Health Insurance Industry Promises Reforms After $476 Million PR and Lobbying Campaign

By Wendell Potter - AHIP, the big PR and lobbying outfit for most health insurers, undoubtedly believes the praise it got from Trump administration officials and some members of Congress this week – when it announced changes insurers presumably will make voluntarily to alleviate the burden of prior authorization demands on patients and health care providers – has taken the heat off insurers. Read Full Article…

HVBA Article Summary

1. Massive Lobbying Expenditures: Since 2020, the health insurance industry—including trade groups like AHIP and BCBSA, along with major insurers such as UnitedHealth, Cigna, and CVS/Aetna—has spent an estimated $476.5 millionlobbying Congress and federal agencies. This money has largely been directed toward maintaining the status quo, defending profitable practices like prior authorization, and shielding Medicare Advantage and pharmacy benefit managers from stricter regulations.

2. Skepticism Toward Industry Self-Regulation: Despite AHIP’s public assurances that insurers can be trusted to act in the public interest without new legislation, critics—particularly former insiders—argue that AHIP functions primarily as a lobbying and PR organization with no real enforcement power. The article contends that these assurances are not credible given the industry’s longstanding profit-driven behavior and resistance to reform.

3. Imbalance in Advocacy Resources: The article highlights a stark disparity in resources between the health insurance industry and patient advocacy groups. While reform-minded organizations operate on modest budgets, the industry leverages hundreds of millions of dollars for lobbying, advertising, and political influence, making it significantly harder for reforms that prioritize patient care over corporate profits to gain traction.

Insurers promised to ease prior authorization. Providers expect them to deliver

By Paige Minemyer - While major provider organizations welcomed insurers' pledge earlier this week to reform prior authorization, these groups withheld praise without yet seeing the efforts bear fruit. Bobby Mukkamala, M.D., president of the American Medical Association (AMA), said in a statement that patients and physicians both will need to see the promises made yield significant results to ease the headaches around prior auth. Read Full Article…

HVBA Article Summary

1. Insurers' New Pledge Reflects Longstanding Concerns: The recent pledge by health insurers to improve prior authorization processes mirrors many of the priorities outlined in a 2018 consensus statement from major healthcare organizations. These include reducing the number of authorizations required, preserving continuity of care for patients, and increasing the use of automation. Industry leaders stress that while the pledge is a positive step, it must be followed by clear, measurable actions to ensure real progress.

2. Skepticism and Demand for Accountability: Although the healthcare community is encouraged by the acknowledgment that the current system is burdensome and inefficient, organizations like the AMA, AHA, and Premier emphasize that voluntary pledges alone are not sufficient. They call for enforceable reforms and regulatory oversight to guarantee that changes are actually implemented and that care decisions remain in the hands of patients and their providers.

3. Potential for Broader Impact if Changes Are Realized: Expanding reforms already required in Medicare Advantage and Medicaid managed care to the commercial insurance market could significantly reduce administrative burdens, improve access to timely care, and help mitigate clinician burnout. Stakeholders express optimism but also underscore the need for ongoing collaboration, transparency, and monitoring to ensure the proposed improvements are effectively and consistently applied across the healthcare system.

ACA marketplace enrollment could shrink by half: 5 numbers to know

By Rylee Wilson - Marketplace enrollment could decline between 47% and 57% if premium tax credits expire and proposed changes in Congress become law, according to an analysis from Wakely, a healthcare market research firm. The “One Big Beautiful Bill,” a 1,000+ page budget reconciliation package, would limit marketplace eligibility for some lawfully present immigrants and will eliminate passive re-enrollment in plans each year. Read Full Article…

HVBA Article Summary

1. Expiration of Enhanced Subsidies Could Significantly Reduce Enrollment: Wakely projects that if Congress does not extend the enhanced subsidies set to expire at the end of 2025, between 25% and 30% of current marketplace enrollees may no longer purchase coverage. This loss of subsidies is expected to be the primary driver behind the projected decline in enrollment across the individual insurance marketplace.

2. Marketplace Enrollment Is Expected to Decline Broadly Across Populations: According to the analysis, overall marketplace enrollment could decrease by 11.2 to 13.6 million individuals due to a combination of policy shifts, including proposed changes to eligibility checks and enrollment periods. While most of the losses are expected among subsidized members, even unsubsidized individuals may opt out due to estimated premium increases ranging from 7% to 11.5%.

3. States Without Medicaid Expansion Will Be Disproportionately Affected: The analysis indicates that states which have not expanded Medicaid under the Affordable Care Act could see especially steep drops in marketplace enrollment, with declines ranging from 53% to 64%. This highlights the regional disparities in how upcoming policy and subsidy changes could impact access to affordable healthcare coverage.

Cigna faces lawsuit over use of web trackers from Meta and other companies

By Allison Bell - A California resident is suing three subsidiaries of Cigna and other parties in a state court in Sacramento, California, over allegations that the company's use of website tracking tools violated her privacy. The plaintiff, Myriah Avalos, is seeking to represent a class that would consist of all California residents who entered personal medical information into Cigna's website before January 2015. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Allegations of Privacy Violations: The plaintiff alleges that Cigna violated several California privacy laws—most notably the Confidentiality of Medical Information Act—by allowing third-party tracking tools on its website to collect users’ sensitive health-related data, such as symptom descriptions, without obtaining prior user consent.

