House committee approves two employer health benefits bills

By Allison Bell - Members of the House Education and Workforce Committee have approved two bills that could help small employers copy big employers' health benefits strategies. The committee voted 21-15 to recommend the Association Health Plan Act bill and 21-15 to recommend the Self-Insurance Protection Act bill. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Partisan Division Over Healthcare Legislation: The House Education and the Workforce Committee advanced two healthcare bills with unanimous Republican support and near-unanimous Democratic opposition, highlighting a strong partisan divide. The legislation centers on expanding access to alternative health coverage options, which Republicans support as a way to increase flexibility and affordability, while Democrats view it as a threat to existing ACA protections.

2. Intended Support for Small Employers: Supporters of the bills argue that they would make it easier for small businesses, self-employed individuals, and other groups to access more affordable and customizable health coverage. By allowing Association Health Plans (AHPs) and easing restrictions on self-insured plans using stop-loss insurance, the bills aim to give small employers access to similar regulatory advantages and bargaining power enjoyed by large employers.

3. Democratic Concerns About ACA Undermining and Consumer Protection: Democratic lawmakers oppose the bills on the grounds that they could weaken the Affordable Care Act by creating parallel coverage options with fewer mandated benefits. They argue this could lead to risk segmentation, higher premiums in the ACA marketplace, and reduced consumer protections, particularly if stop-loss arrangements function like insurance but avoid key regulations.

Bipartisan GUARD Act Would (Finally) Make Insurers Pay — Not Just Veterans and Taxpayers

By Wendell Potter and Joey Rettino - The insurance industry has pulled off a multi-billion-dollar heist for years — one that’s come at the direct expense of America’s veterans and the taxpayers who want to support them. But now, in a rare act of bipartisan sanity, Congress has the chance to stop it. Lawmakers have introduced the Guarantee Utilization of All Reimbursements for Delivery of Veterans’ Health Care Act, or GUARD Veterans’ Health Care Act. Read Full Article…

HVBA Article Summary

1. Current Policy Enables Double Billing: A loophole in Medicare Advantage (MA) and Part D programs allows private insurers to collect full payments from the federal government for veteran care, even when that care is actually delivered by the Department of Veterans Affairs (VA). This results in taxpayers effectively paying twice—once through Medicare and again through VA funding—for services only rendered once.

2. Financial and Systemic Consequences: This duplicative payment structure is projected to cost up to $357 billion over the next decade. It diverts resources away from the VA, which generally provides higher-quality and more cost-effective care, and contributes to a fragmented system. Additionally, programs like the Veterans Community Care Program have faced scrutiny over inflated costs, poor oversight, and questionable billing practices.

3. Proposed Legislation Aims for Reform: The GUARD Act seeks to address this issue by allowing the VA to recover payments for care it provides to veterans enrolled in MA or Part D plans. This would help align the billing system with standard insurance practices, reduce wasteful spending, and ensure taxpayer dollars are reinvested into strengthening the VA’s healthcare services for veterans.

Louisiana AG Files 3 Lawsuits Against CVS Alleging Unfair, Deceptive, and Unlawful Practices

By Katabella Roberts - Louisiana Attorney General Liz Murrill announced on June 24 that she has filed three separate lawsuits against pharmacy chain CVS, accusing it of engaging in unfair, deceptive, and unlawful practices that have “harmed Louisiana patients, independent pharmacies, and the public at large.” Read Full Article…

HVBA Article Summary

1. Allegations Against CVS: The State of Louisiana has filed three lawsuits against CVS and its affiliates, accusing the company of using its vertically integrated pharmacy benefit management (PBM) structure to unfairly influence drug pricing, harm independent pharmacies through high fees and restrictive practices, and misuse customer data for political lobbying.

2. Legal and Regulatory Concerns: The lawsuits seek injunctive relief and restitution, asserting that CVS's practices violate Louisiana’s Unfair Trade Practices and Consumer Protection Law. The state alleges CVS engaged in deceptive conduct, including spread pricing and leveraging customer data obtained through state contracts without proper consent.

3. CVS’s Defense: CVS denies the allegations, stating its actions complied with the law and that its integrated model offers lower costs and broader access. The company argues that limiting or removing CVS services in Louisiana would financially harm the state and its residents.

CMS head urges PBMs to end drug rebates

By Alexandra Murphy - CMS Administrator Mehmet Oz, MD, is calling on the nation’s largest pharmacy benefit managers to voluntarily abandon the current drug rebate model, or risk its elimination by the government, Bloomberg reported June 24. Read Full Article…

HVBA Article Summary

1. Potential Shift in PBM Practices: Dr. Oz indicated that there may be a current opportunity for the three largest pharmacy benefit managers (PBMs) to consider ending the longstanding rebate or kickback system, where drugmakers make payments to PBMs after prescriptions are dispensed. This shift could represent a significant change in how prescription drug pricing is managed.

