Thought inflation was bad? Health Insurance Premiums are Rising Even Faster

By Phillip Reese - Kirk Vartan pays more than $2,000 a month for a high-deductible health insurance plan from Blue Shield on Covered California, the state's Affordable Care Act marketplace. He could have selected a cheaper plan from a different provider, but he wanted one that includes his wife's doctor. Read Full Article…

HVBA Article Summary

1. Rising Health Insurance Costs: Health insurance premiums in California have nearly doubled over the last 15 years, significantly outpacing inflation and wage growth. Families with employer-provided coverage now face average monthly premiums approaching $2,000, with employees absorbing an increasing share of the costs. This financial strain extends beyond California, as similar premium spikes have been observed nationwide.

2. Impact on Small Businesses and Workers: Many small businesses, like A Slice of New York, struggle to offer affordable health insurance due to their limited bargaining power with insurers. As a result, more workers are turning to individual marketplace plans such as Covered California. The percentage of small businesses providing health coverage has steadily declined over the years, leading to increased job instability as employees seek positions with better benefits.

3. Efforts to Curb Costs: In response to escalating health care expenses, California has implemented a statewide health care spending cap aimed at limiting annual cost growth. The newly established Office of Health Care Affordability has set ambitious targets to slow premium increases over the next decade. While similar initiatives in other states have helped control cost growth, experts warn that these measures will not immediately make health care significantly more affordable for individuals and families.

Trump proposes cutting ACA enrollment period, ending ‘Dreamer’ coverage

By Nathaniel Weixel - The Trump administration is proposing to shorten ObamaCare’s annual open enrollment period by a month, a move the administration said is aimed at helping consumers pick the right plan. According to a proposed rule released Monday, open enrollment would run from Nov. 1 through Dec. 15, instead of through Jan. 15. Read Full Article…

HVBA Article Summary

1. Shortened Open Enrollment Period: The CMS proposal aims to reduce consumer confusion and streamline enrollment by shortening the open enrollment period, mirroring a similar move made during President Trump’s first term. This change could impact the number of enrollees, as a previous reduction in enrollment time led to significant declines in sign-ups.

2. Repeal of Coverage for Dreamers: The proposal includes eliminating ObamaCare coverage for immigrants who entered the U.S. illegally as children, known as Dreamers. This would reverse a Biden-era rule that allowed approximately 147,000 immigrants to enroll, though the rule has already faced legal challenges.

3. Changes to Essential Health Benefits: The CMS suggests removing coverage for “sex-trait modification” as an essential health benefit starting in 2026. This proposed change could significantly impact access to gender-affirming care under ACA plans.

Another Reprieve? Proposed Budget Bill Includes Telehealth, HAH Extensions

By Eric Wicklund - The up-and-down battle over Medicare telehealth and Hospital at Home waivers is on the upswing again, as a proposed bill to fund the government through September includes extensions for both. But in typical good news-bad news fashion, those proposed extensions would only run to September, leaving health systems and hospitals wondering whether to keep those programs going or shut them down. Read Full Article…

HVBA Article Summary

1. Temporary Extension of Telehealth Waivers: The proposed Continuing Resolution unveiled on March 8 extends key pandemic-era telehealth flexibilities and the CMS Acute Hospital Care at Home (AHCAH) program through September 30, ensuring temporary continuity of access while Congress negotiates a longer-term solution.

2. Challenges in Long-Term Planning: While the extension prevents an immediate lapse, the ongoing uncertainty over permanent telehealth funding forces healthcare providers to reconsider their investment strategies, with some already scaling back or delaying virtual care programs.

3. Gaps in Telehealth Coverage: Despite the extension, several telehealth provisions, such as first-dollar coverage for HDHPs and HSAs, expanded support for digital health in cardiology and pulmonary rehab, and Medicare Diabetes Prevention Program enhancements, were not included, highlighting ongoing gaps in telehealth policy.

Senate confirms Lori Chavez-DeRemer as DOL secretary

By Allison Bell - Members of the U.S. Senate voted 67-32 Monday to confirm Lori Chavez-DeRemer as secretary of the U.S. Department of Labor. As the DOL secretary, Chavez-DeRemer will oversee the Employee Benefits Security Administration. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. EBSA’s Role in Regulatory Enforcement: The Employee Benefits Security Administration (EBSA) collaborates with other federal agencies to draft, implement, and enforce key regulations affecting employer benefit plans, including ERISA, HIPAA, MHPAEA, the ACA, and the No Surprises Act.

2. Chavez-DeRemer Nomination and Senate Vote: The Senate confirmed Chavez-DeRemer with Republican support, though three GOP senators opposed her nomination due to concerns over her past support for the PRO Act, which critics argue could affect independent contractors and union membership policies.

3. Upcoming Nominations and Healthcare Oversight: The Senate is preparing to consider nominations for key health and labor positions, including Daniel Aronowitz for EBSA administrator and Dr. Mehmet Oz for CMS administrator, with a Finance Committee hearing scheduled for March 14.

House votes to extend telehealth for 6 months, sends funding bill to Senate

By Emma Beavins and Dave Muoio - The House of Representatives voted 217-213 to pass a continuing resolution that funds the government until Sept. 30, 2025, and extends expiring Medicare telehealth flexibilities until the same date. The House voted mostly along party lines save for Rep. Thomas Massie, R-Kentucky, who said before the vote that he would oppose due to his standing opposition to continuing resolutions. Read Full Article…

HVBA Article Summary

1. Bipartisan Divide on the Continuing Resolution: The House passed a Republican-led continuing resolution to avert a government shutdown, with Rep. Jared Golden (D-ME) as the only Democrat to support it. While Republicans argue the bill maintains federal healthcare programs without cuts, Democratic leaders criticize it for failing to reverse Medicare physician pay reductions and for not safeguarding Social Security, Medicare, and Medicaid.

