UnitedHealth Group Throws a Hail Mary Before CEO Testifies

By Wendell Potter – When I first saw the headline that UnitedHealth Group would “return Obamacare profits to customers in 2026,” my immediate reaction was: Oh good grief. The timing is just too perfect. UnitedHealth’s pledge was tucked neatly into prepared testimony from CEO Stephen Hemsley, just hours before he (and four other Big Insurance CEOs) are to be hauled into Congress to testify before two House hearings on health care affordability. Today, the CEOs will be asked to explain why Americans are paying through the nose for coverage and still getting denied care, trapped in narrow networks and buried under medical debt. Read Full Article...

HVBA Article Summary

1. Timing of UnitedHealth’s Announcement: UnitedHealth Group’s pledge to return ACA profits to customers was announced just before its CEO was scheduled to testify before Congress on health care affordability. The article suggests that the timing of this announcement appears strategic, aiming to influence public perception and congressional scrutiny. This move is characterized as a public relations effort rather than a fundamental shift in business practices.

2. Scope and Impact of the Pledge: While UnitedHealth is the largest insurer in the country, its presence in the ACA marketplace is relatively small, covering about 1 million customers compared to competitors with larger shares. The article notes that the profits involved in this pledge represent only a minor portion of UnitedHealth’s overall business and are unlikely to significantly affect its financial standing. The author argues that this gesture does not address the broader issues of affordability or transparency in the company’s operations.

3. Calls for Greater Transparency and Accountability: The article raises questions about the lack of detailed disclosure regarding UnitedHealth’s ACA profits and enrollment figures. It emphasizes the need for the company to provide more transparency about its pricing, profit allocation, and the true impact of its rebate pledge. The author suggests that meaningful reform would require UnitedHealth and similar companies to open their books and offer clear information to both lawmakers and the public.

Blue Shield CEO Markovich: House hearings highlight need for 'systemic' change in healthcare

By Paige Minemyer – The House Ways and Means Committee hearing has concluded, bringing a long day of questioning for major health insurance executives to an end. More than nine hours of total questioning across two hearings touched on a slew of factors impacting the affordability of healthcare: the Affordable Care Act, claims denials, prior authorization and consolidation. Paul Markovich, CEO of Ascendiun, the parent company of Blue Shield of California, and one of the executives called to the panel, told Fierce Healthcare that the long debate ultimately proves that problems of this magnitude require massive changes. "I hope what everyone takes away from this is that it's a systemic problem that requires a systemic resolution," he said. Read Full Article...

HVBA Article Summary

1. Systemic Issues Require Broad Solutions: The hearings highlighted that challenges in healthcare affordability are deeply rooted and interconnected, involving factors such as the Affordable Care Act, claims denials, prior authorization, and industry consolidation. Paul Markovich emphasized that piecemeal fixes are insufficient and that only comprehensive, systemic reforms can address the underlying problems. This perspective suggests that stakeholders across the healthcare ecosystem must collaborate on large-scale changes rather than isolated adjustments.

2. Debate Over Industry Practices and Regulation: Lawmakers and executives debated the roles of for-profit versus non-profit insurers, the impact of vertical integration, and the effectiveness of current regulations like the medical loss ratio. Some legislators argued that insurer consolidation and profit motives have contributed to rising costs and reduced competition, while others pointed to hospital and pharmaceutical pricing as primary drivers. The hearings also addressed concerns about fraud, improper enrollments, and administrative burdens, indicating a need for more oversight and balanced accountability across all sectors.

3. Technology and Innovation as Potential Solutions: Markovich and other executives pointed to technology-driven initiatives, such as Blue Shield of California's Digital Health Record program, as ways to improve care coordination, transparency, and reduce wasteful spending. The discussion suggested that leveraging digital tools could play a significant role in transforming traditional healthcare models and addressing inefficiencies. However, the hearings indicated that while technology offers promise, it must be part of a broader strategy that includes payment reform and systemic change.

House committee accuses CVS of impeding pharmacy competition

By Ella Jeffries – The House Judiciary Committee in an interim staff report accuses CVS Health of restricting independent pharmacies from working with digital pharmacy competitors to protect its market position. The report, issued Jan. 21 and titled “When CVS Writes the Rules: How CVS Protects Itself From Innovation and Competition,” alleges CVS used its pharmacy benefit manager, CVS Caremark, to change network rules and issue cease-and-desist letters targeting pharmacies affiliated with hub-based digital pharmacy models. Read Full Article...

