Trump’s initial orders reverse Biden on health care costs, protections from discrimination

By Sarah Ownermohle, John Wilkerson, Rachel Cohrs Zhang, and Lizzy Lawrence - President Trump began his second term Monday with a sweeping order aimed at reversing dozens of former President Biden’s top priorities, from regulations aimed at lowering health care costs, to coronavirus outreach, Affordable Care Act expansions, and protections against gender-based discrimination. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Healthcare and Drug Pricing Reversals: Trump's rescissions include Biden-era policies aimed at expanding Affordable Care Act enrollment, reducing drug costs through experimental Medicare and Medicaid models, and increasing access to Covid-19 treatments. These reversals could impact millions of Americans by potentially raising healthcare costs and limiting access to critical medications.

2. Policy Changes on Gender and Discrimination: Trump revoked multiple Biden administration policies that provided protections based on gender and sexual identity, including anti-discrimination measures for LGBTQ+ individuals and transgender rights in schools. He also dismantled the Gender Policy Council, signaling a broader rollback of progressive gender policies.

3. Government and Global Health Policy Shifts: Trump ordered federal workers to return to offices full-time, froze federal hiring, and initiated the U.S. withdrawal from the World Health Organization, citing its mishandling of the Covid-19 pandemic. These moves reflect a broader shift in federal governance priorities and a distancing from international health cooperation.

What Trump's CMS can and can't change with the second round of drug price negotiations

By Zachary Brennan - CMS didn’t wait for President-elect Donald Trump to take office before issuing its second list of drugs to be negotiated under the Inflation Reduction Act, even though the agency had until Feb. 1 to release it. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Potential Policy Shifts Under the Trump Administration: The incoming administration has several options regarding the Inflation Reduction Act (IRA) drug price negotiations, including maintaining the program, weakening it through regulatory changes, or repealing it altogether. However, significant changes would require new guidance, rulemaking, or legal maneuvers.

2. Legal and Procedural Challenges: The Trump administration could impact the IRA by choosing not to defend ongoing lawsuits filed by biopharma companies against the law, similar to its previous approach with the Affordable Care Act. Additionally, while some industry leaders suggest pausing the negotiation process, legal experts argue that the statute does not allow for such a halt.

3. Future Implications and Public Perception: The first indications of policy direction will emerge with CMS guidance for the 2028 drug negotiation cycle, particularly as Medicare Part B drugs become included. While there is bipartisan support for expanding negotiations, a full repeal of the IRA could face public backlash and lead to increased Medicare costs.

UnitedHealth Group Leaders See Cost Pressures Enduring

By Geert De Lombaerde - The volume-coding-payments tussle between hospital operators and insurance companies shows no signs of abating in 2025. And based on the fourth-quarter results and 2025 outlook of UnitedHealth Group Inc., it appears providers have the upper hand for now. Read Full Article…

HVBA Article Summary

1. Higher-than-Expected Medical Costs Impact UnitedHealth's MCR: UnitedHealth Group's medical care ratio (MCR) finished 2024 at 85.5%, exceeding analyst expectations due to factors such as increased healthcare utilization, Medicare Advantage changes, and lingering costs from the Change Healthcare cyberattack. The company anticipates an MCR of around 86.5% in 2025.

2. Hospital Coding Intensity and Industry-Wide Cost Pressures: UnitedHealth CFO John Rex highlighted "aggressive" hospital coding intensity as a major contributor to rising medical expenses, accounting for one-seventh of the 1.5 percentage point increase in MCR from 2023. Other insurers like CVS Health and Elevance Health have also struggled with rising medical costs as post-pandemic healthcare utilization remains strong.

3. Investor Reaction and Strategic Moves: UnitedHealth shares dropped over 4% following the earnings report, erasing approximately $20 billion in market value. Meanwhile, the company expects strong growth at its Optum Health division and is committing to passing 100% of negotiated pharmacy benefit discounts to customers to enhance transparency in drug pricing.

Ozempic among 15 drugs selected for Medicare drug price talks, Round 2, with Big Pharma

By Lynn Cavanaugh - Building on the success of the first round of the Centers for Medicare & Medicaid Services price negotiations last year, the agency has announced the selection of 15 drugs, up from 10 in the first round, for Round 2 of the negotiations with top drugmakers – and popular GLP-1 weight loss drugs, Ozempic, Wegovy and Rybelsus, are in the mix. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Medicare's Price Negotiation Strategy: Medicare has identified 15 high-cost prescription drugs for direct price negotiations with participating pharmaceutical companies, aiming to lower patient expenses. These drugs, which include treatments for diabetes, cancer, asthma, and other conditions, were selected based on their covered drug costs from November 2023 to October 2024.

2. Regulatory and Legal Challenges: The negotiation process, mandated by the Inflation Reduction Act of 2022, faces potential challenges under the incoming Trump administration. While previous lawsuits from pharmaceutical companies against Medicare's price negotiation efforts have largely failed, future legal and political obstacles remain uncertain.

3. Pharmaceutical Industry's Response: Drug manufacturers included in this negotiation round must decide by February 28 whether to participate, with significant financial penalties for those who opt out. CMS plans to engage stakeholders through roundtable discussions and a public town hall meeting to incorporate clinical considerations into the negotiation process, ensuring transparency and broad engagement.

