Trump bill's health effects won't be felt until after midterms

By Maya Goldman - President Trump's tax and spending bill sets in motion nearly $1 trillion in cuts to Medicaid and other health policy changes that could loom over the midterm elections. But the real effects likely won't be felt until well after the ballots are cast. Read Full Article…

HVBA Article Summary

1. Delayed Impact of Medicaid Cuts: Most major changes to Medicaid and the Affordable Care Act (ACA) under the new legislation — including work requirements, eligibility checks, and funding reductions — are set to phase in gradually between 2026 and 2028. This delay could shield lawmakers from immediate political fallout.

2. Immediate ACA and Planned Parenthood Effects: Some provisions, like the expiration of enhanced ACA premium subsidies in early 2026 and the defunding of Planned Parenthood starting in 2025, will take effect sooner. These changes are expected to increase health insurance costs for ACA enrollees and reduce access to reproductive health services.

3. Political and Healthcare System Repercussions: The long timeline of the bill’s implementation presents both a strategic advantage for its supporters and a window for opponents to organize efforts to delay or reverse it. In the meantime, healthcare providers are already adjusting to the anticipated funding changes, potentially leading to service cuts or facility closures.

Trump signs big tax and spending bill into law as industry groups decry healthcare cuts

By Dave Muoio - President Donald Trump signed into law on July 4 his sweeping tax and spending package after the House secured the bill's passage one day before in a 218-214 vote. The House vote ensured the healthcare industry-opposed package would be signed into law in line with the self-imposed July 4 deadline. Read Full Article…

HVBA Article Summary

1. Major Republican-Led Legislation Passed After Internal Resistance: Despite early opposition from over 20 Republican holdouts, only two GOP representatives ultimately voted against the bill. The White House and party leaders worked extensively—including through late-night negotiations and implied political threats—to secure the necessary votes.

2. Bill Includes Tax Cuts and Domestic Spending Changes, Alongside Major Medicaid Reductions: The legislation extends Trump-era tax cuts and temporarily eliminates taxes on tips and overtime, while also increasing funding for immigration enforcement. However, it includes nearly $1 trillion in Medicaid cuts over a decade, projected to leave almost 12 million more Americans uninsured—drawing widespread criticism from healthcare groups and Democrats.

3. Deficit Impact and Budgeting Tactics Raise Concerns Across the Aisle: Though Republicans claimed the bill would result in a budget surplus, the Congressional Budget Office estimated it would add at least $3.3 trillion to the national debt. Critics labeled the GOP's accounting method—counting extended tax breaks as cost-neutral—an "accounting gimmick," heightening concerns about future fiscal policy precedents.

Pharmacies In Desperate Need of an Antidote

By Luke Sullivan - The pharmacy industry seems to be in its most perilous position in recent memory. In the last two weeks, major chains Rite Aid and CVS Health said they were closing a combined 570 pharmacies nationwide. The grocer Kroger announced this month it will close 60 of its stores – and their pharmacies. Read Full Article…

HVBA Article Summary

1. Pharmacy Closures Linked to PBM Tactics: CVS Health and other major pharmacy chains are shutting down locations amid accusations that pharmacy benefit managers (PBMs) — particularly CVS’s own — have squeezed pharmacies financially by under-reimbursing for prescriptions, contributing to nearly 26,000 pharmacy closures in the past decade.

2. Conflict of Interest and Market Control: PBMs, led by CVS, OptumRX, and Express Scripts, control nearly 80% of U.S. prescriptions and use opaque pricing and restrictive contracts that force independent pharmacies to accept unfavorable terms — a practice the FTC has flagged as anticompetitive.

3. CVS Shifting Focus to More Profitable PBM Sector: While closing brick-and-mortar stores, CVS appears to be investing heavily in its PBM operations and online pharmacy services, which are more profitable, suggesting a strategic pivot away from traditional retail pharmacy despite public health consequences.

Eliminating small-group health plans could save workers hundreds, study suggests

By Allison Bell - Eliminating the U.S. small-group health insurance market could be good for the workers, according to a team of four economists led by Sebastián Fleitas. Fleitas and his colleagues argue in a new working paper that having the workers spend their cash and the employers' cash on individual coverage, instead of on premiums for fully insured small-group coverage, would save the workers' households an average of $842 per year. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Greater Choice May Lead to Cost Savings: The research suggests that giving workers the option to select their own health insurance—rather than relying solely on employer-provided small-group coverage—could result in significant cost savings. This is primarily because individuals would be able to choose plans that more closely match their household needs and financial situations.

