New Obamacare Rules Could Raise Deductibles to $31K For Families

By HealthDay Staff – The Trump administration is introducing new rules for Obamacare plans that could lower monthly premiums — but there's a catch. They raise how much people pay out of pocket when they need care. Under the proposed rules, some Affordable Care Act (ACA) plans would allow annual deductibles of more than $15,000 for one person and $31,000 for a family. A deductible is the amount you must pay before insurance starts covering most medical costs. That individual deductible would be eight times higher than the average deductible for workers with job-based insurance. Read Full Article...

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1. Proposal Expands Access to Catastrophic Health Plans: The administration has proposed expanding the availability of catastrophic, high-deductible health insurance plans, which typically feature lower monthly premiums but higher out-of-pocket costs. Supporters, including CMS Administrator Dr. Mehmet Oz and Republican health policy advisers, say the changes are intended to lower costs, increase consumer choice, and improve the functioning of insurance exchanges. They argue the proposal works within existing law to give consumers more flexibility in selecting coverage options.

2. Critics Raise Concerns About Financial Risk and Affordability: Opponents caution that catastrophic or “skinny” plans could leave enrollees exposed to significant medical expenses before coverage begins. Health policy experts warn that individuals with chronic conditions or those experiencing emergencies may face substantial out-of-pocket costs, potentially worsening existing affordability challenges. Some analysts argue that shifting more financial responsibility to patients could exacerbate the current health care affordability crisis.

3. Additional Regulatory Changes and Potential Coverage Impacts: The proposal would also allow multiyear insurance policies, permit plans without fixed provider networks, remove adult dental care from essential benefits, and tighten certain enrollment rules. Plans without networks would pay set reimbursement amounts, requiring patients to cover any charges above those limits. Federal estimates indicate the changes could result in up to 2 million people losing coverage by 2027, and some experts warn that subsidy adjustments could make traditional plans more expensive for those who prefer comprehensive coverage.

University of Mississippi Medical Center reopens clinics after ransomware attack

By Emily Olsen – The University of Mississippi Medical Center is reopening its clinics across the state Monday, more than a week after a ransomware attack forced the academic medical center to curtail operations. UMMC first closed its clinics after a cyberattack in late February took its Epic electronic health record system offline and restricted access to phone and email. But now that the health system can once again access patient records, its clinics will resume normal operations, UMMC said in a Friday statement shared on Facebook. The clinics will also begin reaching out to patients to reschedule cancelled appointments, and will operate under extended hours to accommodate as many patients as possible, UMMC said. Read Full Article...

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1. UMMC Clinics Close Following Ransomware Attack: The University of Mississippi Medical Center (UMMC) shut down its clinics statewide through Tuesday after a ransomware attack took its Epic electronic health record system offline. Hospitals and emergency departments in Jackson, Grenada, Madison County and Holmes County remain open, while clinic appointments and elective procedures are being rescheduled. The health system is prioritizing patients who require time-sensitive care, such as chemotherapy, and continuing inpatient services using paper-based downtime procedures.

2. Federal Response and Operational Adjustments: UMMC, Mississippi’s only academic medical center and operator of seven hospitals, is working with federal authorities including the FBI and other national cybersecurity experts to investigate and contain the incident. The attack disrupted access to phone and email systems, prompting the organization to use a third-party vendor to communicate with patients. Leadership said it has “stopped the bleeding,” though the full extent and scope of the intrusion is still being assessed.

3. Ransomware Risks and Recovery Timelines Highlight Broader Industry Impact: The incident underscores ongoing cybersecurity threats facing healthcare providers, as ransomware attacks can delay care, disrupt operations and potentially expose sensitive patient data. A 2024 survey by Sophos found that only 22% of healthcare organizations fully recovered from a ransomware attack in less than a week, while nearly 40% required more than a month to return to normal operations. Experts note that healthcare organizations are increasingly targeted due to the high value of medical records, and some providers report increased mortality rates following major cyber incidents.

CMS set to suspend enrollment in Elevance Health's Medicare Advantage plans

By Paige Minemyer – The Trump administration has threatened to sanction Elevance Health's Medicare Advantage plans if the insurer does not address concerns around compliance with requirements for submitting risk adjustment data. The Centers for Medicare & Medicaid Services (CMS) sent a notice (PDF) to the company last week, saying that the sanctions will take effect on March 31 if it does not comply, suspending its ability to enroll people in its MA plans. CMS said the sanctions will "remain in effect until CMS is satisfied that the deficiencies upon which the determination was based have been corrected and are not likely to recur." Read Full Article...

