Bipartisan House bill aims to free some state benefits laws from ERISA leash

By Allison Bell – Two House members have introduced a bipartisan bill that could let states their own rules for employers' self-insured dental plans. Federal law lets states regulate the business of insurance, but a provision in the Employee Retirement Income Security Act of 1974 preempts state efforts to regulate employers' health benefit plans. In practice, employers and benefits advisors have assumed that ERISA preempts any state laws concerning employers' self-insured benefit plans. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Improving Dental Administration Act Introduced: The Improving Dental Administration Act has been introduced by Rep. Jeff Van Drew (R-N.J.), a dentist, and Rep. Herb Conaway (D-N.J.), who holds both medical and law degrees. The bill has gained support from the American Dental Association and several other dental professional organizations, including the Academy of General Dentistry. It would create an exception to ERISA preemption for self-funded dental plans, potentially allowing certain state-level regulations to apply.

   Debate Over ERISA Preemption and Employer Plans: ERISA preemption currently shields many self-insured employer benefit plans from state insurance regulations and coverage mandates. Employers, insurers, and benefits groups argue that this protection encourages companies to offer benefits by reducing administrative complexity and costs, especially for multistate coverage. Critics of changes to ERISA warn that weakening preemption could make administering employer-sponsored plans more complicated and expensive.

   Broader Policy and Legal Context: Health care providers have increasingly sought ways to allow states to regulate aspects of benefit administration affecting provider networks. Similar disputes are already occurring in federal courts over whether states can impose rules on pharmacy benefit managers serving self-insured employer health plans. The introduction of the Van Drew–Conaway bill could prompt a new policy and legal debate over the scope of ERISA preemption.

Why More U.S. Doctors Are Moving to Canada

By Wendell Potter – When I was an insurance executive, whenever major health care reform bills were getting traction in Washington, my colleagues and I pulled our propaganda playbooks off the shelf and launched our fearmongering campaigns. A big part of the playbook centered on the Canadian health care system, which the insurance industry and its allies have been villainizing for decades. We portrayed the system as a nightmare. We led people to believe that Canadians had to wait for months for medically necessary care in rundown, ill-equipped hospitals, and that government bureaucrats in Ottawa rationed everybody’s care. Read Full Article...

HVBA Article Summary

1. Health Policy Messaging and Past Misrepresentations: Past claims that large numbers of Canadians were traveling to the United States for medical care were exaggerated or based on misleading information used in political and policy debates. While some Canadians do seek certain procedures in the U.S., most Canadians support and are protective of their national health care system. Canada’s system also has trade-offs, including fewer MRI machines and longer wait times for some elective procedures.

2. Rising Interest Among U.S. Doctors Moving to Canada: Recruiting agencies and medical licensing organizations have reported a significant increase in U.S. physicians exploring opportunities to practice in Canada. Data cited in the piece shows a sharp rise in inquiries and account registrations from American doctors seeking information about Canadian licensing pathways. Physicians considering relocation often cite dissatisfaction with administrative burdens, insurance authorization requirements, and broader political or professional concerns in the United States.

3. Canadian Recruitment Efforts and Physician Experiences: Canadian provinces facing physician shortages have launched recruitment campaigns and streamlined licensing processes to attract U.S. doctors. Some provinces now allow qualified American physicians to begin practicing quickly while paperwork is completed. Doctors who have relocated report that practicing in Canada allows them to treat patients without the same financial barriers to care, though the system still faces challenges such as longer waits for certain services.

Health care now the top financial concern for U.S. households, outpacing rent

By Alan Goforth – Although 9 in 10 U.S. adults have health insurance, having sick, uninsured or underinsured family members may lead to medical bills that put a strain on household budgets, according to a Peterson-KFF Health System Tracker report. In 2024, about 17% of adults reported delaying or not getting health care because of cost, including those who delayed or did not get medical or mental health care and those who rationed prescription drugs. "Health care is the household expense that worries people the most, even more than monthly utilities, food, rent or mortgage, and gasoline or transportation costs," the report said. "About two-thirds of adults say they worry about being able to afford health care expenses for themselves and their family, including 32% of adults who are very worried and 34% of adults who are somewhat worried." Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Health Care Costs Surpass Other Household Worries: The report highlights that health care expenses have become the top financial concern for U.S. households, surpassing worries about rent, utilities, and food. This trend persists despite the high rate of health insurance coverage among adults. The anxiety stems from the potential for significant out-of-pocket costs, particularly when family members are uninsured or underinsured.

