UnitedHealth Helped Write the Law It Now Blames for Your Rising Premiums

By Wendell Potter – UnitedHealth Group, the country’s biggest health insurance conglomerate, wowed Wall Street last week when it announced that its profits increased a whopping 55% during the second quarter of 2026, from $5.2 billion at the end of 2Q 2025 to $8 billion in 2Q 2026. That puts the company on track to post profits for the year north of $30 billion. UnitedHealth achieved its impressive profit growth during the second quarter largely by:

• shedding more than 1.5 million of its health plan enrollees and

• spending a considerably smaller percentage of its customers’ premiums paying claims than it did in the same quarter last year. Read Full Article...

HVBA Article Summary

1. UnitedHealth’s Critique of the No Surprises Act: Company executives told investors that the Independent Dispute Resolution (IDR) process under the No Surprises Act is adding to medical cost trends in its commercial business. They argued that arbitration is being overused in certain regions and by a small number of provider groups, driving up payouts when arbiters side with doctors. Executives pointed to industry survey data claiming a significant share of disputes are ineligible and that some awards far exceed Medicare rates. The company has suggested that changing how arbitration awards are calculated would help control future costs.

2. Research and Lobbying Ties to the Law’s Origins: The article reports that UnitedHealth helped fund and shape academic research that influenced congressional action on surprise billing. According to court records and reporting by The Intercept, the insurer supplied claims data, reviewed drafts, and maintained behind-the-scenes involvement while its role was not publicly disclosed. That research framed certain provider groups as primary drivers of surprise billing and was cited as lawmakers developed the legislation. The piece argues that this history complicates the company’s current public criticism of the same law.

3. Courtroom and Regulatory Setbacks for Insurers: Several courts have recently dismissed insurer lawsuits alleging fraud and racketeering in the arbitration system, with judges suggesting that low initial payment offers may explain why providers often prevail. A Nevada jury previously found UnitedHealth liable for unfair reimbursement practices and awarded punitive damages, citing serious misconduct. Meanwhile, recent federal rulemaking reduced arbitration filing fees, and proposed legislation in Congress would penalize insurers for failing to promptly pay after losing disputes. Together, these developments indicate that both courts and regulators have, so far, resisted insurer efforts to curb the arbitration process.

Marsh avoids giving U.S. health benefits market details

By Allison Bell – Executives from Marsh today shied away from describing how the U.S. health benefits market performed in the second quarter. The New York-based risk management reported higher companywide earnings for the quarter, in spite of the earthquake in Venezuela and the military conflict in the Middle East. At Mercer's benefits unit, "health grew 3%, reflecting continued growth across our regions, especially in international," Marsh Chief Financial Officer Mark McGivney said during a public conference call Marsh held to go over its latest results with securities analysts. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Companywide Growth Outpaced Health Segment: Marsh reported $1.3 billion in net income on $7.4 billion in revenue for the quarter ended June 30, compared with $1.2 billion in net income on $7 billion in revenue a year earlier. Overall revenue increased 6.2%, while net income rose 4.5%, indicating steady profitability despite global disruptions. In contrast, the health business grew more slowly than Marsh’s broader operations, highlighting a relative soft spot within an otherwise solid earnings report.

2. Limited Transparency on U.S. Health Performance: Executives declined to provide specific figures on how Mercer's U.S. health benefits business performed compared with its global health operations. An analyst from Evercore ISI suggested the U.S. segment may have been weaker, but company leaders avoided confirming that interpretation. The lack of detail makes it difficult to draw firm conclusions about domestic market conditions based solely on the quarter’s results.

3. Management Urges Caution and Points to Long-Term Momentum: Vice Chair Patrick Tomlinson emphasized that Mercer Health had delivered more than 5% growth in each quarter over the past few years and cautioned against extrapolating from a single period. He said Marsh continues to win global benefits management deals with U.S. multinationals and sees strong demand among large employers in the United States and Europe. Management expressed confidence that the overall growth trajectory remains positive, signaling expectations for continued momentum beyond the current quarter.

New Bill Seeks to Create Public Option on ACA Marketplaces

By Marissa Plescia – U.S. Representative Angie Craig (D-Minnesota) introduced a bill last week that aims to create a government-run public health insurance option on the Affordable Care Act Marketplaces. Read Full Article...

