ACA reforms in the GOP’s tax bill were little-noticed. That might change

By John Wilkerson - Enrollment in Affordable Care Act marketplace health plans has more than doubled since 2020, and most of that growth has been in states won by President Trump. House Republicans’ legislative agenda could cut that by one-third and make the insurance more expensive. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Republican legislative proposals targeting ACA marketplace policies: Republicans have shifted focus away from direct Medicaid cuts and are instead proposing changes to Affordable Care Act (ACA) marketplace policies through the “One Big Beautiful Bill Act.” These include reducing enrollment periods, increasing income verification requirements, eliminating temporary financial assistance, and requiring full repayment of tax credits if income estimates are incorrect — changes that could reduce ACA enrollment by approximately 8 million people, according to projections.

2. Disagreement over fraud estimates and policy impacts: Republican lawmakers cite concerns about improper or fraudulent ACA marketplace enrollments, with some estimates suggesting millions of enrollees may not meet eligibility requirements, costing billions annually. Others argue these figures are overstated and note that current systems are designed to accommodate individuals with variable incomes, such as gig workers. The scheduled expiration of enhanced premium tax credits, which expanded enrollment, could further reduce marketplace participation by an estimated 4.4 million people if not extended.

3. Voter and political dynamics influencing policy debates: The growing number of Republican voters in regions with significant Medicaid and ACA enrollment has added complexity to the policy debate. While some Republican leaders caution against cuts that could affect constituents, the party is also advancing tax policies — such as adjustments to taxes on tips, overtime, and child tax credits — that may appeal to working- and middle-class voters. Political strategists suggest these broader tax benefits may help counterbalance concerns about proposed changes to ACA-related programs.

Express Scripts, CVS sue Arkansas officials over law barring PBMs from owning pharmacies

By Paige Minemyer - Pharmacy benefit management giants Express Scripts and CVS Health are suing Arkansas officials to challenge a law that bars PBMs in the state from owning pharmacies. In the lawsuit, filed Thursday in Arkansas district court, Express Scripts argues that the bill is "innocuously -- and deceivingly" titled as "An Act To Prohibit A Pharmacy Benefits Manager From Obtaining Certain Pharmacy Permits," but it would have the effect of shutting down many pharmacies across the Natural State. Read Full Article…

HVBA Article Summary

1. Arkansas’ groundbreaking law bans PBM-owned pharmacies: Governor Sarah Huckabee Sanders signed the first-in-the-nation law barring pharmacy benefit managers (PBMs) from owning or holding stakes in pharmacies within Arkansas, aiming to combat what the state calls anticompetitive practices, inflated drug prices, and reduced patient access. The law, taking effect January 1, 2026, has limited exemptions and will push Arkansas to the forefront of state-level PBM reform.

2. PBMs and large chains warn of pharmacy closures and patient harm: Express Scripts and CVS filed lawsuits arguing the law violates federal law, restricts patient choice, endangers access to affordable and lifesaving medications, and could force closures of over 35 retail pharmacies, including 23 CVS locations. They warn of job losses, broken patient-pharmacist relationships, disrupted home delivery services, and reduced access to specialty and mail-order pharmacies, particularly affecting rural patients.

3. Local vs. national competition fuels legal and political tensions: While Arkansas lawmakers frame the law as supporting independent, local pharmacies, national chains like CVS claim the law is designed to push out large out-of-state competitors, creating unfair exemptions (such as for Walmart, the state’s largest employer). The Pharmaceutical Care Management Association and other PBM advocates argue the law will ultimately increase healthcare costs for Arkansas employers and limit pharmacy service options.

Employer healthplan performance gap expands, says J.D. Power

By Laura Beerman - J.D. Power has released the results of its 2025 U.S. Commercial Member Health Plan Study. This year’s study, now in its 19th year, highlight notable and growing gaps in member satisfaction among the nation’s health insurers. “Brand performance gaps in the commercial health insurance market are no longer subtle—they’re widening in ways that directly affect satisfaction, retention and competitive strength,” said Caitlin Moling, J.D. Power senior director of global healthcare intelligence in the study press release. Read Full Article… 

HVBA Article Summary

1. Member Satisfaction Hinges on Clarity and Digital Engagement: The J.D. Power study found that commercial health plan satisfaction remains low, averaging 563 out of 1,000, with wide regional variation (523–594). Members who understand their out-of-pocket costs and out-of-network coverage report better satisfaction, fewer denied claims, and improved access to care. However, many digital tools offered by plans go underutilized due to a gap between availability and member awareness, signaling an opportunity for plans to improve communication and education.