HVBA Article Summary

1. Congressional Concerns Over Antitrust Issues: The House Judiciary Committee raised concerns that CVS Health's business practices—particularly those involving its pharmacy benefit manager, CVS Caremark—may have violated federal antitrust laws. The committee’s findings, part of a broader investigation into consolidation in the healthcare industry, highlighted what it characterized as emerging anti-competitive behavior within the pharmaceutical supply chain. Lawmakers called for new legislative measures to address these perceived issues.

2. CVS Health Denies Allegations and Defends Practices: CVS Health firmly rejected the committee's report, labeling it as “misguided, misleading and inaccurate.” The company defended the role of CVS Caremark, stating it is committed to making prescription drugs more affordable in the U.S. CVS emphasized its efforts to reduce fraud, waste, and abuse in the pharmaceutical supply chain and maintained that its practices are aligned with industry standards and obligations to clients, government programs, and patients.

3. Policy Clarifications and Fraud Monitoring Cited by CVS: CVS Health clarified that it is not opposed to pharmacy hub models and updated its provider manual in 2025 to facilitate greater collaboration with network pharmacies. The company asserted that its policies are uniformly applied across different providers and noted that CVS Caremark does not engage directly with hub operators. Additionally, CVS cited documented instances of fraud associated with hub models as justification for its ongoing monitoring, framing these efforts as essential to protecting the integrity of the healthcare system.

US withdraws from the World Health Organization

By Jennifer Rigby and Emma Farge - The United States officially left the World Health Organization on Thursday after a year of warnings that doing so would hurt public health in the U.S. and globally, saying its decision reflected failures in the U.N. health agency's management of the COVID-19 pandemic. President Donald Trump gave notice that the U.S. would quit the organization on the first day of his presidency in 2025, via an executive order. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Financial and Operational Impact on WHO: The U.S. withdrawal has triggered a significant budget crisis for the World Health Organization, leading to staff reductions and cuts to management teams. As the largest financial contributor, the U.S. previously provided about 18% of the agency's funding. The loss of this support is expected to result in the WHO shedding around a quarter of its workforce by mid-year and scaling back its global health initiatives.

2. Legal and Diplomatic Disputes Over Fees: There is ongoing disagreement between the U.S. government and international observers regarding the payment of outstanding fees, which amount to approximately $260 million. While U.S. law is interpreted by some as requiring these payments before withdrawal, U.S. officials dispute this obligation and have ceased further contributions. This dispute has raised concerns about compliance with both domestic and international statutes and could affect future U.S. participation in global health governance.

3. Broader Implications for Global Health Collaboration: Health experts and international leaders warn that the U.S. exit from the WHO could undermine global efforts to detect, prevent, and respond to health threats. The move may weaken established systems of cooperation and information sharing, potentially increasing risks for both the U.S. and the international community. Despite calls from figures like Bill Gates and WHO leadership for the U.S. to reconsider, officials indicate there are no plans to rejoin or participate as an observer in the near future.

House passes health funding package, including PBM reform

By Paige Minemyer – The House passed a key appropriations package that would fund the Department of Health and Human Services through Sept. 30, including a step toward reforms for pharmacy benefit managers. The package passed by a 341-88 vote, and it includes elements that would prevent PBMs from tying compensation in Part D to the list price of drugs, and boost price transparency for employers in their PBM contracts. Rep. Buddy Carter, R-Georgia, a pharmacist and vocal supporter of PBM reform, celebrated the passage in a statement. Read Full Article...

HVBA Article Summary

1. House Passage of PBM Reform and Broader Health Funding Measures: The House has passed a comprehensive healthcare funding package that includes reforms targeting pharmacy benefit managers (PBMs). These reforms aim to increase transparency, impose flat fees, and enhance oversight of PBM operations. The bill also proposes significant investments in rural health, maternal and child health, the healthcare workforce, and telehealth services, while cutting back on administrative spending within the Department of Health and Human Services (HHS).

2. Divergent Reactions Reflect Stakeholder Tensions: The PBM reforms have drawn strong reactions: proponents such as Rep. Buddy Carter and the National Community Pharmacists Association welcomed them as long-overdue corrections to market imbalances that allegedly harm patients and pharmacies. In contrast, the Pharmaceutical Care Management Association (representing PBMs) opposed the bill, arguing it could increase healthcare costs and limit employer choices, ultimately favoring pharmaceutical companies over consumers.

