2025: Big Insurance’s $1.7 Trillion Year

By Wendell Potter – The seven largest for-profit health insurance conglomerates took in nearly $1.7 trillion from their customers in 2025 – $175 billion more than in 2024 – and they booked more than $54 billion in profits (earnings from operations). The companies — UnitedHealth, CVS/Aetna, Cigna, Elevance/Anthem, Humana, Centene and Molina — achieved that revenue growth in part by charging their private-paying customers (and the government) much more in premiums and fees in 2025 than in 2024. The cost of an employer-sponsored family policy increased an average of 6% last year and is expected to spike even higher this year. Read Full Article...

HVBA Article Summary

1. Record Revenues and Profits Amid Shrinking Coverage: In 2025, the seven largest U.S. health insurers saw significant increases in both revenue and profits, despite covering fewer people than the previous year. This growth was driven by higher premiums and fees charged to both private customers and government programs. The trend highlights a disconnect between insurer financial performance and the number of Americans actually receiving coverage.

2. Shift Toward Government Programs and Vertical Integration: A growing share of insurer revenue now comes from taxpayer-funded programs like Medicare Advantage and Medicaid, with companies such as UnitedHealthcare and Humana relying heavily on these sources. Insurers are also steering more patients into their own subsidiaries, such as pharmacy benefit managers and provider networks, increasing internal transactions and consolidating control over the healthcare delivery chain. This strategy has led to a rise in “intercompany eliminations,” reflecting more business being conducted within the same corporate group.

3. Rising Costs and Consumer Impact: The cost of employer-sponsored health insurance continues to rise, with average family premiums and out-of-pocket expenses increasing substantially since 2015. Insurers are responding to shareholder pressure by raising premiums, reducing provider networks, and increasing patient cost-sharing, which may make it harder for many Americans to access care. As a result, the number of uninsured and underinsured individuals is likely to grow, and the value of health insurance coverage is eroding for many consumers.

What does today’s Supreme Court decision striking down tariffs mean for the pharmaceutical industry?

By Peter Wehrwein – The Trump administration has other legal avenues to impose tariffs on pharmaceuticals despite today’s Supreme Court decision striking down many of the administration’s current tariffs. In a 6-3 decision, the court ruled that President Donald Trump did not have the authority to impose tariffs under a 1977 law, the International Emergency Economic Powers Act. But at a White House press conference this afternoon, Trump said there were numerous other statutes and authorities that give the president the power to impose tariffs. He cited Sections 122 and 301 of the Trade Act of 1974; Section 232 of the Trade Expansion Act of 1962; and Section 338 of the Tariff Act of 1930, commonly referred to as the Smoot-Hawley Tariff Act. Read Full Article...

HVBA Article Summary

1. Alternative Tariff Authorities Remain Available: Although the Supreme Court invalidated tariffs imposed under the International Emergency Economic Powers Act, the administration retains the ability to impose tariffs using other statutes, such as Sections 122 and 301 of the Trade Act of 1974 and Section 232 of the Trade Expansion Act of 1962. These alternative legal avenues allow for continued leverage over the pharmaceutical industry. The administration has already announced plans to use a 10% tariff under Section 122 as a replacement.

2. Limited Immediate Impact on Industry Deals: Existing agreements between drug manufacturers and the administration, such as direct-to-consumer discounts and commitments to domestic manufacturing, are unlikely to be reversed as a result of the court’s decision. The administration’s ongoing authority to threaten sector-specific tariffs under other laws continues to influence industry behavior. As a result, the pharmaceutical industry is expected to maintain its current pricing and manufacturing strategies in the near term.

3. Ongoing Uncertainty and International Considerations: The ruling may reduce some uncertainty by shifting tariff-setting power back to Congress, potentially allowing for more predictable policy changes. However, the U.S. is bound by international agreements like TRIPS, which complicate the imposition of pharmaceutical tariffs and could increase domestic production costs due to reliance on imported ingredients. The history of shifting implementation dates and policy reversals has created volatility for manufacturers, and future tariff actions may still be subject to political and legal challenges.