2. Regional, Blues, and Provider-Led Plans Lead in Satisfaction: Kaiser Foundation Health Plan dominated satisfaction rankings, holding the top spot in several regions (including an 18-year streak in California), followed by strong performances from Blue Cross Blue Shield plans and other provider-led health plans like Capital District Physicians’ Health Plan, Providence Health Plan, UPMC Health Plan, and Baylor Scott & White Health Plan. National carriers like Aetna saw selective success, while UnitedHealthcare ranked lowest in member satisfaction across 11 out of 22 measured regions.

3. Satisfaction Directly Influences Employer Plan Choices: The report emphasizes that member satisfaction is now a key competitive factor, with 20% of employers citing low employee satisfaction as a reason to switch health plans. Deductibles play a major role in satisfaction, with average deductibles remaining high ($2,847 for small employers and $2,630 for midsize) and impacting perceptions of access, cost, and trust. Plans that prioritize better engagement, education, and service improvements are better positioned to attract both members and employer clients.

Key California lawmaker calls for tight health privacy rules for AI patient data collection

By Allison Bell - Should governments try to keep artificial intelligence systems from collecting patient data, or should they simply regulate how companies use the information that the AI systems collect? California Assemblymember Rebecca Bauer-Kahan, D-San Ramon, Calif., said Wednesday that California should regulate AI systems' efforts to collect patient data, not just potentially harmful uses of the data. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Regulatory gaps between large and small health systems: Bauer-Kahan emphasized that smaller healthcare providers often lack the leverage or resources to negotiate robust data protection agreements when adopting AI tools like scribe systems, leaving patients more exposed to privacy risks. In contrast, larger health systems, with greater clout, can secure stronger contractual safeguards — highlighting a widening gap in how patient privacy is protected across different parts of the healthcare system.

2. Global ripple effects of California’s health AI laws: Given California’s status as the world’s fifth-largest economy and its regulatory authority over Silicon Valley’s tech giants, the state’s evolving approach to health AI laws — whether focusing on regulating data collection (upstream) or on how data is ultimately used (downstream) — could serve as a blueprint for national and international regulatory frameworks, setting global precedents in health AI governance.

3. Debate over regulating data use vs. collection: Experts like Dr. Obermeyer stressed that focusing regulatory efforts on downstream uses of health data, such as enforcing bans on discriminatory underwriting or harmful applications, may provide more precise and effective safeguards without stifling innovation. Overly restricting upstream data collection, by contrast, could inadvertently block the development of lifesaving AI tools, affecting not only healthcare providers but also employer health plans, insurers, and patients relying on advanced digital health solutions.

Benefits Think: Why becoming a fiduciary adviser is good for business

By Al Lewis - Is becoming a fiduciary adviser good for business? The short answer is, as of middle May, yes. The Sixth Circuit just held that a third-party administrator (TPA) creating an excessive, conflicted and undisclosed fee structure likely violated an implied fiduciary obligation to the plan sponsor. It would be very easy to infer that if a TPA is exposed to liability for excessive revenues, an adviser being commissioned on those excessive revenues also could be liable. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Definition and Legal Responsibility of a Fiduciary: A fiduciary is someone legally obligated to act in the best interest of the people they serve, setting aside personal interests — a much stricter role than a typical broker or adviser. Under ERISA, private-sector health plan sponsors and designated managers are ERISA Fiduciaries, personally liable for decisions on behalf of the plan. Many employers and individuals are unaware they carry this legal responsibility, but ignorance is no defense under the law.

2. What It Means to Be a Fiduciary Adviser: While there’s no formal legal definition for fiduciary advisers, best practices include full transparency around all forms of compensation — no hidden fees, overrides, or side deals. Fiduciary advisers disclose any financial relationships, commissions, or bonuses, ensuring clients understand how the adviser is paid and eliminating undisclosed conflicts of interest that are common in the industry, particularly with entities like pharmacy benefit managers (PBMs).

