Inside Big Insurance’s $1.7 Trillion Year | EP 2

By Wendell Potter and Joey Rettino – Every three months, the nation’s largest health insurers release earnings statements filled with crammed financial tables, investor language and Wall Street jargon. Most people never see them. Even fewer try to understand what they really reveal about how the U.S. health care system works. In second episode of the HEALTH CARE un-covered Show, we do something no one else does: walk you through the most recent earnings reports of seven of the largest for-profit health insurance corporations in the country — UnitedHealth Group, CVS Health (Aetna), Cigna, Elevance, Humana, Centene and Molina. As you’ll see, the results paint a striking picture of how powerful and profitable Big Insurance has become. Read Full Article...

HVBA Article Summary

1. Record Revenues and Profits Amid Declining Coverage: In 2025, the seven largest for-profit health insurers collectively generated nearly $1.7 trillion in revenue and over $54 billion in profits, despite insuring 10 million fewer people than the previous year. This financial growth occurred even as the number of people covered by these companies decreased, highlighting a disconnect between profitability and coverage expansion. The increase in revenue is attributed to higher prices, stricter barriers to care, and a greater reliance on taxpayer-funded programs.

2. Vertical Integration and Government Contracts Drive Growth: Much of the industry’s recent expansion is linked to self-dealing through vertical integration and large government contracts. For example, UnitedHealthcare now receives more than 77% of its revenue from government programs such as Medicare Advantage and Medicaid. The article notes that Medicare Advantage, a privatized and profitable alternative to traditional Medicare, was overpaid by $84 billion last year, underscoring the significant role of public funds in insurer profits.

3. Shareholder Enrichment Through Stock Buybacks: Between 2015 and 2025, these seven insurers spent more than $137 billion on stock buybacks, a practice that increases earnings per share and benefits shareholders and executives. This allocation of funds could have been used to lower premiums or out-of-pocket costs for consumers but instead prioritized investor returns. The article compares the financial scale and growth of these insurers to major American corporations, emphasizing that many now surpass household names like Chevron, PepsiCo, and Bank of America in revenue.

What does it cost to die in America? Search your Zip code.

By Youyou Zhou – Everyone — politicians, economists and myself included — has been talking about the cost of raising kids. But an equally dire reality facing Americans that’s not drawing enough attention is the cost of dying. Births in the United States barely outpaced the number of deaths in recent years. In more than a dozen states, deaths have already exceeded births since 2020. With a declining birth rate and aging population, the trend is only accelerating. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Elderly Care Is the Largest Expense: The final years of life in the United States can be extremely costly, with elderly care representing the most significant portion of these expenses. Long-term care, such as nursing homes or in-home caretakers, can easily exceed $180,000 over several years, and costs are rising faster than inflation. Coverage for these services is limited, as Medicare generally does not pay for long-term care, and Medicaid eligibility varies by state and income.

2. Funeral Costs Add Substantial Financial Burden: Funeral expenses, including burial or cremation, legal matters, and cemetery plots, can add thousands of dollars to the total cost of dying. The average funeral cost in the U.S. is around $7,700, but this can vary based on the type of service and location. Emotional stress at the time of death can lead families to spend more than necessary, making advance planning important.

3. Estate and Inheritance Taxes Affect a Minority but Can Be Significant: While most Americans do not pay federal estate or inheritance taxes due to high exemption thresholds, some states impose their own taxes with much lower limits. Twelve states and D.C. have estate taxes, and five states levy inheritance taxes, which can significantly reduce the assets passed on to heirs. The impact of these taxes depends on where a person lives and the size of their estate, making location an important factor in end-of-life financial planning.

Hospitals seek help from Congress, and face tough questions

By Ron Southwick – At a House committee hearing on the costs of health care, healthcare leaders outlined challenges with affordability. Lawmakers asked about price transparency and the growth of the 340B program. Healthcare leaders appeared before Congress to discuss the problems of affordability and access, and hospitals faced scrutiny from some lawmakers. Rick Pollack, president and CEO of the American Hospital Association, said Medicaid cuts will raise the likelihood of hospitals cutting services, and some shutting down. Read Full Article...

