Big Shifts: CVS Is Pulling the Plug on ACA Coverage — And 1 Million Americans Will Pay the Price

By Wendell Potter and Joey Rettino - In what’s becoming an all-too-familiar pattern, CVS Health announced it will pull Aetna out of the Affordable Care Act (ACA) marketplace in 2026, leaving about a million people across 17 states searching for new health coverage — and in some cases, fighting to afford any at all. This marks yet another retreat by a major for-profit insurer from a program designed to provide affordable health coverage to Americans who don’t get it through work. Read Full Article…

HVBA Article Summary

1. Aetna's ACA Exit Highlights Profit Over People: On the same day CVS Health announced nearly $1.8 billion in quarterly profits and a new deal to boost sales of the expensive weight-loss drug Wegovy, it also revealed that Aetna is exiting the Affordable Care Act (ACA) marketplace. The insurer cited "regulatory uncertainty" and economic volatility, but critics argue the move reflects a prioritization of shareholder interests over patient needs, especially as nearly 1 million individuals will now lose coverage amid rising premium concerns.

2. Vertical Integration and Obesity Drug Profits Take Priority: CVS is intensifying its focus on the lucrative obesity drug market by giving Wegovy preferred status on its PBM formulary, displacing a competitor’s product. This shift underscores how CVS uses its vertically integrated model—spanning insurance (Aetna), pharmacy benefit management (Caremark), and retail pharmacies—to abandon lower-margin businesses like ACA plans in favor of higher-profit ventures, raising concerns about how this consolidation impacts affordability and access to care.

3. Employer Plans Are Quietly Being Restructured Toward CVS-Owned Services: Beyond the ACA market, CVS is also steering employer-based insurance members toward CVS-owned pharmacies, limiting consumer choice and potentially disrupting patient care. This growing trend reflects how corporate consolidation can restrict access, reduce transparency, and prioritize internal profitability over patient-centered decision-making—especially as political uncertainty threatens the broader health insurance landscape.

Chronic disease prevention a pillar of new MAHA-ified CMS Innovation Center strategy

By Noah Tong - The CMS Innovation Center, responsible for implementing cost-saving pilot payment models, is choosing to base models it prioritizes off three principles, the department announced May 13. The principles—promoting evidence-based prevention, empowering people to achieve health goals and ensuring competition—are meant to ensure Innovation Center models move program beneficiaries to accountable care arrangements, limit high utilization and ensure models are “fiscally sound,” the Centers for Medicare and Medicaid Services (CMS) said. Read Full Article…

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1. CMMI to Focus on Simplified, Risk-Based Payment Models with Emphasis on Prevention: The Center for Medicare and Medicaid Innovation (CMMI) aims to streamline its benchmarking methodology, limit state influence on rate-setting, and ensure alternative payment models include downside financial risk—paired with advanced shared savings or prospective payments. Prevention will be a priority, with potential models addressing nutrition, tobacco use, and cancer screenings, alongside expanded initiatives like the Medicare Diabetes Prevention Program and ACO REACH.

2. Broader Innovation Strategy Embraces AI, Caregiver Support, and Waivers for High-Need Populations: CMMI plans to partner with the private sector to test improvements in Medicare Advantage and Medicaid, integrate artificial intelligence, and explore new cell and gene therapies. Future models may offer waivers for accountable care organizations assuming global risk, such as bypassing National Coverage Determinations for certain durable medical equipment or reducing cost-sharing for preventive services.

3. Shift Toward Multi-Payer Alignment and Long-Term Incentives to Support Value-Based Care: Acknowledging barriers like misalignment across payers, CMMI will prioritize specialty-focused longitudinal care models and longer-term financial structures (e.g., advanced shared savings over extended timeframes). Although CMS is abandoning its 2030 goal of transitioning all Medicare beneficiaries to accountable care, it remains committed to promoting risk-based models that improve chronic condition management and encourage equitable, sustainable system transformation.

