Obamacare Enrollees Could See Big Changes in 2026

By Ann Carrns - A shorter open enrollment period, less help choosing a plan, higher health insurance premiums for many people — those are just a few changes now brewing that could affect your health insurance for 2026 if you have coverage through the Affordable Care Act marketplace. One shift is the scheduled end of more generous financial subsidies that, in recent years, have allowed many more people to qualify for marketplace plans with lower or no monthly premiums. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Proposed Rule Could Limit Access and Affordability: The Trump administration, through CMS, has introduced a proposed rule that could significantly impact marketplace enrollment and affordability. While the administration claims it promotes fiscal responsibility, health policy experts argue the changes could restrict eligibility, reduce affordability, and make it harder for people to enroll or renew coverage—potentially leading to steep premium hikes and millions losing insurance if enhanced subsidies expire.

2. Key Changes Include Shorter Enrollment Periods and Elimination of Low-Income Flexibility: Among the most notable changes are a shortened open enrollment period—cutting the deadline back to December 15—and the removal of a year-round enrollment option for low-income individuals. These shifts could limit consumer flexibility, particularly for those who rely on extra time during the holiday season or need affordable alternatives after discovering higher premium costs in January.

3. Support Services Cut and DACA Recipients Excluded: The proposed rule also slashes funding for health insurance navigators by 90%, reducing the support available to help consumers choose and enroll in plans. Additionally, the rule would reverse a recent policy expansion by excluding DACA recipients (“dreamers”) from ACA coverage, potentially barring tens of thousands from affordable health insurance and further marginalizing a vulnerable group.

Meet the 15 Most Innovative Companies moving the needle in healthcare

By Shalene Gupta - While we’ve made great strides in technology, around the world people are increasingly unhappy with the rising cost of healthcare and their access to it. More than ever before, we need to celebrate companies that are working to improve the overall quality and ease of access to healthcare. This is why for the second year in a row, Fast Company has chosen to expand its list of Most Innovative Companies in healthcare to include 15 honorees. Read Full Article…

HVBA Article Summary

1. Innovative Healthcare Solutions: A diverse group of companies is tackling long-standing healthcare challenges from multiple angles. WellRithms is reducing costly overbilling for employers and unions, Homeward Health is reinventing rural care by connecting patients with local resources, and Nest Health is bringing holistic, in-home medical and social care to high-risk families—addressing health disparities at their root.

2. AI at the Forefront: Artificial intelligence is becoming central to healthcare innovation. Abridge is easing clinician burnout with real-time AI-powered transcription and multilingual support, Apella is optimizing surgical workflows through AI-driven monitoring and documentation, and Infinitus Systems is cutting administrative burden by automating phone-based insurance and billing communications.

3. Impactful Growth and Reach: These forward-thinking companies aren’t just building better solutions—they’re scaling fast. Abridge added a new customer weekly in 2024 and now supports major institutions like Kaiser and Mayo Clinic. Babson Diagnostics performed over 54,000 small-sample blood tests post-launch, and Knownwell expanded to multiple cities with its inclusive, trauma-informed approach to obesity and primary care.

Sound of silence? What the CMS Innovation Center’s announcement does and doesn’t say

By Jeffrey Davis and Simeon Niles - March 20, 2025 – The Centers for Medicare & Medicaid Services (CMS) Innovation Center made headlines last week by announcing that it would end eight models early. The Innovation Center put out a fact sheet explaining its rationale behind these decisions. At the end of the fact sheet, the Innovation Center states that it will lay out a strategy for testing innovative payment models in both Medicare and Medicaid. Read Full Article…

HVBA Article Summary

1. Cost Savings Drive Decision-Making: The CMS Innovation Center is prioritizing financial performance above all, aiming to end several models early—some just launching—based on projected savings of $750 million. While specific reasons for ending each model weren't provided, the overarching message is clear: models must demonstrate potential for cost reduction to survive under this administration.

2. Shift Toward Mandatory and “Permanent” Models: While voluntary models, especially in primary care, are being phased out or re-evaluated, mandatory models like TEAM and IOTA are moving forward. The Innovation Center appears to be favoring models that can guarantee Medicare savings, and may encourage migration toward more permanent programs like Medicare Advantage, rather than piloting new short-term initiatives.

3. Primary Care Is a Priority—But Specialty Care May Be Next: The Innovation Center reiterated its support for primary care, despite ending key models like Primary Care First and Making Care Primary. However, it remained silent on specialty care, leaving open the possibility that new specialty-focused models may be in development, particularly if they offer promising cost-savings potential.

