New surprise billing fix may not reduce disputes

By Maya Goldman – A new bid to fix the process for resolving surprise billing disputes may not make a dent in the massive backlog of cases. Why it matters: Providers and insurers have been sparring over how to settle claims for out-of-network services almost from the moment Congress protected privately insured patients from getting stuck with huge, unexpected costs. - More than 5 million claims have gone to arbitration since 2022, and many remain unresolved. Driving the news: The Trump administration last week finalized a plan to streamline arbitration by expanding which disputed items and services can be lumped together. Read Full Article...

HVBA Article Summary

1. Streamlined Arbitration Process May Increase Disputes: The new plan aims to make arbitration more efficient by allowing more claims to be grouped together and lowering administrative fees. However, analysts predict these changes could actually lead to a higher volume of disputes rather than reducing the existing backlog. This is because the process becomes more accessible and less costly, encouraging more providers to enter arbitration.

2. Mixed Reactions from Stakeholders: Providers and some analysts believe the changes could benefit smaller and independent medical practices by making dispute resolution more attainable. On the other hand, insurance industry representatives argue that the rule favors providers and could drive up overall health care costs. There are concerns that private-equity-backed practices and middlemen may exploit the system, potentially leading to higher payouts and increased costs for patients.

3. Unresolved Issues and Future Uncertainty: The plan does not address how to calculate the median in-network rate, a key benchmark in negotiations, which remains under judicial review. Some details of the new process are yet to be clarified and may be subject to future guidance or legal challenges. Stakeholders are watching to see if the changes will ultimately reduce the backlog or if further reforms will be necessary.

CMS outlines new Medicaid work requirements, exemptions and $600M tech investment

By Chad Van Alstin – New work requirements for Medicaid established as part of last year’s One Big Beautiful Bill Act are set to go into effect in 2027, and now the details are being finalized. The new rules will impact state Medicaid programs funded by the federal government. All new barriers to Medicaid entry will go into place on Jan. 1, unless states decide to opt into them earlier. Broadly, the new requirements for Medicaid eligibility will impact all adults in the U.S. from age 19-34, who are not pregnant and deemed able-bodied to work. Read Full Article...

HVBA Article Summary

1. New Medicaid Work Requirements: Beginning in 2027, adults aged 19-34 who are not pregnant and are considered able-bodied will be subject to new work requirements to qualify for Medicaid. These changes are part of the One Big Beautiful Bill Act and will be implemented across state Medicaid programs that receive federal funding. States have the option to adopt these requirements earlier if they choose.

2. Exemptions and Reporting Changes: The new rules include exemptions for individuals who are disabled, frail, or otherwise unable to work, as well as for half-time college or trade school students. States will face updated reporting requirements to ensure compliance with the new eligibility standards. The Centers for Medicare & Medicaid Services (CMS) is providing support to states through advancements in data technology to streamline these processes.

3. $600 Million Technology Investment: CMS is allocating $600 million to upgrade health IT systems, aiming to improve efficiency and transparency in Medicaid eligibility and appeals processes. The new data infrastructure is expected to be operational by 2028, providing patients with greater insight into their eligibility and simplifying paperwork submission. CMS leadership has emphasized the importance of safeguards for technology vendors and a balanced approach to reducing fraud while maintaining access for those in need.

Individual HSA contribution limit to rise 2.27% in 2027

By Allison Bell – The Internal Revenue Service says important numbers at the heart of personal health benefit account programs will rise by about 2% to 3% in 2027. The IRS announced the new, inflation-adjusted parameters for health savings accounts and some health reimbursement arrangements in Revenue Procedure 2026-24. For individual contributions to HSAs, for example, the annual contribution limit will increase to $4,500, from $4,400, and the minimum deductible will increase to $1,750, from $1,700. For some types of health reimbursement arrangements, the maximum employer contribution will increase to $2,250, from $2,200. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. IRS Announces Modest Increases for 2027: The IRS has set new contribution and deductible limits for health savings accounts (HSAs) and certain health reimbursement arrangements (HRAs) for 2027, reflecting inflation adjustments. These increases are based on the Chained Consumer Price Index for All Urban Consumers, which rose by 2.19% overall, while the medical care component increased by 2.77%. The changes mean that individuals and employers will be able to contribute slightly more to these accounts, but the growth is modest compared to rising health care costs.

2. Impact on Account Holders and Health Care Costs: While the limits for HSA and HRA contributions are rising, the rate of increase is not keeping pace with the growth in medical expenses. Workers who maximize their contributions may still find it challenging to cover increasing health care costs, as the annual out-of-pocket maximums and deductibles are also climbing. This underscores the ongoing pressure on consumers to manage health care spending despite tax-advantaged savings opportunities.

