The $2.67B BCBS antitrust settlement payout: 6 things to know

By Jakob Emerson – Payments from the $2.67 billion Blue Cross Blue Shield antitrust settlement began rolling out May 11, more than a decade after the original lawsuit was filed. The litigation began in 2012, when health plan members filed a series of antitrust lawsuits against the BCBS Association and its affiliates, alleging the companies conspired to divide up markets and avoid competing with each other, thereby driving up costs for consumers. The cases were consolidated in 2013 and later proceeded as a class action. BCBS denied all allegations of wrongdoing. Read Full Article...

HVBA Article Summary

1. Settlement Finalized After Extended Court Review: Blue Cross Blue Shield Association reached a $2.67 billion antitrust settlement in 2020 covering individuals and employers with BCBS coverage between 2008 and 2020, while admitting no wrongdoing. A federal judge approved the agreement in 2022, and subsequent legal challenges were rejected by the 11th U.S. Circuit Court of Appeals in 2023. The U.S. Supreme Court declined to hear further appeals in 2024, allowing the settlement to remain in effect.

2. Structural Reforms Increased Competition Among BCBS Plans: In addition to the financial settlement, Blue Cross Blue Shield Association agreed to eliminate association rules that limited competition among affiliated Blue insurers. The changes removed requirements tied to Blue-branded revenue and allowed certain large employers to seek competing bids from BCBS plans outside their headquarters’ geographic market through the “second blue bid” process. These reforms were designed to create more competitive opportunities for large national accounts within the BCBS system.

3. Antitrust Scrutiny and Litigation Continue Across the Industry: Early market activity suggests the rule changes are already affecting competition, with Elevance Health reporting success bidding for national accounts in competing BCBS territories. Industry observers note that larger BCBS organizations may benefit most from the new structure, potentially increasing consolidation pressure on smaller regional plans. Separate provider settlements and new lawsuits filed in 2026 alleging reimbursement suppression, market allocation, and price fixing indicate that antitrust scrutiny of the BCBS system remains ongoing.

Kennedy fires heads of task force that sets insurance coverage rules

By Maya Goldman – Health Secretary Robert F. Kennedy Jr. fired the co-chairs of the U.S. Preventive Services Task Force last week. Why it matters: The move could open the task force up to more political influence. It comes as the administration prepares to vet new applicants to the committee, a process in which the chairs would typically be involved. The expert panel recommends which health services insurers must cover at no cost to patients under the Affordable Care Act. Read Full Article...

HVBA Article Summary

1. HHS Removes Preventive Services Task Force Chairs: Health and Human Services Secretary Robert F. Kennedy Jr.ended the appointments of task force chairs John Wong and Esa Davis effective immediately, even though their terms were set to continue through 2027 and 2028. HHS stated the dismissals were administrative decisions unrelated to performance following a review of current appointments. The department said the action was intended to help preserve confidence in the continuity and durability of the task force’s work.

2. Leadership Changes Raise Concerns About Continuity: The task force has recently postponed several meetings and is currently accepting applications for new members, whose terms are expected to begin in June. Esa Davis said she was surprised by the decision and expressed concern about the loss of institutional knowledge and delays to ongoing preventive care recommendations. She emphasized the importance of the task force’s recommendations in helping patients access preventive screenings, medications, and counseling services.

3. Experts Question Potential Impact on Independence and Standards: Aaron Carroll said the dismissals could create concerns about political influence and the scientific rigor of future recommendations. He noted that the task force’s guidance plays a role in determining which preventive services are covered by insurance without cost-sharing. Questions also remain about how replacement members will be selected while the panel temporarily lacks active chairs.

Supreme Court lets Medicare drug price negotiations stand: What it means for health systems

By Ella Jeffries – The U.S. Supreme Court has declined to hear petitions from six major drugmakers challenging the Medicare Drug Price Negotiation Program, leaving in place lower court rulings that upheld the program and effectively closing off the industry’s best remaining path to dismantling it through the courts. The justices refused to take up separate appeals brought by AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Janssen, Novartis and Novo Nordisk, and gave no reason for their decision. The decision is the latest blow to an industrywide legal campaign that began when President Joe Biden signed the Inflation Reduction Act into law in August 2022. PhRMA President and CEO Stephen Ubl said at the time the industry would “explore every opportunity to mitigate the harmful impacts from the unprecedented government price setting system being put in place.” Read Full Article...