2. Disparities in Access and Financial Strain: Certain groups, including Black adults, those under 65, individuals in poor health, and the uninsured, are more likely to delay or forgo medical care due to cost. Uninsured adults, regardless of income level, are especially vulnerable to rationing care or skipping prescription medications. These disparities suggest that insurance status, health, and demographic factors play a major role in determining who is most affected by health care affordability issues.

3. Steady Rates of Forgone Care Since the Pandemic: The proportion of adults delaying or skipping medical care and prescriptions due to cost has remained relatively stable since the pandemic. While there was a decline in forgone care during 2020, this was attributed more to people avoiding care because of COVID-19 concerns rather than improved affordability. The persistence of these trends indicates that financial barriers to health care remain a significant and ongoing challenge for many Americans.

GuardDog Telehealth admits to improper record sharing in Epic court case

By Sydney Halleman – A defendant in the lawsuit brought by Epic accusing health information network Health Gorilla and several of its clients of improperly accessing patient records has admitted to fraudulently requesting patient data, according to a new legal filing released Friday. Beginning in 2024, GuardDog Telehealth — a client of Health Gorilla — improperly accessed patient records in order to provide them to law firms, while falsely asserting it was using the data to treat patients, according to the filing. Read Full Article...

HVBA Article Summary

1. GuardDog Telehealth Accused of Misusing Patient Records: A legal filing alleges that beginning in 2024, GuardDog Telehealth improperly accessed patient records through interoperability networks while claiming the data was needed to treat patients. According to the filing, the company instead reviewed and summarized the records to provide information to law firms. The allegations raise concerns about the misuse of sensitive medical data under the appearance of legitimate healthcare services.

2. Epic and Health Gorilla Dispute Data-Sharing Oversight: The allegations are part of a broader lawsuit in which Epic claims Health Gorilla allowed certain clients to access patient records and potentially monetize them without proper vetting or patient consent. Health Gorilla denies the claims and argues that GuardDog never disclosed any non-treatment use of patient information. The company also says Epic’s lawsuit could threaten healthcare interoperability and data exchange across the industry.

3. Proposed Judgment Could Restrict GuardDog’s Access to Data Networks: A stipulated judgment between Epic and GuardDog would permanently bar GuardDog from requesting patient data through the TEFCA and Carequality interoperability frameworks if approved by a judge. The agreement would also require the company to delete any patient health information previously obtained through those networks. Epic suggested the agreement could encourage other defendants in the lawsuit to reach similar settlements.

Less Weight Regain, More Health Loss after Stopping GLP-1s?

By Marilynn Larkin – Patients on GLP-1s who stopped taking the drugs maintained about 25% of their weight loss at 1 year, but whether their regained weight is mainly fat or lean mass isn’t clear, new research suggested. “When we began this work, there was — and still is — a prevailing narrative around GLP-1 receptor agonists (RAs) that says they must be taken indefinitely or ‘you’ll gain it all back, when treatment stops,’” said Brajan Budini and Steven Luo, both medical students at the University of Cambridge, Cambridge, England. “We wanted to assess whether the evidence actually supports that view,” they told Medscape Medical News. Read Full Article...

HVBA Article Summary

1. Weight Regain After GLP-1 Discontinuation: A systematic review of 48 studies found that body weight typically increased after patients stopped taking GLP-1 receptor agonists used for weight loss. Analysis of six randomized trials with 3,236 participants showed that about 60% of the weight lost during treatment was regained within one year after discontinuation. However, modeling suggested that weight regain may eventually stabilize below pretreatment levels, leaving roughly 25% of the original weight loss maintained long term.

2. Study Design and Data Limitations: The review included 36 randomized controlled trials and 12 non-randomized studies involving adults with overweight or obesity, with treatment durations ranging from 10 to 104 weeks and follow-up periods of 4 to 104 weeks after stopping medication. Most studies were assessed as having a moderate risk of bias. Secondary outcomes such as A1c levels and systolic blood pressure generally rebounded after treatment cessation, although available data were insufficient to fully model these changes.

