Trump’s State of the Union trumpets healthcare greatest hits, but no new policies

By Rebecca Pifer Parduhn – America has entered its “golden age,” President Donald Trump argued in a lengthy State of the Union address Tuesday night that glossed over the biggest achievements of the president’s second term so far but was notably light on healthcare. The economy is improving, prices are coming down, illegal immigration is under control and crime is plummeting, the president said, while lauding guests in attendance like Erika Kirk and the Olympic gold medal-winning U.S. men’s hockey team. Read Full Article...

HVBA Article Summary

1. Limited Healthcare Focus Despite Economic Importance: During what became the longest State of the Union address on record at 1 hour and 47 minutes, healthcare received relatively limited attention, with the president spending roughly five minutes discussing the issue and introducing few new policy initiatives. This occurred even as healthcare costs rank among Americans’ top economic concerns in recent KFF polling and as Republican midterm strategy is expected to rely heavily on arguments that administration policies are lowering costs related to insurance premiums, prescription drugs, and medical care.

2. Healthcare Plan Proposal and Prescription Drug Pricing Claims: Trump reiterated criticism of the Affordable Care Act and promoted his proposed “Great Healthcare Plan,” which would redirect federal subsidies from insurance companies directly to consumers purchasing coverage. He also highlighted pharmaceutical pricing efforts, including “Most Favored Nation” agreements negotiated with more than a dozen drugmakers, claiming prescription drug prices had fallen by 300% to 600% or more. The speech additionally promoted TrumpRx, a direct-to-consumer drug purchasing platform intended to provide lower-cost medications.

3. Expert Assessments and Policy Omissions: Health policy analysts noted that the administration provided limited detail on how the proposed reforms would reduce overall healthcare costs and argued that MFN pricing primarily affects Medicaid programs and cash-paying consumers, limiting its impact for most insured Americans. The article also reports that manufacturers have increased prices on hundreds of brand-name drugs despite these initiatives. The speech did not address several major healthcare controversies or policy areas, including Medicaid cuts passed in GOP legislation last summer, vaccine access disputes, delayed health research funding, or reductions to the federal health workforce.

Payers, employers urge federal action on No Surprises arbitration ‘manipulation’ 

By Jakob Emerson – A coalition of more than 60 employer groups, insurers, patient advocacy and labor organizations sent a letter Feb. 24 to the Treasury Department, Labor Department and HHS, urging the Trump administration to crack down on what they describe as systemic abuse of the No Surprises Act’s arbitration process. The letter, signed by Elevance Health, BCBS Michigan, Blue Shield of California, and Point32Health, argues the independent dispute resolution process, designed to resolve out-of-network billing disputes, has instead become a “profit-seeking tool” for a handful of provider groups that are overwhelming the system with inflated claims. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Rising Costs and Expanding Use of the IDR Process: The article highlights growing concern among healthcare stakeholders that the Independent Dispute Resolution (IDR) process is contributing to increased costs across the healthcare system. Research cited by the coalition estimates at least $5 billion in additional spending between 2022 and 2024, driven by administrative fees and arbitration payments that frequently exceed typical market rates. The number of disputes has also dramatically outpaced federal expectations, with more than 3.3 million cases filed between mid-2022 and May 2025 compared to an initial projection of 17,000 annually.

2. Regulatory Delays and Continued Policy Uncertainty: Efforts by federal regulators to reform the IDR system remain unresolved, as a proposed rule introduced by the Department of Health and Human Services in November 2023 has been delayed by ongoing legal challenges and is still under federal review. This prolonged rulemaking process has created uncertainty around how arbitration decisions should be conducted and regulated, while participation in the IDR system continues to grow and shape payment outcomes across the healthcare market.

3. Calls for Greater Oversight and Clearer Arbitration Standards: The coalition and several health plans argue that gaps in oversight and guidance may allow certain providers and arbitration entities to disproportionately benefit from the current system. Data cited in the letter shows high provider success rates in disputes and payment determinations significantly above benchmark amounts, alongside insurer lawsuits alleging misuse of arbitration eligibility rules. Stakeholders are urging federal agencies to improve transparency, clarify eligibility requirements, and strengthen accountability measures to ensure the IDR process functions as originally intended.