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1. Elevance Health Discloses Potential CMS Suspension Notice: Elevance Health announced in an SEC filing that it received notice from CMS regarding potential marketing and enrollment suspensions related to its Medicare Advantage program. The company stated that any suspension would not affect individuals currently enrolled or the benefits they receive. Elevance said it is reviewing the notice and reaffirmed its commitment to compliance and program integrity.

2. CMS Alleges Improper Data Submission Practices: CMS claims that since November 2018, Elevance Health has failed to submit corrected diagnostic code data through required electronic systems after certain codes were deemed unsupported by medical records. Instead, the agency alleges the company provided encrypted data via USB drives, a method CMS has explicitly rejected, including as recently as October 2025. CMS stated that this conduct may violate statutory and regulatory requirements involving risk adjustment data accuracy, overpayment reporting, and certification obligations.

3. Company Response and Market Impact: Elevance Health said the alleged noncompliance relates to claims predating April 3, 2023, and noted that it revised its practices following additional federal guidance at that time. The company stated it is engaging cooperatively with CMS to address the concerns outlined in the notice. Following the disclosure, Elevance Health’s share price declined by nearly 9% in midday trading on Monday.

Blue Cross Blue Shield carriers face new provider antitrust suit

By Allison Bell – The Healthcare Justice Coalition and the remnants of two large physician staffing firms are suing the Blue Cross Blue Shield Association and the 33 Blue Cross and Blue Shield carriers over allegations about violations of federal antitrust rules. The plaintiffs have accused the Blues of working together in ways that have increased the cost of coverage. Read Full Article... ^{_{(Subscription required)}}

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1. Blue Cross and Blue Shield Providers File New Antitrust Lawsuit: Health care providers have filed a lawsuit in the U.S. District Court for the Northern District of California seeking to block the Blues from using their national accounts and BlueCard programs to set provider payment rates. The plaintiffs argue that these programs allow carriers to coordinate pricing and limit competition. Representatives for the Blue Cross and Blue Shield Association declined to comment on the complaint.

2. Programs Affect Employer Plans and Nationwide Coverage: The Blue Cross and Blue Shield carriers provide or administer coverage for approximately 118 million people. The BlueCard program allows members in employer-sponsored national accounts plans to access care across different Blue Cross and Blue Shield networks nationwide. Plaintiffs contend that the national accounts structure influences how carriers share data and determine provider payments.

3. Lawsuit Follows Prior Multibillion-Dollar Settlements: The new case comes after years of antitrust litigation, including a $2.7 billion settlement with employer plaintiffs approved in 2022 and a $2.8 billion settlement with provider plaintiffs approved in 2025. The current plaintiffs include providers that opted out of the earlier provider settlement, including entities representing bankrupt physician staffing firms. They maintain that, despite prior legal changes, the national accounts program continues to limit competition among the Blues.

One Generic Cancer Drug Costs $35. Or $134. Or $13,000.

By John Tozzi, Tanaz Meghjani, and Mathieu Benhamou – Ida Martin’s first chemotherapy treatment at Rush University Medical Center cost her health plan $13,560. When she went down the street to a clinic for her next infusion three weeks later, the price dropped to $134. “Same drug, different prices,” said Martin, a 62-year-old cook with colon cancer. The clinic was even still within the Rush system. “It’s ridiculous.” Health spending in the US now tops $5 trillion a year with families and companies facing their steepest insurance premium hikes in years. Politicians often blame pharmaceutical companies, insurers, wasteful procedures and a bloated system too tangled to tame. Read Full Article... ^{_{(Subscription required)}}

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1. Generic Cancer Drugs Generate Large Hospital Markups: Hospitals across the U.S. are charging private insurers substantially more than Medicare for decades-old generic chemotherapy drugs, transforming low-cost treatments into significant revenue sources. A Bloomberg News review of pricing data from more than 1,700 hospitals found that 40% billed at least one insurer five times Medicare’s payment rate, while some cases exceeded Medicare prices by hundreds of times, including markups above 350 times for the drug oxaliplatin, which Medicare would reimburse at about $35 per dose. These pricing practices affect multiple insurers and at least eight generic cancer drugs, increasing costs that are ultimately passed on to employer health plans and patients.

2. Hospitals Cite Operational Costs as Pricing Justification Amid Expert Debate: Health systems argue that chemotherapy charges reflect not only medication costs but also expenses related to specialized nurses, clinical staff, equipment, and maintaining facilities that serve all patients regardless of ability to pay. A 2024 New England Journal of Medicine study found hospitals commonly mark up drugs 2.5 to 3 times acquisition cost, which providers say helps offset losses from government insurance programs and sustain complex medical operations. However, employer health plans and pricing experts question whether these factors justify extreme cases where negotiated private insurance rates reach five to ten times—or even hundreds of times—Medicare levels.

