To tackle healthcare costs, representatives weigh curbs on provider consolidation

By Dave Muoio – Provider consolidation was tip of the tongue Wednesday during a hearing that sat hospital and physician association leaders across from legislators. Members of the House Energy and Commerce Committee’s Subcommittee on Health often returned to the issue when seeking answers on the drivers of, and solutions for, Americans’ rising healthcare costs. Other policy issues including physician reimbursement, price transparency and the 340B drug discount program curbs also received airtime and legislator support—primarily from the subcommittee’s Republicans, as Democrats nearly to a man sought to underscore what they described as the more existential threats to access as well as affordability stemming from the One Big, Beautiful Bill Act’s sweeping Medicaid cuts. Read Full Article...

HVBA Article Summary

1. Provider Consolidation and Rising Costs: Lawmakers and witnesses at the hearing repeatedly discussed how consolidation among healthcare providers is believed to contribute to higher healthcare costs. Many panelists, including representatives from physician and employer groups, argued that increased consolidation reduces competition and can lead to higher prices for patients and payers. There was consensus that supporting independent physician practices through better reimbursement could help slow the trend of acquisitions by larger health systems and private equity.

2. Divergent Views on Legislative Solutions: The hearing highlighted differing opinions on how best to address healthcare costs, with some lawmakers focusing on curbing provider consolidation and others emphasizing the impact of proposed Medicaid cuts. While some witnesses supported legislative changes such as site-neutral payments and reforming anti-kickback rules, hospital representatives were more cautious, citing potential benefits of consolidation like reduced operating costs and improved quality. The debate also touched on whether large health systems' efficiencies actually translate into savings for patients.

3. Broader Policy Context and Impact on Access: The discussion extended beyond consolidation to include concerns about Medicaid cuts and their potential to reduce insurance coverage and increase uncompensated care. Witnesses and some lawmakers warned that such cuts could force hospitals to close services or facilities, leading to higher premiums and poorer health outcomes. The overall sentiment was that addressing immediate threats to coverage and affordability should be prioritized alongside longer-term reforms targeting provider market dynamics.

Gallagher CEO sees no signs of U.S. labor market weakness

By Allison Bell – The headlines about the U.S. labor market may be gloomy, and job hunters may be reporting facing more trouble with finding new positions than they had expected. But, from the perspective of a company selling employee benefits, the employment conditions still look pretty good. That's the assessment of J. Gallagher, the chairman and chief executive officer of Gallagher, a giant insurance brokerage, benefits consulting and human resources advisory firm. "We're just not seeing signs of economic weakness," Gallagher said Tuesday at an investor meeting. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Labor Market Conditions Shift Employer Priorities: The U.S. job market continues to show more job openings than people actively looking for work, according to Gallagher benefits consulting CEO William Ziebell. As a result, many employers are shifting their focus toward retaining existing workers rather than primarily recruiting new employees. Separate workforce data referenced in the article indicates that 56% of employees are currently staying in their jobs out of necessity, reflecting cautious behavior among workers during economic uncertainty.

2. Gallagher Revenue Exposure Depends on Employer Size: Gallagher generates revenue differently depending on the size of the employer clients it serves. For companies with 300 or fewer employees, much of the revenue comes from headcount-based sales commissions, meaning workforce reductions could affect revenue more directly. For larger employers, compensation arrangements are usually negotiated in advance, so even if those employers later reduce staff and seek to renegotiate fees, revenue typically remains unchanged in the short term because the scope of services stays the same.

3. Employer Health Benefit Costs Continue Rising: Employers renewing health coverage are facing significant price increases across multiple areas of benefits. Fully insured group health plans are rising from high single-digit percentages to more than 10%, stop-loss insurance premiums for self-insured plans are increasing in the mid-teens and in some cases above 20%, and prescription drug benefits are climbing into the low double digits. These increases are driven by factors such as higher healthcare utilization, more diagnostic testing and treatments, provider consolidation, hospital workforce shortages, cost shifting from Medicare and Medicaid to commercial plans, growing chronic disease rates, and the introduction of new cell and gene therapies.

Employer Groups Applaud Bill that Aims to Spur Competition in Healthcare

By Marissa Plescia – In a letter to lawmakers on Monday, employer advocacy groups applauded the introduction of the Healthy Competition for Better Care Act, a bill that aims to increase competition in healthcare. The letter was signed by the American Benefits Council, the ERISA Industry Committee, the National Alliance of Healthcare Purchaser Coalitions, the Purchaser Business Group on Health, the Silicon Valley Employers Forum and the Small Business Majority. The bill was introduced in the Senate last week by Jon Husted (R-Ohio). Reps. Jodey Arrington (R-Texas), Rick Allen (R-Georgia), Donald Davis (D-North Carolina) and Chuck Edwards (R-North Carolina) previously introduced a companion bill in the House. Read Full Article...

