Individual market insurers requesting largest premium increases in more than 5 years

By Jared Ortaliza, Kaitlyn Vu, Matthew McGough, Shameek Rakshit, Imani Telesford, Lynne Cotter, Emma Wager, and Cynthia Cox - Each spring and summer, health insurers submit rate filings to state regulators to justify premium changes for the coming calendar year. Several factors drive premium changes, and usually the cost of medical care (the prices of health services and the amount of care people are receiving) is the primary driver of premiums. However, heading into 2026, there are also policy changes that insurers expect will drive up their costs and, thus, increase premiums beyond what they would otherwise charge. Read Full Article…

HVBA Article Summary

1. ACA Marketplace premiums are expected to see their largest increases since 2018 in 2026: Across over 100 insurers, premiums are projected to rise by a median of 15%, with more than a quarter proposing increases of 20% or more. These hikes are driven by rising healthcare costs, including hospital and physician services, growing prescription drug spending (notably GLP-1 drugs), and labor market pressures affecting provider contracts.

2. The expiration of enhanced premium tax credits is a key driver of higher rates: With subsidies set to end after 2025, out-of-pocket premium payments for subsidized enrollees could rise by over 75%, prompting many healthier individuals to leave the market. Insurers anticipate this will create a sicker risk pool, adding roughly 4% to premiums beyond typical cost growth.

3. Tariffs and regulatory changes are adding to pricing pressures and uncertainty: Some insurers cite tariffs on drugs, medical equipment, and supplies as raising premiums by about 3% on average, while new rules like the ACA Marketplace Integrity and Affordability rule create operational uncertainty, though they are not yet significantly affecting rates. Finalized 2026 premium rates will be released in late summer ahead of open enrollment.

One-third of Americans still live in pharmacy, hospital or provider health care desert

By Alan Goforth - More than 120 million Americans lack proper access to health care services, a new study from Good Rx Research found. “Today, roughly 81% of counties across the United States are a health care desert of some kind, meaning the majority of the population lacks proper access to either pharmacies, primary care, hospitals, hospital beds, trauma centers or community health centers,” the report said. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Health care deserts impact a large share of Americans: More than 120 million people, roughly one-third of the U.S. population, live in counties considered health care deserts, where access to essential services like pharmacies, hospitals, trauma centers, or primary care is limited or inconvenient. These gaps mean many communities struggle to meet even basic health needs, with residents often facing significant travel times to reach care.

2. Access to care continues to decline across multiple sectors: Since the first report in 2021, over 1,300 pharmacies have closed, raising the number of people living in pharmacy deserts to 48 million, up from 41 million. Hospitals and federally funded health centers remain vulnerable to closure due to shifting policies and funding withdrawals, while primary care availability lags behind demand, worsening overall access.

3. Shortages create layered barriers for patients and communities: Millions of Americans face overlapping challenges such as traveling more than 15 minutes to reach a pharmacy, over 30 minutes to a hospital, or over an hour to a trauma center. In many federally designated primary care shortage areas, a single provider serves 7,597 people—2.5 times the recommended ratio—leaving residents with limited and delayed access to care.

'Abuse of power': Senators call out 'shady tactics' after investigating Pfizer, Lilly DTC platforms

By Andrea Park - After a nine-month investigation into direct-to-consumer telehealth platforms launched by Eli Lilly and Pfizer, a group of senators has released a report suggesting the platforms may allow pharmas to inappropriately influence doctors’ prescribing habits. Read Full Article… 

HVBA Article Summary

1. Senators’ Investigation into Pharma-Linked Telehealth Platforms: A group of U.S. lawmakers, including Sens. Durbin, Welch, Warren, and Sanders, launched a probe into LillyDirect and PfizerForAll, along with several telehealth companies they partner with. The investigation aimed to determine whether these branded platforms steer patients toward specific medications, potentially inflating prescription rates and driving up costs for federal healthcare programs like Medicare and Medicaid.

2. Findings on Prescription Patterns and Provider Relationships: The senators’ report found that patients routed through the platforms had notably high rates of receiving prescriptions—85% for PfizerForAll users and 74% for LillyDirect users. Providers working with these services were far more likely to prescribe drugs from Lilly or Pfizer compared to other medications, and some of these providers had financial ties to the drugmakers, raising concerns about potential influence over prescribing practices.

3. Concerns About Patient Care and Potential Conflicts of Interest: The investigation highlighted concerns about the quality and integrity of care, noting that many virtual visits relied solely on patient questionnaires, often without video interaction or full medical records. Some platforms allowed patients to preselect medications before seeing a provider, and LillyDirect’s provider search tool appeared to favor doctors with financial connections to Lilly. While the report found no direct evidence of incentives for prescribing, it warned of possible conflicts of interest and overprescribing risks.

