Arizona Congressman re-introduces bill to repeal ACA, but will Trump, fellow lawmakers agree?

By Allison Bell - Rep. Andy Biggs is continuing the fight to kill the Affordable Care Act package. The Arizona Republican has introduced a bill that would repeal both the Patient Protection and Affordable Care Act and the other bill that makes up the ACA, the Health Care and Education Reconciliation Act of 2010. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Potential Impact on Health Benefits: If the new bill successfully repeals the ACA, it could reintroduce medical underwriting in the fully insured small-group market, eliminate bans on annual and lifetime coverage limits for essential health benefits, and remove the requirement for coverage of children on parental plans until age 26.

2. Legislative Process: The bill, like its predecessor, will be reviewed by eight House committees, including Energy and Commerce, Ways and Means, and Judiciary. The full text of the new bill is not yet available, but it is expected to closely mirror the previous version, which sought to repeal the ACA without a replacement plan.

3. Political Climate and Public Sentiment: The bill emerges amid strong public support for the ACA, with a Gallup poll indicating that 54% of U.S. adults approve of the law. President-elect Donald Trump has expressed criticism of "Obamacare" but has committed to managing the system until a better alternative can be implemented.

HHS proposes HIPAA update to boost healthcare cybersecurity

By Emily Olsen - Cybersecurity has become a critical component of healthcare delivery, with nearly every component of the system from appointment scheduling to prescription ordering reliant on connected technology, regulators wrote in the proposed rule. Read Full Article…

HVBA Article Summary

1. Enhanced Cybersecurity Requirements: The HHS has proposed significant updates to the HIPAA security rule, including mandates for healthcare organizations to create and maintain a technology asset inventory and network map, conduct more detailed risk analyses, and ensure security policies are documented, tested, and updated regularly to combat rising cyber threats.

2. Stronger Access Controls: The proposal introduces a requirement for covered entities and their business associates to implement multi-factor authentication (MFA) to prevent unauthorized access, following the massive Change Healthcare breach where compromised credentials were exploited due to MFA not being enabled.

3. Ongoing Security Monitoring: The proposed rule would require healthcare organizations to perform vulnerability scans at least every six months and conduct annual penetration testing to identify and mitigate cybersecurity risks proactively.

Why Republicans Are Warming To Extending Obamacare Subsidies

By Bruce Jepsen - Republican members of Congress who once opposed expanding – and even wanted to repeal – the Affordable Care Act are coming around to extending subsidies that allow more Americans to buy individual coverage, also known as Obamacare. Read Full Article…

HVBA Article Summary

1. Senator Murkowski's Support for ACA Subsidy Extension: Senator Lisa Murkowski, a Republican from Alaska, has expressed support for extending Affordable Care Act (ACA) subsidies, emphasizing their importance in keeping health insurance affordable amid rising healthcare and prescription drug costs. She acknowledged bipartisan concerns but stressed the absence of decreasing healthcare costs for families.

2. Impact of Subsidies on Coverage and Premiums: The expanded ACA subsidies, implemented through the Inflation Reduction Act of 2022, have significantly contributed to record enrollment and improved coverage access, particularly in Republican-leaning states. Insurance executives warn that removing these subsidies could lead to substantial premium increases, with some areas seeing costs rise by nearly 900%.

3. Bipartisan Recognition of Subsidy Benefits: Health insurers and industry leaders, including Centene and Oscar Health executives, continue to highlight the bipartisan benefits of ACA subsidies. They emphasize the role of these subsidies in ensuring affordable coverage for low-income families and gig economy workers, with many advocating for continued support to prevent drastic cost increases for vulnerable populations.

6 hot benefits topics for HR leaders to watch this year

By Dawn Kawamoto - What will be the top benefits headline of 2025? It will be a year of change, experts predict, with trends that will be sharply influenced by external factors and that will have clear impacts on HR and benefits leaders. Read Full Article… 

HVBA Article Summary

1. Data Integration and Analytics: Employers are expected to increasingly leverage integrated health and wellness data platforms and advanced technologies like AI tokenization in 2025. These tools will enable better analysis of cross-program impacts, such as understanding how financial wellness initiatives influence employee stress levels through comprehensive data analysis from biometric, mental health, and benefit utilization sources.

