Obamacare Breaks Enrollment Record At 24 Million As Trump Preps Return

By Bruce Japsen - The Biden administration announced Wednesday another record year of enrollment in individual coverage under the Affordable Care Act with another week remaining to sign up for such health benefits. Read Full Article…

HVBA Article Summary

1. Record Enrollment in ACA Marketplace: The Centers for Medicare & Medicaid Services (CMS) announced that 23.6 million Americans have signed up for individual-market health insurance through the ACA Marketplace for the 2025 plan year, surpassing the previous record of 21 million in 2024. The open enrollment period remains ongoing, with 3.2 million new consumers added this year.

2. Bipartisan Support for ACA Subsidies: Expanding subsidies under the ACA has played a crucial role in increasing coverage affordability, benefiting insurers like Centene, Cigna, and UnitedHealthcare. Some Republican lawmakers, such as Sen. Lisa Murkowski, have expressed support for extending these subsidies, which are set to expire at the end of the year.

3. Future Uncertainty Under Trump’s Presidency: While ACA enrollment continues to grow, uncertainty looms regarding future healthcare policy under former President Donald Trump, who returns to office this month without a disclosed healthcare agenda. His previous efforts to repeal the ACA during his first term were unsuccessful, raising questions about potential policy shifts.

Pennsylvania program helps overturn 50% of health insurance denials in first year, new data shows

By Nicole Leonard - A state program designed to help Pennsylvanians fight health insurance denials was successful in overturning decisions and reinstating coverage in about half of all cases, according to new data released Wednesday. Read Full Article…

HVBA Article Summary

1. Impact of the Independent External Review Program: Since its launch, the state Insurance Department’s Independent External Review program has processed 517 appeals, with expert reviewers overturning insurer denials or limitations on coverage in 259 cases. Insurers are required to reinstate or retroactively apply coverage for pending procedures, medications, and health visits when claims are successfully appealed.

2. Rising Insurance Denials and Lack of Transparency: National trends indicate a rise in insurance denials, with nearly one in five people reporting a denied health insurance claim in 2023. However, data on individual insurer denial rates and successful appeals remain scarce and are rarely publicly disclosed.

3. Eligibility and Appeal Process: Pennsylvania residents can access the Independent External Review program after completing their health insurer's internal appeals process. The program covers state health plans, Affordable Care Act Marketplace plans, and most commercial insurance policies but excludes self-funded employer-sponsored health plans.

Biden leaves behind a remarkable legacy in public health

By Leana S. Wen - Joe Biden is leaving behind a legacy that, as many have pointed out, is mixed at best. But there is one area where the outgoing president has consistently shone: public health. Read Full Article…

HVBA Article Summary

1. Aggressive COVID-19 Response and Vaccination Campaign: President Biden led a mass vaccination campaign that saved an estimated 3.2 million American lives within two years, significantly reducing the impact of the coronavirus pandemic.

2. Efforts to Curb the Opioid Epidemic: Biden's administration implemented bold overdose prevention strategies, including making naloxone more accessible, removing the X-waiver requirement for opioid addiction treatment, and expanding telehealth services. These measures led to a historic 14.5% decrease in overdose deaths, the largest recorded reduction in U.S. history.

3. Prescription Drug Cost Reductions: Biden fulfilled his promise to lower prescription drug costs for seniors through the Inflation Reduction Act, which capped Medicare Part D out-of-pocket spending at $3,500 in 2024 and $2,000 in 2025. Additionally, Medicare was authorized to negotiate drug prices for the first time, providing significant savings for millions of beneficiaries.

New Biden rule will ban medical debt from credit reports, but will Trump keep it?

By Allison Bell - The Consumer Financial Protection Bureau has completed final regulations that could stop health care providers from reporting most medical debt to credit bureaus. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Increased Upfront Payment Requirements: The CFPB's new regulations may prompt doctors, dentists, and hospitals to require patients to pay for care upfront, as ACA International warns. This shift could particularly impact consumers who cannot afford out-of-pocket costs, leading them to use high-cost financing options like credit cards and payday loans.

2. Changes in Credit Reporting: The regulations will prevent credit reporting companies from including medical bill information in consumer reports sent to lenders, eliminating data on approximately $49 billion in medical debt from 15 million Americans' credit histories. Supporters argue this change will reduce barriers to jobs and housing, while critics claim it could encourage irresponsible financial behavior.

3. Potential Financial Behavior Shifts: Critics like Kimberly Stone argue that the removal of medical debt from credit reports might lead to consumers neglecting smaller medical bills, especially under $500, potentially shifting debt collection strategies from credit reporting to legal actions like lawsuits, wage garnishments, and asset seizures.