ER doctor payments fell 12% since No Surprises Act took effect

By Allison Bell – Insurers and health plans may have slashed payments to some types of physicians during the first years that the federal No Surprises Act was in effect. The law is supposed to protect insured patients from getting big, unexpected, out-of-network bills. The act was signed into law in December 2020 and took effect Jan. 1, 2022. Commercial payers' "allowed amounts" for emergency room facilities increased 5.8% between 2019 and 2021, and then increased another 6.1% between 2021 and 2023, according to the U.S. Government Accountability Office. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Impact on Physician Payments: The No Surprises Act, intended to shield patients from unexpected out-of-network bills, has coincided with notable reductions in payments to certain medical specialists, particularly emergency room doctors and anesthesiologists. While hospital facility payments increased, physician payments declined, suggesting a shift in how reimbursements are distributed within the healthcare system. This trend may contribute to growing dissatisfaction among ER doctors and other affected providers.

2. Dispute Resolution and Legal Challenges: The act established an independent dispute resolution (IDR) process for payers and providers to resolve out-of-network billing disagreements. Both insurers and healthcare providers have expressed concerns about the fairness of this process, leading to multiple lawsuits from both sides. These ongoing disputes highlight the complexity and contentiousness of implementing federal protections in the healthcare billing landscape.

3. Data Limitations and Patient Responsibility: The Government Accountability Office's analysis was based on a large but incomplete commercial claims dataset, which may not fully represent all payers or regions. Additionally, the reported "allowed amounts" include both insurer payments and patient out-of-pocket costs, with patients now responsible for a significant share of medical bills. Challenges in collecting patient payments could further complicate financial trends for both hospitals and physicians.

Eli Lilly launches new form of Zepbound

By Erica Cerutti – Eli Lilly has launched a multidose version of its blockbuster weight loss drug Zepbound that gives patients a month’s worth of treatment in a single injection pen. On Feb. 23, the drugmaker said the FDA approved a label expansion for Zepbound (tirzepatide) to include the four-dose, single-patient-use KwikPen. The device contains four weekly doses, reducing the number of pens patients need each month compared with single-dose injectors. Read Full Article...

HVBA Article Summary

1. FDA Approval for Multidose Pen: The FDA has approved an expanded label for Zepbound, allowing the use of a four-dose KwikPen that provides a month’s supply in a single device. This change is intended to simplify the treatment regimen for patients by reducing the number of injection pens required each month. The approval reflects ongoing efforts to improve patient convenience and adherence to weight loss therapies.

2. Pricing and Access via LillyDirect: The new multidose KwikPen will be available to self-paying patients through Eli Lilly’s direct-to-consumer platform, LillyDirect, with prices starting at $299 per month for the lowest dose. Patients can choose between the multidose pen or a single-dose vial at the same price, offering flexibility in how they receive their medication. This approach may help address some barriers to access for individuals paying out of pocket.

3. Broader Context in Weight Loss and Diabetes Treatments: Tirzepatide, the active ingredient in Zepbound, is also marketed as Mounjaro for Type 2 diabetes, and a similar KwikPen device is already available for that indication. The introduction of the multidose pen for Zepbound aligns with trends in the pharmaceutical industry to streamline medication delivery for chronic conditions. This move may also position Eli Lilly competitively in the growing market for GLP-1-based weight management therapies.

Millions on Medicare Advantage Forced to Switch Plans as Insurers Exit

By Shannon Firth – About one in 10 Medicare Advantage (MA) enrollees, roughly 2.9 million people, will be forced to disenroll from their plan in 2026, following a spike in MA plans leaving the market, a study showed. The mean forced disenrollment rate for MA beneficiaries jumped from 1% in 2018-2024 to 6.9% in 2025, and then to 10% in 2026, reported Mark K. Meiselbach, PhD, of the Johns Hopkins Bloomberg School of Public Health in Baltimore, and co-authors in a research letter in JAMA. Meiselbach told MedPage Today that "the massive uptick in the past 2 years in plan exits relative to very infrequent plan exits over the prior 5+ years" was surprising, and "signals a changing landscape." "It is also shocking to see the total or near-total collapse of MA in several states," he said. Read Full Article...

HVBA Article Summary

1. Significant Increase in Forced Disenrollments: The rate of forced disenrollment among Medicare Advantage beneficiaries has risen sharply from 1% during 2018-2024 to 10% in 2026. This increase corresponds with a surge in Medicare Advantage plans exiting the market, affecting approximately 2.9 million enrollees nationwide. The trend indicates a rapidly changing landscape in the Medicare Advantage market with substantial impacts on beneficiaries.