ICHRA push reinvigorates employer health market in Connecticut

By Allison Bell – Connecticut's Affordable Care Act public exchange program is seeing enough broker and employer interest in the new cash-for-coverage plans to provide numbers. Workers at employers with individual coverage health reimbursement arrangement plans can use contributions from the employers to buy their own individual or family major medical coverage. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Growing Employer Interest and Early Adoption of ICHRA Plans: Access Health CT reported that 33 employers were offering Individual Coverage Health Reimbursement Arrangement (ICHRA) plans at the start of the year, covering approximately 325 workers. Interest in future adoption appears strong, with about 400 insurance brokers completing ICHRA training programs and roughly 650 employers demonstrating serious interest in offering ICHRA-based coverage, indicating potential expansion of the model within Connecticut’s employer market.

2. Employer Appeal Driven by Budget Predictability and Administrative Simplicity: Connecticut employers are increasingly exploring ICHRAs as an alternative to traditional group health insurance due to features such as predictable healthcare budgeting, expanded employee choice among individual market plans, and reduced administrative burdens tied to annual group plan renewals. National estimates from HealthSherpa suggest that between 400,000 and 800,000 individuals nationwide may already be using ICHRA arrangements to finance health coverage.

3. ICHRA Growth Occurs Alongside Mixed Performance of ACA SHOP Marketplaces: The Affordable Care Act’s Small Business Health Options Program (SHOP) was designed to help small employers access affordable coverage, with states such as Connecticut, California, and Colorado maintaining relatively active programs. However, employer participation has been limited in many states, with Nevada officials previously indicating SHOP enrollment covered fewer than 10 people. In Connecticut, Access Health CT provides coverage to about 52,000 residents overall, and an estimated 500 employers currently offer SHOP plans, though detailed enrollment figures have not been publicly released.

Medicare Advantage growth slows as plans exit markets

By Maya Goldman – Medicare Advantage enrollment is declining in seven states this year, an analysis of federal data shows. Why it matters: The private Medicare program that covers more than half of seniors still is growing nationally, but at a slower rate than in the recent past as rising medical costs and federal policy changes spur a market realignment. By the numbers: MA enrollment for the 2026 plan year decreased from 2025 levels in Vermont, Wyoming, New Hampshire, Idaho, Minnesota, Maryland and South Dakota, according an analysis from consulting firm Chartis released Thursday. Read Full Article...

HVBA Article Summary

1. Limited and Uneven State-Level Medicare Advantage Enrollment Growth: Medicare Advantage enrollment growth slowed significantly at the state level this year, with New York emerging as the only state to post enrollment growth exceeding 5%, compared with eight states that achieved similar growth last year. Vermont was the only state to experience a decline in enrollment, and analysts indicated that decreases were largely driven by insurers exiting markets they no longer viewed as financially viable rather than shifts in beneficiary preferences.

2. Diverging Insurer Performance Shapes Market Competition: Insurer results varied notably during the latest enrollment cycle, with Humana gaining nearly 1.2 million enrollees — an increase of roughly 21% — making it the strongest performer this year. UnitedHealth Group’s Medicare Advantage enrollment declined by more than 5% year over year but still remains the largest carrier with approximately 9.3 million members. At the same time, startup Devoted Health more than doubled its enrollment to about 455,000 beneficiaries by expanding specialized plans focused on high-needs populations.

3. Financial Pressures Driving Plan Changes and Future Market Uncertainty: Ongoing profitability challenges continue to influence insurer participation in Medicare Advantage markets, as about 1 in 10 beneficiaries were required to switch plans this year after their previous coverage option was discontinued, according to a JAMA study. While health insurance executives expressed a more positive five-year outlook for the program, many anticipate benefit reductions by 2027, and analysts warn that a proposed flat federal payment update could prompt additional insurers to exit markets if financial conditions do not improve.