ACA health insurance will cost the average person 75% more next year, research shows

By Selena Simmons-Duffin - Health insurance premiums are going way up next year for people who buy their insurance on Healthcare.gov or the state-based marketplaces, according to an analysis out Friday. The average person who buys Affordable Care Act insurance will be paying 75% more for their premium, according to the analysis from KFF, a nonpartisan health policy research group. Read Full Article…

HVBA Article Summary

1. Expiration of enhanced ACA subsidies is driving expected premium hikes: Health insurers say their 2025 premium increases are largely due to the end of pandemic-era federal subsidies that temporarily lowered costs for Affordable Care Act (ACA) marketplace plans. These subsidies, introduced during the Biden administration, made coverage far more affordable, and their expiration is now a bigger factor than rising hospital or drug prices in driving rates upward.

2. Loss of subsidies could significantly reduce coverage: Without the enhanced tax credits, premiums for many enrollees are projected to rise sharply, in some cases jumping from $60 to $105 per month. This increase is expected to lead some generally healthy individuals to drop their coverage, and the Congressional Budget Office projects that 4.2 million to 8.2 million people could become uninsured over the next decade as a result.

3. Political and market impacts are intertwined: While Congress could extend the enhanced subsidies, Republican lawmakers have opposed doing so, arguing that they mask the rising cost of Obamacare and place a burden on taxpayers. Without renewal, many of the enrollment gains in recent years—particularly in Republican-led states such as Texas, Florida, and Georgia—could be reversed, and insurers expect a sicker, more expensive risk pool as healthier individuals exit the market.

New Jersey public employees face major premium rate increases in 2026

By Jakob Emerson - New Jersey public employees are facing an up to 36.5% rise in health insurance premiums in 2026. The State Health Benefits Program for county and local employees could see costs rise 36.5%, school employees’ premiums could rise 29.7%, and state workers could see a 21% increase, according to an analysis by Aon published by Gov. Phil Murphy’s office on July 9. Read Full Article…

HVBA Article Summary

1. Higher health plan premiums are being recommended due to several cost and risk pressures: In addition to covering large financial losses from previous years, the proposals reflect the impact of rising medical and prescription drug prices—particularly expensive weight-loss medications like Wegovy and Ozempic—as well as higher overall healthcare utilization. The departure of healthier employees from the plans is also contributing to a less balanced risk pool, putting further upward pressure on rates.

2. Rebuilding reserves is a major driver behind the proposed increases: Beyond covering rising costs, the recommended rate hikes are designed to restore emergency cash reserves that were depleted in recent years. These reserves are essential for ensuring the long-term financial stability of the health plans and for protecting them against future unexpected claims or economic downturns.

3. The premium changes are still preliminary and subject to oversight: Before any of these recommended rates can take effect, they must undergo a review and approval process by state committees responsible for overseeing the health plans. This process will determine whether the proposed increases are justified and set the final rates.

SHRM 2025 Employee Benefits Survey Takeaways for Business Leaders

By James DaSilva - The 2025 SHRM Employee Benefits Survey can give you better information and context for making the tough judgment calls that can shift the needle on employee engagement, productivity, and retention. Here are a few takeaways from this year’s results to consider when making benefits decisions. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Regulatory compliance remains a priority: With a new presidential administration reassessing federal regulations, companies must stay alert to potential changes in laws and enforcement that could impact how benefits are structured, reported, and offered. Organizations operating across multiple states or localities also need to closely track regional updates to avoid compliance gaps.

2. Hybrid and flexible work models are stabilizing: A majority of employers continue to offer hybrid schedules or flexible work arrangements, showing that this model is becoming a sustainable standard rather than a temporary solution. Companies should view this as a chance to design work structures that enhance productivity while also supporting employee engagement, satisfaction, and long-term retention.

3. Emerging trends like generative AI and GLP-1 drug coverage require strategic planning: Employers must create thoughtful strategies for integrating generative AI, including training employees to use it effectively and ethically while combining it with human judgment. Additionally, rising demand for GLP-1 drugs for diabetes and weight management presents both opportunities and challenges, requiring a balance between meeting employee health needs and managing significant cost implications.

Drugs like Ozempic cut death risk 30% for people with obesity and type 2 diabetes: JAMA study

By Allison Bell - For people who are obese and have type 2 diabetes, using Ozempic and other GLP-1 agonist drugs cuts the all-cause mortality rate by 30%, according to a new paper published by a journal affiliated with the Journal of the American Medical Association. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. GLP-1 agonists were linked to a lower risk of certain complications: In a study of 60,860 U.S. patients aged 40 and older with diabetes and obesity (2017–2024), those taking GLP-1 agonists such as semaglutide (Ozempic, Wegovy) or tirzepatide (Mounjaro, Zepbound) had a 19% lower risk of stroke and a 37% lower risk of dementia compared to similar patients taking other antidiabetic drugs.

2. Findings are observational and need further research: The results were based on patient record analysis, not randomized trials, so researchers emphasized that more controlled studies are needed to confirm whether GLP-1 agonists directly protect the brain and vascular system beyond blood sugar control.

3. Cost and broader impact considerations: While current GLP-1 drugs can cost over $10,000 annually, analysts project prices will drop as patents expire and newer drugs emerge. The findings suggest potential health and financial benefits for employers and health plans if these drugs are made widely accessible to eligible patients once prices fall.