HVBA Article Summary

1. Legislative Focus on Anticompetitive Practices: The Healthy Competition for Better Care Act seeks to address several anticompetitive contract clauses between insurers and healthcare providers. By targeting practices such as all-or-nothing, anti-steering, anti-tiering, most-favored-nation, and gag clauses, the bill aims to foster a more competitive environment in the healthcare sector. Supporters believe these changes could help lower costs and improve access to high-value care for patients and employers.

2. Employer Groups' Concerns About Consolidation: Employer advocacy organizations have expressed ongoing worries about the consolidation of health systems, which they argue leads to restrictive contracts and higher costs without corresponding improvements in quality. These groups contend that dominant provider systems use their market power to impose terms that limit network flexibility and hinder employers' ability to design value-driven benefit plans. The bill is seen as a response to these concerns, aiming to restore balance and encourage innovation in healthcare purchasing.

3. Potential Impact on Healthcare Markets: Proponents of the legislation argue that its provisions would enhance transparency, allow more flexible contracting, and incentivize patients to choose high-quality, lower-cost providers. By removing barriers to competition, the bill could enable employers and insurers to negotiate more favorable terms and improve overall market dynamics. If enacted, these measures are expected to support better outcomes for both employers and healthcare consumers.

Long-Term Care Insurance: What Employers and Plan Sponsors Need to Know

By Steve Cain – Planning for extended health care events, also known as long-term care (LTC), is becoming an integral part of retirement planning in the United States due to increasing longevity, retirement savings shortfalls, the rising cost of care, and the growing strain on social programs, including Medicare and Medicaid. More than 40% of employees surveyed believe that they are somewhat or extremely likely to need LTC support and services as they age, according to a recent Employee Benefit Research Institute (EBRI) report. Read Full Article...

HVBA Article Summary

1. Growing Need and Rising Costs of Long-Term Care: Long-term care (LTC) is becoming an increasingly important part of retirement planning as Americans live longer and face rising health care costs. About 56% of adults turning age 65 between 2021 and 2025 are projected to need significant long-term care services during their lifetime, and the average duration of disability requiring care is 3.6 years for women and 2.5 years for men. The financial impact can be substantial, with median annual costs around $77,792 for a home health aide and $111,325 for a semiprivate nursing home room, and these costs are expected to continue increasing due to inflation and growing demand for services.

2. Limited Coverage Through Public Programs: Public insurance programs cover only a limited share of long-term care costs, leaving many individuals responsible for financing care themselves. Medicare pays for about 10% of long-term care services, while Medicaid is the largest payer but typically requires recipients to meet poverty-level eligibility standards. As a result, individuals often rely on personal savings, unpaid care from family members or private long-term care insurance to cover extended care needs, highlighting the importance of early planning for potential LTC expenses.

3. Employer-Sponsored Long-Term Care Insurance Options: Employers may play a role in helping workers prepare for future long-term care needs by offering worksite LTC insurance programs as a voluntary benefit. Surveys show that more than 40% of employees believe they are somewhat or extremely likely to need long-term care, and 81% consider LTC insurance somewhat or very important, yet only about 25% of employers offer this coverage and only 9% of eligible employees enroll. Worksite programs can offer features such as guaranteed issue coverage, payroll deductions and portable policies, although adoption may be limited by premium costs, employee awareness and the complexity of LTC insurance products.

45% of insured adults now trust AI as much as their physician

By Alan Goforth – Although providers remain the most trusted resource for health-related decisions, many consumers express similar levels of trust in artificial intelligence tools, the latest EBRI/Greenwald Research Consumer Engagement in Health Care Survey found. When asked how much they trust AI or digital health assistant tools compared with care from a provider, 45% of privately insured adults aged 21 to 64 said they trust AI tools as much as or more than their provider, while 55% said they trust their provider more: Trust AI tools much more than provider, 3%. Trust AI somewhat more, 10%, Trust both equally, 32%. Trust AI tools somewhat less, 27%. Truest AI tools much less, 28%. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. AI Tools Increasingly Complement Traditional Health Care: Survey findings indicate that while health care providers remain the most trusted source for medical guidance, consumers are increasingly incorporating AI-enabled tools into their health decision-making process. Rather than replacing clinicians, these technologies are being viewed as supportive resources that can assist with health information, monitoring, and decision support. The results suggest that consumers see AI as a complementary tool alongside traditional medical care.

2. Consumers Interested in Better Health Data Sharing: Many respondents expressed a desire for more effective sharing of their health data across the health system, particularly with their doctors and health insurance providers. A majority said they wish their data could be shared more efficiently with their physician, indicating interest in improved coordination and communication. These responses highlight potential value in technologies that can better integrate and exchange health information.

3. Mixed Confidence but Growing Use of Smart Health Technology: Survey results show that many consumers believe smart health technologies make it easier to access care and support healthier lifestyle choices, with more than half reporting comfort with AI use in these tools. Some respondents also said that digital health tools have encouraged them to seek in-person medical care. At the same time, similar proportions questioned the accuracy of the data generated by these technologies or reported uncertainty about how to start using AI tools for health-related decisions.