Novo, searching for a spark, spotlights new data for three-pronged obesity drug

By Ben Fidler – Once the leader in the ultra-lucrative market for obesity drugs, Novo is now reeling. Chief rival Eli Lilly now claims more than 60% of the U.S. market due to the success of tirzepatide, a medication known as Zepbound for obesity, and that’s become the world’s top-selling medicine. Compounders have chipped away at sales of Novo’s flagship weight loss medication Wegovy. Even the early launch success of the company’s Wegovy pill has been overshadowed by troubling sales forecasts as well as, more recently, the failure of one its newer drugs to match Zepbound in a head-to-head trial. Read Full Article...

HVBA Article Summary

1. Novo Nordisk’s Expansion Into Triple-Hormone Obesity Treatments: Novo Nordisk is working to strengthen its position in the weight-loss drug market through UBT251, an experimental therapy targeting three gut hormones — GLP-1, GIP, and glucagon — rather than the one or two targeted by most current treatments. The company obtained partial rights to the drug through a deal with United Biotechnology valued at up to $2 billion, part of more than 60 licensing agreements between Western and China-based drugmakers last year, including six focused on obesity therapies. This multi-hormone approach is intended to potentially produce greater weight loss than existing medications such as Wegovy or Zepbound.

2. Rising Competitive Pressure From Eli Lilly’s Clinical Results: Competition in the obesity drug market is intensifying as Eli Lilly advances retatrutide, another triple-hormone therapy that has demonstrated strong clinical outcomes. In a Phase 3 trial released in December, retatrutide produced up to 29% weight loss, a result analysts described as significantly raising expectations for future obesity treatments. Earlier mid-stage research published in The New England Journal of Medicine reported 17.5% weight loss after 24 weeks, suggesting continued improvement may be possible as trials expand and study designs focus more directly on maximizing weight reduction.

3. UBT251 Remains in Earlier Development With Key Data Pending: While promising, UBT251 is still progressing through clinical testing, with detailed trial data scheduled to be presented at a medical meeting later this year. Novo Nordisk leadership has indicated early findings suggest a potentially differentiated clinical, safety, and tolerability profile compared with competing drugs. The company also plans to begin a Phase 2 diabetes study in 2026, reflecting ongoing efforts to expand the therapy’s role across obesity and metabolic disease treatment areas.

Coming of age in a broken system: What health care is doing to young Americans

By Adam Berkowitz – There's a quote from Dave Chase that I think about constantly: "Imagine if a foreign country was causing this kind of collateral damage on our economy. We'd go to war in a second." He wasn't talking about a military threat. He was talking about health care. And the generation absorbing the most damage? The one just now entering the workforce, starting families, and trying to build a life in an economy that has quietly rigged the game against them. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Economic Disadvantage for Young Americans: Young people entering the workforce today face significant economic challenges compared to previous generations, including lower relative earnings, higher student debt, and unaffordable housing. Health care costs have become a major factor eroding their financial stability, often surpassing other expenses like housing or education. This generational disparity is reflected in declining wealth ownership among those under 40 and a growing sense of disillusionment about the future.

2. Health Care as a Driver of Wealth Erosion: The article highlights that health care spending is now the second-largest expense for most employers, with a substantial portion lost to inefficiency, fraud, or waste. Despite increased employer spending on benefits, young employees often find themselves unable to afford or effectively use their health coverage due to high deductibles and complex plan designs. This dynamic results in a system where both employers and employees lose economic value, while intermediaries benefit.

3. Employer Responsibility and Opportunity: Employers play a crucial role in addressing these systemic issues, as the structure and transparency of benefits packages directly impact young workers' well-being and engagement. Forward-thinking companies are redesigning health plans to better meet the needs of younger employees, emphasizing primary care, mental health, and clear communication. By demanding greater accountability from vendors and treating compensation holistically, employers can help restore trust and offer meaningful support to the next generation of workers.