3. Uncertainty Around Health Effects and Long-Term Outcomes: Researchers noted that it remains unclear whether regained weight consists of the same proportions of fat and lean mass as before treatment. Experts suggested that cardiometabolic markers, including blood pressure, lipid levels, and inflammation, may worsen again after medication is stopped. They emphasized that combining GLP-1 medications with lifestyle interventions may be important for maintaining health benefits after treatment.

3 ways well-designed benefit programs go beyond financial wellness

By Doug Sabella – More American employees are feeling the weight of rising costs, tight budgets and the pressure of an uncertain economy. As they navigate these financial strains, most employers feel responsible to support employees' financial wellness. They're expanding benefit offerings, rolling out financial education programs, introducing access to money management tools — and even incentivizing employees to save. And it's paying off. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Employers Are Expanding Financial Wellness Support but Acknowledge More Is Needed: Payroll Integrations’ Employee Financial Wellness Report found that nearly half of workers now feel completely supported by their companies in financial wellness, up from 28% the previous year. At the same time, 64% of employers believe they could be doing more to support employees’ financial well-being, reflecting growing recognition that financial wellness programs are still developing. Employees say benefits such as cost-of-living raises (57%), budgeting and savings tools (44%), retirement education (43%), and personalized benefits (41%) would help improve their financial security.

2. Financial Wellness Benefits Can Reduce Stress and Support Workplace Productivity: Employers are expanding offerings such as health insurance, retirement plans, emergency savings accounts, and family-related benefits to help employees manage financial uncertainty and unexpected expenses. When employees feel financially supported, they may experience less financial stress, which can help them focus more effectively on their work responsibilities. These programs are designed to strengthen employees’ financial stability while also supporting productivity and overall workplace engagement.

3. Benefit Programs Influence Employee Retention and Talent Recruitment: The report found that 42% of employees would leave their job for a benefits-related reason, while strong offerings such as health insurance (67%), retirement plans (53%), and family benefits (53%) are key factors that encourage employees to stay. Clear communication also plays an important role, with 49% of employees saying they are more likely to remain in their role when benefits are consistently explained, and the share of workers who feel fully educated about their benefits rising to 44% from 27% the year prior. Benefits also affect hiring decisions, as 67% of workers say they would not accept a job without retirement benefits and 65% would decline an offer without health insurance.

Younger generations experience serious health issues earlier in life

By Ayo Mseka – Younger generations are going through serious health issues earlier in life, with substantial implications for employer-sponsored health plans. That was the word from UnitedHealthcare and Health Action Council, which published a white paper on their findings. The report pointed out that costs for employer-sponsored health care benefits are rising more quickly than general inflation and wage growth, affecting employers and their employees. For example, the report said, KFF’s 2025 Employer Health Benefits Survey reports a 6% increase in per-employee benefit costs in 2025, with a projected 6.5% rise in 2026. Read Full Article...

HVBA Article Summary

1. Employer Health Costs Rising Faster Than Wages and Inflation: A new report finds that costs for employer-sponsored health care benefits continue to rise faster than general inflation and wage growth, increasing financial pressure on both employers and employees. The data shows that serious health events such as heart attacks, strokes, complex surgeries, cancer and genetic disorders are becoming more common across the workforce. These major health events are now about twice as frequent as they were five years ago, and the average monthly claims tied to them have increased nearly 40% since 2020.

2. Younger Workers Experiencing Faster Growth in Health Costs: The report highlights a generational shift in health care spending patterns across employer health plans. While millennials and Generation Z still have lower overall health care claims than older generations, their costs are rising at a much faster pace, with year-over-year growth between 2023 and 2025 nearly double that of baby boomers. Researchers attribute this trend in part to younger adults developing chronic conditions such as diabetes, obesity and high blood pressure earlier in life and being less likely to engage in regular primary care.

3. Preventive Care and Early Intervention Linked to Lower Costs: The report suggests that employers can use workforce health data to design benefits and engagement strategies that encourage earlier intervention and preventive care. Employees who regularly visit a primary care provider experience about 27% lower claims for major health events and have fewer emergency room visits and hospital admissions. Employers are also encouraged to consider clearer benefit design, improved care navigation and evidence-based programs such as metabolic health support, lifestyle coaching and weight-management initiatives to address early warning signs before they develop into higher-cost health events.