CMS: 22.8M have signed up for ACA marketplace coverage through Jan. 3, lagging 2025 enrollment

By Paige Minemyer – The Trump administration has released a new update on enrollment on the Affordable Care Act's exchanges, with signups lagging notably behind figures for the 2025 plan year. Per the latest snapshot report, nearly 22.8 million people have signed up for coverage across the exchanges through Jan. 3. By comparison, 23.6 million people had enrolled in ACA plans through Jan. 4, 2025, according to a report from a year ago. Read Full Article...

HVBA Article Summary

1. ACA Enrollment Update: The Centers for Medicare & Medicaid Services (CMS) report that a total of 22.8 million individuals have enrolled in health insurance coverage through the Affordable Care Act (ACA) marketplaces so far this enrollment season. Of this total, 2.8 million are new enrollees, while nearly 20 million are returning customers renewing or continuing their plans. Notably, this figure reflects a modest decline in new signups compared to the same period last year, when 3.2 million people newly enrolled, suggesting a slight dip in first-time participation.

2. Platform Breakdown and Enrollment Timeline: Enrollment is distributed across two primary platforms: 15.6 million people signed up via Healthcare.gov, the federally-run marketplace, while 7.2 million enrolled through state-based exchanges. Among the new customers, about 2.1 million selected plans through Healthcare.gov, indicating it remains the most utilized platform for new signups. The ACA open enrollment period continues through Thursday, January 15, offering individuals time to choose or switch plans. For those who enroll by the deadline, health coverage will take effect on February 1, 2026.

3. Ongoing Political Dispute Over Subsidies: The ACA marketplaces are currently at the center of a partisan debate in Congress focused on addressing the rising cost of premiums following the expiration of enhanced subsidies that were introduced during the COVID-19 pandemic. Democrats advocate for a "clean" three-year extension of these subsidies to buy time for negotiating long-term healthcare affordability solutions. Republicans, on the other hand, are pushing for broader structural reforms, including policies involving health savings accounts and direct payments to individuals. While a House-approved package to extend subsidies has moved to the Senate, it is expected to fail, and President Trump has signaled a possible veto if it reaches his desk.

Cigna's Express Scripts sued over alleged $3.6M generic flipping strategy

By Allison Bell – A giant supermarket chain is suing a giant pharmacy benefit manager over how the PBM handles claims for brand-name drugs. The supermarket chain, Albertsons, has accused Cigna's Express Scripts unit of routinely violating pharmacy contract network terms in 2023 by reclassifying claims for brand-name drugs as claims for generic drugs. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Albertsons Sues Express Scripts Over Alleged Underpayment: Albertsons Companies has initiated a lawsuit against Express Scripts, a major pharmacy benefit manager (PBM), alleging it was underpaid by $3,665,637 during a 2023 financial reconciliation. The complaint claims Express Scripts reclassified certain prescription drugs—originally paid for as brand-name medications—to generic status after the fact, allowing it to reimburse Albertsons at lower rates. Drugs such as Clomid and Suboxone were cited as examples, though the specific reimbursement figures were redacted.

2. Potential Impact on Pharmacy Access in Communities: This legal dispute highlights growing friction between PBMs and retail pharmacies, which could have significant consequences for patient access to medications. If major supermarket chains like Albertsons become discouraged from maintaining pharmacy operations due to unfavorable reimbursement practices, it may intensify the "pharmacy desert" issue in parts of the U.S. where pharmacy access is already limited—particularly in rural or underserved areas.

3. Broader Industry Context: Coding and Reimbursement Disputes: The clash between Albertsons and Express Scripts reflects a broader trend across the healthcare industry involving disputes over coding practices and reimbursement strategies. As health insurers and third-party administrators face a surge in claims, they are scrutinizing coding for potential inflation of patient severity. This has led to conflicts with providers, and now retail pharmacies, over whether coding changes are being used to justify reduced payments—mirroring ongoing battles between hospitals, physicians, and insurers.

Anthropic rolls out Claude for Healthcare: 7 notes

By Giles Bruce – Anthropic has launched Claude for Healthcare, the latest generative AI company to customize its offerings for specific healthcare use cases across providers, payers and biotech. The AI startup, which is reportedly valued at $350 billion, rolled out the platform Jan. 11. Here are seven things to know. Read Full Article...

