Senate takes first step toward ending the government shutdown

By Mary Clare Jalonick and Lisa Mascaro – The Senate took the first step to end the government shutdown on Sunday after a group of moderate Democrats agreed to proceed without a guaranteed extension of health care subsidies, angering many in their caucus who say Americans want them to continue the fight. In a test vote that is the first in a series of required procedural maneuvers, the Senate voted 60-40 to move toward passing compromise legislation to fund the government and hold a later vote on extending Affordable Care Act tax credits that expire Jan. 1. Final passage could be several days away if Democrats object and delay the process.. Read Full Article...

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1. Temporary Bipartisan Compromise to End Shutdown: A coalition of moderate senators — Jeanne Shaheen, Maggie Hassan, and Angus King — helped forge a bipartisan agreement aimed at ending the prolonged government shutdown. The deal would temporarily fund the government through late January and schedule a mid-December Senate vote on extending health care tax credits under the Affordable Care Act. However, it stops short of guaranteeing that the subsidies making coverage affordable will actually continue, leaving Democrats’ top demand unresolved and health care policy hanging in the balance.

2. Divided Democratic Response Centered on Health Care: The agreement exposed a sharp split among Democrats, many of whom believe that accepting the deal without firm health care commitments weakens their negotiating leverage. While moderates like Tim Kaine and Dick Durbin voted to advance the bill, Senate Leader Chuck Schumer and most Democrats opposed it, emphasizing that health care affordability remains a core priority. Progressive House members were even more vocal, condemning the plan as a “betrayal” for failing to guarantee lower costs and secure the continuation of critical health care subsidies.

3. Shutdown Fallout and Health Care Uncertainty Ahead: As the shutdown’s effects worsened — grounding flights, delaying food aid, and straining social programs — the debate over health care subsidies became the central unresolved issue. The agreement ensures back pay for federal workers but offers no clarity on whether millions will retain enhanced health coverage once temporary funding expires. With a December vote looming, Republicans are divided between supporting limited extensions and pursuing broader cuts or overhauls, leaving the future of Affordable Care Act subsidies uncertain and potentially affecting access and costs for millions of Americans.

Anthem’s New 10% Penalty Targets Hospitals and Doctors

By Wendell Potter – Anthem Blue Cross plans have joined UnitedHealth and Cigna in taking extreme measures to satisfy Wall Street but penalize hospitals and potentially thousands of doctors and physician groups that Anthem excludes from its provider networks. What Anthem is proposing is not only extreme but brazen in that it goes way beyond what any managed care company I know of has ever undertaken to pad its bottom line by reducing patient choice. It wouldn’t just restrict access to certain providers, it would effectively eliminate access. Read Full Article...

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1. Anthem’s 10% Reimbursement Cut Could Strain Hospital Operations: Beginning in January, Anthem — owned by Elevance Health Inc. — will slash reimbursements by 10% on hospital and outpatient facility claims that include services from out-of-network doctors. The policy affects hospitals in 11 of the 14 states where Anthem operates. While Elevance says the move is to “support patient care and reduce out-of-pocket expenses,” critics note it could impose major administrative costs as hospitals must constantly track which physicians are in-network, or risk being dropped from Anthem’s network if they make errors.

2. Independent Physician Practices Could Face Financial Instability: Medical societies representing thousands of doctors have warned that Anthem’s new rule is “deeply flawed and operationally unworkable.” They argue it shifts Elevance’s network adequacy obligations onto facilities that have no control over the contracting status of independent physician groups. These groups say the policy could force hospitals to pressure independent doctors into joining Anthem’s network under unfavorable terms, potentially driving many independent practices out of business and further consolidating control among large insurers and hospital systems.

3. Industry-Wide Cost-Cutting Trends Reflect Investor Pressure Across Major Insurers: Anthem’s move follows similar actions by UnitedHealth and Cigna — UnitedHealth announced plans to drop thousands of doctors to align with its “value-based care” model, while Cigna resumed automatic downcoding, a billing reduction practice once banned by a federal court. These measures come as the stock prices of all three companies have fallen sharply in 2024, amid investor concerns over rising medical claims. Critics argue that while insurers justify these policies as cost-saving for patients, they largely aim to restore shareholder confidence and could lead to reduced patient access, delays in care, and greater administrative burdens for providers.

To cover or not cover GLP-1s? Employers might not have a choice.

By Ginger Christ – The increasing use of GLP-1s for weight loss, instead of solely type 2 diabetes management, is putting employers in a tricky position, according to research released Oct. 22 by The Peterson Center on Healthcare and KFF. With the often pricey drugs, such as Ozempic and Wegovy, growing in popularity, companies have to decide whether to provide coverage for weight loss. However, there soon might not be a choice, one insurer reportedly told an occupational health manager at a large manufacturer. Read Full Article...

