Insurance CEOs set for back-to-back congressional hearings on affordability

By Paige Minemyer – The executives at several leading health insurers are set for a gauntlet on Capitol Hill today, speaking in back-to-back hearings about the affordability of healthcare. Stephen Hemsley, CEO of UnitedHealth Group; David Joyner, CEO of CVS Health; Gail Boudreaux, CEO of Elevance Health; David Cordani, CEO of the Cigna Group; and Paul Markovich, CEO of Ascendiun, the parent of Blue Shield of California, will address the House Energy & Commerce Committee's Health Subcommittee today at 9:45 a.m. ET. Then, they'll speak before the House Ways & Means Committee at 2:30 p.m. ET. Read Full Article...

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1. Debate Over ACA Tax Credit Expiry and Rising Premiums: Lawmakers are holding hearings to address the consequences of the expiration of enhanced premium tax credits for ACA exchange plans, a change that has contributed significantly to rising premiums in the individual insurance market. Ellen Allen, executive director of West Virginians for Affordable Healthcare, and ReShonda Young, an Iowa resident who has benefited from these tax credits, are scheduled to speak at the morning and afternoon sessions, respectively. The political divide is clear: President Donald Trump and other Republicans accuse insurers of profiting from these subsidies while consumers face increasing costs. The hearings aim to clarify whether the loss of these enhanced credits or broader systemic issues are driving affordability concerns.

2. Insurers Cite Rising Hospital and Drug Costs as Premium Drivers: In their prepared testimonies, insurance executives argue that premium hikes are primarily the result of increasing healthcare costs, particularly in hospital and drug spending. Gail Boudreaux of Elevance Health reported a 9% increase in hospital spending in 2024 alone, while UnitedHealth’s Andrew Witty and Cigna’s David Cordani emphasized long-term trends, noting hospital prices have grown three times faster than inflation over the past 25 years. Hospital services now account for over 30% of total healthcare expenditures, making them a dominant force in overall cost increases. Executives assert that these rising costs—not insurer profit-taking—are the key factor behind higher premiums.

3. Scrutiny of Insurers’ Role in Escalating Prescription Costs: Another major topic in the hearings is the soaring price of prescription drugs, which insurers say are a growing burden on healthcare affordability. Cigna CEO David Cordani highlighted that the median price of a new prescription drug reached $370,000 in 2024, a sharp rise from around $2,000 twenty years ago. This surge has drawn attention to the influence of pharmacy benefit managers (PBMs), particularly the “Big Three”—Optum Rx (UnitedHealth), Express Scripts (Cigna), and Caremark (CVS). As all three insurers operate a PBM, legislators are expected to question how these entities contribute to or mitigate rising drug costs during the hearings.

Congress pitches bipartisan health package: 8 things to know

By Alan Condon – Hospital leaders are getting long-awaited clarity from Congress this week as lawmakers unveil a bipartisan healthcare deal tied to a broader government funding package. The 771-page proposal includes major wins for providers, including a multiyear delay of Medicaid DSH cuts, key Medicare payment extensions for rural hospitals and permanent hospital-at-home authority. It also preserves pandemic-era telehealth flexibilities and boosts funding for the health workforce, research and community care. Read Full Article...

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1. Bipartisan Support Focuses on Practical Healthcare Measures: The bill deliberately excludes President Trump’s recent “Great Healthcare Plan” proposals — including ideas like most-favored-nation drug pricing and direct payments to Americans — in favor of bipartisan policies that have been gaining traction in Congress. Provisions in the bill include increased oversight of pharmacy benefit managers (PBMs), a key issue for both parties, though it leaves out the continuation of enhanced ACA subsidies that supported nearly 93% of the 24.3 million Americans enrolled in marketplace plans last year.

2. Extension and Stabilization of Health Programs: As part of a broader $1.2 trillion “minibus” appropriations package, the healthcare components aim to stabilize critical programs tied to agencies like HHS and the Department of Labor through fiscal year 2026. The bill provides extensions for Medicare telehealth flexibilities through 2027 and the Acute Hospital Care at Home waiver through 2030, and it increases CMS program operations funding by $195 million (totaling $4.1 billion) while boosting NIH funding to $48.7 billion, including support for cancer, ALS, Alzheimer’s, and women’s health research.

3. Enhanced ACA Subsidies Not Included, Raising Coverage Concerns: The exclusion of the enhanced ACA tax credits — which expired at the end of 2025 — has drawn criticism from hospital leaders who fear millions may lose access to affordable care. The Urban Institute estimates that 4.8 million people could lose their health coverage without an extension, and organizations like Ascension have warned that many patients may be forced to choose between healthcare and basic needs, increasing the likelihood of medical debt.

