Here's what the CEOs at major for-profit payers earned last year

By Paige Minemyer – As the health insurance industry continues to face significant headwinds and challenges, the CEOs of major firms largely stayed steady in their compensation for 2025. Based on annual proxy filings from the six major national payers, these executives earned a total of $190.5 million in compensation last year. One of the notable storylines from 2025 was the sudden departure of UnitedHealth Group CEO Andrew Witty in May, and his replacement, Stephen Hemsley, carries a unique compensation package that skews this year's report. Read Full Article...

HVBA Article Summary

1. Executive Compensation Driven Largely by Stock and Option Awards: Chief executives at major health insurers including UnitedHealth Group, The Cigna Group, CVS Health, Elevance Health, Humana, and Centene Corporationearned compensation packages ranging from approximately $18 million to $61 million in 2025. The majority of executive pay came from stock and option awards rather than base salary, reflecting compensation structures tied to long-term company performance. Stephen Hemsley of UnitedHealth Group received the highest compensation package at $60.9 million, largely due to a one-time $60 million option award tied to his return as CEO.

2. Health Insurers Faced Financial and Operational Pressures in 2025: Companies across the sector navigated rising healthcare costs, increased utilization, regulatory scrutiny, and challenges in Medicaid, Medicare Advantage, and Affordable Care Act marketplace businesses. Several insurers responded with operational changes, including pharmacy benefit management reforms, strategic business evaluations, and adjustments to insurance exchange participation. Leadership transitions also occurred at multiple organizations, including CEO changes at UnitedHealth Group and CVS Health, as companies worked to stabilize performance and adapt to market pressures.

3. CEO Pay Ratios Highlight Wide Gaps Between Executives and Median Employees: Reported CEO-to-median-employee pay ratios varied significantly across companies, ranging from 206:1 at Centene to 748:1 at UnitedHealth Group. Median employee salaries generally ranged from about $63,000 to $95,000, while executive compensation packages reached tens of millions of dollars. Companies noted that certain compensation figures, particularly at UnitedHealth Group, were influenced by one-time awards and may not reflect future pay structures.

Hospitals face growing fallout from ACA coverage cliff

By Alan Condon – The warning signs were visible for months. Enhanced ACA premium tax credits expired at the end of 2025, and insurers are pulling back from the ACA marketplace while enrollment composition shifts toward high-deductible bronze plans. Now, the knock-on effects of these moves are beginning to emerge as leaders from the largest for-profit health systems elaborated on first-quarter results. Nashville, Tenn.-based HCA Healthcare reported a 15% decline in exchange equivalent admissions in the first quarter while Dallas-based Tenet Healthcare saw exchange revenues fall roughly 9% to 10% year over year. Read Full Article...

HVBA Article Summary

1. Declining Exchange Enrollment and Insurer Participation: The expiration of enhanced ACA premium tax credits at the end of 2025 has led to insurers reducing their presence in the ACA marketplace. This has resulted in a decrease in total exchange enrollment and a shift in the types of plans selected, with more individuals choosing high-deductible bronze plans. The reduction in insurer participation and enrollment is creating financial and operational challenges for hospitals, as fewer patients are covered by exchange plans.

2. Rising Uninsured Volumes and Collection Challenges: As more patients lose or drop their exchange coverage, hospitals are experiencing an increase in uninsured admissions. Hospital executives note that these patients do not stop seeking care, but instead present as uninsured, which makes it significantly harder for hospitals to collect payment. This shift is contributing to higher levels of uncompensated care and bad debt, putting additional strain on hospital finances.

3. Complexities in Revenue Recognition and Patient Cost-Sharing: The ACA's 90-day grace period for premium payments adds uncertainty to hospital revenue recognition, as hospitals must estimate which patients will ultimately lose coverage. Additionally, the move toward bronze and higher cost-sharing silver plans means that even insured patients are facing greater out-of-pocket expenses. Hospitals are adjusting their financial strategies to account for increased risk in collecting copays and deductibles, reflecting a broader trend of rising patient financial responsibility.

