10.9 million people would lose health insurance under Trump’s tax cut bill, CBO projects

By John Wilkerson - House Republicans’ tax bill would lead to nearly 11 million people losing health insurance, providing a key source of savings to help finance President Trump’s tax cuts, according to projections that nonpartisan congressional scorekeepers published Wednesday. Another 5.1 million people would become uninsured from a combination of expiring Affordable Care Act subsidies and new ACA rules that Trump’s health department proposed, the Congressional Budget Office said. Those coverage losses are separate from the CBO’s official score of the tax bill. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Projected Insurance Losses and Medicaid Impacts: The Congressional Budget Office (CBO) estimates that the proposed legislation would result in 16 million people losing health insurance coverage over a decade, primarily due to Medicaid cuts and the expiration of enhanced ACA subsidies. About 7.8 million individuals would lose Medicaid coverage, with 5.2 million of those losses tied to newly imposed work requirements. An additional 4.2 million people could lose coverage from the ACA marketplaces if subsidies are not renewed.

2. Fiscal Impacts and Tax Cuts: While the bill includes over $1 trillion in cuts to federal health care spending, it would still increase the federal deficit by $2.4 trillion over ten years. The deficit increase stems largely from extending and expanding Trump-era tax cuts, which alone account for $2.2 trillion. Critics argue this creates a shift in resources from low-income health coverage to tax benefits that favor wealthier individuals.

3. Policy Changes and Political Outlook: The bill introduces several structural changes to Medicaid and ACA operations, including eligibility restrictions for certain immigrants, tighter enrollment rules, and reduced flexibility for states to secure Medicaid funding. It also includes smaller reforms like PBM transparency and pausing nursing home staffing regulations. Senate Republicans are expected to revise parts of the bill—particularly around Medicaid—before aiming for passage by early July, amid debt limit negotiations.

Family Sues UnitedHealth’s Optum Rx and Walgreens Over Son’s Preventable Death

By Wendell Potter and Joey Rettino - Cole Schmidtknecht should be alive today. He was 22 — young, insured, and doing what he was supposed to do to manage his asthma. But in the blink of an eye, a behind-the-scenes price hike at the pharmacy counter turned deadly. The inhaler Cole had relied on for years — Advair Diskus — suddenly shot up in price from $70 to more than $500. He couldn’t afford it. And five days later, he was gone. Read Full Article…

HVBA Article Summary

1. Tragic Consequences of PBM Practices: The lawsuit brought by Cole Schmidtknecht’s parents against Optum Rx and Walgreens highlights how opaque and profit-driven PBM decisions can have fatal consequences. Despite having insurance and a valid prescription, Cole’s preventative inhaler was dropped from coverage without warning — neither he nor his doctor were notified, and the pharmacy did not provide an affordable alternative. The incident underscores systemic failures in communication and accountability in pharmacy benefit management.

2. PBMs Prioritize Profit Over Patient Access: Pharmacy Benefit Managers — especially the "Big Three" (CVS Caremark, Cigna’s Express Scripts, and UnitedHealth’s Optum Rx) — wield enormous power over drug pricing and access. Through formulary control and rebate-driven incentives, PBMs often favor high-priced drugs that generate larger rebates, while more affordable or medically necessary alternatives may be excluded. This profit-maximizing model often results in higher costs and limited options for patients — with little transparency or recourse.

3. Growing Bipartisan Push for PBM Reform: Cole’s story has amplified momentum in Congress for PBM reform. Lawmakers on both sides of the aisle are introducing legislation aimed at increasing transparency, banning harmful practices, and holding PBMs accountable. Industry groups funded by the major PBMs are spending heavily on advertising to maintain the status quo, but bipartisan voices — like Rep. Jake Auchincloss — are demanding change, arguing that lives and public trust are at stake.

Group term life, accidental death premiums continue pattern of positive growth rates

By Alan Goforth - Active premium growth rates increased by 5% for group term life and 3% for accidental death and dismemberment in 2024. Growth rates for both types of polices have remained positive since 2016, according to the 2024 Group Term Life Market Study from Gen Re. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Strong Growth in Group Term Life Premiums and Market Concentration: Total group term life in-force premiums rose to $33.2 billion in 2024, a 5% increase from 2023, with new sales premiums growing by 12% to $3.2 billion. The top 10 carriers dominated the market, holding 83% of new sales premium share and contributing roughly $2.7 billion.

2. Case Volume Stability, but Fewer New Covered Lives: While both new sales and in-force group term life case counts increased by 1% in 2024—continuing a positive trend since 2020—new sales lives declined by 6%, and in-force lives held flat. The majority of cases fell into smaller employer size brackets (10–99 lives accounted for 55% of new cases).

3. Premium and Face Amount Trends Signal Shifting Market Dynamics: The average face amount for new sales was $131,355, while in-force averaged $104,899. Premium-per-case rose 11% for new sales and 4% for in-force business, with monthly premium rates increasing across the board. Meanwhile, accidental death and dismemberment (AD&D) premiums saw modest 3% growth in both new and in-force categories.