Wegovy and Zepbound tipped to fuel $20B boom in heart failure market

By Nick Paul Taylor - GlobalData has named heart failure as the next disease to feel the sales-boosting power of GLP-1 drugs. The analysts expect launches of medicines including Eli Lilly’s Zepbound and Novo Nordisk’s Wegovy to help add $20 billion to the value of the market in a decade. Read Full Article…

HVBA Article Summary

1. Expanding Heart Failure Market and Growth Projection: The heart failure drug market, valued at $13.5 billion across key regions in 2022, is projected to more than double to $33.7 billion by 2032, driven by a near-10% compound annual growth rate fueled by late-phase pipeline advancements and expanded treatment options.

2. Key Drug Developments and Competitor Moves: Major pharmaceutical companies are actively competing in the heart failure space, with Boehringer Ingelheim securing expanded approval for Jardiance and Novo planning to resubmit Wegovy data in early 2025 after a previous withdrawal. Lilly also intends to file tirzepatide for heart failure approval by the end of 2024, while Bayer advances with Kerendia.

3. Factors Driving Market Success: Analysts highlight that new heart failure treatments will gain market share more effectively if they offer novel mechanisms of action, demonstrate superior clinical outcomes, or enhance patient compliance, with promising candidates like Mesoblast’s Revascor and Bayer’s Kerendia emerging alongside GLP-1 therapies.

Cyberattacks, tech disruption ranked as top threats to business growth

By Alexei Alexis - The global average cost of a data breach last year was nearly $4.9 million, a 10% spike compared with 2023 levels, according to IBM research. Read Full Article…

HVBA Article Summary

1. Cybersecurity and AI Manipulation as Top Threats: Cybersecurity breaches and malicious AI manipulation were identified as the most significant threats to business growth, with 40% of executives citing cyber breaches and data leaks as primary disruptors, far exceeding concerns about accidents, regulations, and social unrest.

2. Impact on Healthcare and Financial Losses: The massive cyberattack on UnitedHealth's Change Healthcare in early 2024 affected data from 100 million people and resulted in $2.5 billion in financial losses, including $1.7 billion in direct response costs and $705 million in business disruption impacts.

3. Business Response and Risk Mitigation: To combat rising cyber threats, 86% of companies have implemented or plan to implement business interruption coverage, and many are increasingly adopting tools for real-time cyber incident monitoring. Corporate leaders are urged to take a holistic, proactive approach to risk management.

Health insurers will step off the roller coaster in 2025

By Rebeca Pifer - Health insurers had a tumultuous 2024. The industry was buffeted by sweeping policy changes that pressured reimbursement, while higher medical utilization drove costs up. And by year’s end, payers found themselves engulfed in a firestorm of public anger over controversial business practices. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Insurers' Performance and Policy Outlook: Managed care companies faced significant stock underperformance in 2024, declining by about 13% compared to the S&P 500’s 23% growth. However, the incoming Trump administration’s pro-business stance is expected to improve the policy environment for insurers in 2025, particularly benefiting privatized Medicare plans while Medicaid and ACA funding may face cuts.

2. Trust and Transparency Initiatives: The tragic death of UnitedHealthcare CEO Brian Thompson has intensified scrutiny on insurer practices, particularly claim denials and care restrictions. Insurers are expected to respond by increasing efforts to rebuild consumer trust through improved transparency, governance on AI usage in claims management, and enhancing customer engagement to simplify coverage navigation.

3. Medicare and Medicaid Adjustments: Profitability in Medicare Advantage plans is projected to improve slightly, but continued benefit reductions and premium hikes may persist due to high utilization rates. Simultaneously, Medicaid faces potential funding cuts under the Trump administration, with likely moves toward reducing federal support and reintroducing eligibility restrictions, such as work requirements.

Extended telemental health flexibilities ‘still far from an ideal outcome’

By Heather Biele - Congress recently extended Medicare telehealth flexibilities that waive a requirement for an in-person visit before a patient can receive mental health services via telehealth. Read Full Article…

HVBA Article Summary

1. Medicare Telehealth Extension: The American Relief Act, signed by President Joe Biden on Dec. 21, extends Medicare telehealth flexibilities through March, continuing measures first implemented during the COVID-19 pandemic. These policies have helped patients with substance use disorder stay in treatment and reduce overdose risks.

2. Policy Criticism and Future Efforts: While the extension is a positive step, Kyle Zebley of the American Telemedicine Association emphasized that it remains an imperfect solution, calling for continued collaboration between policymakers and healthcare leaders to ensure long-term, uninterrupted patient care.

3. DEA and HHS Flexibilities: Separately, the DEA and HHS extended the ability of healthcare professionals to prescribe certain controlled medications via telehealth, including audio-only visits, through the end of 2025. Finalized regulations for telehealth prescribing are still under development.