Senator's bill could help more small employers use association health plans

By Allison Bell - Sen. Rand Paul is heating up efforts to help self-employed people and small employers join together to buy health coverage. The Kentucky Republican has introduced a Senate version of the "Association Health Plans Act" bill. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Key provisions of the bill: The proposed Association Health Plans (AHPs) would be accessible to associations that have been established for at least two years and engage in activities beyond simply offering health benefits. Importantly, these AHPs would be prohibited from discriminating against applicants or enrollees based on their health status, aiming to provide broader and more equitable access to group health coverage.

2. Legislative context and sponsors: This bill is closely aligned with earlier AHP proposals, including a “health marketplace pool” draft introduced by Rand in November and an almost identical AHP bill from Rep. Tim Walberg, R-Mich., chairman of the House Education and the Workforce Committee, introduced in April. Rand’s current bill has one cosponsor, Sen. Roger Wicker, R-Miss., while Walberg’s bill has gained broader Republican support, with 13 cosponsors.

3. Market impact debate: Although some commercial insurers and regulators express concerns that AHPs could destabilize the fully insured group market by attracting healthier groups away, supporters like legal advisor Christopher Condeluci counter that no evidence has shown AHPs harm existing markets. In fact, Condeluci argues that AHP flexibility could make them appealing to both high-risk and low-risk groups, potentially balancing market dynamics rather than undermining them.

AI vs Physicians in 2050: Happy Future or No Future?

By Eric Spitznagal - Last February, Microsoft co-founder and billionaire philanthropist Bill Gates appeared on The Tonight Show and shared some bold predictions about artificial intelligence (AI). In just a decade, he told host Jimmy Fallon, AI will be capable of “great medical advice” and humans will no longer be needed “for most things.” Read Full Article…

HVBA Article Summary

1. AI is rapidly advancing in medical diagnostics but isn’t ready to replace doctors yet: Recent studies, like Google’s AMIE project, show AI can match or even outperform human doctors in certain diagnostic settings — achieving up to 60% accuracy compared to 34% for unassisted physicians. Yet, while AI is proving powerful in tasks like image analysis, diagnostic predictions, and clinical decision support, experts agree that full replacement of human clinicians is unlikely in the near future. By 2050, AI may deeply integrate into healthcare workflows, but human judgment, empathy, and nuanced patient interaction will remain essential.

2. The future of healthcare likely depends on human-AI collaboration, not competition: Researchers emphasize that instead of viewing AI as a competitor, the healthcare industry should explore optimal human-AI teaming models. AI can handle routine screenings, data-heavy tasks, and predictive modeling, freeing physicians to focus on complex diagnoses and patient relationships. Successful integration will depend on balancing AI’s speed and pattern recognition with clinicians’ ability to interpret context, read nonverbal cues, and deliver empathetic care — something AI still struggles to authentically replicate.

3. Major challenges remain around trust, bias, and patient acceptance of AI in healthcare: Despite impressive capabilities, AI tools face hurdles: they must be rigorously validated for accuracy across diverse patient populations, avoid algorithmic bias, and overcome public skepticism. Studies show patients are often uncomfortable with AI-driven diagnoses, especially for serious conditions, and may perceive AI-generated empathy as hollow. As a result, future healthcare professionals will need both strong technical literacy and people skills to thrive in a system where AI enhances — but does not replace — human care.

Business Group on Health: Employers To Maintain Well-Being Benefits Despite Cost Challenges

By Marissa Plescia - Most large employers plan to uphold their well-being benefits in 2025 even though they’re facing increasing healthcare costs and global economic headwinds, according to a recent survey from the Business Group on Health. The Business Group on Health is a nonprofit advocacy organization for large employers. Read Full Article… 

HVBA Article Summary

1. Employers are prioritizing well-being despite rising healthcare costs: Among 131 employers surveyed (covering 11.2 million workers), 73% plan to maintain their well-being programs in 2025, 20% will expand them, and nearly all (94%) are raising expectations for vendors by using tools like health dashboards to improve value and measure outcomes.

