House Budget Committee overcomes conservative pushback to advance reconciliation package

By Noah Tong - A key House panel has signed off on the GOP's massive reconciliation package, after overcoming some intra-party pushback on the provisions. The House Budget Committee advanced the proposal late Sunday after several Republicans joined Democrats in rejecting the proposal in a 16-21 vote on Friday. Four GOP representatives sided against the bill, arguing that the included spending cuts are back-loaded. Read Full Article…

HVBA Article Summary

1. Controversial Medicaid Reforms Advance Despite Backlash: The House Budget Committee advanced a sweeping Republican-led reconciliation bill along party lines, with proposals to impose Medicaid work requirements starting in 2029, eliminate federal provider taxes, and restrict benefits for immigrants. Despite initial resistance from conservative members who wanted faster implementation, the bill moved forward following internal negotiations. The legislation has sparked significant protests, particularly from disability rights advocates and healthcare groups, and is expected to face a tough battle in the Senate.

2. Potential Coverage Losses and Financial Strain on States and Providers: The Congressional Budget Office estimates over 13 million people could lose health insurance under the current bill, with hospitals, health centers, and advocacy groups warning of reduced access to care, increased uncompensated hospital costs, and service closures. Critics argue the bill creates bureaucratic hurdles and strips away protections, especially for low-income and vulnerable populations, without offering viable funding alternatives for states.

3. Tax and Coverage Provisions Draw Sharp Divides: Alongside Medicaid cuts, the bill includes expansive tax-related provisions: it expands Health Savings Accounts (HSAs), introduces new paid family leave tax credits, and rebrands ICHRAs (individual coverage health reimbursement arrangements). While Republicans argue these measures offer choice and affordability, critics say they primarily benefit higher-income earners and do little for families struggling to afford care. Immigration-related healthcare access is also further restricted, tightening eligibility for ACA subsidies and Medicare enrollment.

Senate Report Calls For Reforms to 340B Drug Pricing Program

By Luke Gale - If your health system participates in the 340B Drug Pricing Program, additional oversight may be coming your way. A report recently released by Senator Bill Cassidy (R-Louisiana calls on Congress to require participating providers to complete detailed annual reporting on 340B savings and revenues, and how those benefits are passed on to patients. Cassidy, chair of the Senate Health, Education, Labor, and Pensions Committee Chairman, based his recommendations on the results of a two-year-long investigation. Read Full Article…

HVBA Article Summary

1. Senate report urges reforms to improve transparency and patient benefits in the 340B program: The report recommends that Congress consider capping fees charged by contract pharmacies and creating clearer guidelines to ensure 340B drug discounts benefit patients directly. These changes reflect growing concerns over whether savings are being passed on or used primarily to subsidize broader hospital costs.

2. Debate centers on accountability vs. flexibility in how 340B funds are used: Health systems like Bon Secours Mercy Health and Cleveland Clinic argue that the law doesn’t require them to track or directly share 340B savings with patients. However, many covered entities—including FQHCs like Sun River Health and Yakima Valley—demonstrate direct patient benefits through free or discounted drug programs.

3. Rapid program growth has triggered political and regulatory scrutiny: With over 60,000 provider organizations now participating—up 600% since 2000—and $66.3 billion in outpatient drug spending in 2023 alone, the 340B program is under heightened review. Future policy shifts, including potential changes following recent executive actions and court rulings, may impact provider savings and call for strategic financial planning.

House GOP pushes for big changes to HDHPs, HSAs

By Jakob Emerson - House Republicans are looking to finalize the details of their budget reconciliation package by the end of the month, which would include major changes to health reimbursement arrangements and high deductible health plans. Read Full Article…

HVBA Article Summary

1. Expanded HSA Eligibility and Use: The proposal allows broader access to Health Savings Accounts (HSAs), including permitting Medicare Part A enrollees and individuals on ACA bronze or catastrophic plans to contribute. It also enables the use of HSAs for worksite clinic discounts, fitness memberships (up to $500 for individuals, $1,000 for families), and direct primary care (capped at $150/month for individuals, $300 for families).

2. Increased Flexibility for Contributions and Reimbursements: Spouses over 55 could make catch-up contributions to a shared HSA instead of separate accounts. Employees could convert FSA or HRA balances into HSA funds (up to the FSA annual limit), and medical expenses from up to 60 days before opening an HSA could be reimbursed.

3. Targeted Support for Lower-Income Households: Individuals earning under $75,000 ($150,000 for families) could make additional HSA contributions—$4,300 for individuals and $8,550 for families—phased out at higher income levels, offering enhanced savings opportunities for lower- and middle-income earners.

CMS Proposes Streamlined Data Collection and Digital Advancements for LTCH Quality Reporting in FY 2026

By Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P - The Centers for Medicare & Medicaid Services (CMS) is proposing targeted changes to the Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP) in the fiscal year (FY) 2026 Inpatient Prospective Payment System (IPPS) Proposed Rule. These updates are designed to reduce reporting burden, eliminate outdated or redundant measures, and pave the way for future digital innovation in post-acute care quality reporting. Read Full Article…

HVBA Article Summary

1. Streamlined Data Requirements and Reduced Reporting Burden: CMS proposes removing nine data elements from the LTCH CARE Data Set in FY 2026—including items for deceased patients and certain Social Determinants of Health (SDOH) measures—citing duplication and limited utility. This is projected to save LTCHs over 2,600 hours and $180,000 annually by FY 2028, reflecting a shift toward more efficient and meaningful quality reporting.