1 in 5 patients affected by persistent drug shortages

By Kristen Smithberg – Drug shortages across the United States are taking a measurable toll on patient care and physician workflow, according to a recent survey of 902 primary care physicians published in JAMA Network Open. Roughly 1 in 5 patients have been affected, with the highest impact seen in medications for endocrinology, stimulants, infectious disease, pulmonology and pain management, the survey found. Pediatricians reported particularly high impacts for infectious disease, pulmonology and stimulant drugs. Nearly all affected patients discontinued the specific medication leading to 57 % experiencing minor adverse events. Read Full Article... ^{_{(Subscription required)}}

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1. Widespread Impact on Patient Care: Drug shortages are affecting a significant portion of the patient population, particularly those needing medications for endocrinology, infectious diseases, pulmonology, and pain management. Pediatricians are especially seeing high impacts in their patient groups. The shortages often force patients to discontinue their prescribed medications, which can lead to adverse health outcomes and increased risk of complications.

2. Physician Response and Administrative Burden: Physicians are more likely to switch patients to alternative drugs than to delay prescriptions, with most considering factors such as efficacy, side effects, and patient costs. The process of managing shortages adds substantial administrative work, requiring additional staff time and contributing to physician frustration and burnout. Communication gaps, such as delayed notifications about shortages, further complicate timely and effective patient care.

3. Underlying Causes of Shortages: Experts attribute the ongoing drug shortages to several systemic issues, including concentrated manufacturing, low profit margins, regulatory challenges, natural disasters, and rising demand. These factors combine to create persistent supply problems that are difficult to resolve quickly. Addressing these root causes will likely require coordinated efforts across the pharmaceutical industry, regulators, and policymakers.

UnitedHealth to offer rebates to its Obamacare customers

By Amina Niasse – UnitedHealth Group Inc. (UNH.N), will provide rebates to its Obamacare plan members in 2026, company CEO Stephen Hemsley said in a prepared testimony released Wednesday. Americans face higher healthcare costs this year after Congress allowed generous COVID-19-era tax credits for federally subsidized Obamacare plans to expire. The enhanced credits, introduced by the American Rescue Plan and extended by the Inflation Reduction Act, led to about a doubling of Obamacare sign-ups, according to estimates by KFF, a health policy firm, and President Donald Trump has said he will only support an extension that provides funds directly to shoppers. Read Full Article...

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1. UnitedHealthcare Will Rebate ACA Profits to Support Market Stability: UnitedHealthcare announced in prepared testimony that it will voluntarily eliminate and rebate its profits from ACA (Affordable Care Act) plans in 2025. This decision is intended to help stabilize the ACA marketplace amid Congressional delays in developing long-term policy solutions. The company emphasized its commitment to strengthening the affordability and sustainability of these plans and voiced support for increasing consumer choice in the ACA market.

2. Lapse in Congressional Action May Lead to Doubling of Premiums in 2026: Congress has not extended the enhanced Obamacare tax credits, even after the close of the ACA open enrollment period, which may lead to higher financial burdens for consumers. According to data from KFF, the average premium cost is projected to rise dramatically—from $888 in 2025 to $1,904 in 2026—leaving millions of Americans at risk of significantly increased out-of-pocket expenses if subsidies are not renewed.

3. ACA Enrollment Expected to Drop Despite Plan Expansion Across 30 States: While UnitedHealthcare will offer ACA marketplace plans in 30 states for the 2026 plan year, the company anticipates a major decline in ACA enrollment—by approximately two-thirds—according to its third-quarter earnings call. A spokesperson also noted that UnitedHealthcare is coordinating with the Trump administration on implementing the upcoming profit rebates. Meanwhile, executives from major competitors such as Cigna Group, CVS Health, and Elevance are scheduled to testify before the House health subcommittee.

Less than 10% of health care dollars are spent on women's health

By Alan Goforth – Although women comprise half of the world’s population, fewer than 1 in 10 dollars of private health care investment goes to women’s health. Just three areas -- women's cancers, reproductive health and maternal health – account for 90% of this already limited funding. “Men's health has long been the default baseline for research and product development, with clinical standards, trial designs and innovation pipelines often calibrated to male physiology and needs," said Shyam Bishen, head of the Center for Health and Healthcare at the World Economic Forum. "This approach systematically sidelines conditions that affect women uniquely, differently or disproportionately, leaving critical areas underfunded, under-researched and underserved." Read Full Article...

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1. Investment in Women's Health Remains Limited: Despite women making up half of the global population, private health care investment in women's health is disproportionately low. The majority of funding is concentrated in just three areas, leaving many other significant health concerns for women underfunded. This lack of investment can hinder research, innovation, and access to care for a wide range of conditions affecting women.