3. Price Transparency Reveals Savings Opportunities but Persistent System Challenges: Employer-sponsored health plans are increasingly analyzing claims data to identify pricing discrepancies and redirect patients to lower-cost treatment sites without changing medical therapy. One union health plan covering approximately 230,000 members and spending $1.3 billion annually reported saving more than $13,000 per chemotherapy infusion, while another case involved nearly $90,000 in hospital charges, equal to more than 700 times Medicare’s rate for the same drug. Despite federal transparency rules requiring hospitals to disclose prices, experts note that limited compliance, complex data, and concentrated hospital market power continue to make reducing excessive pricing a slow and resource-intensive process.

Why claims data underestimates mental health risk

By Ray Fabius, M.D., FAAP, FACPE – Mental health is often the most prevalent condition among white-collar workforces and second only to musculoskeletal issues in blue-collar settings. Yet, many senior leaders still can't answer a fundamental question: how many of their employees are living with a behavioral health condition? That knowledge gap creates a strategic blind spot with direct implications for performance, safety, retention and cost. Closing it requires employers to look differently at data from health plans, TPAs, PBMs and EAPs with the help of their advisers and insist on reporting that reflects a population health perspective rather than fragmented benefit utilization. Read Full Article... ^{_{(Subscription required)}}

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1. Mental Health Data Requires an Integrated, Population-Level View: Organizations often focus narrowly on metrics like EAP call counts or isolated claims rather than evaluating the overall prevalence and impact of behavioral health conditions across their workforce. A more comprehensive approach integrates medical and pharmacy claims and groups related conditions such as depression, anxiety, substance use, and attention disorders to reflect how employees actually experience mental health challenges. This broader lens reveals the true scale of mental health’s influence on workforce performance and total health costs.

2. Granular Reporting and Meaningful EAP Metrics Improve Decision-Making: Differentiating between low-intensity services and higher levels of care helps employers identify where support and investment are most needed. EAP utilization rates of 2% to 5% may underestimate actual demand, while proactive promotion and stigma reduction can increase engagement closer to 10% to 12%. Reporting that includes unique users, reasons for seeking care, satisfaction, outcomes related to absenteeism and presenteeism, and website search trends provides more actionable insight.

3. Coordinated Strategy Strengthens Workforce Health and Performance: Effective behavioral health management requires collaboration among employers, health plans, TPAs, PBMs, and EAP providers to create a cohesive view across all data sources. Regular reviews of prevalence, cost, comorbidities, and referral pathways help ensure employees are guided to appropriate ongoing care. By treating behavioral health as a core chronic condition affecting performance and resilience, organizations can move from fragmented initiatives to a sustained, strategic approach to emotional well-being.

Are We Prescribing GLP-1s Wrong?

By Taylor Kantor, MD – The obesity medicine community has spent 3 years celebrating GLP-1 medications as a breakthrough. They are. But in too many instances, we're prescribing them wrong. Many physicians hand patients a pen injector, schedule a follow-up in 12 months, and follow the exact titration schedule from the pharmaceutical trials. No deviation. No individualization. No ongoing support. Our study of 1131 patients shows what's possible when GLP-1 therapy is delivered within a comprehensive care model, not as a standalone prescription. Read Full Article...

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1. Real-World Outcomes Exceeded Clinical Trial Benchmarks: Patients who completed 68 weeks of semaglutide therapy within an individualized care protocol lost an average of 21.8% of total body weight, compared to 14.9% in the STEP 1 trial over the same timeframe. Nearly half of participants lost more than 20% of their body weight, and over 99% achieved clinically significant weight loss of at least 5%. The study included more than 1,000 patients across 49 states treated entirely through telehealth, with an average starting weight of 228 pounds and average age of 44.

2. Telehealth Model Enabled Frequent Monitoring and Individualized Care: Patients averaged 12.7 provider interactions over 52 weeks, allowing for real-time dose adjustments, proactive side-effect management, and ongoing behavioral support. Rather than following a fixed titration schedule, dosing decisions were based on individual response and clinical judgment. App-based tools supported engagement, with the majority of patients regularly tracking weight and utilizing virtual access to providers.

3. Compounded Medication Use and Safety Outcomes: Due to branded medication shortages between 2023 and early 2025, 95% of patients used compounded semaglutide during the study period. Dosing errors were reported in 1.3% of patients, and the overall adverse event rate was 1.76%, with most side effects described as gastrointestinal and manageable. The findings suggest that structured oversight, patient education, and accessible clinical support may help maintain safety, though compounded medications require careful monitoring and are not presented as a universal substitute for branded options.