending into 2027, for insurers to fully adapt to the ongoing cost pressures. This suggests the industry may face prolonged financial and operational difficulties, with limited short-term solutions.

Handling SMB benefits costs spike: A Q&A with David Feinberg

By Lily Peterson - Small businesses are facing a perfect storm of economic pressures. SMB owners are gravely concerned about the hyper-inflationary cost of employee benefits. Health insurance premiums have been outpacing inflation for years, forcing employers to make difficult tradeoffs that affect everything from employee retention to customer pricing. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Health Insurance Costs Are a Major Pressure Point for Small Businesses: Rising healthcare premiums—growing at over 10% annually—are outpacing inflation and forcing small businesses to make difficult choices, such as reducing benefits, increasing employee contributions, or absorbing higher costs themselves. These challenges are especially critical as labor (including benefits) is often the largest business expense after salaries.

2. Resilient Small Businesses Are Taking a Strategic, Long-Term Approach: Despite financial pressures, many small businesses remain confident by adopting smarter benefits strategies. These include limiting plan choices, educating employees, and exploring alternative models like ICHRAs. Successful businesses are also prioritizing transparency and tailoring solutions rather than defaulting to the most expensive options.

3. Industry Communication Gaps and Misaligned Solutions Pose Risks: There’s a disconnect between macro-level industry trends (e.g., rising costs from demand for specialty drugs) and what small businesses are told. Many solutions touted in the market—like level-funded plans or ACA marketplaces—carry hidden tradeoffs. Small businesses should proactively ask brokers about renewal trends, carrier behavior, and plan benchmarks to avoid being caught off guard.

New Antiobesity Drugs Eagerly Anticipated

By Melissa Warburg - GLP‑1 medications are delivering impressive weight loss and shifting the trajectory of patient health. Now, a wave of next‑generation multiagonists and novel antiobesity drugs — with more targets, better delivery, and efficacy that can rival surgery's — is on the horizon. Read Full Article…

HVBA Article Summary

1. Oral and Nonpeptide GLP-1 Options Are Emerging: New oral formulations like oral semaglutide (50 mg) demonstrated up to 15.1% weight loss in a phase 3 clinical trial, offering an alternative for patients who prefer not to take injections. Additionally, orforglipron, a small-molecule, nonpeptide GLP-1 receptor agonist, is showing promise in late-stage trials for weight management.

2. Multi-Target Drugs Show Enhanced Efficacy: Next-generation drugs such as retatrutide, which acts on GLP-1, GIP, and glucagon receptors, resulted in up to 24.2% weight loss in under one year during a phase 2 trial—comparable to outcomes from bariatric surgery. Combination therapies like CagriSema and survodutide aim to preserve lean mass, improve cardiovascular markers, and treat conditions like metabolic dysfunction-associated steatohepatitis.

3. Diverse Mechanisms Support Personalization and Adherence: With drugs in development like MariTide—which blocks GIP while activating GLP-1 and may require only monthly or bimonthly dosing—patients who don’t respond to current GLP-1s could have more convenient and tailored options. These advancements expand clinicians’ ability to offer personalized and potentially more tolerable treatments.