Trump’s FDA nominee, Marty Makary, faces his first test

By Rachel Roubein - In 2021, Marty Makary took to Fox News and blasted the Food and Drug Administration. In an op-ed, he called for an overhaul of leadership and culture at the agency that he said was “broken” and “mired in politics and red tape.” Nearly four years later, the Johns Hopkins surgeon is in a position to lead the very agency he lambasted. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Confirmation Amid Controversy – Makary's confirmation hearing comes at a time of significant upheaval at the FDA, with past firings, budget cut threats, and scrutiny from Health Secretary Robert F. Kennedy Jr. Senators are expected to press him on key issues, including vaccine policies and his stance on the Trump administration’s decision to cancel discussions on flu vaccinations.

2. Balancing Contrarian Views with Leadership – Known for challenging medical conventions, Makary has criticized blanket COVID-19 vaccine mandates and government health policies while maintaining a pro-vaccine stance. His ability to navigate FDA leadership while holding unconventional views will be tested, especially if tasked with implementing Kennedy’s controversial proposals.

3. Industry Ties and Policy Challenges – Having advised Trump officials and built relationships with Kennedy’s allies, Makary has positioned himself as a reform-minded yet establishment-backed nominee. His resignation from multiple corporate board positions underscores concerns about industry influence, while FDA supporters hope he will defend the agency from funding cuts and political pressures.

The hardest hit states if ACA premium tax credits expire

By Jakob Emerson - Texas will see the biggest economic hit if ACA premium tax credits expire at the end of 2025, according to a March 3 brief from the Commonwealth Fund. The ACA provides low- and middle-income individuals with premium tax credits to purchase health coverage on the exchange. Originally authorized by the American Rescue Plan Act in 2021, enhanced PTCs were later extended by the Inflation Reduction Act. Without another congressional extension, the PTCs will expire at the end of 2025. Read Full Article…

HVBA Article Summary

1. Widespread Economic Impact – If premium tax credits (PTCs) expire, the U.S. economy could experience a total GDP loss of $34.1 billion and an overall economic output reduction of $57 billion, with Texas, Florida, and Georgia facing the most severe declines.

2. Increased Uninsured Population – Without an extension of PTCs, an estimated 4 million individuals will lose health insurance, leading to decreased access to medical care, worsened health outcomes, and potential declines in workforce productivity.

3. State-Level Federal Funding Reductions – The elimination of enhanced PTCs would significantly reduce federal funding across states, with Texas losing $6.3 billion, Florida $4.2 billion, and Georgia $2.5 billion, further straining healthcare systems and local economies.

VA terminates 585 'non-mission-critical or duplicative' contracts to redirect over $900M to vet care

By Dave Muoio - The Department of Veterans Affairs (VA) continues to clean house, announcing Monday afternoon the termination of 585 contracts it said will help redirect more than $900 million to healthcare, benefits and services for veterans. The VA said its cuts are the “first step” in an audit of the roughly 90,000 contracts it currently has in place—a process its announcement stressed is being conducted with in-house expertise and feedback. Read Full Article…

HVBA Article Summary

1. Contract Eliminations and Cost Savings: The VA reviewed nearly 2,000 professional services contracts, cutting those deemed “non-mission-critical or duplicative,” such as staff mentoring and executive support. The canceled contracts total $1.8 billion, with remaining funds redirected to veteran care and services.

2. Focus on Core Mission and Efficiency: The VA emphasized that these cuts will not negatively impact veteran care, benefits, or services. Instead, they aim to enhance efficiency by prioritizing resources for essential medical and support functions while eliminating wasteful spending.

3. Broader Workforce and Budgetary Implications: The contract terminations follow recent workforce reductions affecting over 2,400 employees, with additional cuts rumored. These changes align with a broader federal effort to streamline spending, including the controversial Department of Government Efficiency (DOGE) initiative led by Elon Musk.

Hundreds of stakeholders urge Congress to make HSA telehealth provision permanent

By Alan Goforth - More than 300 organizations recently sent a letter to congressional leaders, encouraging them to make permanent a provision that allows employers to offer telehealth services below the deductible to employees with a Health Savings Account. More than 8 in 10 employers intend to offer employees and their dependents access to lower- or no-cost mental health support through their tele-mental health provider this year, the letter said. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Importance of Permanent Telehealth Flexibility: Employers emphasize that maintaining expanded telehealth flexibilities is essential for supporting employee and family mental health needs. Without these provisions, employees face higher out-of-pocket costs, creating barriers to accessing necessary mental and behavioral health care.

2. Employer and Congressional Support: A significant majority of employers prioritize behavioral health care access, with surveys showing strong bipartisan support in Congress for making telehealth flexibilities permanent. Data indicate that virtual health is seen as a crucial component of future healthcare strategies.

3. Call to Action for Legislative Action: The Alliance to Fight for Health Care and other advocates urge Congress to pass legislation ensuring permanent telehealth flexibility. They argue that continuing pre-deductible coverage for telehealth services enhances affordability and accessibility, particularly for mental health care.

