House approves 3-year ACA subsidy boost extension by 230-196 vote

By Allison Bell – Members of the U.S. House voted 230-196 today to pass an Affordable Care Act health insurance premium subsidy bill over the opposition of House Republican leaders. The bill would keep the temporary high level of premium subsidies that was in effect in 2025 in place for three more years. Seventeen Republicans ended up voting for final passage of the bill and helping Democrats send it to the Senate for further consideration. All Democrats who participated voted for the bill. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Bipartisan Momentum for ACA Subsidy Extension: The ACA subsidy bill is gaining traction in the House with growing Republican support, an unusual development for health reform legislation. In December, supporters used a discharge petition, signed by four Republicans, to force a House vote on the bill, and they later secured nine Republican votes for passage of the discharge motion. As of the most recent vote, 11 Republicans supported House Resolution 780, indicating bipartisan willingness to consider extending ACA subsidies. However, to pass in the Senate under normal rules, the bill still requires a two-thirds majority, making further bipartisan agreement essential.

2. Impact of Expiring Subsidies and Rising Costs: The current enhanced subsidies—expanded during the COVID-19 pandemic—removed the previous income cap of 400% of the federal poverty level and made subsidies available to anyone whose standard coverage would exceed about 9% of their income. These enhancements are set to expire at the end of 2025, potentially reinstating what critics call a “subsidy cliff” for middle- and upper-income individuals. For example, Sen. Lisa Murkowski shared a case where an Alaskan constituent’s health coverage costs would jump from $500 per month to $3,000 per month in 2026 without the subsidy extension.

3. Legislative Implications Beyond Subsidies: As the ACA subsidy bill advances, it could draw legislative attention to a broader range of healthcare policies. Lawmakers may link its progress to related measures involving pharmacy benefit managers (PBMs), health savings accounts (HSAs), and individual coverage health reimbursement arrangements (ICHRAs). This kind of dealmaking, often seen in high-stakes negotiations, could result in bundled reforms that go beyond the ACA subsidies and touch various aspects of the healthcare financing system.

HHS loses bid to suspend court block on 340B rebate pilot

By Alexis Kramer – The federal government likely won’t be able to overturn a court order that blocked it from kicking off its 340B rebate pilot, appeals judges ruled, dealing another blow to drugmakers that were poised to begin the program this month. The US Court of Appeals for the First Circuit denied HHS’ request to suspend a lower court’s preliminary injunction against the pilot program while it considers the agency’s appeal. Read Full Article...

HVBA Article Summary

1. Court Blocks HHS 340B Pilot Over Lack of Evidence: The First Circuit Court ruled against the U.S. Department of Health and Human Services (HHS), finding that the agency failed to demonstrate it would likely succeed in defending its 340B pilot program on appeal. The court criticized HHS for submitting a weak administrative record that lacked analysis of the pilot’s impact on hospitals eligible for the 340B drug discount program.

2. Concerns from Hospitals vs. Support from Drugmakers: The American Hospital Association (AHA), which filed the lawsuit, argued that the rebate-based pilot would financially burden hospitals serving vulnerable communities and increase administrative complexity. In contrast, pharmaceutical companies and industry groups supported the rebate model, stating it would reduce duplicate discounts and improve oversight and data accuracy.

3. Limited Scope of the Pilot and Legal Implications: The blocked pilot would have applied to only the first 10 drugs selected for Medicare price negotiations under the Inflation Reduction Act, involving nine major drugmakers. While HHS has not commented publicly, the court’s decision halts the planned January 1 launch and adds uncertainty around future implementation of similar models.

2026: A Tough Road Ahead in Health Care

By Luke Sullivan – As we ring in the new year there is one thing – maybe the biggest thing – lingering from 2025 that can’t be dropped: The alarming state of health care. Every aspect of the health care system feels like it’s working against its customers by prioritizing profits over care. There are significant signs we could be at a breaking point. More Americans than ever are opting to go without health insurance. A Gallup poll found 1 in 3 are considering running that risk, saying they can’t afford the costs. Read Full Article...