3. Notable Omissions and Anticipated Senate Debate: While the bill addresses numerous healthcare priorities, it notably excludes a renewal of the Affordable Care Act’s enhanced subsidies, which expired on January 1 and are contributing to rising insurance premiums. It also does not include legislative elements from the White House's "Great Healthcare Plan." The bill now moves to the Senate, where it enjoys some bipartisan support, though significant revisions may still occur.

Long-term GLP-1 use trims medical cost growth: Aon

By Elizabeth Casolo – Long-term GLP-1 use slows medical cost growth, according to findings published Jan. 13 from professional services firm Aon. The firm analyzed 192,000 GLP-1 users from July 2022 to March 2025, comparing outcomes to non-users, through commercial medical and pharmacy claims data. This research builds off 2025 analyses. Read Full Article...

HVBA Article Summary

1. GLP-1 Therapies Significantly Slow Medical Cost Growth, Especially with High Adherence: According to the research, employees using GLP-1 medications for diabetes experienced a 6 percentage point reduction in medical cost growth between 12 to 30 months compared to a control group, with an even greater 9-point drop among those with at least 80% adherence. For weight loss, the cost growth reduction was 3 percentage points over 12 to 18 months, and 7 points for those with 80% or higher adherence. This suggests that consistent and supported use of GLP-1s can meaningfully alter cost trajectories over time.

2. Female GLP-1 Users Show Substantial Health Benefits but Also Face Elevated Risks in Specific Areas: Female users of GLP-1s saw notable health improvements, including a 47% decrease in hospitalizations for major cardiovascular events, around a 50% drop in ovarian cancer incidence, a 14% decline in breast cancer incidence, and a 16% reduction in osteoporosis. They also had lower hospitalization risks related to alcohol or drug abuse, bariatric surgery, and certain pancreatic disorders. However, they experienced higher hospitalization rates for gallbladder surgery than male GLP-1 users, indicating that while benefits are substantial, some gender-specific risks remain.

3. Total Costs for GLP-1 Users Remain Higher, but Future Drug Market Changes May Offset This: Despite the reductions in cost growth, overall healthcare expenses for GLP-1 users are still higher than for non-users, largely due to the high short-term cost of the drugs themselves. However, the research notes that this may change as oral GLP-1 formulations and direct-to-consumer programs expand, potentially compressing prices. Employers are advised to make data-informed, flexible coverage decisions that consider both the clinical benefits and evolving market dynamics, as no one-size-fits-all approach currently exists.

A benefit manager shares strategies for alleviating admin burdens

By Paola Peralta – Benefit leaders are becoming increasingly bogged down by the benefit administration process, and it's keeping them from some of the more meaningful aspects of their jobs. HR and benefit managers currently spend 12 hours on average — more than a fourth of their work week — on payroll and benefit-related administrative tasks, according to a recent employee benefits report from benefit management platform Payroll Integrations. Twenty-seven percent admit to spending 20 hours or more on these tasks. As a result, benefit leaders are stretched thin and struggling to keep up with the rest of their responsibilities. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Administrative Burden on HR and Benefits Teams Has Intensified: HR and benefits leaders are increasingly overwhelmed by time-consuming administrative duties such as compliance tracking, payroll tax obligations, and navigating state-specific employment laws — especially in a remote or hybrid-first environment. These growing demands pull professionals away from core people management tasks, including benefits education and engagement. According to a Payroll Integrations report cited in the article, 73% of employees are actively seeking more support in understanding their benefits, highlighting a growing gap between employee needs and HR bandwidth.

2. Employee Experience and HR Effectiveness Are Adversely Impacted: The overwhelming workload leads to frequent stress and an increased risk of administrative errors — such as missed pay deadlines or misapplied differential pay policies — which can harm both compliance and employee trust. Because urgent tasks take precedence, more strategic and human-centered efforts like employee recognition programs or career development initiatives are often sidelined. This not only diminishes the employee experience but also leaves HR professionals feeling disconnected from their purpose.

3. Staffing Adjustments and Technology Adoption Are Critical for Sustainability: Organizations are encouraged to revisit their staffing models and explore how technology can alleviate manual tasks. Bostic shares that her team is considering adding a junior HR role dedicated to employee engagement and education, which would allow senior staff to refocus on higher-level strategy. Long-term success depends not just on improving systems, but also on investing in the well-being and career growth of HR professionals.