LIMRA launches new tools to help life insurers adopt AI

By Ron Southwick - LIMRA’s AI Governance Group (AIGG) continues to lead efforts to help U.S. life insurance companies safely and effectively adopt AI, with the launch of Turnkey Templates & Strategic Guides. Whether developing AI in-house or with a vendor, these resources are designed to help companies make informed decisions regarding AI adoption, LIMRA said. Read Full Article…

HVBA Article Summary

1. Collaborative AI Implementation Frameworks: LIMRA’s AI Governance Group (AIGG) has developed turnkey, customizable AI frameworks—complete with cost-benefit analysis tools—to help insurance companies safely and effectively implement AI. These frameworks are designed to address shared industry challenges and promote fairness, accountability, and transparency.

2. Strategic Industry Alignment and Education: With contributions from over 100 executives across 50+ companies, AIGG aims to educate members, foster collaboration, establish benchmarks, and enhance customer experience—all while driving productivity and profitability in the insurance sector.

3. Future-Focused and Flexible Roadmap: AIGG is actively expanding its work through 2025 and 2026, with upcoming frameworks focused on Agentic AI and AI Agents. The group is forming subcommittees to accelerate development and plans to remain agile in addressing emerging industry needs.

Optum Rx’s new payment model favors brand names over generics

By Paige Twenter - Effective March 20, Optum Rx will increase reimbursements to pharmacies for brand-name drugs and cut them for generics. Optum Rx said the new pharmacy payment models are in response to price increases set by brand name drug manufacturers. Read Full Article…

HVBA Article Summary

1. Optum Rx is moving away from a longstanding industry reimbursement model that emphasized generic drug use, citing the widespread success of generic adoption and the growing financial strain from an influx of high-cost branded medications.

2. Independent pharmacies are facing mounting financial pressures, with 99% experiencing reduced reimbursements; many owners are dipping into personal savings or cutting back on inventory to stay in business, contributing to the closure of nearly one U.S. pharmacy per day in 2023.

3. Optum Rx’s new cost-based payment model, launched March 20 and set for full implementation by 2028, aims to better support more than 24,000 independent pharmacies by raising reimbursements for branded drugs—part of a broader industry trend also seen with recent reforms by CVS Health and Express Scripts.

UnitedHealth's PBM gets mixed reviews for reimbursement change

By Allison Bell - UnitedHealth's Optum Rx pharmacy benefit manager unit made peace offerings to independent pharmacies and patients this week. PBM watchers viewed the offerings with interest. Some have welcomed the announcements. Some are questioning the news. Some are wondering what the offerings really are. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Optum Rx to Shift Reimbursement Model by 2028: Optum Rx announced it will transition to a reimbursement model that pays out-of-network pharmacies based on a drug’s acquisition cost plus, in some cases, a dispensing fee—aiming for implementation by January 1, 2028. Independent pharmacy advocates have expressed cautious optimism but want more details.

2. Reduced Prior Authorization for Chronic Conditions: In a move to simplify medication access for patients with chronic illnesses, Optum Rx plans to cut prior authorization requirements by up to 25%, starting with reauthorization eliminations for about 80 drugs. This change has drawn both praise and skepticism from industry professionals.

3. Mixed Reactions Reflect Lingering Trust Issues with PBMs: While some stakeholders, like Traverse Benefits, welcomed the changes as positive for consumers, others—such as the National Community Pharmacists Association and Dr. Cyrus Attia—raised concerns about whether Optum Rx’s announcements represent genuine reform or are primarily public relations efforts.

Surging Stress: Learn Why 40% Of Employees Cried At Work Recently

By Bryan Robinson, Ph.D. - The American workforce Is burdened by surging stress in 2025, fueled by global political turmoil and unmet mental health needs. Nearly 40% of employees have cried at work in the past month, according to a new survey from Modern Health--an organization determined to create a healthier, more resilient workforce with personalized high-quality care. On top of that, nearly half of employees say their life was easier during the pandemic than it is in 2025. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Return-to-Office Mandates and Escalating Workplace Pressures: The new administration’s strict return-to-office policy is adding to employees’ stress, especially those who have thrived in remote roles. Coupled with increasing job demands and limited flexibility, this shift is fueling an unprecedented burnout rate of 66%—the highest ever recorded at the start of 2025.

2. Political Turmoil and Economic Instability as Key Stressors: Employees are deeply affected by global political unrest, economic uncertainty, and constant exposure to distressing news. These external pressures have overtaken finances and crime as the leading drivers of poor mental health, with 96% of workers following troubling current events that are eroding optimism and workplace morale.

3. Insufficient Preventive and Inclusive Mental Health Support: Many organizations still focus on crisis response rather than preventive mental health care. Workers—especially Gen Z—feel unsupported, with some reconsidering their career paths due to ongoing stress. Without trust-based, accessible, and proactive support systems, companies risk losing talent and undermining workplace culture.