2. Nature of the Data Collection: According to the complaint, the embedded trackers from entities like Meta, Pinterest, and Snapchat recorded users’ real-time interactions on the site, including mouse movements, clicks, keystrokes, and URLs visited. The plaintiff asserts this information was neither anonymized nor restricted from being used by those third-party companies for their own purposes.

3. Legal Context and Broader Impact: The lawsuit also invokes the California Consumer Privacy Act, Invasion of Privacy Act, and business competition laws, reflecting the state’s strong stance on data protection. Similar legal actions have been brought against other health insurers, such as Blue Shield of California and the SAG-AFTRA health plan, under California's wiretapping and medical data confidentiality laws.

National Health Expenditure Projections, 2024–33: Despite Insurance Coverage Declines, Health To Grow As Share Of GDP

By Sean P. Keehan, Andrew J. Madison, John A. Poisal, Gigi A. Cuckler, Sheila D. Smith, Andrea M. Sisko, Jacqueline A. Fiore, and Kathryn E. Rennie - National health expenditures are projected to have grown 8.2 percent in 2024 and to increase 7.1 percent in 2025, reflecting continued strong growth in the use of health care services and goods. During the period 2026–27, health spending growth is expected to average 5.6 percent, partly because of a decrease in the share of the population with health insurance (related to the expiration of temporarily enhanced Marketplace premium tax credits in the Inflation Reduction Act of 2022) and partly because of an anticipated slowdown in utilization growth from recent highs. Read Full Article…

HVBA Article Summary

1. Health Spending Growth to Outpace Economic Growth Through 2033: Over the 2024–2033 period, national health care expenditures are projected to grow at an average annual rate of 5.8%, consistently outpacing GDP growth, which is expected to average 4.3% per year. This sustained differential is projected to result in the health sector accounting for a larger share of the economy—rising from 17.6% of GDP in 2023 to 20.3% by 2033—highlighting ongoing pressure on the economic burden of health care.

2. Temporary Policy Measures Drive Enrollment and Spending Volatility (2024–2026): Health insurance coverage and spending trends between 2024 and 2026 are shaped by the phasing out of temporary policy measures, including the FFCRA’s Medicaid continuous enrollment requirement and the IRA’s enhanced Marketplace subsidies. As these provisions expire, enrollment in Medicaid and direct-purchase plans is projected to decline, contributing to a slight drop in the insured rate and leading to slower growth in private insurance spending after a sharp rise in 2024.

3. Medicare Spending Projected to Grow the Fastest Among Payers: Medicare is projected to experience the highest rate of spending growth among major payers, averaging 7.8% annually from 2024 to 2033. This is largely due to continued enrollment of aging baby boomers and increased service utilization. However, provisions in the Inflation Reduction Act—such as the $2,000 cap on out-of-pocket drug costs and new drug price negotiation authority—are expected to help temper prescription drug spending within the Medicare program during the latter part of the projection period.

Benefits Think: Making the business case for hearing benefits

By Jeremy Oswald - As HR professionals, we constantly seek ways to enhance employee well-being while maximizing business outcomes. One benefit that remains surprisingly overlooked — despite its significant impact on workplace productivity and employee retention — is hearing coverage. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Hearing benefits boost productivity and communication: Untreated hearing loss can significantly hinder employees' ability to listen, understand, and engage during meetings, training, and day-to-day interactions. By providing hearing care, companies can enhance workplace communication, reduce burnout, and foster greater participation, leading to improved overall productivity.

2. Low cost, high return investment: Hearing benefits are surprisingly affordable, with options starting as low as $0.05 per member per month — far less than dental or vision coverage. Despite the minimal cost, the return is substantial in terms of employee satisfaction, reduced frustration, and increased workplace performance.

3. Improves recruitment and retention: In a competitive job market, hearing benefits can serve as a key differentiator. With 40% of employees more likely to stay and 34% more inclined to join companies that offer this support, providing hearing coverage helps attract and retain talent while promoting a culture of care and inclusion.

Dual-Target Weight Loss Treatment Shows Promise

By Megan Brooks - Amycretin — a novel experimental molecular targeting both the glucagon-like peptide 1 (GLP-1) and the amylin receptor — has shown promise for weight management in early-phase clinical trials. Administered as a once-weekly injection or daily oral pill, Amycretin was generally well tolerated and led to weight loss at the highest doses tested in adults without diabetes and with overweight or obesity. Read Full Article… 

HVBA Article Summary

1. Amycretin Shows Promising Weight Loss Effects: In early clinical trials, amycretin—a novel drug that activates both GLP-1 and amylin receptors—demonstrated substantial weight loss benefits. Participants receiving the highest injectable dose lost up to 24% of their body weight over 36 weeks, while those on the highest oral dose lost an average of 13.1% over 12 weeks. These results suggest superior weight-loss potential compared to existing oral obesity medications over similar durations.

2. Tolerability and Safety Profile Encouraging but Requires Further Study: Amycretin was generally well tolerated, with the most common side effects being gastrointestinal issues like nausea and vomiting, as well as decreased appetite. These effects were dose-dependent and mostly mild or moderate. However, limitations such as small sample sizes, variable dosing regimens, and a high dropout rate—particularly in the injectable trial—highlight the need for larger, more controlled studies to confirm safety and efficacy.

3. Potential for Broader Metabolic Benefits: In addition to weight loss, amycretin therapy was associated with reductions in fasting blood glucose and improvements in glycated hemoglobin and lipid profiles. These early findings suggest that dual activation of GLP-1 and amylin receptors may offer metabolic benefits beyond weight reduction, though further research and direct comparisons with existing treatments are necessary to validate these effects.