2. Mental, physical, and financial health dominate well-being strategies: All surveyed employers include mental health in their programs, with 47% ranking it as the top priority, followed closely by physical health (99%, especially for weight management) and financial health (92%), which includes offerings like student loan help, tuition reimbursement, and emergency savings support.

3. Global and social well-being strategies are gaining traction: About 85% of employers have or are developing globally consistent well-being strategies, despite cultural and legal challenges, while three-quarters provide social connection programs like peer coaching; additionally, 59% plan to strengthen efforts addressing social determinants of health in the coming years.

Sixth Circuit Holds that Blue Cross Blue Shield of Michigan Acted as Fiduciary in Alleged Overpayment and Clawback Scheme

By Elizabeth Hopkins - Allegations of opaque and self-dealing fee schemes have long been part of ERISA pension litigation. More recently, as plan sponsors and others begin to peel back the layers of health care fee and reimbursement structures, litigation challenging these practices has followed. This case involves one such suit. Read Full Article…

HVBA Article Summary

1. Sixth Circuit Reversal on Fiduciary Status and Claims Processing Control: The Sixth Circuit overturned the district court’s dismissal, finding that Blue Cross Blue Shield of Michigan (BCBSM) exercised fiduciary control over Tiara Yachts’ self-funded ERISA health plan by managing plan assets, including deciding claim payments and applying the “flip logic” approach. The court determined that BCBSM’s discretion over both payments and its own compensation through the Shared Savings Program (SSP) positioned it as a fiduciary under ERISA, allowing Tiara Yachts to bring breach of fiduciary duty claims.

2. Contractual Agreements Do Not Shield Against Fiduciary Breach Claims: The court strongly rejected BCBSM’s defense that its actions were purely contractual and thus outside ERISA’s fiduciary reach. It clarified that even when a plan administrator operates under a contract, it can still breach fiduciary duties by mismanaging or squandering plan assets. Accepting BCBSM’s argument, the court warned, would effectively “gut” ERISA’s fiduciary protections, undermining safeguards intended to prevent self-dealing and mismanagement of employee benefit plans.

3. Expanded Pathways for ERISA Remedies and Defined Limits:
   The appellate court confirmed that Tiara Yachts could seek relief under both ERISA Section 502(a)(2), for losses to the plan, and Section 502(a)(3), for equitable remedies like restitution and disgorgement of specific funds BCBSM retained. However, it limited recovery under Section 502(a)(3) to traceable funds still in BCBSM’s possession, meaning Tiara Yachts cannot claim equitable relief for provider overpayments that BCBSM never recovered, refining the scope of potential remedies available under the law.

Majority of benefits plan sponsors rank cost increases as top challenge in 2025

By Michael Popke - With U.S. health care costs expected to keep climbing in 2025, it’s no surprise that benefits plan sponsors cite “cost reduction” as their top priority when considering changes to employee benefits programs, according to results of the “2025 Lockton National Benefits Survey.” Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Cost reduction has firmly emerged as the top employer priority: For the first time since the annual survey’s launch in 2019, reducing healthcare costs has surpassed attracting and retaining talent, with the number of employers prioritizing cost cutting jumping 18% between 2022 and 2025, while talent-related priorities have dropped by 14% since 2023. This shift reflects the mounting impact of rising healthcare expenses on organizations of all sizes and signals a clear need for employers to take a more strategic approach to managing benefit costs.

2. Employers remain cautious and risk-averse when adjusting benefits: Despite recognizing the need to manage costs, only 9% of plan sponsors consider themselves “trailblazers” willing to lead on benefits changes, while the majority (53%) prefer to wait and follow tactics already proven effective by other companies. This cautious stance highlights a delicate balancing act, as employers weigh cost-saving measures against the risk of being perceived as reducing employee value or neglecting workforce expectations.