2. Renewed Policy Interest: The Trump administration appears poised to revisit previous efforts to eliminate these post-sale payments to PBMs, signaling a renewed focus on increasing transparency and potentially reducing prescription drug costs through structural reform.

3. Market Dominance and Legislative Inaction: Despite CVS Health, UnitedHealth Group, and Cigna collectively controlling around 80% of all U.S. prescriptions, bipartisan proposals to reform PBM operations have stalled in Congress, with no major legislation yet passed to address concerns over pricing practices.

Hospital costs account for one-third of nation’s overall health care spending

By Alan Goforth - Although pharmaceutical companies and insurance providers receive much of the attention, hospitals -- especially nonprofit systems -- are the primary driver of health care cost inflation and systemic inefficiency. In 2023, Americans spent more than $1.5 trillion at hospitals, accounting for nearly one-third of total health care expenditures, a new report from the Center for Medicine in the Public Interest found. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Lack of Price Transparency and Oversight: Despite federal efforts, including those under the Trump administration, nearly 80% of hospitals were still not complying with transparency rules as of last year. This lack of accountability has led to patient confusion and unexpected costs. In response, both federal and state officials are beginning to take action through executive orders, subpoenas, and new legislation aimed at enforcing transparency in hospital billing practices.

2. Rising Costs and Inefficient Models: Over the past 25 years, hospital service prices have dramatically increased, far surpassing inflation. Fee-for-service payment structures incentivize hospitals to perform more procedures—regardless of medical necessity—resulting in costly, inefficient, and sometimes unnecessary care. The report highlights these systemic inefficiencies, including administrative bloat and duplicate services, as major contributors to the rising cost of healthcare.

3. Calls for Reform and Legislative Action: The report outlines several proposed reforms to address the disconnect between hospital operations and patient needs. These include requiring clear, upfront pricing from hospitals, standardizing payments regardless of care setting, tying nonprofit hospital status to measurable community benefits, and implementing stricter oversight of executive pay. These measures aim to shift healthcare priorities from revenue generation to patient well-being and operational transparency.

Healthcare’s broken math: 11 signs the numbers don’t add up

By Scott Becker and Molly Gamble - Healthcare has a daunting and growing supply and demand problem. We have a growing population in the United States and not enough physicians, nurses, allied healthcare providers and technicians. It is a very clear and simple math problem. We have approximately 340 million people in the United States and only about 840,000 direct patient care physicians and about 5.3 million nurses. Similarly, we face shortages across the board in other provider types and critical staff roles. Read Full Article…

HVBA Article Summary

1. Worsening Workforce Shortages in U.S. Healthcare: The U.S. is facing a growing supply-demand imbalance in healthcare, with physician and nurse production barely replacing those retiring or reducing hours. Primary care is especially affected, and geographic disparities leave rural and low-income areas critically underserved. Despite increased training efforts, projections show continued shortages over the next decade.

2. Equity and Access at Risk: These shortages are fueling systemic inequities. Wealthier, connected patients gain easier access through concierge and self-pay models, while those with fewer resources face longer wait times and diminished care. Dependence on personal networks for timely care undermines fairness, and older patients are especially vulnerable as retiring physicians are not being replaced quickly enough.

3. Comprehensive Solutions Required: Addressing the crisis demands a dual approach: expanding the provider workforce and optimizing care delivery. This includes streamlining medical education, leveraging non-physician clinicians, enacting targeted policy reforms, and integrating supportive technologies. However, technology alone cannot compensate for the scale of the provider shortage.

‘Twincretin’ Weight Loss Scales Up Cardiometabolic Gains

By Jo Shorthouse - Patients who lose weight taking the drug tirzepatide experience robust improvements in cardiometabolic health, gains that appear to increase with the extent of pounds lost, researchers have found. The findings from a post hoc analysis of the SURMOUNT-1 trial confirm the close association between weight loss and improvements in cardiovascular risk factors and point to potential trajectories patients may experience when taking the medication, experts said. Read Full Article… 

HVBA Article Summary

1. Weight Loss with Tirzepatide Shows Dose-Dependent Cardiometabolic Benefits: In a post hoc analysis of the SURMOUNT-1 trial, tirzepatide-induced weight loss in individuals without diabetes was associated with linear improvements in several cardiometabolic markers — including blood pressure, insulin resistance, glycemic control, and lipid profiles — with each additional 5% of weight reduction producing measurable benefits.

2. Even Modest Weight Loss Leads to Clinically Relevant Improvements: Participants who lost between 5% and 10% of their body weight experienced significant health gains, such as reductions in systolic/diastolic blood pressure, hemoglobin A1c, and insulin resistance. These findings support the clinical value of relatively modest weight loss targets in managing cardiometabolic risk.

3. Findings Inform Individualized Treatment Targets but Are Limited by Study Design: While the analysis helps guide personalized weight loss goals based on specific health outcomes, its post hoc nature and exclusion of placebo participants limit generalizability. Additionally, long-term cardiovascular outcomes were not assessed and remain under investigation.