Trump's NIH pick Bhattacharya's challenges to include research funding cuts

By Ahmed Aboulenein - President Donald Trump's nominee to lead the National Institutes of Health, vocal U.S. COVID-19 policy critic Dr. Jay Bhattacharya, is widely expected to advance after facing questions on Wednesday in a Senate committee confirmation hearing. Read Full Article…

HVBA Article Summary

1. Senate Confirmation and Partisan Divide: While Senate Republicans support Bhattacharya’s nomination as a necessary reform at the NIH, Senate Democrats are expected to scrutinize his stance on agency independence, scientific integrity, and controversial public health positions during the confirmation process.

2. Leadership and Policy Shifts at NIH: If confirmed, Bhattacharya will oversee a $50 billion budget and 27 research institutes, facing immediate legal battles over research funding cuts and potential restructuring efforts aimed at shifting NIH’s focus toward more innovative research and reducing the influence of long-serving officials.

3. Challenges and Opposition from Public Health Leaders: Bhattacharya’s past criticism of COVID-19 policies and advocacy for free speech protections in NIH funding place him at odds with mainstream public health figures. His leadership may spark further debates over vaccine mandates, agency staffing cuts, and the broader role of federal oversight in scientific research.

House may hurry to lock in the current HSA preventive care coverage rules

By Allison Bell - Members of the U.S. House are rushing to update the federal law that governs preventive benefits coverage for people with health savings accounts. House leaders have put a bipartisan HSA preventive benefits bill, the Chronic Disease Flexible Coverage Act bill, on a list of items that could come to the House floor this week "under suspension of the rules." Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. House Suspension Process & Bipartisan Cooperation: The House is using the suspension process to advance the Chronic Disease Flexible Coverage Act, indicating broad bipartisan support. If Republicans and Democrats can work together on this HSA benefits bill, it may pave the way for further bipartisan collaboration on other legislative matters.

2. Codifying IRS Guidance into Federal Law: The bill aims to make the IRS’s 2019 guidance on preventive care coverage for chronic disease management in HSA-compatible high-deductible health plans (HDHPs) a permanent federal law. This would provide more certainty for insurers and self-funded employer health plans, ensuring continued coverage for essential treatments without cost-sharing.

3. Potential Impact on Healthcare Access & Costs: By securing preventive care benefits for individuals with chronic conditions, the bill could reduce complications and hospitalizations, ultimately lowering healthcare costs. Additionally, it reinforces the role of HSAs in encouraging cost-conscious healthcare decisions while maintaining necessary protections for those managing chronic illnesses.

America doesn’t need more health care reform—it needs a health care revolution

By Mark Newman - Despite decades of reform attempts, the United States spends twice as much per capita on health care as any other wealthy nation. We spend 40 cents of every health care dollar on administration, billing, insurance paperwork, and other non-medical overhead. That’s over a trillion dollars yearly going to middlemen instead of medicine—a huge cost burden on employers and consumers alike. Read Full Article…

HVBA Article Summary

1. Lack of Transparency Drives Rising Costs: Employers bear a significant financial burden for health care, yet they often lack visibility into where their money is going. A complex web of intermediaries, including insurance companies and pharmacy benefit managers, obscures true costs through hidden fees, rebates, and financial engineering, making it nearly impossible to make informed decisions.

2. Direct Relationships Can Reduce Costs and Improve Care: By bypassing unnecessary intermediaries and fostering direct connections between employers and health care providers, companies can significantly cut costs while enhancing care quality. Real-world examples, such as direct primary care models, have demonstrated potential savings of 30% or more while improving accessibility and efficiency.

3. Technology and Data-Driven Strategies Are Essential: Modern technology can streamline administrative processes, reduce inefficiencies, and improve care coordination. Employers must leverage data analytics to track spending, identify cost drivers, and implement automation where possible to create a more transparent and sustainable health care system.

Benefits Think: How to fix healthcare with the single stroke of a pen

By Paula Muto, M.D. - Dear Mr. President, With one bold action, you have the power to save millions of lives and trillions of dollars: ban network restrictions and suspend harmful incentives in healthcare. These systemic barriers are fueling a crisis in access to care for patients and doctors. They're also driving up costs for everyone, including employers. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Physician Exodus and Rising Costs: Physicians are leaving private practice due to administrative burdens, declining reimbursements, and increasing consolidation by private equity and hospital corporations. These consolidations lead to higher costs and reduced access to care, exacerbating the doctor shortage.

2. Artificial Barriers to Patient Care: Insurance network restrictions force patients to pay financial penalties and out-of-pocket costs for seeing out-of-network doctors, limiting their ability to access care. These barriers function as a form of restraint of trade, contributing to the financial collapse of rural hospitals and reduced healthcare options.

3. Fixing the Healthcare Crisis: The healthcare system can be reformed with two simple steps: banning network restrictions so patients can see any doctor they choose and eliminating incentive programs that distort care and drive up costs. A transparent, fee-for-service model would ensure fairness, lower costs, and improve access to care for all Americans.