HVBA Article Summary

1. Medicaid Cuts and Hospital Viability: Hospital leaders warned that upcoming Medicaid cuts could force hospitals to reduce services or even close, which would negatively impact patient access to care. Lawmakers and healthcare executives expressed concern that these cuts, combined with the expiration of Affordable Care Act tax credits, could result in higher insurance premiums for all Americans. The potential for increased emergency room visits and longer wait times was highlighted as a consequence of reduced coverage and hospital closures.

2. Calls for Greater Price Transparency: Lawmakers pressed hospitals on the lack of clear and accessible pricing for medical services, noting that patients and employers struggle to understand or compare costs. Industry representatives acknowledged that current pricing structures are often irrational and not tied to quality or safety. There was bipartisan agreement that enforcing existing transparency rules and improving accountability are necessary steps to address affordability and empower consumers.

3. Debate Over the 340B Drug Discount Program and System Reform: The federal 340B Drug Discount Program was a point of contention, with some lawmakers arguing it has expanded beyond its original intent and others defending its role in supporting underserved communities. Testimony also addressed the need for increased investment in primary care and the potential benefits of allowing physician-owned hospitals to foster competition. Overall, participants agreed that reforms should focus on fixing benefit designs, enhancing transparency, and ensuring coverage that protects patients from high out-of-pocket costs.

Automatic enrollment in Medicare Advantage plans under consideration, top Trump health official says

By Tara Bannow – President Trump’s Medicare director said Thursday his team is considering a policy that would automatically enroll Medicare beneficiaries into Medicare Advantage plans, a controversial idea that was touted in the conservative Project 2025 policy blueprint. Chris Klomp said the Centers for Medicare and Medicaid Services is mulling the feasibility of models that would either automatically enroll beneficiaries into the private form of Medicare or accountable care organizations, such as those that participate in the Medicare Shared Savings Program. Individuals could still opt into a different insurance arrangement. Right now, people who don’t make a choice are covered by traditional Medicare. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Proposed Consideration of Default Medicare Enrollment Changes: Federal health officials are exploring whether Medicare beneficiaries could be automatically enrolled into either Medicare Advantage plans or accountable care arrangements rather than traditional fee-for-service Medicare. Officials emphasized that the concept is still under review and that no formal policy proposal has been finalized. Any broad change to Medicare’s enrollment structure would likely require approval from Congress.

2. Potential Benefits of Coordinated Care Models: Supporters of default enrollment argue that placing beneficiaries in coordinated care models may strengthen relationships between patients and providers while improving care quality and cost management. The policy discussion aligns with a federal goal to place all traditional Medicare beneficiaries in accountable care relationships by 2030. However, available research offers mixed evidence on whether Medicare Advantage or accountable care organizations consistently produce better health outcomes.

3. Cost and Consumer Protection Concerns: Critics caution that automatically enrolling beneficiaries into Medicare Advantage could increase federal spending and create challenges for patients seeking to keep specific providers or medications. Analysts note that Medicare Advantage currently costs the government more per enrollee than traditional Medicare due to payment structures and risk-adjustment practices. Advocacy groups also warn that automatic enrollment, particularly for people eligible for both Medicare and Medicaid, could cause confusion about opt-out options and limit informed plan choice.

How AI therapies are changing health care

By Adriel Bettelheim – AI is increasingly being combined with prescription drugs and other therapies in the push to personalize medicine. But that's making it harder to define whether a compound or an algorithm is actually doing the healing. Optimism over new ways to deliver customized, real-time care in patients' homes is being tempered by legal and regulatory questions about how to treat hybrid products that learn and evolve from their interactions with patients. One concern is whether the technology can overtake the treatment and make a drug useless without the accompanying data. Read Full Article...

HVBA Article Summary

1. Integration of AI and Medicine: Artificial intelligence is being increasingly integrated with prescription drugs and therapies to provide more personalized and real-time care. This combination is leading to the development of hybrid products that can adapt and evolve based on patient data and interactions. However, this evolution also blurs the line between what is considered a drug and what is considered a digital therapeutic, complicating both clinical and regulatory definitions.

2. Regulatory and Insurance Challenges: The rapid proliferation of AI-powered health apps and devices has outpaced the ability of regulators and insurers to keep up. While the FDA has approved several AI-based tools for conditions like depression and post-surgical recovery, insurance coverage remains inconsistent, with Medicare offering limited support and private insurers adopting a patchwork approach. The uncertainty around reimbursement and the difficulty in measuring patient benefit are significant barriers to broader adoption.