2. Preference Varies by Health and Income: According to the economists, workers’ preferences for coverage types are influenced by their health status and income level. Sicker or lower-income individuals are more likely to stick with small-group insurance, while healthier or higher-income individuals may find individual coverage more appealing due to greater flexibility and potentially better alignment with their personal circumstances.

3. Policy Debate Around Small-Group Market Decline: As enrollment in the small-group insurance market continues to decline, researchers and lawmakers are considering various alternatives. These include mechanisms like individual coverage health reimbursement arrangements (ICHRAs) and association health plans, which could give small employers more options for supporting their employees' access to health insurance.

What Administering My Father’s Home Infusions for 10 Years Taught Me About Improving Chronic Illness Care

By Ryan Johnson - During my years as an ER nurse, I saw my father in the chronic illness patients who regularly came through our doors. Like them, he spent decades suffering from emergency conditions that could have been prevented with proper and consistent care. But unlike them, his ER visits eventually slowed, then stopped completely. Not because of a miracle cure, but because he had me: a reliable and skilled nurse performing his life-saving infusions in the home — on time, every time. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Home infusion care can significantly improve patient outcomes: The author’s father experienced better health and quality of life once he began receiving more frequent, reliable infusions at home, administered by a skilled nurse. This suggests that many chronic illness patients could benefit similarly if care were more accessible outside hospital settings.

2. Skill specialization is critical in home-based healthcare: The article highlights a mismatch between the complexity of infusion treatments and the generalist training of many home health nurses. Bringing experienced hospital nurses with specific technical expertise into the home can lead to safer and more effective treatment.

3. Systemic barriers hinder the expansion of home infusion services: Administrative obstacles, staffing issues, and outdated care models prevent broader adoption of home-based chronic care. Overcoming these challenges with better systems, specialization, and technology could ease hospital burdens and improve outcomes for millions.

Cigna sues Bristol Myers Squibb, alleges monopoly tactics for cancer drug

By Kristen Smithberg - Health care insurer Cigna accused drugmaker Bristol Myers Squibb of attempting to retain a monopoly on its Pomalyst blood cancer drug by keeping generic versions of the drug off the market. The allegations were outlined in a complaint filed in Manhattan federal court June 24. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Allegations of Anticompetitive Conduct: Cigna has filed a lawsuit alleging that Bristol Myers’ Celgene unit engaged in anticompetitive behavior by filing baseless patent lawsuits and paying generic drugmakers to delay competition, which it claims helped maintain a monopoly over the multiple myeloma drug Pomalyst (pomalidomide).

2. Claims of Fraud and Overpayment: The complaint also accuses Celgene of misleading the U.S. Patent and Trademark Office by withholding prior patent information and overstating test results. Cigna argues these actions led to inflated drug prices, causing the insurer to overpay significantly and prompting it to seek triple damages through a jury trial.

3. Context and Legal Background: The lawsuit follows a similar, previously dismissed case by Blue Cross Blue Shield of Louisiana, with the judge ruling insufficient evidence of fraud. Bristol Myers, which acquired Celgene in 2019, has not yet publicly responded to the current allegations.

DOJ accuses defendants of sending fraudulent claims to Aflac

By Allison Bell - The U.S. Department of Justice is prosecuting allegations of claim fraud against private health insurers and benefit plans, as well as against government health benefits programs. Officials made that point [last] Monday by including a case involving Aflac and a case involving an unnamed dental insurer on a list of "health care fraud takedown cases" that it discussed at a press conference. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Widespread Fraud Targeting Public Health Programs: Federal and state agencies have launched coordinated enforcement actions against individuals involved in various healthcare fraud schemes, which collectively caused or attempted to cause $14.6 billion in losses. These cases primarily targeted government-funded programs such as Medicare, Medicaid, and workers' compensation.

2. Major Operation Against International Crime Ring: The largest and most complex case, known as Operation Gold Rush, exposed an international criminal organization that allegedly used the stolen identities of 1 million U.S. citizens to file approximately $10.6 billion in fraudulent Medicare claims for urinary catheters and other medical devices.

3. Multiple Smaller Schemes Also Charged: Prosecutors also filed charges in several smaller but significant cases, including a Michigan-based dental insurance fraud involving fake claims submitted using real employees’ and dentists’ information, and a group of Washington Metro employees accused of defrauding Aflac by submitting forged medical documents for over $362,000 in supplemental insurance claims.