The Other Health Care Cliff Americans Are About to Fall Off

By Wendell Potter – In mid-December, members of Congress members left Capitol Hill for the final time in 2025, thus ensuring that the year would end with a failure arguably more significant than anything they accomplished during the prior 12 months: the end, despite a widespread public clamor for action, of subsidies put in place during the pandemic that made premiums of ACA marketplace plans affordable for millions of Americans. Read Full Article...

HVBA Article Summary

1. Rising Out-of-Pocket Costs Compound Premium Increases: Beyond soaring premiums due to the expiration of ACA subsidies, many Americans face sharply higher out-of-pocket expenses such as deductibles and copayments. For example, average deductibles for ACA Silver plans are expected to rise to $5,304 in 2026, while Bronze plans could see deductibles spike to $7,576. This increase places a significant financial burden on patients, especially those with chronic conditions or serious illnesses, potentially leading to unaffordable health care costs despite having insurance coverage.

2. Policy Changes and Employer Trends Worsen Financial Strain: The Trump administration's finalized ACA rules increased the maximum out-of-pocket limits by about 4%, resulting in individuals potentially paying up to $10,600 and families up to $21,200 before insurance coverage begins. Additionally, employers are increasingly shifting health care costs onto employees through higher deductibles, with more than half of private-company employees now having access to high-deductible plans. These factors collectively exacerbate the financial challenges faced by insured Americans.

3. Consequences Include Coverage Loss and Risky Alternatives: The rising costs have led many Americans to drop their ACA marketplace coverage altogether, as seen in Pennsylvania where about 40,000 people canceled plans after premium hikes. Others are turning to less comprehensive and riskier options like short-term plans, catastrophic plans, or faith-based sharing plans, which often lack essential coverage and protections. This trend raises concerns about increased uninsured rates and greater financial vulnerability for many families in 2026.

This week on The Hill: GOP faces health care bind with subsidies expired

By Sudiksha Kochi – GOP lawmakers returning to Capitol Hill are facing a health care bind, with Affordable Care Act (ACA) subsidies having expired Dec. 31, and no clear path forward for extending them. The GOP remains split over whether to extend the subsidies at all. But last month, four Republican centrists, frustrated with party leadership, joined Democrats in backing a discharge petition on legislation to extend the subsidies for three years. Speaker Mike Johnson (R-La.) told reporters in December he plans to bring the bill to the floor this week, according to CBS News. Read Full Article...

HVBA Article Summary

1. Division Within the GOP on ACA Subsidies: Republican lawmakers are divided on whether to extend the recently expired Affordable Care Act subsidies, with some centrists breaking from party leadership to support an extension. This internal split complicates efforts to reach a consensus and move legislation forward. The lack of unity could impact the party's ability to negotiate effectively with Democrats and address constituents' concerns about rising health care costs.

2. Legislative Deadlines and Political Leverage: The looming government funding deadline at the end of January adds urgency to the debate over ACA subsidies. Democrats may use the necessity of passing a funding bill as leverage to push for an extension of the subsidies, as they have previously withheld support for spending packages that did not address health care issues. Failure to resolve the subsidies question could risk another government shutdown, increasing pressure on both parties to find a compromise.

3. Potential Impact on Health Care Costs and Reform: Without an extension, ACA premiums are projected to rise significantly, with some estimates indicating average increases of 26 percent and even higher spikes in certain states. Lawmakers are considering various reforms, including the possibility of incorporating health savings accounts and abortion restrictions, though these proposals face partisan disagreement. The outcome of these negotiations will have direct consequences for millions of Americans who rely on ACA subsidies to afford health insurance.

Schlichter Bogard Unleashes a New ERISA Suit Genre

By Nevin E. Adams, JD – A number of national employers (and consultants) found some coal in their Christmas stocking[s]…courtesy of Schlichter Bogard LLC. While it is not the healthcare fiduciary litigation many have been expecting, it does deal with benefits, and charges of a breach of fiduciary duty in what were allegedly excessive premiums in accident, critical illness, cancer, and hospital indemnity insurance — voluntary benefits that are not subsidized by employers. It was a classic Schlichter litigation “dump” with suits filed against multiple employers alleging similar violations all on the same day (and, if prior history holds true, this won’t be the last batch). That said, this group included United Airlines, CHS/Community Health Systems Inc., Universal Services of America LP, and Laboratory Corp. of America Holdings. Read Full Article...