HVBA Article Summary

1. Supreme Court Decision Solidifies Medicare Negotiation Program: By declining to hear the pharmaceutical industry's appeals, the Supreme Court has left in place lower court rulings that support the Medicare Drug Price Negotiation Program. This effectively ends the industry's primary legal avenue to challenge the program's constitutionality. As a result, the program will continue to operate as established under the Inflation Reduction Act.

2. Operational and Financial Impacts for Health Systems: With litigation concluded, health systems must now focus on the operational realities of the negotiation program. Pharmacy and supply chain leaders have identified the program as a significant challenge, requiring careful planning across various revenue streams. The complexity of implementing the rebate process and adapting to new pricing structures is expected to affect both daily operations and the financial stability of hospitals and pharmacies.

3. Ongoing Adjustments and Legislative Changes: Drug manufacturers and health systems are already adapting to the evolving landscape, with some companies accelerating price increases for certain products. Legislative actions, such as the One Big Beautiful Bill Act, have delayed negotiations for some top-selling drugs and narrowed the scope of the program, impacting projected federal savings. These changes highlight the dynamic nature of drug pricing policy and the need for ongoing strategic adaptation by stakeholders.

71% of US adults use health-related apps, 64% devices: report

By Cailey Gleeson – Digital health has become integral to most Americans’ daily lives, with 71% of U.S. adults using health-related apps and 64% using health-related devices, according to a new report from Reach3 Insights. The Digital Health Trends 2026 report polled 1,043 people across the U.S. aged 18 years and up who used the company’s platform. Christine Nguyen, vice president of Reach3 Insights, which conducted the survey, said in a statement that digital health tools are “becoming deeply integrated into how people manage their daily lives.” “Consumers increasingly describe these tools as part of their routines, motivation and peace of mind,” Nguyen said. Read Full Article...

HVBA Article Summary

1. Widespread Adoption of Digital Health Tools: The report highlights that a significant majority of U.S. adults are now using health-related apps and devices as part of their daily routines. This widespread adoption suggests that digital health technologies have moved beyond early adopters and are now mainstream tools for health management. The integration of these tools into daily life reflects changing consumer expectations and behaviors regarding personal health.

2. Changing Preferences in Wearable Technology: There has been a notable shift in the types of wearables people are using, with holistic wearables gaining popularity while fitness-oriented devices have seen a decline. This trend indicates that consumers are increasingly interested in tracking a broader range of health metrics, not just physical activity. The data suggests a growing emphasis on overall wellness and personalized health insights.

3. Evolving Interest in Digital Health Services: While overall use of digital health tools is rising, interest in some specific services such as telehealth, online pharmacies, DNA testing, and meal planning has decreased. At the same time, more consumers are turning to artificial intelligence chatbots for health information, with usage rates doubling in recent years. These shifts point to a dynamic digital health landscape where consumer preferences and technology adoption continue to evolve.

DOL Rules Idaho Farm Bureau Health Plan May Qualify as ERISA Plan

By James Van Bramer – The Department of Labor issued an advisory opinion stating that the group health plan for the Idaho Farm Bureau’s members’ employees qualifies as an employee welfare benefit plan under the Employee Retirement Income Security Act, while also falling under additional regulatory scrutiny as a multi-employer arrangement. In an advisory opinion dated May 1…the DOL’s Employee Benefits Security Administration concluded that the plan, designed to provide group health coverage to employees of the nonprofit farm bureau’s members’ agricultural employers, meets federal standards for plans established by a bona fide association of employers. Read Full Article...

HVBA Article Summary

1. DOL Supports Idaho Farm Bureau Health Plan Structure: The U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) stated that the Idaho Farm Bureau Federation meets key ERISA requirements for sponsoring an association health plan because its members share sufficient organizational cohesion and common economic interests. The proposed arrangement would allow eligible Idaho agricultural employers with at least two full-time employees to participate in a consortium-sponsored health plan. EBSA also pointed to the governing benefits committee, controlled by participating employers, as evidence that the plan could function as a legitimate employer group under ERISA.

2. Opinion Leaves Key Compliance Questions Unresolved: While EBSA supported the overall framework, the advisory opinion stopped short of fully endorsing the arrangement or confirming ongoing compliance. The department emphasized that whether participating employers exercise meaningful real-world control over the plan remains a factual determination that was not resolved in the opinion letter. EBSA also classified the arrangement as a multiple employer welfare arrangement (MEWA), which subjects the plan to additional federal and state oversight due to longstanding concerns about fraud and insolvency risks in similar arrangements.