Want to boost benefits engagement? Start smaller

By Lee Hafner - Employee benefits are one of the main reasons people join and stay with a company — so why don't more workers engage with these offerings? Lack of awareness and understanding of what's available are major hurdles to benefits utilization, particularly for the youngest cohort in the workplace: According to financial software platform Payroll Integrations, 73% of employees said they want more education on their company benefits, with Gen Z feeling especially in the dark. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Breaking Down Benefits Education for Better Engagement: Employers can overcome information overload by breaking benefits education into smaller, digestible pieces. Utilizing a mix of digital tools—such as videos, text messages, QR codes, and infographic-style microsites—significantly improves engagement. Flimp’s report found that companies using these methods achieved an average 70% engagement rate, with employees spending over a minute per visit on benefits content.

2. Year-Round, Targeted Benefits Communication: Instead of overwhelming employees during open enrollment, companies can reinforce benefits knowledge through scheduled monthly or quarterly campaigns. Employers can highlight individual benefits—such as HSAs or wellness programs—through focused communications, ensuring employees receive relevant information when it matters most. This year-round strategy also helps build a centralized repository for benefits education.

3. Aligning Benefits with Meaningful Causes and Events: Employers can enhance participation by framing benefits around relevant social issues, awareness months, or workforce-specific initiatives. For example, National Nutrition Month can be an opportunity to promote wellness benefits. Employee resource groups (ERGs) also provide a platform to introduce benefits tailored to specific demographics, such as child care benefits for working parents. By connecting benefits to topics employees care about, organizations can drive deeper engagement and awareness.

Employers still skimp on mental health benefits, regulators say

By Allison Bell - Many employers are bad at analyzing their behavioral health benefits and making sure that the benefits are comparable to their other health benefits, but they are quick to improve when regulators come by. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Findings on Behavioral Health Provider Networks: EBSA investigations revealed that behavioral health provider directories in employer health plans often contained inaccurate information, with only 8% to 28% of entries being accurate for providers accepting new patients. This contrasted with higher usability rates (24% to 37%) for other types of health care providers. Employers attributed these issues to a weak supply of behavioral health providers and low reimbursement rates, with some plans paying behavioral health providers as little as 88% to 98% of Medicare's rates compared to 120% to 123% for medical and surgical providers.

2. Enforcement Challenges and Actions: EBSA's limited resources and authority pose significant barriers to enforcing the Mental Health Parity and Addiction Equity Act (MHPAEA). With only 302 investigators overseeing 13,900 plans, EBSA faces budget constraints, yet it has achieved compliance in many cases by prompting employers to address network adequacy and reimbursement disparities. One employer plan, for instance, improved its behavioral health provider network after EBSA found that participants had to seek 37% to 50% of their behavioral care out-of-network due to inadequate provider availability.

3. Regulatory and Political Landscape: The Biden administration's final MHPAEA regulations face uncertainty due to high compliance costs, estimated at $656 million in the first year. As President Biden's term ends, the incoming Trump administration and Congress may take alternative approaches to improve access to behavioral health care. Despite challenges, there is bipartisan recognition of the need to address behavioral health access issues, with potential opportunities to enhance EBSA’s enforcement authority to include behavioral health service providers directly.

FDA bans red dye popular in candy, other ultraprocessed foods

By Emma Bascom - The FDA announced a ban on the controversial red dye no. 3, which gives food and drinks a bright, cherry red color and has also been associated with cancer in laboratory rats. Read Full Article…

HVBA Article Summary

1. FDA's Ban on Red No. 3: The FDA has revoked authorization for Red No. 3 in food and ingested drugs under the Delaney Clause, which prohibits additives linked to cancer in humans or animals. The decision follows a 2022 petition by the Center for Science in the Public Interest (CSPI) and other organizations, citing studies indicating carcinogenic effects in male rats.

2. Scientific Controversy: While the FDA acknowledges the studies showing cancer risks in rats, it argues that the hormonal mechanism involved does not apply to humans, and typical exposure levels are significantly lower. The agency maintains that available scientific data does not support claims that Red No. 3 poses a public health risk.

3. Regulatory and Policy Context: The phase-out of Red No. 3 aligns with broader FDA efforts to enhance food safety and labeling, including redefining “healthy” on food packaging and proposing clearer front-of-package nutrition labels. This move comes amid heightened scrutiny of the FDA’s role in public health, including its response to the U.S. obesity epidemic.

GLP-1s Show No Increased Risk for Thyroid Cancer

By Nancy A. Melville - In the largest study of its kind involving a diabetic population, the use of glucagon-like peptide 1 receptor agonist (GLP-1 RA) drugs shows no significantly increased risk for thyroid cancer, with the important caveat of the study’s relatively short follow-up period. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. No Short-Term Association Between GLP-1 RAs and Thyroid Cancer – A large multisite study analyzing data from six population-based databases found no significant short-term increase in thyroid cancer risk among users of GLP-1 receptor agonists (GLP-1 RAs) compared to dipeptidyl peptidase 4 inhibitors (DPP-4is), with follow-up periods ranging from 1.8 to 3.0 years.

2. Study Strengths and Limitations – The study stands out for its large-scale analysis and robust methodology; however, its relatively short follow-up period limits the ability to assess long-term thyroid cancer risks. The inability to analyze medullary thyroid cancer risk due to its rarity also remains a limitation.

3. Clinical Implications and Reassurance – While previous studies raised concerns about a potential link between GLP-1 RAs and thyroid cancer, this study's findings provide reassurance to patients and clinicians, reinforcing that the benefits of GLP-1 RAs likely outweigh potential thyroid-related risks, particularly for individuals without known risk factors for medullary thyroid cancer.