3. Cost-saving efforts are focusing on four core areas while maintaining key benefit priorities: The report identifies network solutions, eligibility management, pharmacy strategies, and plan optimization as the main avenues for reducing costs, with options ranging from low-disruption to more progressive or disruptive changes. At the same time, employers are continuing to address critical employee needs: 54% provide standalone mental health assistance programs, 33% offer intensive lifestyle programs targeting weight loss, and 29% cover GLP-1 medications, while nearly half (46%) provide advocacy or navigation services to help employees navigate healthcare decisions.

GLP-1 prescriptions surge in US: 7 study notes

By Paige Twenter - In 2024, 4% of U.S. adults were prescribed a GLP-1 therapy — a 363.7% increase from 0.9% in 2019, according to a Fair Health analysis of more than 51 billion commercial claim records. Fair Health also found that, over those six years, the percentage of adults with a GLP-1 prescription for obesity or overweight increased from 0.3% in 2019 to 2.05% in 2024, a relative increase of 586.7%. Read Full Article… 

HVBA Article Summary

1. Obesity and overweight diagnoses are rising faster than treatment uptake: While the percentage of U.S. adults diagnosed with obesity or overweight (without Type 2 diabetes) jumped from 0.03% in 2019 to 0.67% in 2024 — a nearly 2,000% relative increase — more than 80% of these individuals still did not receive any active intervention such as a GLP-1 prescription, bariatric surgery, or behavioral health services, highlighting a persistent and concerning treatment gap despite the surge in diagnoses.

2. GLP-1 prescriptions are increasing, especially among younger adults: The proportion of adults with obesity or overweight (but no diabetes) receiving GLP-1 prescriptions rose significantly from 3.7% in 2019 to 16.5% in 2024, with the sharpest growth seen among 18–39-year-olds (from 0.19% to 1.33%). However, despite this rise, use of behavioral health services among GLP-1 patients plummeted from nearly half (47.2%) in 2019 to just 12.4% in 2024, suggesting a shift away from integrated care approaches.

3. Shifting obesity treatments and medication trends: Traditional interventions like bariatric surgery saw a marked decline, dropping from 0.12% in 2019 to 0.07% in 2024 (a 41.8% decrease), while GLP-1 medications — particularly Ozempic, which rose from 0.1% to 2% — became the dominant treatment option, outpacing moderate growth from other GLP-1 drugs like Mounjaro, Saxenda, Wegovy, and Zepbound; additionally, there was a striking 80%+ increase in pancreatitis diagnoses among non-diabetic GLP-1 users, underscoring emerging safety considerations.

FDA Will Make Importing Prescription Drugs From Canada Easier for States

By Ashley Gallagher - The FDA announced new pathways under section 804 of the Federal Food, Drug, and Cosmetics Act that will allow states and Indian tribes to import certain prescription drugs from Canada to reduce the cost of drugs to Americans.¹  Read Full Article…

HVBA Article Summary

1. FDA Pushes for Lower Drug Prices via Importation: The FDA has launched initiatives allowing states like Florida to import lower-cost prescription drugs from Canada under the Section 804 Importation Program, aiming to address U.S. drug prices that are often 5–10 times higher than in wealthy European countries. These programs are part of a broader executive order focused on reducing drug costs, while the FDA emphasizes its commitment to maintaining the high quality, safety, and effectiveness of imported medications for American patients.

2. Concerns Over Supply Chain and Safety Risks: Despite the potential for meaningful cost savings, many health experts and pharmacy organizations caution that drug importation programs could undermine the stability of the pharmaceutical supply chain, expose patients to greater risks of counterfeit or mishandled drugs, and worsen Canada’s own drug shortages, which have affected thousands of medications in recent years. U.S. law enforcement will monitor for counterfeit threats, but critics argue that oversight gaps remain.

3. Divided Support Among Stakeholders: While state governments and federal agencies point to projected savings—such as Florida’s estimated $180 million annually by supplying Canadian medications to Medicaid enrollees, clinics, and prisons—nearly 75 pharmacy organizations have voiced strong opposition. They argue that reducing drug costs should never come at the expense of patient safety, stressing that state importation programs increase the chances of mix-ups, mislabeling, and distribution errors, especially for vulnerable populations relying on safe and consistent access to medications.