3 ways AI-powered communication is curing benefits confusion

By Danielle Anderson - A recent U.S. study found that health insurers' average customer experience (CX) index score declined for the third year in a row. In an industry that should prioritize the wellbeing and peace of mind of its members, this trend is troubling. So, how can health insurers and benefits professionals work toward reversing these trends and proving to customers that they are the number one priority? Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. AI is transforming benefits navigation and access: Health care benefits remain fragmented across multiple platforms and administrators, creating confusion for patients and advisors alike. AI-powered communication tools simplify this complexity by consolidating information, streamlining access, and reducing administrative burden, helping patients better understand and use their benefits.

2. AI enhances advisor efficiency and decision support: Large language models and predictive analytics enable benefits advisors to deliver personalized, timely insights by quickly accessing plan details, eligibility changes, and potential high-cost risks. This shifts advisor focus from administrative triage to strategic guidance, improving both patient outcomes and cost efficiency.

3. AI-driven tools improve claims transparency and support: Intelligent systems can clarify the claims process, flag anomalies, and provide real-time updates, reducing patient frustration. Virtual assistants extend advisor capacity by handling routine inquiries around the clock, allowing human advisors to focus on more complex, value-added support.

Healthcare costs for average person increase 6.7% in 2025

By Jakob Emerson - Outpatient care and pharmacy costs were the main drivers of the 6.2% increase in healthcare expenses for a family of four from 2024 to 2025, according to the latest Milliman Medical Index. Milliman has tracked healthcare costs for 20 years and noted in its 2025 report that the composition of a typical family and the distribution of healthcare costs have shifted since its inception. Read Full Article…

HVBA Article Summary

1. Healthcare Costs Continue to Climb in 2025: The total cost of healthcare for a family of four with employer-sponsored insurance is projected to reach $35,119 in 2025, up from $33,067 in 2024. For an average individual, costs will rise 6.7% to $7,871, highlighting ongoing inflation in employer health plans.

2. Pharmacy and Outpatient Care Drive Increases: Pharmacy costs are expected to rise by 9.7% and outpatient facility care by 8.5% year over year—making them the top contributors to cost growth. Since 2005, outpatient facility costs have grown by 286% and pharmacy costs by 234%, far outpacing other healthcare sectors.

3. Cost Burden Shifting Slightly Toward Employees: While employers continue to cover most healthcare costs, their share has declined from 61% in 2005 to 58% in 2025. Employees now pay more via payroll deductions (rising from 21% to 27%), though out-of-pocket spending has declined slightly from 18% to 15%. Additionally, pharmacy rebates are projected to cover 31%–33% of allowed drug costs for large group commercial plans, helping offset some of the rising expenses.

DOL, HHS, Treasury Continue Push for More Health Care Pricing Transparency

By James Van Bramer - In an effort to improve price transparency in health care, the U.S. Departments of Labor, Health and Human Services and the Treasury announced new steps aimed at ensuring Americans have access to clearer cost information about medical services and prescription drugs. Read Full Article…

HVBA Article Summary

1. Federal Push for Drug Price Transparency: The Department of Labor, in coordination with other federal agencies, issued a request for public input focused on enhancing prescription drug price disclosure. This effort seeks feedback on the accessibility of pricing data for health plans, the effectiveness of current pricing formats, and innovative approaches taken by individual states to improve transparency and consumer understanding.

2. Updated Guidance to Streamline and Clarify Disclosures: The agencies released new guidance establishing clearer timelines for when health plans and insurers must publish pricing disclosures. The updates are designed to minimize the release of trivial, duplicative, or overly complex data and instead promote cost information that is clear, relevant, and useful for consumers making health care decisions.

3. Hospital Price Accuracy Requirements Expanded: The Centers for Medicare and Medicaid Services (CMS) issued new rules requiring hospitals to post the actual prices of medical items and services, replacing previous practices of listing only estimates. CMS also invited public feedback on how hospitals can improve the accuracy and completeness of their pricing data, reinforcing a broader, bipartisan effort under both Trump and Biden administrations to enforce and enhance the 2021 Hospital Price Transparency Rule.

Online Obesity Clinics Report Consistent Weight Loss With Lower Doses of Semaglutide

By Ashley Gallagher - Patients utilizing online obesity clinics have similar weight loss as reported in clinical trials with less than half of the medication, according to results that will be published in The Lancet Digital Health. The research was presented at the European Congress on Obesity 2025.^1,2  Read Full Article…

HVBA Article Summary

1. Real-world weight loss outcomes using lower semaglutide doses: In a Danish study of nearly 2,700 adults in a digital weight management program, participants achieved a mean weight loss of 16.7% over 64 weeks using an average weekly semaglutide dose of just 1.08 mg—lower than typical trial doses. This real-world evidence (RWE) suggests that personalized, lower-dose regimens paired with structured behavioral support can yield meaningful weight loss while potentially reducing drug costs and side effects.

2. Integrated lifestyle and medication support improves outcomes: The program combined semaglutide with intensive behavioral therapy (IBT), diet, exercise, and coaching. Participants received ongoing medical oversight and personalized treatment plans, showing that structured lifestyle interventions significantly contribute to the success of obesity medications. Outcomes were consistent across BMI levels, age groups, and sexes, reinforcing the importance of a comprehensive care model.

3. Pharmacists play a pivotal role in treatment adherence and access: Pharmacists in community settings can help patients overcome key barriers such as medication cost, adherence challenges, and education needs. Their involvement ensures better communication between patients and healthcare providers and enhances the likelihood of sustained weight loss success when using GLP-1 medications like semaglutide.