3. Advisory Opinion Signals Broader Policy Interest in Association Coverage Models: The advisory opinion does not carry the force of law, but it provides insight into how federal regulators currently interpret ERISA requirements for association health plans. The opinion is notable because formal Department of Labor advisory opinions have been relatively uncommon in recent years, although issuance increased in 2025 and this marked the department’s first opinion of 2026. Labor officials said the arrangement could expand access to employer-sponsored health coverage for small agricultural businesses by lowering costs and reducing regulatory complexity, while potentially serving as a model for similar groups nationwide.

Employees want more control over their health plan. Are ICHRAs the answer?

By Lee Hafner – When it comes to a solution for more personalized healthcare plans, individual coverage health reimbursement arrangements are on everyone's lips, but what does the transition to offering them actually look like? Over half (51%) of employees said they should control their health plan choices, and 49% said they'd prefer to receive money from their employer and shop for their own coverage, rather than go on a company plan, according to a survey from health benefits tech company and individual coverage health reimbursement arrangement (ICHRA) provider Take Command. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Healthcare Cost Concerns Drive Interest in Individual Coverage: Survey results showed that 73.5% of respondents experienced somewhat or significantly higher health insurance costs for 2026. Workers enrolled in individual insurance plans were more likely to report stable costs compared to those in traditional group plans. The findings suggest that affordability and plan flexibility are contributing factors behind employee interest in individual coverage options such as ICHRAs.

2. ICHRAs May Better Fit Certain Industries and Workforce Structures: The article highlights that ICHRAs are not considered a one-size-fits-all solution, but may work well for specific industries and employee populations. Survey data showed stronger support for employer-funded individual plans among IT workers compared to government and policy employees. Employers with distributed teams, mixed full- and part-time workforces, or rising group plan renewal costs may find ICHRAs more effective than traditional national PPO plans.

3. Employers Encouraged to Compare Coverage Models and Employee Needs: Experts recommend that benefit leaders evaluate group plans, level-funded plans, and ICHRAs side by side to determine the best fit for their organizations. Employers may also consider offering both group coverage and ICHRAs to serve different employee populations. The article notes that healthcare benefits remain a major retention and recruitment factor, with nearly 95% of surveyed workers saying benefits influence their decision to stay at or leave a job.

Trump administration hits state small-group dental and fertility mandates

By Allison Bell – The administration of President Donald Trump is trying to knock some relatively new state benefits mandates, such as mandates for fertility benefits and for dental coverage for adults, out of standard major medical insurance benefits packages in 2028. The administration is also preparing to open up the Affordable Care Act public exchange system to new types of products, impose new marketing rules on agents and brokers who work with the ACA exchange system, and eliminate a program that has given outside vendors a chance to train the agents and brokers who people sign up for coverage through HealthCare.gov. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. ACA Essential Health Benefit Rules Narrow State Flexibility: CMS finalized new rules that limit how states can expand “essential health benefits” (EHB) through mandated additions to benchmark plans. Beginning in 2028, benefits may only be included in EHB packages if they were adopted voluntarily by the benchmark plan, required under federal law, or mandated before Dec. 31, 2011. Federal officials say the policy is intended to reduce subsidy spending and lower coverage costs, while some states argue it restricts their ability to tailor health coverage to local needs.

2. Changes Could Affect Coverage Standards for Fully Insured and Self-Insured Plans: The updated EHB framework may lead to leaner and potentially less expensive major medical plans by excluding some state-mandated benefits from EHB status. Services such as fertility treatments could still be covered by insurers or employers, but some ACA protections tied specifically to EHB designation — including limits on annual or lifetime caps and out-of-pocket costs — may not apply in the same way. CMS stated that benefits remaining within benchmark plans would continue to receive applicable consumer protections.

3. CMS Tightens ACA Exchange Oversight and Updates Enrollment Outlook: CMS also finalized stricter eligibility verification policies for consumers seeking ACA premium tax credit subsidies and revised broker oversight rules, including restrictions on misleading AI-generated endorsements. The agency ended the use of third-party HealthCare.gov training vendors, citing low utilization and annual administrative costs. Despite tighter enrollment policies and the expiration of enhanced pandemic-era subsidies, CMS now projects ACA exchange enrollment will remain higher than previously expected through 2027.