From Nonprofit Blues to Wall Street Blues: Elevance's Stock Points Down

By Wendell Potter - The company now known as Elevance, which owns Blue Cross plans in 14 states, took a drubbing on Wall Street yesterday after executives told shareholders that it had to pay out way more in medical claims during the second quarter than expected, especially in its Medicare Advantage business. As a reminder, Wall Street hates to hear such news, so much so that investors rushed to sell their shares in the company, sending the stock price to $296.39 – a 52-week low – before closing at $302.45 yesterday afternoon. That’s down 47% from the all-time high of $567.36 it reached last September. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. For-profit health insurers are experiencing significant and sustained stock market declines: Several major companies, including UnitedHealth, Elevance, Centene, Cigna, CVS/Aetna, Humana, and Molina, have seen sharp drops in share prices, with Centene and Molina reaching 52-week lows. UnitedHealth, in particular, has lost nearly 55% of its stock value since late 2023 and even withdrew its annual profit guidance, an unusual move that spooked investors. These developments suggest growing doubts among shareholders about the sector’s near-term profitability and stability.

2. Controversial cost-control practices like prior authorization are under increasing scrutiny: Insurers continue to rely on strategies such as denying or delaying care and enforcing “step therapy” (or “fail first”) requirements, where patients must try less expensive, insurer-preferred treatments before receiving the drugs their doctors recommend. While these policies help insurers manage expenses and maximize returns on negotiated drug prices, they can delay effective treatment, increase the risk of complications, and ultimately raise costs if patients’ conditions worsen over time.

3. The transformation of nonprofit health plans into for-profit corporations has reshaped the health insurance landscape: Moves like Blue Cross of California’s conversion into WellPoint (later Elevance) in the 1990s, orchestrated by Leonard Schaeffer, marked a turning point for the industry. These conversions fueled rapid consolidation, significant stock market growth, and immense executive payouts while helping create today’s large, profit-driven insurers. Critics argue this shift contributed to a more complex, expensive, and profit-focused U.S. health care system, though companies like Elevance have still delivered substantial long-term returns for investors despite current volatility.

ACA affordability percentage increases to 9.96% for 2026

By Allison Bell - The Internal Revenue Service has increased an important health benefits parameter — the employee's "required contribution percentage" — to 9.96% for 2026, up from 9.02% for 2025. Today, the federal Affordable Care Act requires some employers to offer employees affordable coverage with a minimum value or face the risk of owing penalties. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Federal Poverty Level (FPL) Safe Harbor Adjustment: Employers can demonstrate that they offer affordable coverage by limiting an employee’s self-only premium share to an amount based on the federal poverty level (FPL) multiplied by the required contribution percentage. For 2026, this threshold is projected to rise to $129.89 per month, up from $117.64 in most of the country for 2025.

2. Impact on Employers and HRAs: The new FPL safe harbor amount affects only the employee’s share of premiums (not the total premium) and may also influence how much employers contribute to certain health reimbursement arrangements (HRAs), including Individual Coverage HRAs (ICHRAs) tied to Affordable Care Act (ACA) exchange plans.

3. Compliance and Penalties: Large employers (50 or more full-time employees) must meet ACA affordability requirements to avoid potential IRS penalties if their coverage is deemed unaffordable and employees qualify for premium tax credits. The FPL safe harbor is one of three IRS-approved methods employers can use to determine affordability.

Employers Will Likely Reduce Health Benefits in 2026, New Mercer Survey Reveals

By Marissa Plescia - To combat rising healthcare costs, employers may be looking to reduce healthcare benefits in 2026, according to a new survey from consulting firm Mercer. The survey, released Wednesday, revealed that 51% of large employers (500 employees or more) said they are likely or very likely to make changes that would shift more costs to employees. This includes increasing deductibles or out-of-pocket maximums. In last year’s survey, 45% of employers said this. Read Full Article…

HVBA Article Summary

1. Rising Healthcare Costs Are Driving Strategic Shifts: U.S. employers expect health benefit costs to increase by nearly 6% in 2025, with 2026 potentially bringing even steeper increases. To manage these pressures, many are implementing short-term cost controls while also adopting longer-term strategies, such as narrow network plans that focus on high-quality, cost-effective care, and non-traditional options like variable copay plans that give employees price transparency before choosing providers.

2. Managing Prescription Drug Costs, Especially GLP-1s, Is a Priority: With 44% of large employers currently covering GLP-1 drugs for obesity, the rising expense of these medications has become a major concern. Seventy-seven percent of employers say cost management is extremely or very important, and some may reconsider offering coverage as costs rise, weighing the potential for long-term workforce health savings against immediate financial challenges.

3. Mental Health and Pharmacy Transparency Are Growing Focus Areas: Beyond cost management, employers are expanding initiatives to support workforce well-being and financial efficiency. Roughly three-quarters plan to offer digital mental health resources like mindfulness and cognitive behavioral therapy tools by 2026, over half will provide live or in-person stress management programs, about 40% are training managers to identify mental health struggles, and 61% are exploring alternative, more transparent pharmacy benefit models to help control drug spending.

21 states sue CMS over new ACA restrictions

By Jakob Emerson - A coalition of 21 Democratic-led states are suing HHS and CMS over new ACA rules they allege would impose significant barriers to receiving health coverage. The lawsuit, filed July 17 in the U.S. District Court for the District of Massachusetts, challenges a final rule that CMS introduced earlier this year to amend ACA marketplace regulations, which the plaintiffs argue will lead to millions of people losing access to health insurance, raise costs for states, and reduce the availability of essential health benefits. Read Full Article… 

HVBA Article Summary

1. New CMS Rule Could Lead to Coverage Losses and Benefit Reductions: The rule, taking effect August 25, introduces stricter eligibility verification, shortens open enrollment periods, and removes gender-affirming care from essential health benefits, potentially resulting in up to 1.8 million people losing health coverage.

