An emerging shutdown deal doesn’t extend expiring health subsidies. Here’s what could happen to them

By Ali Swenson – A legislative package that appears on track to end the longest government shutdown in U.S. history leaves out any clear resolution on the expiring Affordable Care Act tax credits that have made private health insurance less costly for millions of Americans. The deal agreed to by Senate Republicans and a handful of Democrats on Sunday instead only guarantees a December vote on the enhanced premium tax credits, which are set to expire at the end of the year without congressional action. Read Full Article...

HVBA Article Summary

1. ACA Subsidies at Risk Without Congressional Action: The enhanced Affordable Care Act (ACA) premium tax credits — which have helped reduce health insurance costs for millions over the past four years — are set to expire unless Congress intervenes. With House Speaker Mike Johnson and other Republican leaders not agreeing to a vote, the likelihood of an extension appears slim. Without action, subsidized enrollees could see their premiums more than double, according to an analysis by the nonprofit KFF. The financial impact will vary, with higher earners facing much larger increases and lower earners experiencing smaller but still significant hikes.

2. Public Support Exists, but Congressional Gridlock Remains: Although Congress has yet to act, a KFF poll conducted Oct. 27–Nov. 2 shows about 75% of U.S. adults, including around 50% of Republicans, support extending the expiring tax credits. However, the delay may already have consequences: enrollment for 2025 coverage began on Nov. 1, and consumers are seeing sharp increases. For example, one Pennsylvania resident’s monthly premium is set to rise from $160 to $260, with a higher deductible as well. Experts warn that even if subsidies are later reinstated, some people may not return to the marketplace after initially being priced out.

3. Alternative Proposals Emerge from Republican Lawmakers: Rather than renewing the ACA subsidies, some Republicans — including former President Trump and Sen. Bill Cassidy — have proposed alternatives like pre-funded federal flexible spending accounts for health-related expenses. Trump suggested redirecting savings from subsidy cuts “directly to the people.” Sen. Rick Scott also announced plans for a bill to distribute funds via health savings-style accounts. These proposals are still in early stages, and it remains unclear how much money they would save Americans or how broadly they would apply.

UnitedHealthcare rolls back remote monitoring coverage for most chronic conditions

By Emma Beavins – Despite the momentum of remote monitoring uptake, UnitedHealthcare has quietly pushed out a massive change to its coverage policies that could impact thousands of Medicare beneficiaries. Health Secretary Robert F. Kennedy Jr.’s Make America Healthy Again campaign has focused on the treatment and prevention of chronic diseases. The first major physician pay rule to come out of RFK Jr.’s Department of Health and Human Services expanded remote monitoring and incentivized upstream advanced primary care, which often includes remote monitoring of chronic conditions. Read Full Article...

HVBA Article Summary

1. UHC Limits RPM Coverage to Two Specific Conditions: Starting January 1, 2026, UnitedHealthcare will only cover remote patient monitoring (RPM) for chronic heart failure and hypertensive disorders during pregnancy, removing coverage for common uses like Type 2 diabetes and general hypertension. This change affects UHC’s more than 600 Medicare Advantage plans, which cover 96% of eligible seniors. UHC claims the evidence for broader RPM use is “insufficient,” though critics say the cited studies are weak and unrepresentative.

2. Critics Challenge Policy’s Legal and Clinical Basis: Experts argue UHC misrepresented medical guidelines, notably misquoting the 2025 ACC/AHA Joint Guideline, which actually supports home blood pressure monitoring. Legal analysts contend that Medicare Advantage plans must match traditional Medicare coverage, where RPM has been reimbursed since 2019. They call the move a broad denial of services, rather than an individualized assessment of medical necessity.

3. Policy May Harm Patients and Undermine Cost Savings: The change could disrupt care for tens of thousands of patients, with providers warning of worse health outcomes. Data from one RPM program showed $1,308 in annual savings per patient and a 27% drop in hospitalizations. Another example at Geisinger Health System showed monthly savings of $216 per patient through improved blood pressure control. The policy could also weaken RPM companies financially and open the door for insurers to limit other Medicare-covered services.

Trump proposes sending ACA subsidies direct to consumers, rattling health insurance stocks

By Allison Bell – President Donald Trump spooked health insurance investors Saturday by proposing in a Truth Social post — in response to the current fight in Congress over federal health insurance premium subsidies — that the government should send health insurance subsidies straight to consumers, rather than to health insurers. Trump posted the following: "I am recommending to Senate Republicans that the Hundreds of Billions of Dollars currently being sent to money sucking Insurance Companies in order to save the bad Healthcare provided by ObamaCare, BE SENT DIRECTLY TO THE PEOPLE SO THAT THEY CAN PURCHASE THEIR OWN, MUCH BETTER, HEALTHCARE, and have money left over. In other words, take from the BIG, BAD Insurance Companies, give it to the people, and terminate, per Dollar spent, the worst Healthcare anywhere in the World, ObamaCare. Unrelated, we must still terminate the Filibuster!" Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Health Insurer Stock Decline Signals Market Concerns: At press time, around 1 p.m. Eastern time, the shares of six major publicly traded health insurers experienced notable drops compared to Friday’s closing prices. UnitedHealth saw the smallest decrease at 0.89%, while Oscar Health faced the steepest decline at 15.69%. Other decreases included 2.48% for Cigna, 1.76% for CVS Health (Aetna’s parent company), 3.68% for Elevance Health (formerly Anthem Blue Cross), and 7.32% for Centene. These declines suggest growing investor concern over policy uncertainty and potential regulatory shifts in the health insurance market.