2. Broader Health Impacts and Economic Consequences: Women tend to spend more time in poor health or with disabilities compared to men, which not only affects their well-being but also impacts workforce participation. Many prevalent conditions such as cardiovascular disease, osteoporosis, menopause, and Alzheimer's are underfunded despite their significant burden on health systems. Addressing these gaps could unlock a market worth over $100 billion by 2030 if care standards were met for all women.

3. Momentum and Recommendations for Change: There is growing recognition among investors that women's health represents a substantial growth opportunity rather than a niche market. The report recommends collaborative efforts to expand research, increase transparency, and reduce investment risk through blended financing. It also suggests that expanding reimbursement and modernizing regulatory frameworks could help lower barriers for new initiatives in women's health.

Wegovy Injections Vs. Pills: Which Works Best? Doctors Explain

By Korin Miller – GLP-1 (glucagon-like peptide-1 receptor agonists) like Ozempic and Wegovy continue to make headlines as more research points to the benefits of taking these medications. Traditionally, patients administer these via injection, but now, one medication in particular is available to take in pill form. So, which works best: Wegovy injection vs. pill? And is the answer the same for all GLP-1s? Read Full Article...

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1. GLP-1 Medications Mimic Natural Hormones to Promote Weight Loss: GLP-1 drugs like Wegovy, Ozempic, and Rybelsus work by replicating the GLP-1 hormone released in the gastrointestinal tract during meals, which helps regulate blood sugar, suppress appetite, and delay stomach emptying. These effects lead to increased satiety and lower food intake, making weight loss a common outcome. Semaglutide-based medications have shown substantial results, with patients losing an average of 15% of their body weight during clinical trials, while offering additional benefits for managing type 2 diabetes.

2. Injectables Offer Convenience; Pills Show Comparable or Greater Effectiveness: Injectable GLP-1s are taken weekly and slowly absorb through subcutaneous fat, offering convenience for those seeking less frequent dosing. Oral options like Wegovy pills must be taken daily on an empty stomach and require users to delay meals and other medications for up to an hour, which can be inconvenient. Still, the oral form has shown slightly better clinical results, with users losing an average of 16.6% of their body weight, compared to 15% for injections. Rybelsus, another oral GLP-1 not FDA-approved for weight loss, has led to an average 8-pound weight reduction.

3. Choosing the Right Option Depends on Access, Lifestyle, and Personal Preference: Cost, insurance coverage, and needle aversion play a major role in determining the best GLP-1 format for each individual. Injectables may offer a stronger research base and lower dosing frequency, but they are often more expensive, may require refrigeration, and are unsuitable for those uncomfortable with injections. Pills are portable and needle-free but demand daily adherence and specific timing. Both forms share similar side effects, including nausea, vomiting, and upset stomach. Experts emphasize that the most effective choice is one that aligns with patient needs and can be used consistently over time.

New Dietary Guidelines: Eat More Meat and Whole-Fat Dairy

By Alicia Ault – The federal government wants Americans to eat more protein, specifically meat and whole-fat dairy products, putting them at the top of a new “upside-down” food pyramid, along with a message encouraging the consumption of “real food.” Vegetables and fruits are also placed at the top of the pyramid, along with an expected emphasis on consuming saturated fats. The new 2025-2030 Dietary Guidelines for Americans — stripped down to a lean 10 pages compared to the prior iteration’s 164 pages — debuted at a White House press briefing on January 7. Read Full Article...

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1. Shift in Dietary Guidance on Fats and Processed Foods: The updated federal dietary guidelines mark a significant departure from previous approaches by moving away from strict limits on saturated fat — despite retaining the 10% threshold — and emphasizing the importance of protein and healthy fats. The guidelines now strongly advise reducing intake of highly processed foods, added sugars, and excessive sodium, signaling a broader focus on whole, nutrient-dense foods rather than demonizing individual macronutrients.

2. Political and Industry Influence Raises Concerns: The guideline development process was notably reshaped under HHS Secretary Robert F. Kennedy, Jr., who replaced the existing panel with members reportedly tied to the beef, dairy, and supplement industries. This change, along with the rejection of the prior scientific report favoring plant-based diets, has led to both praise and concern about potential bias, especially regarding the emphasis on animal-based protein and downplaying saturated fat risks.

3. Mixed Reactions from Medical and Health Organizations: Health organizations like the AMA and AAP supported elements of the new guidelines — particularly the calls to reduce added sugars and ultraprocessed foods — while others, including the AHA and ACC, expressed caution about relaxed attitudes toward saturated fats and red meat. These groups highlighted the need for more scientific clarity and continued advocacy for plant-based and lean protein sources to mitigate cardiovascular risks.