3. Direct Primary Care and Legislative Updates: The IRS notice for 2027 also clarifies how much HSA funds can be used for direct primary care (DPC) membership fees, a provision enabled by the One Big Beautiful Bill Act of 2025. For 2027, HSA owners can spend up to $150 for individuals and $300 for families on DPC memberships without incurring penalties or extra taxes. This development offers more flexibility for HSA holders seeking predictable costs for routine health care services.

Biologics Continue to Transform Psoriasis Care, Giving Physicians and Patients More Options

By Damian McNamara, MA – Biologics continue to transform the treatment of psoriasis. Dermatologists use terms such as “night and day,” “profoundly different,” and “amazing” to describe the biologics era compared with treatment before biologics became available. Despite these advances, however, challenges remain, with few patients facing high treatment costs, inequitable access, or a lack of response to a particular biologic, whereas few experience an initial benefit that starts to wear off over time. And regardless of their effectiveness in treating psoriasis, an unanswered question remains: How long do patients need to stay on biologic therapy to maintain their response? Read Full Article...

HVBA Article Summary

1. Biologics Have Dramatically Improved Psoriasis Outcomes: The introduction of biologic therapies has significantly changed the landscape of psoriasis treatment, offering rapid and effective disease control for many patients. Dermatologists report that these treatments can induce remission in a majority of moderate-to-severe cases, a stark contrast to the limited and often toxic options available in the past. This shift has led to improved patient quality of life and increased demand for advanced therapies.

2. Multiple Biologic Options and Ongoing Research: There are now several classes of biologics available, including IL-17 and IL-23 inhibitors, which have shown high efficacy in clinical studies. Comparative research indicates that some biologics outperform others in achieving near-complete skin clearance, and ongoing studies are exploring even longer-acting agents and new oral therapies. The field continues to evolve, with both injectable and oral targeted treatments expanding the range of options for patients.

3. Challenges Remain Regarding Access, Cost, and Long-Term Management: Despite their effectiveness, biologics can be expensive and access may be limited by insurance formularies and administrative hurdles. Some patients may lose response over time or require ongoing therapy to maintain remission, raising questions about optimal treatment duration. Researchers are working to address these issues by developing therapies with longer dosing intervals and by investigating strategies to sustain remission with less frequent treatment.

Alternative health plans: The expectation of familiarity and the execution gap

By Al Rogers – Employers aren't exploring alternative health plans out of curiosity. Rising healthcare costs continue to strain budgets, and traditional models leave little room to manage that pressure. Employers face a 9% increase in healthcare costs this year, forcing many organizations to reevaluate whether their current approach is sustainable. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Rising Costs Drive Interest in Alternatives: Employers are increasingly considering alternative health plans as a response to escalating healthcare expenses and the limitations of traditional insurance models. The pressure of rising costs is prompting organizations to seek solutions that offer more control and predictability in their benefits spending. This shift is not driven by a desire for novelty, but by necessity and the need for sustainable cost management.

2. Operational Execution Is Critical for Success: While alternative health plans may promise cost savings and flexibility, their success largely depends on reliable operational infrastructure. Employers and employees expect these plans to function with the same dependability as traditional options, including timely payments and clear processes. When operational issues arise, such as delays or confusing workflows, the perceived risks can outweigh the theoretical benefits, making adoption less attractive.

3. ICHRAs and Infrastructure Shape the Future: Individual Coverage Health Reimbursement Arrangements (ICHRAs) are gaining traction, with significant year-over-year growth among larger employers. However, the long-term viability of ICHRAs and similar models will be determined by their ability to deliver familiar, stable experiences and integrate seamlessly with existing systems. The article emphasizes that innovation in health benefits must be matched by operational maturity to earn employer trust and achieve lasting adoption.

Patients with treatment-resistant depression are costing Medicare big

By Anastassia Gliadkovskaya – A patient with treatment-resistant depression (TRD) costs Medicare 21%, or $8,000, more annually than a patient with depression that is controlled. So finds a new report from Health Management Associates (HMA), a health policy consulting firm. The report aimed to quantify the direct economic impact of the condition, looking at Medicare claims data from 2022 and 2023 for its analysis. The firm identified major depressive disorder claims that included at least one inpatient encounter or at least two hospital outpatient claims within a year. Read Full Article...