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1. GLP-1 Coverage Is Rapidly Expanding Among Employers: A growing number of large U.S. employers are beginning to offer insurance coverage for GLP-1 medications for weight loss. According to the 2025 KFF Employer Health Benefits Survey, 43% of employers with 5,000+ workers now provide this coverage, up from 28% the previous year. Industry predictions suggest this trend will continue, with most insurance companies expected to cover GLP-1s within the next 9 to 12 months. This shift signals a broader normalization of GLP-1 coverage in employer-sponsored health plans.

2. High and Rising Costs Are a Major Concern for Employers: Many companies that cover GLP-1s report significantly higher-than-expected prescription drug spending. About 60% of large employers offering the benefit said costs exceeded projections, with some seeing annual spending increases of up to 50%. In response, some have raised employee co-pays or implemented requirements for additional support programs. These financial pressures are prompting employers to re-evaluate how they balance affordability with accessibility.

3. Employers Weigh Cost Against Potential Health Benefits and Satisfaction: Despite financial concerns, employers often view GLP-1 coverage as beneficial for improving employee health outcomes—particularly for those with conditions like high blood pressure—and as a valuable component of employee satisfaction. Some companies require participation in wellness programs to qualify for coverage, including regular check-ins and verified lifestyle changes. For many organizations, the perceived long-term health benefits and workforce morale gains help justify the upfront costs. This suggests that employee well-being is increasingly seen as a strategic investment.

FDA Adds 6 More Meds to Pilot Program for Speedy Review of Drugs in the National Interest

By Frank Vinluan – Two obesity drugs are among the six new medications that could get faster FDA review under a new pilot program open to products addressing certain national health priorities. Rare and infectious diseases as well as cancer are the other therapeutic areas covered by the new batch of voucher recipients. The vouchers announced Thursday come three weeks after the FDA unveiled the first nine drugs selected for this Commissioner’s National Priority Voucher (CNPV) program. Eligible products must meet criteria such as improving affordability or increasing domestic manufacturing. Another consideration is addressing an unmet public health need. Read Full Article...

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1. FDA Priority Review Vouchers Awarded to a Range of Innovative Drugs: The FDA has granted priority review vouchers to six pharmaceutical products spanning multiple therapeutic areas, including obesity, cancer, genetic disease, and infectious disease. These include Novo Nordisk’s injectable GLP-1 drug Wegovy and Eli Lilly’s oral GLP-1 candidate orforglipron, two cancer treatments (Hernexeos from Boehringer Ingelheim and Jemperli from GSK), Vertex’s gene therapy Casgevy for sickle cell disease, and Johnson & Johnson’s tuberculosis drug Sirturo. The vouchers are intended to speed up the regulatory review process for these and potentially future applications.

2. Focus on Expanding Access, Indications, and Treatment Convenience: Many of the drugs receiving vouchers are part of efforts to broaden treatment options and improve patient accessibility. Wegovy, already approved for obesity, was recently expanded to treat fatty liver disease (MASH), and GSK’s Jemperli is now approved for a wider range of cancers beyond endometrial cancer. Eli Lilly’s orforglipron, though not yet approved, could offer a more convenient oral alternative to injectable obesity drugs. These developments reflect a broader trend toward improving usability and extending clinical benefits across more patient populations.

3. New FDA Review Program Aims to Speed Access to High-Impact Therapies: The new priority review voucher program, announced by FDA Commissioner Marty Makary in June, is designed to accelerate the time it takes to review and potentially approve treatments that address serious or unmet medical needs. This initiative draws authority from several federal laws and introduces a one-day, team-based review model leveraging multidisciplinary expertise within the agency. The FDA states that this approach could reduce decision times from the usual 10–12 months down to just a few months, marking a significant shift in how breakthrough therapies reach the market.

How HR leaders can engage Gen Z employees during open enrollment

By Mike Fish – The generational shift in the workplace is in full swing, and Gen Z employees are gaining a greater foothold. This cohort of employees has surpassed baby boomers by 3% and they are expected to make up nearly 30% of the total workforce by 2030. As this trend evolves, employers have an imperative to adapt — ensuring they are meeting expectations and providing the right support to retain and attract top Gen Z talent. Read Full Article... ^{_{(Subscription required)}}

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1. Gen Z Workers Face a Significant Benefits Knowledge Gap: According to the Future of Benefits study, more than 4 in 10 Gen Z workers are unsure how their company's benefits work together, and 37% do not understand supplemental benefits. This lack of understanding contributes to financial stress, with 38% of Gen Z employees reporting significant stress about their household finances. Notably, 73% say that gaining a better understanding of their benefits would reduce this anxiety. These figures underscore the urgency for employers to bridge the benefits education gap for younger workers.

