Health & Voluntary Benefits Association (HVBA) Releases 2025 “Insights That Matter” Poll Report Highlighting Key Trends in Employee Benefits

By HVBA - The Health & Voluntary Benefits Association® (HVBA) today announced the release of its annual Insights That Matter: HVBA DIR Poll Results report, presenting a comprehensive look at the issues shaping the future of health and voluntary benefits in the U.S. workforce. Drawing from more than 24,000 responses across 35+ industry polls, the report highlights the priorities, concerns, and emerging solutions driving the healthcare and benefits landscape in 2025. Read Full Announcement…

HVBA Article Summary

1. Rising Costs and Transparency Drive Strategy: With over half of respondents identifying rising healthcare costs and affordability as their most urgent challenge, employers and brokers are increasingly prioritizing price transparency tools and reference-based pricing as essential tactics to manage expenses and improve plan value.

2. Benefits Expansion, Including GLP-1 Medications: Voluntary benefits such as dental, vision, critical illness, and accident insurance continue to be highly valued, particularly among Gen X employees. At the same time, the majority of respondents oppose eliminating coverage for costly GLP-1 weight-loss medications (like Mounjaro and Wegovy), recognizing their significance for improving employee health outcomes and supporting retention.

3. Innovation and Education Are Key: Employers are exploring nontraditional benefits like pet insurance, “travel as a benefit,” and workplace violence coverage to better attract and retain talent. However, the report also highlights a widespread lack of awareness around compliance requirements tied to the Consolidated Appropriations Act (CAA), pointing to a pressing need for improved industry education and resources.

New bill could increase maximum employer plan No Surprises Act fines to $10,000

By Allison Bell - Lawmakers are introducing a bipartisan bill that could increase the maximum employer health plan penalty for a No Surprise Act claim payment delay to $10,000, from $100 today. The bill would also require federal officials to send annual reports for Congress on what regulators are doing to verify insurer and health plan compliance with the No Surprises Act. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Bipartisan legislation introduced: Rep. Greg Murphy (R-N.C.) introduced the House version of the No Surprises Act Enforcement Act, joined by three Democratic and two Republican cosponsors, while Sen. Roger Marshall (R-Kan.) partnered with Sen. Michael Bennet (D-Colo.) on the Senate version. Both versions aim to strengthen enforcement of the No Surprises Act, which protects patients from unexpected out-of-network medical bills, particularly in emergency care or when treated by out-of-network providers at in-network facilities.

2. Proposed changes focus on insurers: The legislation emphasizes holding health insurers more accountable by proposing enhanced penalties for failing to promptly and fairly resolve disputes over out-of-network medical bills. This aligns with concerns from providers, many of whom argue they face financial strain due to what they consider unrealistically low reimbursement rates from insurance companies.

3. Stakeholder tensions remain: While providers support stricter enforcement on insurers, employer groups such as the ERISA Industry Committee claim that some providers are exploiting No Surprises Act dispute processes to drive up claims and health plan costs. These differing perspectives highlight the ongoing conflict between providers, insurers, and employers over how the law is applied and enforced.

How Drug Prices Got So Bloated

By Luke Sullivan - It’s no secret the brand name prescription drug costs are high. The rising costs have been blamed by health care analysts on kickbacks within the drug supply chain demanded by the federal government, drug distributors (wholesalers), health insurance companies and pharmacy benefit managers (PBMs). Read Full Article… 

HVBA Article Summary

1. Prescription drug prices in the U.S. include significant markups: According to a Drug Channels Institute analysis, $356 billion of the total market value of brand-name drugs represents inflated pricing within the prescription drug supply chain. These markups largely reflect the extra costs built into list prices to accommodate rebates, discounts, and financial concessions for insurers and pharmacy benefit managers (PBMs), rather than solely the manufacturing cost of the drugs themselves.

2. Rebate policies and PBM influence contribute to escalating list prices: Federal rebate requirements, first introduced in the 1990s to ensure Medicaid received at least a 23% discount on brand-name drugs, have expanded significantly over time. As PBMs gained greater control over which drugs are included in health plan formularies, drug manufacturers began inflating list prices to offset these growing rebates, discounts, and placement fees, ultimately raising the apparent “retail” cost of medications.

3. Rising drug costs drive profits for major health care companies: The continued escalation of prescription drug spending, which hit $464 billion in 2024, has helped large health care conglomerates achieve record financial success. Companies like UnitedHealth, now one of the largest corporations in the U.S., have seen soaring profits tied to rising medical and drug costs, reflecting how much of the pricing system benefits corporate interests rather than directly lowering costs for patients.

Benefits council asks Congress to restore expanding 340B program to its original intent

By Alan Goforth - The American Benefits Council is urging Congress to consider the cost to employers, workers and their families as it proposes changes to the 340B drug pricing program. “The council opposes legislation such as the 340B PATIENTS Act that would raise costs for working families with employer-sponsored health coverage and urges Congress to instead work with us on reforms to the 340B program that restore the program to its intent without raising costs for employers, employees and taxpayers,” said Ilyse Schuman, the council’s senior vice president for health and paid leave policy. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. The 340B program has expanded dramatically since its creation: Originally enacted in 1992 to make health care more affordable for vulnerable patients, the program’s discounted drug sales have surged from $7.5 billion in 2013 to $53.7 billion in 2022—a growth of over 700%. By 2023, 340B purchases represented nearly $1 of every $5 spent on brand-name outpatient medicines, totaling $66 billion at discounted prices (or roughly $124 billion at list prices).