FDA’s Latest GLP1 Crackdown: What Compounders and Telehealth Platforms Need to Know

By Justin Coen, Todd Harrison, Claudia Lewis, and Richard Starr – On March 3, 2026, FDA announced it had issued 30 warning letters to telehealth companies marketing compounded GLP‑1 products whose promotion of compounded GLP‑1s, in FDA’s view, implies equivalence to FDA-approved products and/or branding that obscures the actual compounder. These letters build on earlier GLP‑1enforcement actions and public safety communications, signaling that the agency now views this area as an ongoing enforcement priority. Read Full Article...

HVBA Article Summary

1. FDA Issues Warning Letters on Compounded GLP-1 Drug Marketing: The FDA has issued warning letters to companies marketing compounded semaglutide and tirzepatide products, focusing on misleading promotional practices. Regulators object to claims suggesting these compounded products are equivalent to approved drugs or presented in ways that obscure which entity is compounding them. The agency did not directly address whether these products qualify as impermissible “copies” of commercially available drugs under federal compounding rules.

2. Regulators Highlight Safety and Compliance Concerns: The FDA is also building a record of safety concerns tied to compounded GLP-1 medications, including dosing errors, questionable active ingredient sourcing, and reports of serious adverse events. The agency has stated that certain ingredients—such as semaglutide salt forms and investigational agents like retatrutide and cagrilintide—cannot legally be used in compounded formulations. Officials emphasized that compounding should not be used as a workaround to bypass the FDA’s drug approval process.

3. Potential Policy Shift on Peptides Amid Continued GLP-1 Scrutiny: Federal officials have indicated that the FDA may consider reclassifying certain previously restricted peptides to allow lawful compounding with a prescription. This potential shift has been framed as a way to move peptide use into regulated clinical channels rather than unregulated online markets. At the same time, regulators appear to be tightening oversight of compounded GLP-1 products marketed as substitutes for approved medications, suggesting continued enforcement attention in this area.

Change Healthcare Breach Still Affecting Physician, Hospital Finances

By Carrie Arnold – When her billing program first went down in February 2024, Catherine Mazzola, MD, shrugged. Computer systems go down all the time. In a few hours, the New Jersey-based pediatric neurosurgeon assumed she would be back up and running. Two days later, her practice’s bank account had not received any deposits. Read Full Article...

HVBA Article Summary

1. Widespread Financial Disruption: The Change Healthcare ransomware attack in 2024 caused significant financial hardship for both physicians and hospitals, particularly those in small or independent practices. Many providers were unable to submit claims or receive payments for weeks or months, leading to cash flow crises and reliance on emergency loans. The disruption forced some practices to consider drastic measures to stay afloat, such as taking out personal loans or using retirement savings.

2. Systemic Vulnerabilities and Accountability: The breach exposed vulnerabilities in healthcare IT infrastructure, especially the reliance on third-party technology without adequate security measures like two-factor authentication. Regulators and legislators have since scrutinized UnitedHealth and the broader healthcare system to understand the failures and develop better safeguards. The incident highlighted the need for improved cybersecurity and accountability among major healthcare technology providers.

3. Long-Term Impact on Trust and Operations: Even after systems were restored, the effects of the breach lingered, with some practices taking nearly a year to recover financially and operationally. The event eroded trust among healthcare providers in the digital systems they depend on, raising concerns about the fragility of modern healthcare infrastructure. Many physicians now view the digitalization of healthcare with increased caution, recognizing both its necessity and its risks.

Only four states meet more than half of mental health care demand

By Kristen Smithberg – A nationwide shortage of mental health professionals is limiting access to care across the United States, with most states meeting only a fraction of their workforce needs, according to a new report from Inseparable, a policy advocacy organization focused on improving access to mental health care and strengthening the nation's mental health workforce. The 2026 workforce report found that only four states meet more than half of their estimated mental health workforce demand, while nearly half meet 25% or less of the need. Roughly 144 million Americans — about 42% of the population — live in areas without enough mental health professionals, the report found. Workforce shortages contribute to significant treatment gaps, with nearly half of people with a mental health condition receiving no care and more than 80% of individuals with substance use disorders going untreated. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Widespread Workforce Shortages: The report highlights that mental health professional shortages are prevalent across the United States, with only a small number of states able to meet even half of their workforce needs. This shortfall is especially pronounced in rural areas, where geographic isolation and limited provider availability make access to care even more challenging. The COVID-19 pandemic has further strained the workforce, increasing demand for services while reducing available resources.

2. Impact on Access and Costs: Due to insufficient staffing, many individuals are forced to seek care outside of their insurance networks, which can lead to higher out-of-pocket costs and delays in receiving treatment. The shortage of providers also means that a significant portion of people with mental health or substance use conditions do not receive any care at all. These gaps in care can have long-term negative effects on both individual and public health outcomes.

3. Recommendations for Addressing the Crisis: The report suggests a comprehensive approach to strengthen the behavioral health workforce, including expanding training programs, improving provider reimbursement, and investing in crisis response infrastructure. Special emphasis is placed on addressing rural shortages through incentives and telehealth solutions. The recommendations also call for diversified care models and better preparedness for surges in demand, such as those caused by public health emergencies.