HVBA Article Summary

1. Allegations of Fiduciary Breach and Excessive Premiums: The lawsuits allege that several national employers and their benefits consultants breached their fiduciary duties by allowing excessive premiums for voluntary benefits such as accident, critical illness, cancer, and hospital indemnity insurance. The suits claim that employers failed to exercise reasonable diligence in monitoring and negotiating plan terms, leading to overpayment by plan participants. Additionally, consultants are accused of self-dealing by maximizing their commissions at the expense of employees.

2. Voluntary Benefits and ERISA Implications: Voluntary benefits are fully paid by employees through payroll deductions and are marketed to rank-and-file employees to cover gaps in traditional health insurance. The suits argue that certain employer actions, such as endorsing the plans or receiving compensation beyond administrative fees, may subject these voluntary benefit plans to ERISA requirements. The lawsuits highlight that some employers, including United Airlines, have acknowledged their plans are subject to ERISA, which imposes fiduciary responsibilities.

3. Broker Roles and Industry Practices Under Scrutiny: The lawsuits assert that brokers, such as Mercer, acted as functional fiduciaries by exercising discretion over plan administration and selectively withholding information about lower-cost options to increase their compensation. The suits emphasize that employers have a duty to monitor delegated tasks to ensure brokers do not receive excessive fees. Evidence presented includes commission rates significantly higher than industry averages and the lack of competitive bidding for insurance carriers.

7 things to know about life insurance trusts

By Blake Harris – Life insurance is meant to give families peace of mind, but the protection people expect is not automatic. In the wrong circumstances, policy benefits can be pulled into lawsuits, targeted by creditors or cut down by taxes. In other words, the money your clients thought was guaranteed for their loved ones may not always stay fully protected. One of the most reliable ways to prevent that from happening is to use an irrevocable life insurance trust, or ILIT. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. ILITs Offer Legal and Tax Protections: Irrevocable life insurance trusts (ILITs) separate the ownership of a life insurance policy from an individual's personal estate, which can shield the policy from creditors, lawsuits, and estate taxes. This separation helps ensure that the policy's death benefit is not directly tied to the insured's estate, providing both legal and tax advantages for beneficiaries. Properly structured ILITs can help preserve more of the policy's value for heirs.

2. Proper Administration and Timing Are Essential: The effectiveness of an ILIT depends not only on its initial setup but also on ongoing management. Mistakes such as paying premiums directly instead of through the trust or failing to notify beneficiaries can undermine the trust's protections. Additionally, establishing an ILIT before any legal disputes arise is crucial, as transferring a policy after litigation has begun may be considered a fraudulent transfer and could be reversed by courts.

3. ILITs Are Not Suitable for Everyone: While ILITs can be powerful tools for asset protection and estate planning, they may not be necessary for all clients, especially those with small term policies or minimal estate tax exposure. The complexity and cost of setting up and maintaining an ILIT should be weighed against the potential benefits. Advisors should ensure that ILITs are integrated into a client's broader estate plan and consider alternatives, such as offshore trusts, for those with significant assets or higher risk profiles.

Wegovy pill hits market at $299 per month

By Paige Twenter – The first FDA-approved oral GLP-1 for weight loss is now available to U.S. patients for $299 per month through a self-pay platform. Self-paying patients can order the Wegovy pill at $149 per month as they work up to the two highest doses, which are available at $299 per month, according to a Jan. 5 news release from Novo Nordisk, a drugmaker based in Denmark. Read Full Article...

HVBA Article Summary

1. FDA Approval of Wegovy Pill: On December 22, the U.S. Food and Drug Administration approved a daily oral version of Wegovy, a GLP-1-based medication. It is designed to help adults reduce excess body weight, maintain weight loss over the long term, and decrease the risk of serious cardiovascular events such as heart attack, stroke, and cardiovascular-related death. This approval marks a milestone in the treatment of obesity and related conditions with oral medication.