2. Program growth has raised concerns over costs for employers and taxpayers: A recent council report argues that the rapid expansion of 340B has increased employer-sponsored health care costs by reducing available rebates and discounts, promoting greater use of higher-cost medicines, and accelerating hospital-physician consolidation, which shifts care to more expensive settings and raises overall hospital prices.

3. Proposed legislation could further expand 340B’s reach: The 340B PATIENTS Act, introduced by Rep. Doris Matsui and Sen. Peter Welch, would require discounted prices to be extended regardless of where or how drugs are dispensed, including through contract pharmacies. Stakeholders are urging Congress to weigh the potential financial impacts on employers, working families, and taxpayers before approving further expansion.

Coalition of 28 Organizations Urge Congress to Extend ACA Enhanced Tax Credits

By Marissa Plescia - On Thursday, a coalition of 28 healthcare organizations sent a letter to leaders in Congress calling on them to extend the Affordable Care Act enhanced premium tax credits, which are set to expire at the end of the year. The letter was addressed to John Thune, Senate majority leader; Chuck Schumer, Senate minority leader; Mike Johnson, speaker of the House; and Hakeem Jeffries, minority leader of the House. Read Full Article…

HVBA Article Summary

1. Enhanced premium tax credits introduced during the pandemic are set to expire unless Congress acts: Originally enacted in 2020 under the American Rescue Plan and extended through 2025 via the Inflation Reduction Act, these credits currently reduce monthly premiums for millions of Marketplace enrollees. Their expiration at year-end would end subsidies that make coverage more affordable for families and individuals purchasing insurance on state and federal Marketplaces.

2. Expiration of the tax credits could lead to steep cost increases for families and older Americans: Healthcare groups estimate that starting in 2026, a family of four earning $64,000 would face a $2,600 annual premium hike, while a 60-year-old couple earning $80,000 could see a $17,500 increase. These changes, advocates warn, could trigger a cost-of-living crisis for many of the 24 million people currently covered through the individual market.

3. Insurers are already projecting significant premium hikes for 2026, driven partly by the loss of the credits: A KFF and Peterson Center on Healthcare analysis found proposed rate increases averaging 15%—the largest since 2018—linked to the scheduled tax credit expiration as well as rising costs from tariffs on drugs and medical equipment. Healthcare organizations are urging Congress to extend the credits in upcoming legislation to mitigate these increases.

What Factors Influence a Patient’s Success on GLP-1s?

By Marilynn Larkin - Longer treatment duration, not having diabetes, and using semaglutide were among the factors associated with better weight reduction over 12 months among patients taking GLP-1 receptor agonists (RA), a cohort study suggested. Read Full Article…

HVBA Article Summary

1. Study highlights differing patient responses to GLP-1 RA treatment: A real-world, single-center study of 679 patients with overweight or obesity found that weight outcomes after starting GLP-1 receptor agonists (GLP-1 RAs) fell into three categories: successful weight reduction, weight stability, or weight regain. Longer treatment duration, use of semaglutide, nondiabetic status, and higher body fat percentage were associated with greater likelihood of weight loss.

2. Metabolic and renal factors show unexpected associations: Researchers observed that higher baseline estimated glomerular filtration rate (eGFR) was linked with weight regain in some patients, particularly those with prediabetes, while serum creatinine showed a nonlinear relationship with weight loss success at 12 months. These findings were unexpected and require further study to clarify underlying mechanisms.

3. Findings support prior research while informing individualized care: Though the study was relatively small, its results are consistent with previous research and may help refine strategies to tailor GLP-1 RA treatment. The authors emphasize that additional research is needed to confirm predictors of sustained weight reduction and optimize patient outcomes.

EBRI: Long-Term Care One of the Most Under-Addressed Retirement Risks

By Emily Boyle - In a July 22 webinar, the Employee Benefit Research Institute and Morningstar Inc. revealed that employees’ perceptions of long-term care needs, knowledge and accessibility of long-term services and supports, as well as longevity, influence their financial readiness in retirement. The webinar was based on findings from EBRI’s Employee Long-Term Care Survey, fielded in 2024, as well as results from Morningstar’s “The Overlooked Cost: How Long Term Services and Supports Impacts Retirement-Income Adequacy,” released in May. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Awareness and Coverage Gaps in Long-Term Care (LTC): Survey data shows that while 40% of workers expect to need LTC as they age, only 23% have strong knowledge of how to access services, and just 24% report their employer offers LTC insurance—with only 9% of those employees enrolling. Costs, benefits, and accessibility remain the top concerns for workers considering LTC coverage.

2. Significant Financial Impact of LTC on Retirement: Morningstar research highlights that healthcare costs for Baby Boomers in retirement average $131,000 but rise to $242,000 for those with LTC needs. Women, particularly single women, face higher risks of retirement shortfalls due to longer lifespans and greater likelihood of incurring LTC expenses.

3. Evolving Policy and Employer Roles in LTC Solutions: While only Washington currently has a publicly funded LTC program, several states—including New York, Massachusetts, California, and Minnesota—are exploring similar programs. Employers are increasingly offering group LTC options, with the average purchase age dropping from 57 to 47, reflecting growing awareness across generations.