Employer group, cities sue RFK Jr. and others over 2026 Affordable Care Act exchange changes

By Allison Bell - Any federal government moves that hurt the Affordable Care Act public exchange system could hurt small employers, according to the Main Street Alliance. The employer organization has joined a group of plaintiffs suing the administration of President Donald Trump over an ACA public exchange system final regulation for 2026. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. New ACA Regulations for 2026 and Beyond: The Centers for Medicare and Medicaid Services (CMS) introduced new rules for how ACA exchanges will operate starting in 2026. The regulations include a projected 86% reduction in funding for marketing and navigator services, cutting that budget to $72 million, while overall exchange operational spending (excluding marketing) may drop by 2.6%.

2. Legal Challenge Filed Against the Rules: The Main Street Alliance—alongside the cities of Columbus, Baltimore, Chicago, and advocacy group Doctors for America—filed a lawsuit arguing the new rules violate the Administrative Procedures Act. Plaintiffs, many of whom represent small businesses relying on ACA coverage, claim the changes could raise costs and reduce access, forcing some employees to seek jobs with employer-sponsored insurance.

3. Conflicting Impact Projections: The Trump administration contends the regulations will reduce fraud and improve sustainability, with HHS estimating a 5% average drop in individual premiums as a result. In contrast, critics warn the changes could decrease enrollment and weaken the ACA exchange system, making coverage harder to obtain for vulnerable populations.

Big Win for Virtual Care: Telehealth Safe Harbor for HDHPs Is Now Permanent

By Barbara Zabawa - In a landmark development for employer-sponsored health plans, the Senate Amendment to H.R. 1 (“The Big Beautiful Bill”), Section 71306, makes permanent the telehealth safe harbor under 26 U.S. Code § 223(c)(2)(E). This provision ensures that high-deductible health plans (HDHPs) can continue covering telehealth services before the deductible is met—without jeopardizing HSA eligibility. Read Full Article…

HVBA Article Summary

1. Permanent Telehealth Coverage Flexibility for HDHPs: Section 71306 of the Internal Revenue Code now permanently allows High Deductible Health Plans (HDHPs) to provide telehealth and other remote care services without applying the deductible first. This ensures that employees can continue accessing care early in the plan year while maintaining eligibility to contribute to Health Savings Accounts (HSAs).

2. Improved Plan Stability and Accessibility: The permanence of this provision removes previous uncertainty for employers and benefits administrators. It enables consistent plan design that includes pre-deductible telehealth coverage, supporting broader access to remote care while offering a stable, compliant framework for long-term planning.

3. Administrative and Communication Requirements: To fully implement the change, plan sponsors need to update key documents like Summary Plan Descriptions (SPDs), educate employees about ongoing telehealth eligibility, coordinate with third-party administrators and insurers, and provide training to HR and benefits staff to ensure proper execution during open enrollment and beyond.

The Fundamental Problem at the Heart of American Health Insurance

By TR Reid - The United States is the only country where a health insurance executive has been gunned down in the street. But that’s not the only thing that’s unique about American health insurance. Almost all of our peer countries – advanced, free-market democracies — have health insurance companies. Read Full Article…

HVBA Article Summary

1. Profit vs. Purpose in Health Insurance: In most advanced democracies, basic health insurance is run as a nonprofit service focused on public health and access to care. In contrast, U.S. health insurance is primarily operated by for-profit corporations, creating a fundamental tension between the goal of providing care and the incentive to maximize profits for shareholders.

2. Higher Administrative Costs in the U.S.: Private health insurers in the United States allocate a significantly larger share of their premium income—typically 15% to 20%—to administrative costs, including executive salaries and marketing. This contrasts sharply with nonprofit and government-run systems abroad, which usually keep these expenses under 5%. Medicare, a public U.S. program, operates with administrative costs as low as 3%.

3. Implications for Coverage and Access: The profit-driven nature of U.S. health insurance contributes to restrictive practices such as high deductibles, narrow provider networks, limited drug coverage, and burdensome pre-authorization requirements. These measures can hinder access to necessary care and fuel widespread public frustration with insurance companies.

House bill could let workers use HSA, FSA or HRA cash to pay for wearable tech

By Allison Bell - Rep. David Schweikert has brought back the Wearable Equipment Adoption and Reinforcement and Investment in Technology Act bill, or WEAR IT Act bill. The bill would let workers spend up to $375 per year from health savings accounts, health flexible spending arrangements or health reimbursement arrangements on wearable health care devices. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Definition of Wearable Devices Expanded: The proposed bill seeks to formally define "wearable devices" to include not only physical items worn on the body but also related software, provided they are primarily used to collect or analyze physiological data for purposes such as diagnosing, treating, mitigating, or preventing diseases or health conditions.