HVBA Article Summary

1. Rising Costs and Vanishing Coverage: The article highlights a critical health care crisis in the U.S., where soaring costs and diminishing insurance coverage are pushing many Americans to forgo health insurance altogether. This trend is exacerbated by record-high premiums and expensive prescription drugs, with pharmacy benefit managers (PBMs) consolidating control and driving up prices. The closures of thousands of pharmacies and rural hospitals further reduce access to affordable care, creating 'pharmacy deserts' and threatening community health infrastructure.

2. Comparison to 2008 Financial Crisis: The health care system's current state is compared to the 2008 housing market crash, with similar warning signs such as disproportionate cost burdens on consumers, shifting financial risks from employers to workers, and widespread medical debt. The average family health care plan cost has grown to consume a larger share of income, now about 32%, up from 23% in 2006. Lack of transparency in pricing by insurers and PBMs adds to the opacity and complexity, leaving patients vulnerable and uncertain about their medical expenses.

3. Political and Regulatory Challenges: Despite the urgency, meaningful reform faces significant political hurdles. While some states have taken steps to regulate insurers and PBMs, including lawsuits resulting in substantial payouts, federal-level reforms remain elusive amid partisan divides. Efforts to ban medical debt from credit reports are underway in several states, but systemic incentives favor continued growth in health care spending without price controls or transparency. Advocates emphasize the need for comprehensive federal action to address the entrenched profit-driven dynamics harming patients.

MetLife reveals the top priority for employers in 2026

By Jimmy Nesbitt – Employers say controlling health costs is their No. 1 benefits objective in the new year, surpassing attracting and retaining employees and improving productivity for the first time since 2022, according to a new research by MetLife. The company's 2026 Employee Benefit Trends Study also revealed that 83% of employees say rising living expenses and medical costs are their top stressors. On average, employees miss 6.1 days of work due to health-related issues, and 50% avoided medical care for cost reasons. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Impact of Economic Stress on Employee Well-Being: The study reveals that only 44% of employees consider themselves holistically healthy, with 77% expressing concern about broader economic conditions. Financial pressures and rising healthcare costs are eroding well-being across physical, mental, financial, and social dimensions. This stress is contributing to increased burnout, absenteeism, and disengagement — all of which directly affect workplace performance and highlight the urgent need for more proactive health support strategies.

2. Consequences of Delayed Medical Care: Due to rising out-of-pocket healthcare expenses, many employees are avoiding routine or preventive care. This avoidance can cause minor health issues to escalate into more severe and costly conditions. The study warns of a cascading effect: worse health outcomes, more frequent or extended absences, and ultimately higher medical costs for both employees and employers. These findings reinforce that traditional medical coverage alone is no longer sufficient to support workforce health.

3. Strategic Use of Non-Medical Benefits: Employers are increasingly viewing non-medical benefits as essential tools for addressing these challenges. 73% believe these offerings are the most cost-effective way to improve health, while 83% say they help reduce overall medical costs. Employees who engage with five or more non-medical benefits are 38% more likely to report being holistically healthy. High-impact benefits include dental, accident, hospital indemnity, and critical illness coverage. However, the study also emphasizes that increased spending alone is not enough — benefits must be strategic, relevant, and well-communicated to drive meaningful improvements in health and productivity.

New York City employee health insurance fund is insolvent, audit finds

By Jakob Emerson – A joint fund created to stabilize health insurance costs for New York City employees and retirees is insolvent and has accrued $3.1 billion in unreported liabilities, according to a Dec. 30 audit from the NYC Comptroller. The audit found that the Health Insurance Stabilization Fund, created in 1985 and jointly managed by the city’s Office of Labor Relations and the Municipal Labor Committee, can no longer fulfill its intended purpose and recommended that it be dissolved. Read Full Article...

HVBA Article Summary

1. Diversion of Funds Beyond Original Purpose: The fund, initially created to offset cost differences between employee health plans without charging workers more, was used for purposes beyond its original intent—such as wage increases and avoiding layoffs—through $4.3 billion in transfers since 2001. The audit found these uses were inconsistent with the fund’s intended function.

