UnitedHealth CEO Stephen Hemsley says insurer will rebate ACA profits to consumers

By Paige Minemyer – UnitedHealth Group CEO Stephen Hemsley said that the insurance giant will rebate profits from its Affordable Care Act plans back to customers. Hemsley revealed the company's plans in prepared testimony (PDF) for a hearing before the House Energy and Commerce Committee's Health Subcommittee on Thursday morning. He is one of several leaders at large health plans set to discuss the affordability of healthcare and health insurance. The news also comes just days after the ACA's open enrollment period came to a close with no agreement from legislators on what to do about the expired enhanced subsidies, which is set to drive up premiums for many individuals with ACA coverage. Read Full Article...

HVBA Article Summary

1. UnitedHealth's Profit Rebate Initiative: UnitedHealth Group plans to rebate profits from its Affordable Care Act (ACA) plans back to customers in 2026. This voluntary move aims to address concerns about rising healthcare costs and comes amid ongoing legislative discussions about ACA subsidies. The company is working with Congress and the Trump administration to finalize the details of this rebate plan.

2. Market Presence and Historical Context: UnitedHealthcare currently offers ACA plans in 30 states, serving about 1 million members, and has expanded its service area in 11 states. The insurer had previously scaled back its ACA marketplace participation after significant losses in 2016 but began expanding again in 2020 as the market stabilized. Despite being a relatively small player in the individual ACA market, UnitedHealth is taking a notable step by eliminating and rebating its profits for these coverages this year.

3. Policy Recommendations and Industry Criticism: CEO Stephen Hemsley acknowledged that insurers share responsibility for rising healthcare costs and suggested policy changes to improve the ACA exchanges. He recommended allowing premium tax credits to apply to catastrophic plans to increase consumer choice and standardizing broker compensation to align incentives with consumer interests. These proposals aim to promote affordability, value, and access to care while addressing criticisms from both the White House and Republicans regarding insurer profits and subsidy structures.

CEOs from UnitedHealth, CVS, Cigna, Elevance face bipartisan fury at House hearing

By Allison Bell – The House Energy and Commerce Committee's health subcommittee hauled the chief executive officers of four giant health insurers in for a hearing today to ask them to explain the high cost of health care and health insurance. Rep. Morgan Griffith, R-Va., the chairman of the subcommittee, looked hard at the CEOs — Stephen Hemsley of United Health, Gail Boudreaux of Elevance Health, David Cordani of Cigna and David Joyner of Aetna's parent, CVS Health — and told them that employers are losing the ability to offer the health benefits they need to attract talent. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Bipartisan Criticism of Health Insurers: Lawmakers from both political parties strongly criticized top health insurance executives for prioritizing profits while patients face rising premiums, mounting medical debt, and difficulty accessing essential treatments. Testimonies included personal stories of patients denied life-saving care and struggling with high out-of-pocket costs, highlighting growing dissatisfaction with insurers’ management practices and the broader health care system.

2. Health Insurers Defend Role and Suggest Reforms: Insurance company CEOs defended their role in the health care system by emphasizing that insurance costs largely reflect the high underlying costs of health care services. They proposed various reforms to improve system efficiency, including equalizing provider reimbursement across care settings, enhancing data interoperability, and expanding pre-deductible coverage within HSA-compatible plans. UnitedHealth also pledged to return excess profits from ACA exchange plans in 2026 as a gesture of goodwill.

3. Broader Policy Proposals Target Systemic Costs: Experts and policymakers proposed broader reforms aimed at reducing systemic health care costs and shifting financial incentives. Recommendations included eliminating the federal tax exclusion for employer-sponsored insurance, increasing pricing transparency, breaking up provider monopolies, and redirecting federal subsidies directly to consumers through health savings accounts. Some advocated moving away from employer-based coverage and strengthening individual ACA markets, citing international models like Switzerland's system as more efficient alternatives.

