The Sunlight Report on UnitedHealth Group

By Wendell Potter - “It’s what keeps him up at night.” I heard those words early last year from a top Department of Justice official during a briefing about the priorities of the DOJ’s Antitrust Division. Those of us in the room were told that one of the things that most worried Jonathan Kanter, who led the antitrust work for the Biden administration, was the growth, through rapid vertical integration, of big health insurers, UnitedHealth Group in particular. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Expansive Growth and Vertical Integration: UnitedHealth Group has grown into a dominant health care conglomerate, with over 2,600 subsidiaries across clinical, data, pharmacy, and insurance sectors. Much of its profit now comes from non-insurance divisions like Optum, reflecting a strategic shift toward owning and controlling all aspects of care delivery — from physician practices to digital health platforms.

2. Limited Transparency and Regulatory Loopholes: Due to SEC disclosure thresholds that scale with company size, UnitedHealth is not required to report many of its acquisitions, even when they involve billions of dollars. This lack of transparency, combined with complex corporate structuring and minimal public announcements, has enabled the company to expand with little oversight or awareness from regulators, lawmakers, or the public.

3. Market Influence and Financial Self-Reinforcement: UnitedHealth’s business model enables it to direct patients within its own network, allowing it to effectively pay itself for services using premiums and public funds. This structure helps meet ACA requirements while maximizing internal profits, driving a 2,000% stock price increase since 2010. Critics argue that this model reduces competition and may limit patient choice, even for those not directly insured by UnitedHealthcare.

California blocks sale of unauthorized 'Aetna' and 'Blue Shield' group coverage

By Allison Bell - California insurance regulators are trying to shut down what they say is an unauthorized effort to sell single-employer health coverage to individuals and families in California. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Non-Compliant Coverage and Misleading Marketing: The California Department of Insurance found that health plans marketed by Innovative Partners did not meet state standards for individual insurance and may have misled customers into thinking they were purchasing ACA-compliant coverage from recognized insurers like Aetna or Anthem through Covered California.

2. Regulatory Action and Consumer Complaints: The state issued a cease-and-desist order to Innovative and related parties, citing deceptive practices and unresolved consumer complaints, including denied claims and improper charges. Affected consumers also reported difficulties in canceling policies and receiving promised benefits.

3. Unclear Benefit Structure and Provider Relationships: While some services, such as Teladoc and discount networks like First Health, were confirmed to be associated with Innovative’s plans, it remains unclear how these services were represented to consumers. The California Department did not find evidence that these providers were aware of how their services were being used in the marketing of the plans.

Medicare proposes ‘efficiency’ pay cuts that would hit highly paid specialists the most

By Bob Herman and Tara Bannow - Medicare is proposing across-the-board cuts to what Trump administration officials believe are overpriced medical procedures, scans, and tests — a consequential decision designed to even the score between highly paid specialists and primary care doctors. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Medicare proposes changes to physician payment formulas: The federal Medicare agency aims to revise how it determines physician payments by introducing a 2.5% efficiency adjustment in 2026. This effort is driven by concerns that over half of the billing codes have not been reassessed in decades and that current pricing methods—largely influenced by the American Medical Association’s (AMA) Relative Value Scale Update Committee (RUC)—are outdated and lack reliable data.

2. Primary care physicians may benefit, while specialists may see pay cuts: Under the proposed changes, primary care doctors could see payment increases due to the exemption of time-based services from cuts. Meanwhile, specialists such as radiologists, surgeons, and anesthesiologists may face reduced Medicare payments, prompting concerns from their representative organizations about potential effects on service access and fairness.

3. Critics and supporters differ sharply on the proposal’s fairness and impact: Proponents argue the reform helps address long-standing pay disparities that undervalue primary care, while critics—especially from specialty fields—warn that across-the-board cuts could negatively affect patient care and ignore the complexities of individual medical services. The proposal has ignited controversy and public comments are open until September 12.

GLP-1s, Personalization, and Big Pharma Power Plays: What’s Really at Stake in the Eli Lilly Lawsuit 

By Myra Ahmad - The mounting conversations around compounded GLP-1 medications aren’t just about science or safety. Rather, lawsuits and corporate power plays have had massive influence on how these drugs are being perceived and doctors’ ability to make the best treatment decisions for their patients. Most recently, Eli Lilly issued a lawsuit against Mochi Health, the physician-led obesity care platform I founded, challenging our use of compounded tirzepatide formulations. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Compounded medications play a critical role in personalized care: Compounding allows physicians to tailor treatments to individual patient needs—especially when commercial drugs aren't suitable due to dosage, delivery method, allergies, or coexisting conditions. It is a legally recognized and regulated practice, supported by FDA provisions (503A and 503B), and used widely across multiple areas of medicine.