3. The Business Case for Becoming a Fiduciary Adviser: Although acting as a fiduciary may initially reduce income by eliminating hidden revenue streams, over time it builds trust, accountability, and competitive advantage. Advisers can reduce liability exposure and position themselves as ethical partners, helping clients understand their own ERISA fiduciary risks and pushing for clear, documented fiduciary commitments. Transparency in fees, whether through direct consulting or credited commissions, aligns with a market shift increasingly favoring openness in health benefits.

UnitedHealth allegedly paid nursing homes to limit hospital transfers, risking patient health

By Alan Goforth - UnitedHealth Group allegedly made secret bonus payments to nursing homes to cut costs by reducing hospital transfers, according to an investigation by The Guardian. The insurance giant offered nursing homes financial rewards through an incentive program that prevented some residents from receiving critical care at hospitals, the report said. These payments have saved the company millions of dollars but at times have risked the health of residents. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. UnitedHealth Allegations and Federal Investigations: A detailed Guardian investigation claims UnitedHealth embedded its own medical teams inside nursing homes specifically to cut care costs, allegedly resulting in delayed or denied hospital transfers for seriously ill residents — with at least one patient suffering permanent brain damage. While UnitedHealth firmly denies these claims, stating they are “verifiably false,” the company emphasizes that the Department of Justice conducted a multiyear investigation, reviewed extensive evidence, and ultimately decided not to pursue legal action.

2. Financial Incentive Structures and Care Impact: UnitedHealth’s “Premium Dividend” and “Shared Savings” programs financially rewarded nursing homes for maintaining low hospital admissions, tracked by the metric admits per thousand (APK). A low APK triggered bonus payments, while a high APK disqualified facilities from extra funds — creating what former executives describe as a strong profitability-driven motive to avoid hospital transfers, even when patient care was at risk, raising serious ethical and operational concerns.

3. Wider Corporate Turmoil and Investor Fallout: This latest controversy compounds an already tumultuous year for UnitedHealth, which has faced a damaging cyberattack last summer, the murder of an executive in December, multiple lawsuits, and heightened federal scrutiny. Following the release of the Guardian story, UnitedHealth shares slid sharply in trading, reflecting heightened investor anxiety over reputational risks and possible Medicaid and Medicare funding cuts — with the company’s stock losing nearly 50% of its value since peaking in April.

Financial Stress Rises As HR Pros Prioritize Retention: Morgan Stanley at Work Study

By Business Wire - Morgan Stanley at Work today issued new data from its fifth annual State of the Workplace Financial Benefits Study. Amid heightened concerns around inflation and the economy—including fears of a possible recession—the data reveals that companies and employees alike are feeling increased pressure. As financial stress rises, this research underscores the strategic importance of workplace financial benefits both as a perceived safe port in the storm and as a key support for financial outcomes for employees and strategic employment priorities for organizations. Read Full Announcement…

HVBA Article Summary

1. Rising financial stress is impacting work, and employees want help: Two-thirds (66%) of employees report that financial stress is hurting their work and personal life, a rise from last year, and 83% of HR executives are worried about its effect on productivity. Over 80% of employees (especially Gen Z) believe their employers should play a more active role in addressing their financial challenges, signaling a clear demand for stronger workplace financial support.

2. Financial benefits boost employee retention and align with company goals: HR executives rank hiring, retention, and technology investment (including AI integration) as top strategic priorities, and they recognize that financial benefits reducing employee stress are critical for retention. A striking 91% of employees say they’d feel more committed to staying if their company offered benefits tailored to their personal financial needs, with key priorities including savings, long-term investments, and debt reduction.

3. Companies and employees agree more education and alignment are needed: While many HR leaders (93%) and employees (85%) agree that companies need to better help staff understand and maximize financial benefits, 80% of HR leaders report employee requests for support types not currently offered. Effective benefit programs, especially during key financial moments like tax season or company liquidity events, are seen as crucial for both individual financial success and overall company performance.