HVBA Article Summary

1. HIPAA-Compliant AI Tools Streamline Healthcare Operations: Anthropic has equipped its Claude AI model with HIPAA-compliant features aimed at improving healthcare workflows. These capabilities help accelerate prior authorization requests, coordinate patient care to ease clinician workload, and support regulatory submissions, potentially enabling faster delivery of life-saving treatments. The goal is to reduce administrative burdens while enhancing care efficiency.

2. Deeper Integration with Health Data Systems and Automation Capabilities: Claude now connects to key healthcare infrastructure, including CMS’ coverage database, ICD-10 codes, and the National Provider Identifier Registry. It has also gained skills in FHIR development and patient message triage. These upgrades allow the AI to pull coverage requirements, assess clinical criteria, and assist with claims appeals, enabling faster, more accurate decisions while maintaining HIPAA compliance.

3. Broad Use Cases for Patients and Health Organizations: Claude supports both individual health management and enterprise-level operations. Consumers can upload lab results and receive plain-language explanations, summaries of medical history, and tailored questions for doctor visits. Meanwhile, large organizations like Banner Health have adopted Claude for internal platforms such as BannerWise, leveraging it for document analysis, content creation, code optimization, and clinical trial support. This dual focus enhances both patient engagement and organizational efficiency in the healthcare sector.

11 No Surprises Act updates

By Jakob Emerson – The No Surprises Act’s independent dispute resolution process continues to be a source of controversy and litigation nationally more than three years after its implementation, with insurers and providers suing over alleged abuse of the arbitration system. Read Full Article...

HVBA Article Summary

1. High Costs and Volume of IDR Cases: Since its launch in 2022, the Independent Dispute Resolution (IDR) process has generated over $5 billion in total costs, with administrative expenses alone accounting for $2.8 billion. Although federal regulators initially projected just 17,000 disputes annually, the actual number has skyrocketed to more than 3.3 million cases filed between mid-2022 and May 2025. This massive increase in usage has placed a significant administrative and financial burden on the system.

2. Provider Advantage and Insurer Pushback: Providers have won 80%–85% of IDR cases, frequently receiving reimbursement amounts that far exceed in-network and Medicare rates—sometimes up to 4.5 times Medicare rates. In response, insurers have implemented policies to limit what they describe as abuse of the IDR process. For example, some insurers have penalized hospitals for working with out-of-network providers. These efforts have drawn criticism from lawmakers and hospital groups who argue that such policies are anti-competitive and could undermine provider sustainability.

3. Legal and Regulatory Escalation: The rapid growth and contentious nature of IDR cases have led to a wave of lawsuits and formal complaints. Insurers have accused providers and billing companies of manipulating or misusing the system, while providers have filed suits against insurers for nonpayment or delayed payments after arbitration. These developments have prompted bipartisan calls in Congress for stronger federal oversight, enforcement of existing rules, and improvements to eligibility determinations, signaling rising concern about the long-term viability of the current arbitration framework.

Most doctors are deep into AI adoption but dissatisfied with employers' approach to AI tools

By Heather Landi – Physicians are already deep into artificial intelligence adoption—67% of doctors use AI tools daily in their practice and nearly 90% use AI at least weekly. Clinicians are using AI daily for writing notes, drafting documents, patient communication and simplifying routine tasks, according to a recent survey from Offcall, a physician-founded company that provides salary and work transparency, along with financial education for doctors. Offcall surveyed 1,000 physicians across 106 specialties in October to understand how they are using AI tools. Read Full Article...

HVBA Article Summary

1. Widespread Physician Adoption and Optimism About AI: A strong majority of physicians (84%) believe that AI enhances their ability to perform their jobs, and 78% express optimism about AI’s future role in improving patient outcomes. This indicates that most doctors view AI as a valuable tool rather than a threat. Despite the lack of formal institutional mandates, only 3% report never using AI, suggesting that adoption is happening organically and at a grassroots level, driven by frontline needs and interest rather than top-down directives.

2. Frustration with Organizational AI Strategy and Lack of Influence: A large portion of doctors (81%) report dissatisfaction with their organizations’ handling of AI integration, citing slow progress, insufficient communication, and a lack of meaningful physician involvement in key decisions. About 71% feel they have little to no influence over which AI tools are chosen, while 67% believe that having a greater voice in these decisions would improve their job satisfaction. This points to a growing misalignment between clinical staff and administrative leadership when it comes to AI implementation strategies.