2. Questionable Accounting Practices and Delayed Response: An additional $3.3 billion in accounting "offsets" were counted as healthcare savings, even when no actual savings occurred. These practices, along with the failure to take corrective action despite warnings since 2018, led to a significant depletion of the fund. A committee assigned to address the issue failed to issue any formal recommendations.

3. Ongoing Solvency Issues Despite New Plan and Disputes Over Authority: The fund has not fulfilled certain financial obligations since 2019, and its real usable balance is near depletion. A new self-funded health plan may save up to $900 million annually but is still insufficient to restore solvency. Disputes persist between city officials and the comptroller over the interpretation of the fund's legal usage and financial reporting.

OpenAI launches ChatGPT Health

By Naomi Diaz – OpenAI has rolled out ChatGPT Health, a new feature that allows users to securely integrate personal health information with ChatGPT’s AI to better understand and manage health-related questions. Health-related inquiries are already among the most common uses of ChatGPT, with more than 230 million people globally asking health and wellness questions each week, according to OpenAI’s de-identified analysis of user conversations. Read Full Article...

HVBA Article Summary

1. Personalized Health Experience with Enhanced Privacy: ChatGPT Health introduces a dedicated space within the ChatGPT platform where users can connect their medical records and wellness apps—such as Apple Health (iOS only), MyFitnessPal, and Function—to receive personalized responses based on their own health data. This experience includes additional privacy and security measures, such as encrypted conversations, data isolation from other chats, and the assurance that user health data will not be used to train OpenAI’s models.

2. Supportive, Not Diagnostic Role in Healthcare: The tool is intended to assist users in navigating their health journeys by helping interpret lab results, track patterns, prepare for medical appointments, and explore wellness topics like diet, exercise, and insurance. However, OpenAI makes it clear that ChatGPT Health is not designed to diagnose or treat medical conditions and should be viewed as a complement to—not a replacement for—professional healthcare.

3. Clinician-Informed Development and Rigorous Evaluation: Developed over two years with feedback from more than 260 physicians across 60 countries and specialties, ChatGPT Health incorporates extensive clinical input to ensure accuracy, clarity, and safety in its responses. It is evaluated using HealthBench, a framework based on clinician-written rubrics rather than standardized tests, which focuses on contextual understanding and appropriate medical guidance. Access is currently limited to a small user group as the tool continues to be refined.

Emerging GLP-1 drugs are reshaping employers’ 2026 priorities

By Tom Starner – With escalating medical and pharmacy costs as a primary motivator, employers are moving health care benefit cost-containment to the top of their overall priorities for 2026, according to a new survey. In last year’s edition of Brown & Brown’s Employee Health and Benefits Strategy report, employers ranked “attracting and retaining a healthy and engaged workforce” as their top priority. This year, however, the survey’s focus has shifted to strategic cost containment. Central to that conversation will be managing access to and the cost of increasingly popular GLP-1 drug for weight loss. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Shift in Employer Priorities: Employers are now prioritizing health care benefit cost-containment over workforce engagement and retention, a change from previous years. This shift is largely driven by rising medical and pharmacy expenses, which have become a significant concern for organizations. The focus on cost management reflects a broader trend of employers seeking sustainable ways to offer benefits without incurring unsustainable financial burdens.

2. GLP-1 Drug Coverage Strategies: Nearly half of surveyed employers currently cover GLP-1 drugs for weight loss, and most plan to continue this coverage in the near future. However, many employers are implementing restrictions beyond standard prior authorization, such as requiring participation in lifestyle programs or limiting prescribing authority. These measures are designed to manage utilization and control costs associated with these increasingly popular medications.

3. Emerging Pricing and Access Models: New direct-to-consumer pricing strategies and initiatives like TrumpRx are influencing how employers approach GLP-1 drug coverage. These developments may lower out-of-pocket costs for employees but also introduce complexities for employer-sponsored plans, such as increased off-benefit utilization. Pharmacy benefit managers are expected to adapt by leveraging new pricing models to maintain cost control while ensuring appropriate clinical management.