2. Clinical Trial Results and Competing Drug: In a 64-week phase 3 trial conducted by Novo Nordisk, participants taking the daily Wegovy pill achieved an average weight loss of 14%. In comparison, Eli Lilly is developing a competing oral GLP-1 drug called orforglipron, which showed an average weight loss of 12.4% (approximately 27.3 pounds) over 72 weeks in a phase 3 trial involving more than 3,000 adults. Eli Lilly expects a decision on FDA approval for orforglipron in early 2026.

3. Advancement from Injections to Oral Treatment: GLP-1 therapies have traditionally been administered via weekly injections, which can be a barrier for some patients. The development and success of oral GLP-1 treatments like Wegovy and orforglipron represent a major advancement, offering a more convenient and potentially more widely accepted alternative for managing weight and reducing related health risks.

How to level set clients in an unpredictable market

By Perry Braun – As we move into a new year, the landscape for employee benefits brokers and consultants is becoming increasingly unpredictable and more complex than at any other time in the past decade. It is also becoming even more expensive. Aon predicts that employer-sponsored plans will surge about 9.5%, the highest since 2011. Economic pressures, regulatory uncertainty, workforce demographic shifts and structural changes in the healthcare and insurance markets are converging all at once. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Rising Costs and Market Complexity: The employee benefits market is facing its most unpredictable and expensive period in over a decade, with employer-sponsored plan costs projected to rise significantly. Multiple factors, including economic pressures, regulatory changes, and demographic shifts, are contributing to this complexity. Brokers and consultants must be prepared to navigate these challenges with increased expertise and adaptability.

2. Disruption in Insurance and Pharmaceutical Sectors: The individual insurance market is experiencing turbulence, with some employers considering alternatives like cash stipends for employees to purchase their own coverage. At the same time, pharmaceutical costs are taking up a larger share of medical expenses, driven by an aging workforce, chronic diseases, and the introduction of costly specialty medications. These trends are making it harder for employers to manage benefit costs and for employees to make informed choices.

3. Strategic Adaptation and Communication Needed: Brokers and consultants are encouraged to proactively communicate with clients about expected premium increases and the need for new cost-management strategies. Emphasizing employee education and exploring innovative solutions such as virtual medicine and direct contracting can help mitigate some of the unpredictability. Despite ongoing instability, the industry’s history of resilience suggests that adaptability and clear guidance will be key to weathering future challenges.

ACA enrollment drops slightly to 15.6M

By Jakob Emerson – More than 15.6 million people have enrolled in plans on federally run ACA exchanges so far, down from about 16 million at the same point last year, CMS Administrator Mehmet Oz, MD, said Dec. 23. Read Full Article...

HVBA Article Summary

1. Enrollment Trends and Fraud Prevention: Dr. Oz linked the recent decline in Affordable Care Act (ACA) enrollment to federal initiatives aimed at curbing fraudulent or improper enrollments. According to him, actions taken by the Centers for Medicare & Medicaid Services (CMS) over the past year have already removed enough individuals—particularly those with duplicate or overlapping coverage—to explain the slight decrease. He also noted that a politically driven lawsuit has paused further efforts to eliminate improper Biden-era enrollments.

2. Enrollment Data Insights: Despite the recent dip, ACA enrollment had been outpacing last year’s figures earlier in the open enrollment period. As of late November, CMS reported approximately 5.8 million plan selections—a 7% increase year over year. However, this growth was primarily driven by returning enrollees, while new consumer sign-ups were actually down by 4%, indicating a reliance on existing participants to maintain overall momentum.

3. Policy Uncertainty Around Subsidies: The enhanced ACA premium tax credits, which help lower insurance costs, are set to expire on December 31. Recent attempts in Congress to extend the subsidies failed: a Democratic proposal for a three-year extension and a Republican plan centered on health savings accounts both did not pass Senate votes. While four House Republicans joined Democrats in signing a discharge petition to force a vote, House procedural rules mean that any legislative action will likely be delayed until lawmakers reconvene in January.