Congress eyes tackling healthcare consolidation

By Rebecca Pifer Parduhn – Republicans and Democrats in the House Budget Committee spent Wednesday blaming each other for the steep cost of healthcare, and arguing for diametrically opposed ideas to lower it. However, a few areas of bipartisan agreement emerged, including targeting healthcare consolidation — once an unheard-of view for members of the GOP. “We got problems in Peoria with consolidation, with too much power and too many assets in too few market participants,” said Chairman Jodey Arrington, R-Texas, referring to a small community in Hill County. “You know how we feel about big government ... but the most important thing here is, I think there’s common ground here.” Read Full Article...

HVBA Article Summary

1. Bipartisan Concern Over Healthcare Consolidation: Both Republicans and Democrats in the House Budget Committee recognize healthcare consolidation as a significant issue contributing to high healthcare costs. This marks a shift for Republicans, who traditionally have been less focused on this issue, indicating potential for bipartisan legislative efforts targeting monopolistic practices in healthcare markets.

2. Impact of Consolidation on Healthcare Costs and Market Control: The U.S. healthcare industry is highly consolidated, with dominant health systems and insurers controlling most regional markets. This consolidation is linked to higher healthcare prices without corresponding improvements in patient outcomes, raising concerns about the sustainability of rising healthcare spending, which reached $5.3 trillion in 2024.

3. Legislative Efforts and Challenges Ahead: Democrats have introduced bills aimed at curbing consolidation, such as the 'Stop Anticompetitive Healthcare Act' and the 'Patients Before Monopolies Act,' both with some Republican support. Despite bipartisan agreement on the problem, breaking up healthcare monopolies remains a difficult legislative challenge, with smaller reforms like price transparency and PBM regulation seen as more achievable but less impactful on overall affordability.

The strategic shift to self-funded plans with third-party administrators

By Caroline Jessen – In today's rapidly evolving health care landscape, employers are increasingly turning to self-funded health plans as a strategic alternative to traditional fully-insured models. This shift allows organizations to tailor their benefits offerings to better align with their workforce's unique needs, ultimately enhancing employee satisfaction and engagement. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Growth of Self-Funded Plans: There is a significant trend among employers to move away from fully-insured health plans in favor of self-funded models. This shift is driven by the desire for greater flexibility and the ability to customize benefits to meet the specific needs of employees. As a result, more organizations are expected to adopt self-funded plans in the coming years, especially among larger firms.

2. Role of Third-Party Administrators (TPAs): Third-party administrators play a crucial role in the administration of self-funded health plans. They manage essential functions such as plan design, enrollment, claims processing, and member engagement, which helps employers streamline operations. TPAs also enable employers to integrate various vendors and services, allowing for a more tailored and efficient benefits package.

3. Advantages of Flexibility and Data-Driven Decisions: Self-funded plans, supported by TPAs, offer employers the flexibility to quickly adapt to changing workforce needs and market conditions. During events like the COVID-19 pandemic, this adaptability allowed organizations to introduce new services such as telehealth and mental health support. Additionally, TPAs provide valuable data analytics that help employers identify trends, manage costs, and improve employee health outcomes.

US Officially Exits World Health Organization

By Kevin Stocklin – America is officially out of the World Health Organization (WHO). “Today, the United States withdrew from the World Health Organization, freeing itself from its constraints, as President [Donald] Trump promised on his first day in office,” Secretary of State Marco Rubio and Health and Human Services Secretary Robert Kennedy, Jr., declared in a Jan. 22 joint statement. Read Full Article...

HVBA Article Summary

1. U.S. Withdrawal from the WHO and Funding Halt: The Trump administration issued an executive order on January 20, 2025, formally beginning the process of withdrawing the United States from the World Health Organization (WHO), citing dissatisfaction with the WHO’s handling of COVID-19, lack of reforms, and alleged political bias. All U.S. funding and official representation to the WHO have been ordered to cease.