3. Concerns Over Misaligned Incentives and Control of AI Tools: Physicians are most concerned that AI, if controlled primarily by administrators or insurance payers, could be used in ways that conflict with patient care priorities. About 30% cite this misalignment of incentives as their top concern, followed by issues such as liability (20%), erosion of clinical reasoning (15%), technological reliability (15%), and loss of human connection (10%). Additionally, 80% of doctors emphasize the importance of HIPAA-compliant security when adopting AI tools. While cautious, physicians still see value in AI—particularly for reducing documentation burdens (65%) and administrative tasks (48%)—as long as it supports, rather than dictates, their clinical roles.

Common Food Additive Linked to Cancer Risk

By Mike Bassett – A higher intake of preservatives widely used in processed foods and beverages was associated with a modestly increased risk of cancer, according to results from the French NutriNet-Santé prospective cohort. Among more than 105,000 participants, higher intake of several preservatives, including potassium sorbate, potassium metabisulfite, sodium nitrite, potassium nitrate, acetic acid, and sodium erythorbate, was associated with an increased risk of overall, breast, and prostate cancers, reported Mathilde Touvier, MSc, MPH, PhD, of Université Sorbonne Paris Nord and Université Paris Cité, and colleagues. Read Full Article...

HVBA Article Summary

1. Association Between Preservative Intake and Cancer Risk: A large-scale French cohort study (NutriNet-Santé) found that higher consumption of certain food preservatives—especially non-antioxidant types such as sorbates, sulfites, nitrites, nitrates, acetates, and acetic acid—was associated with a modest but statistically significant increase in the risk of overall cancer, as well as specific cancers like breast and prostate cancer. Among antioxidant preservatives, sodium erythorbate was also linked to elevated risks.

2. Potential Public Health Implications and Policy Considerations: The findings raise concerns about the widespread use of food preservatives and suggest that, if confirmed, current regulations may need to be re-evaluated. Experts recommend regulatory actions such as stricter limits, better labeling, and mandatory disclosure of additive contents to enhance consumer protection, particularly given uncertainties around long-term health effects.

3. Study Strengths, Limitations, and Behavioral Patterns: The study analyzed data from over 105,000 participants using repeated dietary assessments and long-term health tracking. Despite its strengths, it was observational in nature, meaning causality cannot be established. It also found that individuals with higher preservative intake tended to be younger, consume more ultra-processed foods, and had different lifestyle patterns, potentially influencing the results.

SAVVI Financial launches retirement income predictor tool

By Paola Peralta – Many employees are worried they won't be able to turn their savings into a reliable paycheck for life, but one company designed a tool aimed to help workers plan for the financial future they need. Financial wellness platform SAVVI Financial launched a new retirement income guidance tool, in partnership with insurance company Voya, that helps employees better understand how far their savings will go in retirement. The platform combines information from employees' 401(k) account balances, taxes, health insurance and Social Security, alongside relevant market data to help employees better understand their retirement spending. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Modern Retirement Planning Requires More Personalization and Support: Today’s employees face a wide range of complex and often overwhelming retirement decisions, including how much income they’ll need, where they’ll live, and what their tax situation will be. Traditional one-size-fits-all approaches are no longer sufficient. Tools like SAVVI’s retirement income planner help bridge this gap by offering dynamic, personalized projections that adjust over time. They also provide guidance on withdrawal strategies and next-step actions, enabling individuals to navigate the retirement process with greater clarity and confidence.

2. Employers Must Evolve to Meet Employees’ Retirement Concerns: With 51% of non-retired Americans expressing concern about outliving their retirement assets, it's increasingly critical for employers to go beyond simply offering savings products. Organizations should prioritize financial education and include lifetime income solutions within 401(k) plans. By addressing both pre- and post-retirement needs, employers can better support their workforce's long-term financial security and help alleviate the anxiety many employees feel about the future.

3. Effective Retirement Tools Benefit Both Employees and Organizations: Providing proactive retirement planning tools is not just a benefit for employees — it also helps relieve the burden on HR and benefits teams, who are often stretched thin. These tools can streamline the retirement process, reduce administrative burnout, and contribute to a more engaged and appreciative workforce. Ultimately, offering strong retirement support enhances company culture, improves employee retention, and positions the organization as an attractive place to work for both current and prospective talent.