HVBA Article Summary

1. Creation of a Medicare-X Public Option: The proposed Medicare-X Choice Act would establish a “Medicare Exchange health plan” available beginning in 2028 for individuals and small businesses purchasing coverage on the ACA marketplaces. The public option would not be open to people who are already eligible for Medicare. Primary care services would be covered without cost-sharing, and participating providers would generally be reimbursed at traditional Medicare rates. However, the Department of Health and Human Services could increase payments by up to 50% in rural areas to support provider participation.

2. Permanent Extension of Enhanced Tax Credits: The bill would make the ACA’s enhanced premium tax credits permanent after they expired at the end of 2025. Those credits, first introduced during the Covid-19 pandemic in 2021, had reduced premium costs for marketplace enrollees. Following their expiration, average monthly Marketplace premiums rose 58%, increasing from $113 to $178, according to KFF. Supporters argue that restoring and extending these subsidies would help stabilize affordability for consumers.

3. Political Support and Broader Policy Goals: The legislation is co-sponsored in the House by Reps. Eleanor Holmes Norton and Mike Quigley, with a companion bill introduced in the Senate by Sens. Michael Bennet and Tim Kaine. Lawmakers backing the measure say it would increase competition in the insurance marketplace and provide a more affordable coverage option nationwide. They frame the proposal as a response to coverage losses and rising costs following Medicaid cuts and subsidy expirations. The bill reflects ongoing Democratic efforts to expand access and move closer to universal coverage through a government-run alternative.

Novo sues Lilly, alleging ‘misleading’ advertising of obesity drugs

By Jonathan Gardner – Novo Nordisk filed a lawsuit against Eli Lilly in a New Jersey District Court, claiming its rival is using “deceptive advertising” in commercials for its GLP-1 products. Filed in a New Jersey District Court, the lawsuit follows a cease-and-desist order in which Novo asked Lilly to take down the advertisements. Lilly hasn’t, so the Danish drugmaker is seeking a permanent injunction to get the ads pulled and for Lilly to “conduct a corrective advertising campaign.” Lilly countered in a statement that the advertising is “truthful, it is transparent, and it is grounded in the most direct scientific evidence available.” Read Full Article...

HVBA Article Summary

1. Dispute Over Comparative Advertising Claims: Novo alleges that Lilly’s ads compare the highest injectable doses of Zepbound and Mounjaro against lower, original doses of Wegovy and Ozempic, creating a misleading impression of superiority. Novo argues that such comparisons omit the availability of its newer, higher-dose Wegovy formulation. The company is asking the court to require Lilly to stop running the ads and to launch corrective advertising. Lilly maintains that its marketing accurately reflects available scientific evidence.

2. Battle Fueled by Market Competition: The lawsuit unfolds amid intense rivalry in the fast-growing obesity drug market. In the first quarter of 2026, Lilly’s Zepbound generated $4 billion in sales, compared with 18.2 billion Danish krone, or about $2.7 billion, for Novo’s Wegovy. Both companies have recently introduced obesity pills, broadening competition beyond injectable treatments. The legal fight reflects the high financial stakes tied to market share and product positioning.

3. Scientific Evidence at the Center of the Case: Lilly cites results from the Surmount-5 head-to-head clinical trial, which found that the 2.4 milligram dose of Wegovy led to 47% lower relative weight loss than Zepbound. Novo counters that there has been no direct comparison of the highest approved doses of both drugs, particularly after the approval of its 7.2-milligram Wegovy dose. Clinical data show weight loss of up to 21% for Zepbound and about 19% for the higher-dose Wegovy in separate trials. The disagreement highlights how differences in trial design and dosing can shape marketing claims and regulatory scrutiny.

UNC Health dismisses 340B underpayment lawsuits targeting Humana

By Elizabeth Casolo – Chapel Hill, N.C.-based UNC Health hospitals have voluntarily dismissed two lawsuits against Humana over alleged 340B drug underpayments, according to July court filings. Read Full Article...

HVBA Article Summary

1. Voluntary Dismissal With Prejudice: UNC Health Care System and its affiliated hospitals, along with Blue Ridge Healthcare Hospitals, moved to dismiss their federal cases against Humana in mid-July. The dismissals were filed in separate U.S. District Courts in North Carolina and were granted with prejudice. This means the claims cannot be refiled, and each party will cover its own legal fees and costs. The filings formally end these specific disputes between the organizations.