2. The Eli Lilly lawsuit raises questions about control over patient care: The lawsuit against providers offering compounded versions of GLP-1 medications, such as tirzepatide, centers on the balance between intellectual property rights and medical autonomy. Critics argue it may limit physicians' ability to prescribe appropriate, affordable alternatives when branded drugs are inaccessible or unsuitable.

3. Access and affordability remain central concerns in obesity treatment: Despite the effectiveness of GLP-1 medications, high costs and insurance limitations make them inaccessible for many. The article suggests that compounded alternatives could help bridge this gap, and frames the lawsuit as part of a broader debate about whether healthcare decisions should prioritize patients' needs or corporate profits.

Benefits Think: Rethinking benefits and vendor partnerships during open enrollment

By Brian Parker - As organizations urgently ramp up planning for open enrollment this fall, the dynamics of employee benefits are rapidly shifting and require more than just maintaining the status quo. Now is the time to keep employees happy and engaged through continuous innovation and prioritizing active, adaptive partnerships. And, through these partnerships, organizations can help employees maximize their benefits and feel fully satisfied with their options. Read Full Article…

HVBA Article Summary

1. Clear, Ongoing Communication Boosts Benefits Engagement: Employees who understand their benefits are significantly more likely to feel satisfied and secure in their roles. However, many lack the knowledge needed to make informed decisions. Consistent, year-round education and communication — beyond just the open enrollment period — can improve understanding, reduce confusion, and drive higher engagement with benefit offerings.

2. Personalized Support Enhances Benefit Utilization: Employees have varying needs, and a one-size-fits-all approach to benefits often falls short. Tailoring offerings to accommodate diverse preferences — such as pet insurance, family-friendly perks, or retirement options — ensures broader relevance. Partnering with vendors can help HR teams provide personalized guidance and fill resource gaps, particularly in larger or understaffed organizations.

3. Surveys Offer Valuable Insight Into Employee Needs: Gathering employee feedback through pre- and post-enrollment surveys, along with brief pulse surveys throughout the year, helps employers stay connected to evolving needs. These insights can reveal gaps in current offerings, highlight areas for improvement, and inspire new benefits strategies — ultimately leading to higher employee satisfaction and retention.

Obesity-Related Cancer Deaths More Than Triple

By Megan Brooks - Cancer deaths related to obesity have risen sharply over the past two decades, especially among older adults, women, non-Hispanic Black individuals and people living with obesity in rural areas, a US study found. Read Full Article…

HVBA Article Summary

1. Obesity-Related Cancer Deaths Are Rapidly Rising: Obesity is associated with a higher risk for 13 types of cancer, accounting for 40% of all cancer cases diagnosed annually in the U.S. A recent analysis of CDC data revealed that obesity-related cancer mortality rates more than tripled between 1999 and 2020, indicating a dramatic and alarming rise that outpaces mortality trends for many other chronic diseases.

2. Disparities Highlight Urgent Public Health Concerns: The study found significant disparities in age-adjusted mortality rates, with higher death rates among women, adults over 65, non-Hispanic Black individuals, rural communities, and those living in the Midwest. These trends point to deeper systemic issues, including unequal access to preventive care, socioeconomic challenges, and delays in diagnosis, all of which contribute to worsening outcomes in already vulnerable populations.

3. Obesity Must Be Reframed as a Cancer Risk: The link between obesity and cancer mortality is often overlooked in clinical settings. Experts emphasize the need for a paradigm shift: obesity should be viewed not only as a cardiovascular or metabolic concern but also as a major cancer risk factor. Effective responses must prioritize early screening, proactive weight management, and policies that promote equitable access to nutritious food, physical activity, and community-based care—especially in underserved areas.

ACA exchange managers updating systems for Trump rule upheaval

By Allison Bell  - The administration of President Donald Trump is making big changes in how Affordable Care Act public exchange programs work, but software teams should be able to update exchange information systems in time for the open enrollment period for 2026 coverage. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Upcoming ACA exchange rule changes are extensive but manageable: Josh Schultz of Softheon states that while the Affordable Care Act (ACA) exchanges are facing significant and unprecedented regulatory changes—such as stricter eligibility verification and a minimum premium payment requirement—he believes the technical aspects can be handled using current infrastructure, provided stakeholders act swiftly.

2. Policy changes may reduce enrollment and shift the risk profile: New rules, including those from the One Big Beautiful Bill Act (OBBBA), are expected to reduce overall exchange enrollment, particularly by excluding legal immigrants from subsidy eligibility. Schultz notes this could stabilize exchanges by reducing rapid enrollment growth and possibly improving the overall risk profile.

3. Employer-based ICHRA programs may play a growing role: While the final OBBBA legislation excluded enhancements to Individual Coverage Health Reimbursement Arrangements (ICHRAs), future legislation could revive them. Schultz suggests that increased employer adoption of ICHRAs may drive more employees to buy plans through the exchanges, partially offsetting any decline in enrollment due to the new rules.