Republicans advance bill with steep cuts to Medicaid as part of Trump agenda

By Nathaniel Weixel and Emily Brooks - Republicans on the House Energy and Commerce Committee advanced legislation Wednesday afternoon containing cuts to Medicaid and health care provisions — some of the most controversial and contentious provisions that will be included in the “big, beautiful bill” of President Trump’s ambitious legislative agenda. Read Full Article…

HVBA Article Summary

1. GOP Plan Centers on Medicaid Cuts to Fund Tax Priorities: The House Energy and Commerce Committee advanced a bill along party lines that includes $880 billion in savings, largely from Medicaid cuts. Key provisions include work requirements for certain adults, limits on provider taxes used to boost federal Medicaid funding, and penalties for covering undocumented immigrants. The changes are estimated to result in over 10 million losing Medicaid coverage and 7.6 million becoming uninsured by 2034, according to the Congressional Budget Office.

2. Partisan Tensions and Protests Underscore Deep Division: The 26-hour markup session was marked by intense partisan clashes, protests, and dramatic moments, including arrests of disability rights activists and pointed remarks from lawmakers. Democrats argued the bill strips healthcare from millions to pay for tax breaks for the wealthy, while Republicans defended it as a way to protect Medicaid for the most vulnerable and curb government overspending.

3. Intraparty Debate Highlights Challenges Ahead: While some moderates secured concessions—such as maintaining the federal Medicaid match rate and avoiding per-capita caps—fiscal conservatives argued the bill doesn’t go far enough. They criticized the delayed implementation of work requirements and called for deeper spending cuts. Speaker Mike Johnson faces a delicate task uniting his party before a floor vote, with both far-right and populist Republicans demanding changes that reflect divergent visions of Medicaid’s future.

Hospital expenses per inpatient day across 50 states

By Molly Gamble - Below are the adjusted expenses per inpatient day in 2023 for nonprofit, for-profit, and government hospitals in every U.S. state, based on the latest estimates provided by Kaiser State Health Facts. The figures are based on information from the 2023 American Hospital Association Annual Survey. They are an estimate of the expenses incurred in a day of inpatient care and have been adjusted upward to reflect an estimate of outpatient service volumes, according to the KFF. Read Full Article…

HVBA Article Summary

1. Wide State-by-State Variations in Hospital Expenses: The average estimated expense per inpatient day varies significantly by state and hospital type. For example, nonprofit hospitals in California report $4,819 per day, while in Mississippi that figure is just $1,064. These disparities reflect regional cost differences and varying operational models across the country.

2. Nonprofit Hospitals Generally Incur Higher Expenses Than For-Profits: Nationally, nonprofit hospitals report higher estimated inpatient expenses ($3,288/day) compared to for-profit hospitals ($2,529/day). However, in some states — such as Nebraska and Washington — for-profit hospitals exceed nonprofit costs, highlighting that ownership type doesn’t consistently predict higher or lower costs.

3. Public Hospitals Show the Greatest Range in Daily Expenses: State and local government hospitals demonstrate the widest cost variability, ranging from as low as $699/day in South Dakota to $5,809/day in Oregon. These fluctuations may be tied to funding mechanisms, service scope, and patient population needs.

5 questions on Trump’s plan to lower US drug prices

By Jonathan Gardner - President Donald Trump’s declaration Monday that the Department of Health and Human Services will pursue a plan to “equalize” drug prices with other countries both seeks to fulfill a campaign promise and fits with the “America first” theme of his second term. The path forward is uncertain, however. At the end of Trump’s first term, his administration had proposed a plan to temporarily apply so-called most-favored nation pricing controls on a limited number of drugs in Medicare, which was rejected by the courts on procedural grounds. Read Full Article…

HVBA Article Summary

1. Trump’s Executive Order Pushes Broad Most-Favored Nation (MFN) Drug Pricing Plan: The order proposes applying MFN pricing to drugs sold in both government and private markets, aiming to slash U.S. drug costs by referencing lower international prices. While framed as a cost-saving measure and potential trade negotiation tool, the order lacks a clear legal pathway to enforce MFN pricing across commercial sectors, raising doubts about its feasibility.