Novo Nordisk will join legal row over FDA's removal of semaglutide from shortage list

By Max Bayer - Novo Nordisk got the green light to join a lawsuit by compounders against the FDA after the agency deemed that the Danish pharma’s blockbuster weight loss drug was no longer in shortage. Read Full Article…

HVBA Article Summary

1. Judicial Intervention – Judge Mark Pittman granted Novo Nordisk's request to intervene in the case after initially denying it due to the absence of FDA representation. This decision allows the pharmaceutical company to actively participate in the legal battle over semaglutide’s removal from the FDA drug shortage list.

2. Legal Challenge Against FDA – The Outsourcing Facilities Association (OFA) is suing the FDA, arguing that the agency improperly removed semaglutide from the shortage list without following standard rulemaking procedures, including a public comment period. The group also cites Novo Nordisk’s regulatory filings indicating continued supply challenges.

3. Business and Market Implications – Compounding pharmacies, such as Hims & Hers, have capitalized on the demand for GLP-1 drugs, but regulatory uncertainty has affected market confidence. The company’s share price has dropped significantly as investors question the sustainability of its compounded semaglutide business amid legal and regulatory scrutiny.

Health Insurance: What Switching To An Individual Coverage HRA Means For Employees

By Jack Hooper - When an employer offers a group health plan, all enrolled employees are placed under a single, uniform policy. Everyone has the same benefits, cost-sharing structure—including deductibles and copays—and access to a specific network of doctors and specialists. These negotiated group rates often result in lower premiums. Although preferred provider organizations (PPOs) allow access to out-of-network providers, these visits often come with out-of-pocket expenses. Read Full Article…  

HVBA Article Summary

1. Personalized Health Insurance Coverage: Unlike traditional group plans that offer the same benefits to all employees, an Individual Coverage Health Reimbursement Arrangement (ICHRA) allows employees to choose health insurance that best fits their unique needs. Factors such as medical history, preferred providers, and specific healthcare services can all be taken into account, ensuring greater flexibility and control over coverage.

2. Financial Independence from Co-Workers' Health Risks: In group health plans, insurance costs are influenced by the collective health of co-workers, which can lead to premium increases after high-cost claims. ICHRA eliminates this dependency by placing employees in the larger individual insurance market, where costs are based solely on their chosen plan rather than the health status of their colleagues.

3. Portability of Health Insurance: With ICHRA, employees can maintain their health insurance coverage even if they switch jobs, as long as their new employer also offers ICHRA. This eliminates the disruptions of changing plans, networks, and providers that often occur when transitioning between traditional employer-sponsored group health plans.

The moneyball approach to employee benefits: Using wins above replacement to maximize value

By Harrison Newman - In baseball’s analytics revolution, teams discovered that traditional statistics like home runs and batting averages told only part of the story. Introducing the concept of wins above replacement (WAR), a statistic that estimates a player's value by comparing them to a replacement-level player, transformed talent evaluation by measuring a player's total contribution compared to a replacement-level alternative. This shift to a comprehensive value assessment offers a compelling framework for reconsidering your employee benefits strategy. Read Full Article…  ^{_{(Subscription required)}}

HVBA Article Summary

1. Beyond Traditional Benefits: Maximizing Value Through Strategic Allocation: Organizations often focus on high-cost, traditional benefits like premium health care plans but may overlook alternative benefits that provide greater overall value. The WAR framework helps employers assess how specific benefits contribute to employee satisfaction, retention, and attraction beyond actuarial value, allowing for more effective budget allocation.

2. Balancing Cost and Perceived Value: Smart Investment in Employee Benefits: Understanding the difference between actuarial value and perceived value is crucial. For example, HDHPs with HSAs may have lower premiums than traditional plans but offer greater perceived value through flexibility and tax advantages. Employers should strategically invest in benefits that employees value most rather than just those with the highest actuarial worth.

3. Building a Sustainable and Impactful Benefits Portfolio: Like managing a sports team under a salary cap, HR leaders must balance cost and impact when designing benefits packages. Prioritizing flexible work options, mental health resources, and lifestyle accounts over trendy, unsustainable perks can lead to long-term employee satisfaction and a competitive edge in talent retention.

CVS sells Medicare Shared Savings business to Wellvana

By Emily Olsen - Shared Savings, or MSSP, is Medicare’s largest value-based care program. Under MSSP, providers band together in accountable care organizations and take on financial risk for patient care, with the goal of offering coordinated services that reduce unnecessary spending or medical errors. In 2023, the program saved the government a record-breaking $2.1 billion, according to the CMS. Read Full Article…

HVBA Article Summary

1. Value-Based Care Enablement – Providers often collaborate with value-based care enablement companies to facilitate their transition to risk-based payment models, leveraging data insights and improving care management.

2. CVS' Role in Value-Based Care – CVS' enablement services support providers in participating in CMS programs like MSSP and ACO REACH, impacting over 1 million patients by the end of 2024. Despite divesting its MSSP business, CVS remains committed to value-based care through Oak Street Health and ACO contracts with Aetna.

3. Financial Challenges and Strategy Shift – Facing a significant drop in profits due to rising medical costs in its Aetna insurance segment, CVS is adjusting its healthcare strategy, maintaining its focus on value-based care while navigating financial pressures.