2. Bipartisan Support and Legislative History: The legislation is co-sponsored by Rep. David Schweikert (R-AZ) and Rep. Ami Bera (D-CA), demonstrating bipartisan backing. It follows a similar bill introduced in 2023 by Rep. Michelle Steel (R-CA), which failed in committee, but this new version may gain more traction due to heightened congressional interest in health-related legislation.

3. Context of Broader Health Tech Legislation: This bill is part of a larger wave of health technology initiatives in Congress, including previous efforts like the One Big Beautiful Bill Act, which included several provisions related to health accounts (HSAs, HRAs, FSAs). Schweikert has also introduced a separate bill proposing that artificial intelligence systems be allowed to prescribe medications, signaling a broader focus on integrating technology into healthcare policy.

CMS under Dr. Oz: 12 key actions 

By Alan Condon - CMS Administrator Mehmet Oz, MD, is charting an ambitious path to reshape federal healthcare policy in line with President Donald Trump’s “Make America Healthy Again” agenda. His vision comes as President Trump on July 4 signed The One Big Beautiful Bill Act, a sweeping package of reforms targeting Medicaid, Medicare, and the ACA marketplace. Read Full Article…

HVBA Article Summary

1. Tightening Oversight and Cost Controls: CMS is implementing a range of oversight and cost-saving measures, including stricter eligibility checks for ACA enrollment, audits for all Medicare Advantage plans, and the closure of funding mechanisms viewed as improper (e.g., Medicaid tax “loopholes” and DSHP/DSIP programs). These efforts aim to reduce federal spending and ensure more accurate allocation of taxpayer dollars.

2. Shifts in Healthcare Policy Priorities: CMS is revising or withdrawing several policies from previous administrations — such as guidance on emergency abortion care — and increasing scrutiny of care practices like gender-affirming treatments for minors. These moves reflect a reorientation toward stricter regulatory standards and a narrower interpretation of federal healthcare funding usage.

3. Emphasis on Transparency and Technological Oversight: CMS is enforcing updated hospital price transparency rules, expanding prior authorization reforms (including AI use), and auditing Medicare Advantage plans more aggressively. These actions signal a broader push for accountability, data-driven oversight, and clearer healthcare cost structures for both providers and patients.

The One Big Beautiful Bill and employee benefits: 6 notes

By Jakob Emerson - On July 4, President Donald Trump signed the “One Big Beautiful Bill Act,” which includes major changes for employee benefits. Read Full Article…

HVBA Article Summary

1. Expanded HSA Eligibility and Usage: Starting in 2025, individuals with bronze and catastrophic ACA plans, as well as those using Direct Primary Care (DPC) services, will be eligible to contribute to Health Savings Accounts (HSAs), with specific limits on DPC fees. Telehealth services will also permanently qualify for HSA-first-dollar coverage without disqualification.

2. Increased Dependent Care FSA Limits: Beginning in 2026, the annual contribution limit for Dependent Care Flexible Spending Accounts (FSAs) will rise to $7,500, increasing flexibility and support for families managing dependent care expenses.

3. Key Proposals Excluded from Final Legislation: Several proposed HSA and ICHRA (Individual Coverage Health Reimbursement Arrangement) reforms were left out, including expanded HSA use for Medicare enrollees, fitness expenses, and spousal catch-up contributions, as well as rebranding ICHRAs and introducing employer tax credits.

Healthcare’s Phone Problem: How to Rebuild Consumer Trust in the Age of Scam Calls

By Jonjie Sena - Generative Artificial Intelligence (GenAI) is revolutionizing all types of businesses, including healthcare. With its ability to generate as well as analyze content, GenAI is helping providers with diagnostic and treatment decisions, informing medical research, and giving patients tools to better understand their health conditions. Read Full Article…

HVBA Article Summary

1. Healthcare as a Target for Scams: The healthcare sector remains highly attractive to fraudsters due to the trust consumers place in provider communications. Scammers often impersonate Medicare or Medicaid representatives to extract personal information or payments, especially during health insurance open enrollment periods when fraudulent activity typically increases.

2. Surge in Robocalls and Consumer Hesitancy: Robocalls and scam calls continue to rise across all sectors, with healthcare being heavily affected. In April alone, Americans received over 4.4 billion robocalls. This growing volume of fraudulent calls contributes to consumer hesitation in answering legitimate healthcare-related phone calls, despite their importance in health management.

3. Verified Call Technology to Improve Trust: New phone technologies are helping healthcare organizations regain trust by displaying the caller's name, logo, and reason for the call, such as "Appointment Reminder" or "Patient Callback." These branded calls are supported by end-to-end verification, offering patients greater assurance that the call is legitimate and enhancing the safety of healthcare phone communications.