2. Healthcare Provisions and Exclusions: The funding patch includes extensions for telehealth flexibilities, community health centers, and certain hospital payment adjustments but does not reverse the 2.83% Medicare physician pay cut, a significant concern for physician advocacy groups. Additionally, it does not address the impending expiration of enhanced Affordable Care Act tax credits, which will be a priority for healthcare stakeholders later in the year.

3. Political Tensions and Future Implications: Democrats argue that the resolution represents a broader Republican effort to cut healthcare funding, pointing to an expected $880 billion in budget reconciliation cuts later this year. Meanwhile, Republicans maintain that the resolution ensures government operations without policy changes or disruptions to federal healthcare programs, setting the stage for continued partisan battles over healthcare funding and policy.

Commonwealth Fund: How letting the ACA premium subsidies expire could impact states

By Paige Minemyer - Enhanced premium subsidies for Affordable Care Act plans are set to expire at the end of this year, and, if they do, the financial impacts would be felt in all 50 states, according to a new report. Researchers at the Commonwealth Fund and George Washington University's (GWU's) Milken Institute School of Public Health estimate that the end of the tax credits would cost states $34 billion in gross domestic product as well as more than $2 billion in tax revenue. The report also estimates it could lead to 286,000 job losses. Read Full Article…

HVBA Article Summary

1. Severe Economic and Job Loss Impact: The elimination of federal premium tax credits would result in a $26.1 billion loss in federal subsidies in 2026, compounding over time. The ten non-expansion states—Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming—would bear the brunt, accounting for 70% of estimated job losses, with 194,000 jobs lost and a $23 billion reduction in GDP.

2. Strain on Healthcare Providers and Rural Areas: Hospitals and healthcare providers, especially in rural regions reliant on Medicaid and marketplace coverage, would face significant revenue declines. With reduced subsidies, insurers may lower payments to providers, leading to potential staffing cuts and financial instability for healthcare organizations.

3. Widespread Economic and Social Ripple Effects: The loss of subsidies would increase the number of uninsured individuals, reducing affordability and access to care. This would not only harm public health but also shrink consumer spending, straining state and local budgets, and negatively impacting businesses and community well-being.

Could GLP-1s cause pharmacy plan bottom lines to balloon in 2025?

By Mark Campbell - Celebrity promotion, social media trends and direct-to-consumer advertising have created massive demand for high-cost GLP-1 drugs. With an estimated 100 million adult Americans (nearly 42%) living with obesity and manufacturers seeking expanded uses for GLP-1s, this trend shows no sign of slowing. Read Full Article…  ^{_{(Subscription required)}}  

HVBA Article Summary

1. Rising Costs and Market Growth: The GLP-1 market is rapidly expanding, with prescription rates surging and market projections reaching nearly half a trillion dollars by 2032. This growth is driven by both increasing demand and newly approved indications, posing significant financial implications for health plans.

2. Policy and Coverage Challenges: The evolving regulatory landscape, including potential changes in CMS coverage requirements, could shape commercial insurance policies. Expanded FDA approvals for GLP-1s in treating conditions beyond diabetes and obesity may increase utilization, further straining pharmacy benefit budgets.

3. Strategic Cost Management: Employers and benefits advisors must carefully evaluate GLP-1 coverage by balancing clinical effectiveness, cost-effectiveness, and long-term financial impact. Implementing prior authorization, step therapy, and utilization management strategies can help optimize access while controlling rising plan costs.

New Data: Benefits Costs are “Unsustainable,” But Some Employers Are Saving $3 Million Annually with AI and Decision Support

By Global Newswire - Businessolver®, a market leader in SaaS-based HR and benefits administration technology, released its seventh annual Benefits Insights Report which features employee benefits preferences, behavioral insights, and trends data alongside AI technology adoption and effectiveness. The data is based on the 18 million individuals represented on Businessolver’s platform, 740,000 annual enrollment surveys, 42,800 benefits preferences surveys, and feedback from nearly 1,400 HR decision makers. Read Full Article…

HVBA Article Summary

1. Balancing Benefits Costs and Employee Expectations: Employers are grappling with record-high healthcare costs and increasing employee demands for expansive benefits. However, financial insecurity and persistent confusion about benefits make it difficult to sustain current spending levels. Nearly half of employees (48%) would panic over a $6,000 emergency bill, and 86% remain confused about their benefits, highlighting the need for better education and decision support.

2. The Role of AI and Decision Support in Benefits Optimization: AI-powered decision support tools are significantly improving benefits enrollment and cost management. Employees are 129% more likely to choose high-deductible health plans (HDHPs) and health savings accounts (HSAs) when assisted by AI. Additionally, 69% of employees use decision support to select the right-fit benefits, leading to cost savings and increased confidence in enrollment decisions.

3. Personalization and Generational Preferences in Benefits: Employees across generations have distinct benefits preferences, requiring a more tailored approach. Boomers prioritize "Performance" benefits like 401(k) plans, while Gen Z values "Delighter" benefits such as employee assistance programs (EAPs). Employers leveraging AI and real-time data analytics can better align benefits offerings with employee needs, improving satisfaction and reducing unnecessary spending.