2. Clarified Reconsideration Process for QRP Compliance: The proposed rule outlines a more structured and transparent appeals process for LTCHs found non-compliant with quality reporting requirements. Though minimal in nationwide administrative burden (+4 hours and +$187.60 in FY 2026), the update aims to ensure fairer resolution of reconsideration requests.

3. Stakeholder Input Sought on Future Quality Reporting Enhancements: CMS issued Requests for Information (RFIs) on three fronts: developing new quality measures focused on long-term recovery and patient function; revising assessment submission deadlines; and advancing digital quality measurement using FHIR® standards. LTCHs are encouraged to provide feedback by June 10, 2025, to influence the future direction of the LTCH Quality Reporting Program.

Third-Party Administrators – The Middlemen Of Self-Funded Health Insurance

By Karen Handorf, Christine H. Monahan, and Kennah Watts - Pharmacy benefit managers (PBMs) have received significant attention from the White House, members of Congress, federal regulators, and state lawmakers, as well as the media, for exploitative, cost increasing practices. Yet, most employer health care dollars are spent on medical care where another type of corporate middlemen—third-party administrators owned by large insurance companies (TPAs)—operates. In contrast to PBMs, corporate TPA practices remain underscrutinized relative to their importance in the health care system. Read Full Article…

HVBA Article Summary

1. Opaque TPA Practices Undermine Cost Control Goals: Although third-party administrators (TPAs) claim to reduce costs for self-funded employer health plans, litigation and investigations suggest they often obscure fees, use spread pricing tactics, and prioritize their own profits. Their contracts typically withhold key reimbursement details and fail to provide transparency into how plan dollars are actually spent, limiting employers’ ability to evaluate value or hold TPAs accountable.

2. Misaligned Incentives and Hidden Fees Inflate Employer Costs: TPAs may overpay affiliated providers, use vague pricing methods for out-of-network care, and profit from programs like “shared savings” and post-payment recovery—often without disclosing how much money actually reaches providers versus administrative fees. In some cases, TPAs are incentivized to allow incorrect payments in order to collect additional recovery fees later, undermining pre-payment cost controls and increasing employer expenses.

3. Need for Regulatory Oversight and Contract Transparency: Despite reforms in the Consolidated Appropriations Act of 2021, TPAs continue to resist employer access to claims data and fee disclosures. Policy makers are urged to investigate and mandate greater transparency in TPA-provider agreements to prevent abuse, enable effective cost containment, and ensure that rising employer health care costs translate into better care and value—not excess profit for intermediaries.

Semaglutide May Cut Cardiovascular Risk Before Weight Loss

By Becky McCall, MSc, MScPh - Semaglutide (Wegovy) is associated with a 41% reduction in the risk for major adverse cardiovascular events (MACEs) within 6 months of initiation — well before patients achieve substantial weight loss or reach the full 2.4 mg weekly dose — according to new data from the SELECT trial. “The cumulative incidence of MACEs during the first 6 months showed a hazard ratio of 0.59,” said Donna Ryan, MD, professor emerita at Pennington Biomedical Research Center in Baton Rouge, Louisiana. Read Full Article…

HVBA Article Summary

1. Early Cardiovascular Benefits Independent of Weight Loss: The SELECT trial showed that semaglutide significantly reduced major adverse cardiovascular events (MACEs) within weeks of treatment—before participants reached the full dose or experienced substantial weight loss. By day 20, a statistically significant reduction in MACEs was observed, with a hazard ratio of 0.63 in the first 3 months and a 53% reduction in CV deaths over six months.

2. Semaglutide’s Cardiovascular Impact May Be Driven by Other Mechanisms: Researchers noted a clear dissociation between weight loss and early cardiovascular benefit, suggesting that semaglutide's effect on reducing CV events may be due to mechanisms beyond weight reduction—potentially anti-inflammatory effects. Experts highlighted the importance of investigating these alternative pathways as obesity is increasingly understood as an inflammatory condition.

3. Study Design Underscores Broader Therapeutic Potential of Semaglutide: Conducted in over 17,600 adults with overweight or obesity and established cardiovascular disease (but without type 2 diabetes), the trial emphasized that semaglutide’s cardiovascular benefit was not primarily tied to weight loss. This positions semaglutide as a potentially dual-purpose therapy—managing both obesity and cardiovascular disease—which could influence treatment decisions and comparisons with other CV and anti-obesity drugs.

Benefits in the balance: Data holds the key to HR’s strategic influence

By Matthew Gregson - HR and reward teams are under growing pressure to prove the value of their work. How can HR and reward professionals strengthen their position? With tighter budgets, rising employee expectations, and greater scrutiny from leaders, instincts and good intentions no longer suffice. Business leaders want hard evidence their employee benefits and wellbeing programmes deliver value; not just for employees, but for their business. Read Full Article…

HVBA Article Summary

1. Lack of data-driven evidence is stalling benefits investment: Over 30% of benefits proposals are being rejected due to insufficient data to justify them, highlighting the growing importance of evidence-based reporting to secure stakeholder buy-in and future funding. Without clear metrics and structured analysis, even well-intentioned benefits strategies risk being overlooked.

2. HR teams must adopt a structured, outcome-focused approach: To strengthen their strategic impact, HR and reward professionals should define specific goals, measure key metrics like cost, satisfaction, and outcomes (e.g., retirement readiness or health trends), and report performance regularly—ideally quarterly—to align with business priorities and support investment decisions.

3. Bridging data and capability gaps is essential for success: Given that many HR teams lack the tools or skills to manage complex benefits data, partnering with advisers can help interpret analytics, benchmark effectively, and build robust business cases. However, internal data—such as claims and feedback—must still drive strategy, not just external benchmarks.