2. Dispute Over Legal and Financial Obligations: Under the WHO’s membership terms, the United States must provide one year’s notice and settle outstanding dues—amounting to $278 million for 2024 and 2025—to complete the withdrawal. The Trump administration has declared it will not pay these dues, a stance the WHO disputes, arguing the U.S. remains a member until conditions are fulfilled.

3. Policy Shift Reflecting Skepticism of Global Institutions: The move aligns with broader Trump administration actions to reduce U.S. involvement in international organizations, including earlier withdrawals from the Paris Accord and multiple U.N.-affiliated climate and social justice groups. The administration has also rejected the WHO’s proposed Pandemic Agreement and International Health Regulations, which aimed to increase the organization’s authority during global health emergencies.

It’s 2026, and We Still Don’t Know Much About Long-Term GLP Use

By Julie Peck – As GLP-1 receptor agonists continue expanding across obesity, diabetes, fatty liver disease, and cardiometabolic care, clinicians are increasingly confronting a pressing question: Does long-term use lead to tolerance, or do apparent “diminishing returns” reflect predictable physiology? It’s a conversation that is evolving quickly as millions of patients move from early weight-loss phases into long-term maintenance. Read Full Article...

HVBA Article Summary

1. Uncertainty Remains About Long-Term GLP-1 Use: Despite the widespread adoption of GLP-1 receptor agonists for obesity, diabetes, and related conditions, there is still limited research on their effects over extended periods. Most available studies focus on short-term outcomes, leaving questions about tolerance and sustained efficacy unanswered. Clinicians and researchers agree that more robust, long-term data are needed to guide patient care and medication management.

2. Plateaus and Weight Regain Are Often Physiological, Not Drug Failure: Clinicians report that patients frequently interpret plateaus or slowed weight loss as medication failure, but these trends often reflect natural physiological adaptation or behavioral factors. Factors such as inconsistent dosing, changes in lifestyle, or metabolic adaptation are commonly responsible for these plateaus. True pharmacologic tolerance to GLP-1s has not been conclusively demonstrated in either clinical trials or real-world data.

3. Need for Individualized and Multi-Modal Approaches: Experts emphasize that obesity is a complex, chronic disease requiring a range of treatment options beyond GLP-1s alone. Cycling on and off medications can worsen long-term outcomes, and some patients may benefit from alternative or adjunct therapies, including oral medications or behavioral interventions. The field is moving toward more personalized strategies, but the lack of long-term evidence makes it challenging to optimize treatment sequencing and maintenance.

GLP-1s could be another tool in combating substance use disorder in the workplace

By Jimmy Nesbitt – GLP-1 drugs have gained worldwide attention for their ability to help some people lose weight, and new research shows they may be able to help with another common problem: Alcohol use. Patients who take medications such as Ozempic and Wegovy are reporting a sharp drop — and sometimes even total loss — of interest in alcohol, according to a study published in JAMA Psychiatry. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. GLP-1 Medications Show Promise in Reducing Substance Cravings: Early research and patient experiences suggest GLP-1 medications — originally for diabetes and weight loss — may reduce cravings for alcohol, opioids, and nicotine by affecting the brain’s reward system. One study showed a 40% drop in opioid cravings over three weeks, while another found a 40% lower rate of opioid overdose and a 50% lower rate of alcohol intoxication among GLP-1 users. Though not designed for addiction treatment, these findings highlight emerging potential.

2. Workplace Impact Could Be Significant Given High Costs of Alcohol Use: Alcohol use disorder leads to $240 billion in annual U.S. costs, largely due to lost productivity, including 500 million missed workdays each year. Since many who drink heavily are employed, GLP-1s could offer relief for both employees and employers — especially in high-risk industries like mining, construction, and food service — by potentially reducing cravings and related workplace disruptions.

3. GLP-1s Work Best as Part of Broader Addiction Care Plans: Experts emphasize that GLP-1s should complement, not replace, established addiction treatments. Substance use disorders are complex and require more than medication — including therapy, counseling, and recovery support. For employers, success depends on integrating GLP-1 coverage with behavioral health services and ongoing care coordination to address the full spectrum of employee needs.