HVBA Article Summary

1. Significant Financial Burden on Medicare: Treatment-resistant depression (TRD) leads to substantially higher costs for Medicare compared to controlled depression. The majority of these expenses are attributed to increased hospitalizations, prescription medications, and more frequent physician visits. This highlights the need for targeted strategies to manage TRD more effectively within the Medicare population.

2. Intensive and Costly Interventions: Patients with TRD often require advanced treatments such as transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT), which are associated with much higher annual costs. These interventions not only increase direct medical spending but also reflect the complexity and severity of managing TRD. The report underscores that these therapies, while beneficial for some, contribute significantly to the overall economic impact.

3. Call for Innovative Solutions: The analysis points out that TRD remains a challenging and underserved area in mental health care, with current interventions being both expensive and not universally effective. The consulting firm emphasizes the need for scalable, long-lasting solutions that can improve both symptoms and daily functioning for TRD patients. Policymakers, clinicians, and researchers are encouraged to prioritize this issue to achieve better outcomes and reduce the economic strain on the healthcare system.

AI-driven change is intensifying mental health needs. Leaders may not be ready.

By Ryan Golden – Employers already faced significant challenges in addressing employees’ mental health issues, but the rapid pace of workplace transformation seen throughout 2026 seems all but certain to further intensify a thunderous storm. Recent surveys of workers have borne out those concerns. The first quarter of the year marked a 65% increase in burnout reported by Glassdoor users compared to the same point in 2025. A separate May report by Monster found that 59% of employee respondents said their job actively hurts their mental health. Read Full Article...

HVBA Article Summary

1. AI’s Dual Impact on Mental Health: The integration of artificial intelligence in the workplace is a major driver of both anxiety and opportunity for employees. While some workers are energized by AI’s potential, many experience fears of job displacement and skill erosion, which can negatively affect their focus and well-being. The way organizations implement AI—including transparency, ethical guidelines, and reskilling efforts—will ultimately determine whether its impact on mental health is positive or negative.

2. Leadership Readiness and Organizational Culture: Many current leadership behaviors, such as relentless work habits and constant availability, may unintentionally undermine mental health initiatives. Experts suggest that promoting resilience, empathy, and psychological safety among leaders is crucial for creating a healthier work environment. Without these qualities, even well-intentioned mental health policies and benefits may fall short if day-to-day management practices do not support employee well-being.

3. Structural and Holistic Approaches Needed: Addressing mental health in the workplace requires more than just offering benefits or awareness campaigns. Organizations are encouraged to adopt structural changes like flexible scheduling, clear communication, and support for caregivers, as well as leadership training focused on psychological safety. Recognizing that employees’ work and personal stressors are interconnected, companies should strive to create environments where energy can be replenished and high performance is sustainable.

About 8% of the country lacked health insurance in 2025, new data shows. That could rise next year

By Mike Stobbe and Al Swenson – The proportion of Americans without health insurance held steady at around 8% of the population in 2025, according to new findings from the U.S. Centers for Disease Control and Prevention. The national survey results, released Thursday, show the all-ages uninsured rate has stayed significantly down from where it was several years ago, but the ranks of the uninsured could soon expand as the Trump administration’s sweeping changes to the health landscape begin to take hold. Massive changes to Medicaid, the government’s safety-net health program for low-income Americans, passed into law last year could result in 10 million more uninsured individuals over a decade, according to Congressional Budget Office estimates. Read Full Article...

HVBA Article Summary

1. Uninsured Rate Remains Stable but May Increase: The share of Americans without health insurance remained at about 8% in 2025, maintaining a lower rate compared to previous years. However, policy changes such as Medicaid cuts and the end of certain Affordable Care Act subsidies are expected to drive the uninsured rate higher in the near future. These changes could reverse recent progress in expanding health coverage.

2. Policy Shifts Could Affect Millions: Congressional Budget Office estimates suggest that recent Medicaid changes could lead to 10 million more uninsured people over the next decade. The expiration of ACA subsidies is also projected to result in around 5 million fewer people enrolling in marketplace plans in 2026 compared to 2025. These figures highlight the significant impact that federal and state policy decisions can have on health insurance coverage.

3. Coverage Trends Influenced by Demographics and Legislation: While most Americans over 65 are covered by Medicare, younger populations rely on a mix of public and private insurance, making them more vulnerable to policy changes. Historical data shows that uninsured rates have fluctuated with legislative actions, such as the Affordable Care Act and pandemic-era protections. Experts agree that future uninsured rates will depend heavily on decisions made by lawmakers and agencies at both the federal and state levels.