Aetna persuades full 5th Circuit appeals court to review an ERISA ruling

By Allison Bell – Aetna has persuaded the 5th U.S. Circuit Court of Appeals to provide a full, "en banc" review for a case involving the arbitration clause in a health plan administration agreement. Federal appeals courts rarely grant petitions for en banc rehearings. The new 5th Circuit decision means that all 17 judges who serve on the 5th Circuit will take a fresh look at a ruling that three of the judges issued in December 2025. Aetna, a subsidiary of CVS Health, administered a self-insured health plan for Aramark, a big food service giant. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. 5th Circuit Rehears Aetna-Aramark Arbitration Dispute: The 5th Circuit Court of Appeals agreed to rehear en banc a dispute between Aramark and Aetna over whether Aramark’s lawsuit concerning alleged improper claims payments must proceed through arbitration or remain in federal court. Aetna argues that the companies’ master services agreement requires disputes to be resolved through binding arbitration in Connecticut, while Aramark contends the case belongs in the federal court system. The rehearing gives the full appeals court another opportunity to evaluate how the arbitration clause should be interpreted.

2. Debate Centers on Definition of Equitable Relief: A key issue in the case is whether Aramark’s claims qualify as “equitable relief,” which the agreement excludes from mandatory arbitration requirements. Aetna maintains that because Aramark is seeking monetary compensation, the claims should not be considered equitable relief and therefore should be arbitrated. One judge on the original 5th Circuit panel expressed concern that treating requests for money damages as equitable relief could expand the exception beyond its intended scope.

3. Case Highlights Broader Arbitration vs. Litigation Questions: The dispute reflects wider debates over the role of arbitration in resolving complex business and healthcare disputes. Supporters of arbitration argue it offers a faster and less costly alternative to court proceedings, while some litigants prefer federal courts because they believe judicial proceedings may provide strategic or procedural advantages. The en banc rehearing is notable because such reviews are uncommon, with the 5th Circuit granting only a small number of rehearing requests each year despite issuing thousands of opinions annually.

Medicare Advantage: What agents in the field are seeing

By Theo Morrill – Two million. That's how many older Americans were displaced from Medicare Advantage plans in 2025, according to agents fielding the calls. Hospital systems pulled out of networks. Carriers dropped unprofitable plans during the annual enrollment period. And the agents who build their practices around MA found themselves scrambling to reposition clients who suddenly had nowhere to go. Read Full Article...

HVBA Article Summary

1. Network Instability and Plan Withdrawals: The Medicare Advantage market is experiencing significant instability, with hospital systems withdrawing from networks and carriers discontinuing unprofitable plans. This has led to a large number of seniors being displaced from their existing coverage, forcing agents to quickly find alternative solutions for affected clients. The volatility is creating uncertainty for both beneficiaries and the agents who serve them.

2. Payment Pressures and Provider Participation: Changes in reimbursement rates from the Centers for Medicare and Medicaid Services (CMS) are putting financial pressure on carriers and, by extension, healthcare providers. Lower payments to carriers result in reduced reimbursements for doctors, which can lead to providers leaving Medicare Advantage networks. This dynamic is contributing to narrower provider networks and making it harder for seniors to access care through their plans.

3. Diverging Agent Strategies and Beneficiary Impact: Agents are divided in their response to these challenges, with some moving away from selling Medicare Advantage plans altogether, while others focus on higher-rated plans or diversify into Medigap offerings. The sustainability of the current reimbursement model is in question, and agents are increasingly concerned about the long-term implications for the 33 million Americans enrolled in Medicare Advantage. Seniors may face more limited choices and potential barriers to switching plans as the market continues to shift.

Turning mental health parity into progress now a business imperative

By Andrew Stocker – Voya's State of Employee Benefits 2026 research shows that mental health sits right at the center of employee well-being. Employers rate mental health support among the highest impact benefits they can offer, and employees increasingly see mental and emotional well-being as fundamental to how they show up at work and engage with their benefits. The need is widespread. According to the National Alliance on Mental Illness (NAMI), 1 in 5 U.S. adults experience mental illness each year. And mental well-being disrupted by stress, anxiety or emotional strain can heavily influence broader healthcare engagement. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Mental Health as a Business Imperative: The article emphasizes that mental health support is no longer a supplemental benefit but a core business necessity. Employers recognize that supporting mental health leads to better employee well-being, which in turn drives improved business outcomes. This shift reflects a growing understanding that mental health directly impacts workforce productivity, engagement, and overall organizational health.