2. Rising Healthcare Costs and Pharmacy Spending: Employers anticipate a 7.8% rise in healthcare spending, the highest in over a decade, driven by chronic conditions and rising prescription drug costs. Pharmacy expenses alone account for over 25% of healthcare budgets, largely due to specialty medications and gene therapies. Employers are likely to renegotiate contracts with pharmacy benefit managers (PBMs) to ensure better pricing and transparency.

3. Increased Focus on Financial Wellness: With ongoing financial stress from inflation and student loan burdens, financial wellness benefits will remain a priority for employers in 2025. Programs such as retirement planning, emergency savings, and student loan assistance are gaining traction as part of a broader effort to support employee well-being and productivity.

Aetna sues drugmakers for widespread price-fixing and collusion

By Nora Tong - Aetna is taking legal action against Pfizer, Novartis, Teva Pharmaceuticals and others, saying the list of drugmakers conspired to overcharge the insurer, consumers and the federal government for generic drugs. Read Full Article…

HVBA Article Summary

1. Collusive Price Fixing and Market Allocation: The complaint alleges that drugmakers conspired to fix prices and allocate market share for generic drugs through secret meetings and communications at trade conferences and private calls. Evidence of written communications was reportedly destroyed to conceal the conspiracy. This collusion involved refusing to bid or submitting intentionally high cover bids, creating artificial pricing stability to maintain elevated drug prices.

2. Impact on Insurers and Legal Actions: Aetna claims that insurers, who typically rely on generic drugs to reduce costs, suffered financial harm due to the artificially high prices driven by this collusion. Multiple insurers, including UnitedHealthcare and Humana, have filed similar lawsuits. Additionally, a coalition of states and the Department of Justice Antitrust Division have scrutinized the drugmakers, with many reaching settlements while some cases remain active in court.

3. Evidence of Collusion and Key Figures: The complaint highlights Teva's central role in the conspiracy, citing financial struggles in 2013 and internal presentations supporting price increases. Executives from multiple companies allegedly colluded at social events and exchanged customer bid information to divide market share. Notably, a former Sandoz executive explicitly endorsed this market-sharing strategy, later cooperating with federal investigators in exchange for leniency.

Concerns Continue Over Private Equity's Reach Into Healthcare

By Shannon Firth - During a Senate Health, Education, Labor, and Pensions (HELP) Committee hearing, nurses described the "unsafe" and "untenable" conditions across hospitals in the Steward Health system, which had filed for bankruptcy a few months earlier. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Private Equity's Role in Healthcare Decline: The Steward hospital crisis highlights how private equity's profit-driven model can jeopardize patient care. Through practices such as real estate sell-offs, excessive loans, and cost-cutting on staff and medical resources, private equity often prioritizes wealth extraction over patient care, leading to dangerous outcomes like hospital closures and patient deaths.

2. Accountability and Legislative Challenges: Despite the severe consequences, efforts to regulate private equity in healthcare have faced significant hurdles. Multiple state bills aimed at increasing transparency and oversight were either blocked or vetoed. At the federal level, proposed legislation to hold executives criminally liable for patient deaths linked to financial misconduct has struggled to gain traction.

3. Uncertain Future Amidst Political Shifts: With a changing political landscape, the future of private equity regulation in healthcare remains uncertain. While some experts fear regulatory backtracking under a new administration, others hope public pressure against profit-driven healthcare practices will push for more aggressive reforms to protect patient care standards.

Top 10 most-read health insurance stories in 2024

By Allison Bell - A look back at the most widely read BenefitsPRO health benefits articles of the year shows that readers are thinking hard about the future of group health coverage, and especially about the future of small, fully insured group health plans. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Rising Demand and Shortages: The popularity of next-generation weight-loss drugs like Ozempic, Wegovy, and Zepbound continues to surge, with the FDA reporting shortages due to high demand. Limited availability of Zepbound and lower-dose Wegovy remains a concern for consumers seeking these treatments.

2. Retail Expansion: Costco has partnered with telehealth company Sesame to offer a weight-loss program, making medications like Ozempic and Wegovy more accessible. The program costs $175 for three months but excludes the cost of the medications themselves, reflecting a growing trend of retailers entering the health services space.

3. Insurance Coverage Developments: Major insurers, including Aetna, Elevance Health, and Kaiser Permanente, are expanding coverage for Wegovy, particularly for Medicare patients with heart conditions, following FDA approval of its use to reduce stroke and heart attack risks. This marks a significant shift in how weight-loss medications are perceived in the broader healthcare landscape.