2. Year-Round Education is Key to Effective Benefits Use: While open enrollment is a natural focus period, data shows that 71% of all employees — and an even higher 72% of Gen Z workers — want to learn about benefits throughout the year, not just during enrollment. Implementing ongoing educational initiatives such as HR office hours, informal learning sessions, or quarterly webcasts can foster a stronger culture of support. This approach helps Gen Z employees feel more confident and prepared to make informed benefits decisions at any point during the year.

3. Leveraging AI and Peer Conversations Boosts Engagement: As digital natives, Gen Z employees are more receptive to technology-driven solutions. In fact, 32% of Gen Z workers feel more optimistic about AI in the workplace than they did last year, and they are more likely than other generations to trust AI to make personalized benefits recommendations. Employers can tap into this trust by using AI tools to personalize benefits guidance. Additionally, enabling peer-to-peer and cross-generational conversations can help Gen Z workers better understand the practical applications of benefits in real-world scenarios, especially as many are still new to the workforce and unfamiliar with the full scope of available offerings.

Public divided about extending ACA enhanced tax credits

By Alan Goforth – Public opinion continues to be divided about extending enhanced tax credits under the Affordable Care Act, an issue that is responsible in part for the ongoing government shutdown. Democrats want the tax credits extended as part of a budget deal, while Republicans want to reopen the government before negotiating over an extension. Without the enhanced tax credits, ACA Marketplace enrollees who benefit from them on average would have to pay more than twice as much out of pocket in premiums next year. Read Full Article... ^{_{(Subscription required)}}

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1. Public Support for Extending ACA Tax Credits Remains High, but Partisan Divisions Are Sharpening: Nearly three-quarters of Americans support extending the Affordable Care Act (ACA) tax credits, indicating strong overall approval. However, support among Republicans has declined notably—from 59% in September to 50%—with even steeper drops among those who align with the Make America Great Again movement (from 57% to 44%). This suggests that while the policy retains majority backing, partisan allegiances are beginning to outweigh previous consensus.

2. The Government Shutdown Strategy Reflects Deep Partisan Splits, Especially Among Independents: When presented with the Democrats’ approach of refusing to pass a budget without including the tax credit extension—even at the cost of a government shutdown—opinions break sharply along party lines. About half of the public supports the Democrats' stance, including 81% of Democrats and 55% of ACA Marketplace enrollees. Meanwhile, another half favors ending the shutdown swiftly, even if it results in higher insurance costs. Independents are nearly evenly divided, underscoring the polarizing nature of the budget standoff.

3. Democrats Hold a Modest Edge in Public Trust on Health Care Issues Ahead of Elections: As the 2025 midterm elections approach, Democrats are viewed more favorably than Republicans on health care issues. More voters trust Democrats to manage the future of the ACA (43% vs. 32%) and to address high insurance costs (39% vs. 33%). Among independents, there is a slight preference for Democrats on ACA management, though they are split on which party is better equipped to handle health care costs. Additionally, among those who want the tax credits extended, a larger share would place blame on Republicans or Trump if that doesn’t happen, suggesting potential political risks for the GOP.

Telehealth groups urge Congress to adopt long-term virtual care fix

By Emily Olsen – Medicare telehealth flexibilities were first adopted during the coronavirus pandemic to preserve access to care as clinicians tried to limit in-person contact with patients. The changes include policies like eliminating geographic restrictions for virtual care and allowing all eligible Medicare providers to offer telehealth. Before the public health emergency, coverage of telehealth in Medicare was largely restricted to beneficiaries living in rural areas, or for certain types of facilities or services. Read Full Article...

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1. Temporary Telehealth Policies Create Uncertainty: Despite widespread bipartisan support in Congress, lawmakers have repeatedly relied on short-term extensions to maintain Medicare telehealth flexibilities. This has led to repeated near-expirations, most recently during a government shutdown that caused the policies to lapse. As a result, healthcare providers have been forced to scale back services or proceed without clarity on whether they will be reimbursed, creating operational and financial instability.

2. Healthcare Organizations Call for Permanent Solutions: A broad coalition of healthcare organizations — including the American Medical Association, Cleveland Clinic, and Intermountain Health — has urged Congress to end the ongoing cycle of temporary policy renewals. In a recent joint letter, they emphasized that these stopgap measures are causing frequent care disruptions and urged lawmakers to implement a permanent telehealth policy for Medicare that would offer greater predictability and reliability for both providers and patients.

3. Upcoming Expiration of Telehealth Prescribing Rules: Another major telehealth policy is approaching a potential lapse: the ability for clinicians to prescribe certain controlled substances via telehealth without a prior in-person consultation. These flexibilities, currently extended through 2025, were introduced during the pandemic and remain under review. Industry advocates argue that extending them again would allow more time to revise a proposed rule seen as burdensome and help avoid disruptions in access to essential treatments. They are calling on the administration and Congress to act quickly in establishing a long-term regulatory approach that supports safe and practical telehealth prescribing.