2. Access and Usability Remain Major Challenges: Despite increased investment and awareness, significant barriers to accessing mental health services persist, such as provider shortages, cost, and scheduling difficulties. These challenges disproportionately affect women, younger employees, and individuals with disabilities. The article highlights that benefits are only effective if employees can easily find, trust, and use them, underscoring the need for clear communication and user-friendly benefit design.

3. Regulatory and Strategic Shifts in Mental Health Parity: Regulatory changes, such as the Mental Health Parity and Addiction Equity Act (MHPAEA), require employers to ensure mental health benefits are as accessible and comprehensive as medical benefits. Employers are now expected to demonstrate that mental health support is not only offered but also meaningfully accessible and utilized. The article suggests that organizations should proactively evaluate and enhance their benefits strategies to stay compliant and support workforce well-being.

Race tightens between cybersecurity pros in healthcare and cyber bad guys everywhere

By Dave Pearson – A new survey of medical-device purchasers shows cyberattacks on medical devices rising in both frequency and harmfulness to patients. Frustratingly to hospital leaders, the upward trajectory is happening despite hospitals’ striving to be more proactive with defensive measures. These include allocating more money for cybersecurity, finetuning security practices and beefing up procurement protocols. The survey was conducted online in March for a cybersecurity vendor, RunSafe Security. Read Full Article...

HVBA Article Summary

1. Rising Threats Despite Increased Efforts: The survey reveals that cyberattacks targeting medical devices are becoming more frequent and impactful, even as hospitals invest more in cybersecurity and refine their protective strategies. This trend suggests that the pace of cyber threats is matching or outpacing the improvements in defensive measures. Hospital leaders are finding that simply increasing budgets and updating protocols may not be enough to counteract the evolving tactics of cybercriminals.

2. Procurement and Regulatory Influence: Many healthcare organizations are responding to cyber risks by tightening procurement standards, such as requiring a software bill of materials and including detailed cybersecurity requirements in vendor contracts. Regulatory guidance from agencies like the FDA and the European Union is also shaping purchasing decisions, with nearly 80% of organizations reporting changes to their processes as a result. This shift indicates a growing recognition that security must be considered at every stage of device acquisition and deployment.

3. Persistent Concerns Over New Technologies: The adoption of AI-equipped medical devices is widespread, but it brings heightened anxiety about potential vulnerabilities. A significant majority of respondents express at least moderate concern about the cybersecurity risks posed by these advanced devices. The report underscores the need for security features to be integrated into devices before they are deployed, as well as strategies to protect existing equipment that cannot be easily replaced.

GLP-1s driving healthcare cost hikes, employers say

By Emily Olsen – Originally developed for Type 2 diabetes, GLP-1s have shown remarkable efficacy at treating obesity, which affects a large swath of Americans. About 1 in 8 adults say they’re currently taking a GLP-1 for weight loss or to manage a chronic condition, according to a survey conducted last year by health policy researcher KFF. However, the popular medications are expensive, with list prices reaching around $1,000 per month. Research shows GLP-1s are contributing to rising healthcare costs, already a challenge for many employers that are struggling to absorb the increased expense. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Employer Concerns Over Rising Costs: A significant majority of employers report that GLP-1 medications are driving up healthcare costs for their organizations. This financial strain is leading some companies to consider dropping coverage for these drugs, especially as overall prescription drug expenses continue to climb. The survey highlights that cost management is becoming a central issue in decisions about GLP-1 coverage.

2. Coverage Strategies and Management: Employers are employing various strategies to manage the use and cost of GLP-1s, such as limiting prescriptions to certain providers, excluding some drugs from formularies, and requiring participation in weight management programs. Most employers use standard cost-sharing arrangements rather than special benefit designs for these medications. Executive management teams are often directly involved in making decisions about GLP-1 coverage, reflecting the high stakes involved.

3. Uncertain Long-Term Benefits: While some research suggests that sustained use of GLP-1s could eventually lower healthcare costs by improving health outcomes, most employers have not yet observed these benefits in their claims data. More than half of employers expect significant clinical improvements, but few have seen evidence of reduced obesity rates or fewer bariatric surgeries so far. This uncertainty adds to the complexity of deciding whether to continue covering these expensive medications.