2. Geographic and Plan Type Disparities: Some states are experiencing extreme impacts, with Vermont seeing 92.2% of enrollees forced to switch plans, and six other states having at least 40% of enrollees affected. Beneficiaries enrolled in preferred provider organization plans, non-special needs plans, smaller carriers, and lower star-rated plans, particularly those living in rural areas, are more likely to face forced disenrollment. This suggests that less profitable or lower-rated plans and rural markets are more vulnerable to insurer exits.

3. Potential Disruptions to Care and Policy Implications: Forced disenrollments can disrupt continuity of care, especially for older beneficiaries with chronic conditions who may face changes in clinicians, specialists, medication coverage, and care coordination. Despite a 5.06% increase in Medicare Advantage payment rates for 2026, plans continue to exit, raising concerns about the sustainability of the for-profit Medicare Advantage model. This situation calls for careful examination of whether current payment and market structures adequately support universal access and beneficiary needs.

'The finger pointing isn't working': Aetna's president talks rebuilding payer-provider trust

By Jakob Emerson – There’s “a hunger for a different kind of dialogue” when it comes to relations between payers and providers, according to Aetna President Steve Nelson. Mr. Nelson laid out a vision for Aetna that centers on rebuilding trust in the industry, an effort he said is already producing measurable results with some of the country’s largest health systems and that informed Aetna’s recognition as Press Ganey’s inaugural health plan of the year earlier this month. “I can tell you firsthand that the provider community and provider organizations wake up every day trying to do good work. And so do payers,” Mr. Nelson told Becker’s. Read Full Article...

HVBA Article Summary

1. Emphasis on Rebuilding Trust: Steve Nelson, Aetna's president, is prioritizing efforts to rebuild trust between payers and providers. He believes that fostering positive intent and focusing on patient outcomes, rather than organizational disputes, can lead to more constructive relationships. This approach has already led to measurable improvements in collaboration with major health systems.

2. Operational Changes to Reduce Friction: Aetna has implemented changes such as bundling pharmacy and medical procedure authorizations and adjusting prior authorization timelines in response to provider feedback. For example, by instituting a 48-hour hold on certain authorizations, Aetna and a partner health system were able to reduce denials and resubmissions by 80%. These operational shifts are intended to streamline processes and reduce administrative burdens for both providers and patients.

3. Ongoing Challenges and Future Initiatives: Despite improvements, challenges remain, including ongoing delays and denials in the prior authorization process and broader tensions over healthcare costs. Aetna is investing in digital tools, AI-powered navigation, and care coordination programs to further enhance member experience and provider engagement. Nelson acknowledges that sustained effort and a new approach to payer-provider dialogue are necessary to address systemic issues and improve patient care.

Why benefits will make or break employee retention in 2026

By Doug Sabella – With the start of the new year, many employees traditionally consider exploring new jobs, alongside other resolutions like fitness goals or budgeting. But for the past two years, more workers have stayed in their roles — not because they're entirely satisfied with them, but because economic uncertainty has made them prioritize stability over the risk that comes with changing jobs. Most often referred to as "job hugging," many employees are clinging to their jobs longer than they'd like. But a growing number will start to reach their breaking point after a few extra years in roles they already know no longer serve them. And when they do, benefits will be a major driver of whether they decide to stay or go. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Benefits as a Deciding Factor: As economic uncertainty wanes and employees become more willing to change jobs, the quality and relevance of benefits packages will play a pivotal role in retention. Workers are increasingly evaluating their employers based on the strength of health insurance, retirement plans, paid time off, and wellness perks. Employers who fail to offer competitive and meaningful benefits may see higher turnover as employees seek better options elsewhere.

2. Need for Modernized HR Processes: Outdated manual HR processes can hinder an organization’s ability to understand and meet evolving employee benefit needs. When HR teams are bogged down by administrative tasks, they have less time to engage with employees and tailor benefits accordingly. Adopting automation and streamlining operations can free up HR to focus on employee engagement and benefits education, ultimately improving retention.

3. Generational Differences in Benefit Priorities: Employees at different life stages and from different generations value distinct types of benefits, such as health insurance for Gen Z or wellness offerings for millennials. Employers must recognize and address these generational divides by directly engaging with their workforce to identify shifting priorities. Designing flexible and responsive benefits programs that reflect these diverse needs will be crucial for retaining talent across all age groups.