2. Legal and Market Uncertainty May Limit Impact: Legal challenges are highly likely, especially given limited executive authority to control private-sector drug prices. Drugmakers might respond by pulling products from low-price countries to avoid influencing U.S. reference pricing. Additionally, confidential rebates and pricing tactics abroad could undermine the accuracy and effectiveness of MFN comparisons.

3. Pharma Industry Pushback and Economic Risk: Industry leaders strongly oppose the plan, warning it could stifle innovation, reduce access to treatments, and jeopardize U.S. biotech investment and jobs. Companies heavily reliant on U.S. revenue—particularly those with high Medicare exposure like Johnson & Johnson and Novo Nordisk—would be most affected if the policy proceeds beyond Medicare to the commercial market.

How to help college grads navigate their benefits

By Paola Peralta - A new wave of college graduates is set to join the labor force, eager to sign up for health insurance and start their 401(k). Yet they will need help from benefit managers and leaders to understand their options. Gen Z are less satisfied with their benefits compared to other generations, and are  less likely to stay with their current employer for another two years, according to a 2024 wellness survey from the Employee Benefit Research Institute and Greenwald Research. Benefit leaders will need to address dissatisfaction and create pathways for long-term growth if they want to retain this new crop of talent. Read Full Article… ^{_{(Subscription required)}} 

HVBA Article Summary

1. Gen Z prioritizes benefits but lacks understanding: While salary and location remain key considerations, Gen Z graduates are placing greater emphasis on benefits that address immediate concerns, such as mental health support, student loan assistance, and tuition reimbursement. However, 76% of Gen Z employees admit they don’t fully understand their benefits packages, leading to confusion, unmet expectations, and dissatisfaction — underscoring the urgent need for employers to provide benefits education and support from the start.

2. Employers must tailor and clearly communicate offerings: To better meet the needs of younger employees, employers should actively survey both current staff and new hires to identify preferred benefits, then restructure offerings accordingly. It’s not enough to make changes — benefit leaders must also communicate updates clearly and consistently, providing educational resources, tools, and hands-on assistance throughout the entire enrollment and utilization process.

3. Education and personalization drive retention: Long-term retention hinges on offering benefit programs that grow with employees, from early-career perks like student loan help to future-oriented coverage like retirement plans and life insurance. By providing educational seminars, personalized guidance, and opportunities for young talent to express evolving needs, employers can help Gen Z make informed choices and build lasting loyalty through thoughtful, well-communicated benefits strategies.

GLP-1s may cut risk of obesity-related cancers: 3 study notes  

By Erica Carbajal - A new study has found GLP-1s may reduce the risk of developing obesity-related cancers by 41% compared to bariatric surgery — a benefit researchers believe could be tied to the drugs’ ability to reduce inflammation. The findings, published May 11 in The Lancet’s eClinicalMedicine journal, are based on data from more than 6,000 adults. Researchers in Israel analyzed EMR data from patients in the country with obesity or diabetes who had no prior history of cancer and who either underwent bariatric surgery or were treated with first generation GLP-1 medications from 2010 to 2018. Read Full Article…

HVBA Article Summary

1. Comparable Cancer Rates, But Stronger Protective Effect from GLP-1s: While both GLP-1 users and bariatric surgery patients experienced similar overall rates of obesity-related cancers (approximately 5–6 cases per 1,000 person-years), GLP-1s were associated with a 41% lower relative risk when researchers adjusted for weight loss. This suggests that GLP-1s may provide cancer protection that goes beyond the benefits of weight reduction alone.

2. GLP-1s May Reduce Cancer Risk Through Anti-Inflammatory Effects: The study’s authors propose that GLP-1s could offer additional cancer-preventive benefits due to their ability to lower inflammation, a known risk factor for multiple obesity-related cancers. This points to biological mechanisms beyond weight loss that may make GLP-1s uniquely effective in reducing cancer risk.

3. Promising Insights, But More Research is Needed: Experts unaffiliated with the study described the findings as encouraging, especially given the lack of long-term cancer data on GLP-1 use. However, they emphasized that the study was observational and based on older medications like liraglutide, with a sample size too small to evaluate individual cancer types. They called for randomized controlled trials using newer GLP-1s such as semaglutide and tirzepatide to confirm these results and explore the underlying biological pathways.