2. States Argue Rule Would Burden Consumers and Health Systems: A coalition of 21 states, including California, Illinois, and New York, claims the rule will raise premiums, increase out-of-pocket costs, and add paperwork burdens that could discourage enrollment, while also straining state Medicaid programs by increasing costs for emergency and uncompensated care.

3. Legal Challenge Targets Exclusion of Gender-Affirming Care and State Law Conflicts: The states argue the rule is “arbitrary and capricious,” undermines state laws requiring coverage for gender-affirming care, and are seeking preliminary relief to block it before the August 25 implementation date.

Most Patients Want AI in Healthcare — If It Means More Time with Their Doctor

By Katie Adams - Patients are becoming more open to the use of AI in healthcare, as they see its potential to reduce administrative work for providers — and therefore create more meaningful, in-person time with them. In fact, nearly 60% of patients support the use of AI if it means they get to spend more time with their doctor, according to recent research from healthcare software company ModMed. This underscores patients’ strong and ongoing desire for human connection, noted Dan Cane, ModMed’s co-founder and co-CEO. Read Full Article…

HVBA Article Summary

1. Patients see AI’s potential but expect transparency and communication:
   The survey found that patients recognize AI’s ability to help healthcare providers by streamlining tasks, reducing wait times, and giving doctors more time for direct care. However, most want to be notified when AI is used and prefer explanations through direct conversations or signed notifications, supplemented by digital channels.

2. Trust hinges on openness, privacy, and human oversight: Patients expect providers to clearly explain AI’s role, how their data is protected, and what safeguards exist to prevent bias. They also want reassurance that AI supports — rather than replaces — human expertise, especially when used for administrative support or clinical decision-making.

3. AI adoption in healthcare is early but depends on three key factors:
   Successful integration will require (1) safe and reliable AI tools, (2) provider confidence and advocacy, and (3) patient trust built through clear communication and visible benefits to their care experience.

Mindfulness-based therapies linked to improved outcomes in comorbid depression, migraine

By Robert Herpen, MA - Mindfulness-based therapies were linked to positive effects on comorbid depression and migraine, but more research is required to determine their mechanisms of action, according to a poster presentation. Clinical research to date shows a link between depressive symptoms and migraine, with the potential for treatments to target patients with both conditions,” Rebecca E. Wells, MD, MPH, FAHS, FAAN, senior author, founder and director, Comprehensive Headache Program at Wake Forest University School of Medicine, told Healio at the American Headache Society 67th Annual Scientific Meeting. Read Full Article…

HVBA Article Summary

1. Mindfulness-Based Therapies Show Promise for Migraine and Depression: Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) were found to improve quality of life for individuals with migraine, with MBSR reducing headache-related disability and migraine frequency, and MBCT offering greater reductions in residual depressive symptoms and enhancing compassion compared with medication.

2. Research Gap Remains for Comorbid Conditions: Despite the overlap between migraine and depression, only one pilot study has examined MBCT for patients with both conditions, showing reductions in migraine-related disability and depression. The lack of broader research highlights the need for further studies on combined treatment approaches.

3. Mindfulness Helps Target Shared Mechanisms of Both Disorders: Mindfulness-based strategies have been shown to reduce pain catastrophizing, rumination, and stress, while improving emotional stability and awareness of negative thoughts—making them promising non-pharmacological options for addressing the bidirectional relationship between migraine and depression.

At-Home Alzheimer’s Testing Is Here: Are Physicians Ready?

By Alicia Ault - Given the opportunity, 90% of Americans say they would take a blood biomarker test for Alzheimer’s disease (AD) — even in the absence of symptoms. Notably, 80% say they wouldn’t wait for a physician to order a test, they’d request one themselves. The findings, from a recent nationwide survey by the Alzheimer’s Association, suggest a growing desire to predict the risk for or show evidence of AD and related dementias with a simple blood test. For consumers with the inclination and the money, that desire can now become reality. Read Full Article…

HVBA Article Summary

1. Direct-to-Consumer Alzheimer’s Blood Tests Expand Rapidly: Five U.S. companies — including Apollo Health, BetterBrain, and Neurogen Biomarking — now sell blood-based biomarker tests directly to consumers, bypassing physicians. These tests measure pTau-217, beta-amyloid 42/40, APOE genes, and other markers, with prices ranging from about $229 for single biomarkers to $800 for full panels. Testing is done via at-home draws or certified labs, as Alzheimer’s cases surpass 7 million in 2024 and are projected to nearly double by 2060.

2. Experts Divided on Benefits and Risks: Advocates say these tests help people plan ahead and adopt healthy habits, noting that 82% of patients in one study felt biomarker results helped them prepare. Critics caution they can fuel anxiety, fatalism, and misinterpretation of everyday forgetfulness. In one study, only 60% of cognitively normal people who initially wanted results chose to receive them, often citing fears over accuracy, limited treatment options, and family burden.

3. Regulatory and Ethical Concerns Remain Unresolved: Only one FDA-approved blood biomarker test exists, available by prescription for symptomatic adults, while most direct-to-consumer options lack oversight, validation, and counseling. The Alzheimer’s Association warns of false positives and advises against testing asymptomatic individuals. Concerns also include potential insurance complications, with 44% of survey respondents worried a positive result could affect healthcare or long-term care coverage despite legal protections.