3. Legal and Policy Implications: The emergence of drug-AI hybrids raises complex legal and intellectual property questions, particularly regarding data ownership and market competition. Lawmakers are considering new legislation to expand coverage for digital therapeutics, but concerns about costs and the proprietary nature of patient data persist. Experts highlight the need for policies that balance rewarding innovation with preventing monopolies, as well as addressing whether patient-generated data should be treated as a trade secret.

Updated: Lilly’s triple-G comparable with Mounjaro, first Phase 3 diabetes data suggest

By Elizabeth Cairns – Eli Lilly’s so-called triple-G reduced blood sugar levels in patients with type 2 diabetes by up to 1.9% in a late-stage trial — a similar margin as Mounjaro achieved in its pivotal diabetes study. The triple-G, which is called retatrutide, also produced 15.3% body weight loss at just over nine months. This combination of blood sugar-lowering and weight loss should make the drug appealing, if it reaches the market, Lilly’s president of cardiometabolic health Kenneth Custer told Endpoints News. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Phase 3 Trial Evaluates Retatrutide in Type 2 Diabetes: The TRANSCEND-T2D-1 Phase 3 trial studied 537 patients with type 2 diabetes who received weekly injections of retatrutide or placebo alongside diet and exercise. Participants began with a 2 mg dose that was gradually increased every four weeks until reaching target doses of 4 mg, 9 mg, or 12 mg. After 40 weeks, retatrutide reduced A1C levels by 1.7–1.9% across doses compared with a 0.8% reduction in the placebo group.

2. Weight Loss Outcomes and Comparison to Existing Therapy: Patients receiving retatrutide experienced weight loss ranging from 11.5% to 15.3% at 40 weeks, while placebo recipients lost 2.6% of body weight. In comparison, tirzepatide (Mounjaro) reduced blood glucose by a similar 1.7% at its highest dose in a separate trial but produced about 11% weight loss. Researchers noted that retatrutide includes glucagon activity in addition to GIP and GLP-1, which is intended to enhance weight reduction rather than further lower blood glucose.

3. Safety Findings and Ongoing Development: Reported side effects were primarily gastrointestinal, including nausea, diarrhea, and vomiting, which are common with incretin-based medications. Dysesthesia, an unusual skin sensation, occurred in 4.4% of patients at the highest dose, and just over 5% discontinued treatment due to side effects. Additional Phase 3 diabetes and obesity trials are ongoing, and regulatory submission timing and branding decisions have not yet been finalized.

Four advisors. Four turning points. One missing assumption

By Matthew Jachelski – Disability income protection planning is one of the most essential components of financial planning and one of the most overlooked. It’s often something advisors plan to discuss “later,” if time allows. But after years working with advisors on income protection, I’ve noticed something interesting: Disability insurance rarely becomes important through training. It becomes important through experience. Read Full Article...

HVBA Article Summary

1. Disability Insurance Is Often Overlooked Until Experience Demands It: Many financial advisors do not prioritize disability income protection in their planning discussions, often relegating it to a future conversation. However, real-life client experiences—such as illness or injury disrupting income—highlight the critical need for this coverage. These moments of disruption reveal that the assumption of continuous income underpins most financial plans, and its loss can quickly unravel even the most carefully constructed strategies.

2. Standard Insurance and Employer Plans May Leave Gaps: Advisors frequently discover that while clients may have robust property, liability, and life insurance, they lack adequate income protection. Employer-provided group disability plans often replace only a portion of income and may exclude bonuses or cap benefits, leaving higher earners especially vulnerable. This gap means that without supplemental individual disability coverage, clients may not have the protection they assume, particularly if their compensation structure is complex.

3. Simple Questions Can Reframe the Conversation: The article suggests that advisors can initiate meaningful discussions about income protection by asking straightforward, relatable questions about what would happen if a client’s income stopped. These questions help clients see disability insurance not as an optional product, but as a fundamental part of financial planning. By addressing this missing assumption, advisors can strengthen their clients’ overall financial security and ensure that plans remain viable even in the face of unexpected income loss.