UnitedHealthcare to cut prior authorization by 10%

By Rylee Wilson - UnitedHealthcare plans to cut prior authorization requirements by around 10% in 2025. In a March 1 notice to providers, the health insurer said it will eliminate prior authorizations for home health services managed by Optum Home & Community, formerly naviHealth. The changes, which take effect April 1, apply to Medicare Advantage and dual special needs plans in more than 30 states. Read Full Article… 

HVBA Article Summary

1. Reduction in Prior Authorization Requirements: UnitedHealthcare plans to cut approximately 10% of its prior authorization requirements in 2025, continuing its efforts to streamline approvals after eliminating 20% in 2023 and introducing a gold card program in 2024.

2. Legal Scrutiny Over AI Algorithm Use: Optum Home & Community, formerly NaviHealth, faces legal challenges regarding its nH Predict tool, which plaintiffs allege was used to wrongfully deny post-acute care. A federal judge has allowed parts of the lawsuit to proceed.

3. Optum’s Defense of AI in Care Recommendations: Optum maintains that nH Predict does not make coverage decisions but serves as a guidance tool for providers and families. Coverage determinations, the company asserts, are based on CMS criteria and member plan terms.

Commonwealth Fund: How letting the ACA premium subsidies expire could impact states

By Paige Minemyer - Enhanced premium subsidies for Affordable Care Act plans are set to expire at the end of this year, and, if they do, the financial impacts would be felt in all 50 states, according to a new report. Researchers at the Commonwealth Fund and George Washington University's (GWU's) Milken Institute School of Public Health estimate that the end of the tax credits would cost states $34 billion in gross domestic product as well as more than $2 billion in tax revenue. The report also estimates it could lead to 286,000 job losses. Read Full Article…

HVBA Article Summary

1. Severe Economic and Job Losses in Non-Expansion States: The 10 states that have not expanded Medicaid would bear the brunt of economic consequences, facing 70% of the projected job losses (194,000 jobs) and $23 billion in GDP reductions. These states rely heavily on marketplace subsidies to extend coverage, making them particularly vulnerable.

2. Financial Strain on Hospitals and Providers: The loss of $26.1 billion in federal subsidies in 2026 would significantly impact healthcare providers, especially in rural areas. With reduced insurance affordability, insurers may cut payments to providers, leading to declining revenues, job losses, and reduced access to care.

3. Broader Economic and Public Health Consequences: The elimination of federal premium tax credits would create a ripple effect, affecting affordability for families, business stability, and state and local budgets. Increased uninsured rates could worsen chronic illness management and overall public health, reversing progress in healthcare access and economic stability.

Prescribing Buprenorphine By Telehealth: Lessons From San Francisco Amidst A Changing Regulatory Landscape

By Jeffrey K. Hom, Hillary Kunins, Benjamin A. Barsky, Leslie W. Sue, Donna Hilliard, Sneha Patil, and Christine Soran - As he endured another night experiencing homelessness in San Francisco, California, “John” was feeling the symptoms of opioid withdrawal, with chills, vomiting, and body aches. These symptoms were all too familiar as he had become accustomed to the cycling in and out of withdrawal after years of using opioids, first heroin and, more recently, fentanyl. Read Full Article…  

HVBA Article Summary

1. Telehealth Expansion for Buprenorphine Treatment: San Francisco’s Navigation-to-Telehealth program leverages federal telehealth exemptions to provide immediate access to buprenorphine for individuals at high risk of opioid overdose. The program, initiated in response to the fentanyl crisis, has facilitated over 2,900 telehealth encounters since March 2024, allowing individuals to receive treatment without prior in-person visits.

2. Impact and Accessibility of Nighttime Telehealth Services: The program effectively reaches people experiencing homelessness and others who struggle with traditional clinic-based care. By operating primarily between 8 p.m. and midnight, it fills a critical gap in healthcare access, ensuring no wrong door or wrong time for treatment. As a result, 85% of telehealth visits have resulted in a buprenorphine prescription, with a pickup rate nearly twice the national average for opioid use disorder medications.

3. Regulatory Changes and the Future of Telehealth Prescribing: New DEA rules in 2025 allow telehealth-initiated buprenorphine treatment without an in-person visit for six months, providing stability for programs like San Francisco’s. However, concerns remain over potential regulatory hurdles, such as tracking treatment duration and proposed special registration requirements. Policymakers are urged to ensure these changes do not create unnecessary barriers to life-saving treatment.

BCBS Michigan posts $1B loss in 2024

By Rylee Wilson - Blue Cross Blue Shield of Michigan reported a loss of $1.02 billion on enterprise revenue of $40.6 billion in 2024, driven by rising utilization of expensive medical services and costs for prescription and specialty drugs. Read Full Article…

HVBA Article Summary

1. Financial Performance & Underwriting Loss: The company reported a significant underwriting loss of $1.7 billion in 2024, leading to a negative operating margin of -4.2%. However, strong investment portfolio performance helped offset some of the losses.

2. Rising Medical & Pharmacy Costs: Medical and pharmacy claims costs increased by $3 billion compared to 2023, with pharmacy claims alone rising by $900 million. Specialty drugs accounted for $544 million of this increase, with $215 million attributed to new autoimmune drug indications. GLP-1 drugs generated $1.1 billion in claims, a 29% increase from the previous year.

3. Operational Adjustments & Cost-Cutting Measures: Blue Cross has a total membership of 5.1 million, with significant Medicare, Medicaid, and ACA enrollments. In response to financial pressures, the company initiated administrative cost reductions, including offering buyouts to over 700 employees and discontinuing GLP-1 drug coverage for weight loss under its large group commercial plans.