2. Dispute Centered on Medicare Advantage Reimbursement Rates: The lawsuits, originally filed in June 2025, alleged that Humana underpaid for drugs purchased through the 340B program between 2018 and 2022. According to the complaints, the insurer reimbursed claims at average sales price minus 22.5% rather than the contractually established rate of average sales price plus 6%. UNC and Blue Ridge argued this payment methodology conflicted with their Medicare Advantage agreements. Blue Ridge had sought more than $2.3 million in damages tied to the alleged shortfall.

3. Legal Context Shaped by Supreme Court Ruling: The complaints referenced a 2022 Supreme Court decision that determined CMS lacked authority to reduce Medicare reimbursement rates for 340B drugs. Following that ruling, CMS issued lump-sum repayments to affected hospitals in early 2024. UNC’s filings contended that Humana relied on similar payment reductions based on its interpretation of CMS policy. While the Humana cases have been dismissed, a separate lawsuit UNC filed against Aetna over similar allegations remains ongoing.

How AI is transforming annual benefits enrollment for HR teams

By Jenny Wear – As HR and benefits leaders head into another annual enrollment season, many are reflecting on what last year's experience revealed for most: Even the best-prepared teams can feel the strain when old systems and new expectations collide. What should be an empowering time for your benefits clients' employees to take control of their health and financial futures is often a scramble filled with stress, confusion and missed opportunities. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. AI Eases Administrative Strain: The article argues that AI can significantly reduce repetitive HR tasks during annual enrollment, such as applying eligibility rules, answering common questions and generating communications. A cited HR Pulse survey found that 43% of respondents see HR and benefits administration as the area where AI delivers the greatest value. By automating routine workflows and enabling self-service tools like virtual assistants, HR teams can redirect time toward strategy and employee support. AI-powered dashboards also make it easier to extract actionable insights without relying on specialized analysts.

2. Employees Struggle With Benefits Decisions: Many workers approach enrollment overwhelmed, particularly younger employees navigating benefits for the first time. A MetLife study cited in the article found that 60% of Gen Z workers surveyed did not fully understand their benefits, and 35% lacked confidence in their selections. AI can address these gaps with personalized reminders, contextual content and real-time assistance. These tools aim to reduce confusion, improve participation and help employees make more informed decisions.

3. Human Oversight Remains Essential: While AI can streamline communications and administrative functions, the author cautions against using it for high-stakes decisions like health plan selection. Research suggests employees do not yet trust AI for life-impacting choices, prompting the need for human-in-the-loop models. In these systems, AI surfaces options and insights, but final decisions are reviewed or made by humans to ensure fairness and transparency. The article emphasizes that responsible implementation requires auditability, explainability and ongoing human oversight.

GLP-1 compounders find loophole in FDA crackdown, study suggests

By Mackenzie Bean – Some compounding pharmacies are making slight tweaks to the composition of their GLP-1s to sidestep an FDA ban on copying approved semaglutide and tirzepatide products, suggest the findings of a study published July 17 in JAMA Health Forum. Read Full Article...

HVBA Article Summary

1. High prevalence of compounded GLP-1 offerings: In a secret shopper review of 103 weight-loss clinics and medical spas across two states, 75 confirmed they were selling compounded GLP-1 receptor agonists for weight loss. The vast majority offered compounded semaglutide and tirzepatide products. This suggests that, despite the FDA declaring shortages resolved and restricting exact copies, compounded alternatives remain widely accessible in certain markets.

2. Formulation changes used to navigate FDA restrictions: More than half of the businesses said their compounded products included additional ingredients, most often B vitamins, with smaller shares adding levocarnitine or glycine. A minority also offered oral or sublingual versions instead of injectable formulations. The researchers said these modifications appear to be a strategy to differentiate the products from branded drugs after federal enforcement resumed.

3. Regulatory and oversight concerns among suppliers: The study identified 23 single-location compounding pharmacies supplying the clinics, with several facing compliance issues. Some lacked proper sterile compounding licenses, and others had received FDA warning letters or state board disciplinary actions in recent years. The authors estimate the market could include more than 4,000 similar businesses nationwide, raising broader questions about regulatory oversight and patient safety.