2. Debate Over ACA Subsidies Could Impact Coverage Affordability: Political tension is rising over the future of Affordable Care Act (ACA) premium subsidies, with Democrats criticizing Republicans for hesitating to renew the expanded pandemic-era subsidy levels. Reverting to pre-COVID rules could result in sharp premium hikes—doubling or tripling—for many enrollees. Individuals near the 400% federal poverty level threshold could see their monthly premium costs jump from under $100 to over $500, potentially reducing affordability and access to coverage.

3. Health Account Models Gain Investor Favor Amid Policy Shift Talk: Amid Republican discussions to revive older consumer-directed healthcare models—such as providing direct cash to individuals via health savings accounts (HSAs)—some market players are benefitting. HealthEquity, a prominent HSA provider, saw its stock price rise 5.44% to $98.81. Conversely, companies managing employer-based reimbursement models, like individual coverage health reimbursement arrangements (ICHRAs), may face challenges if broader reforms disrupt insurers' ability to offer individual coverage without medical underwriting.

Here’s how much weight loss drugs could cost you under Trump’s deals with Eli Lilly, Novo Nordisk

By Annika Kim Constantino – President Donald Trump on Thursday struck landmark deals with Eli Lilly and Novo Nordisk to slash the prices of their blockbuster weight loss drugs. Under the agreements, the monthly out-of-pocket cost of popular injections and upcoming pills could range from $50 to $350 starting next year, depending on the dosage and insurance coverage a patient has, Trump administration officials said. Read Full Article...

HVBA Article Summary

1. Expanded Medicare and Medicaid Coverage with Conditions: Starting in mid-2026, Medicare will begin covering GLP-1 drugs like Wegovy and Zepbound for obesity, expanding beyond their current use for diabetes and cardiovascular risk. Eligible patients must meet specific criteria based on BMI and related health conditions. Additionally, Eli Lilly and Novo Nordisk agreed to a fixed government price of $245/month for non-starting doses, which will apply across Medicare and Medicaid (if states opt in).

2. Lower Direct-to-Consumer Pricing Initiatives: Under agreements tied to Trump’s “most favored nation” policy, GLP-1s will be available at reduced prices through new and existing direct-to-consumer platforms. On the upcoming TrumpRx platform, prices for injectable GLP-1s will start at $350/month and decline to $250. Pills from Eli Lilly and Novo Nordisk, pending FDA approval, will launch at $149/month. Eli Lilly’s LillyDirect platform will also offer reduced pricing starting at $299 for the lowest-dose injectable.

3. Voluntary Industry Price Cuts to Broaden Access: Eli Lilly and Novo Nordisk are voluntarily reducing prices for their existing GLP-1 drugs, aiming to increase affordability for cash-paying patients and support wider public coverage. These reductions facilitate access through both government programs and consumer-facing platforms, potentially expanding treatment availability for obesity and related conditions nationwide.

Democrats introduce bill to repeal Medicare prior authorization pilot

By Emily Olsen – The bill, called the Seniors Deserve SMARTER (Streamlined Medical Approvals for Timely, Efficient Recovery) Care Act, was introduced by Reps. Rick Larsen D-Wash., Suzan DelBene, D-Wash., Kim Schrier, D-Wash., Greg Landsman D-Ohio, Ami Bera, D-Calif., and Pocan last week. It comes months after the WISeR model was announced by the Center for Medicare and Medicaid Innovation, an agency created by the Affordable Care Act that tests payment and care delivery models in government healthcare programs. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Introduction of AI-Backed Prior Authorization in Traditional Medicare: The Centers for Medicare & Medicaid Services (CMS) is launching a pilot program called WISeR that will incorporate artificial intelligence into the prior authorization process for traditional Medicare — which has historically used this method only sparingly. Through WISeR, CMS will partner with private companies to automate approval processes for specific medical services, such as skin and tissue substitutes and electrical nerve stimulator implants, aiming to improve efficiency in medical decision-making.

2. Supporters and Goals of the WISeR Model: According to CMS, the primary goals of the WISeR model are to eliminate unnecessary care, improve resource utilization, and lower costs for both patients and the federal government. Companies selected to participate in the program — including firms based in Texas, New Jersey, Oklahoma, Ohio, Washington, and Arizona — will receive a share of any savings generated through the model. CMS has emphasized that critical services, including inpatient-only and emergency procedures, are excluded from the program, and that final coverage decisions will still be made by licensed clinicians rather than solely by AI systems.

3. Concerns and Legislative Pushback: Several lawmakers, especially Democrats, have raised concerns that the WISeR model could harm patient outcomes by introducing delays or denials in necessary care and placing additional strain on healthcare providers. Critics argue that the financial incentives for companies to reduce spending could prioritize cost-cutting over patient health, particularly if AI-driven tools are making or influencing decisions. Some members of Congress are now seeking to repeal the model, echoing broader concerns about AI use in healthcare and pointing to recent Senate findings that suggest similar AI tools have already led to increased coverage denials in Medicare Advantage.

New Drug Eases Side Effects of Weight-Loss Meds

By Heidi Splete – A new drug currently known as NG101 reduced nausea and vomiting in patients with obesity using GLP-1s by 40% and 67%, respectively, based on data from a phase 2 trial presented at the Obesity Society’s Obesity Week 2025 in Atlanta. Previous research published in JAMA Network Open showed a nearly 65% discontinuation rate for three GLP-1s (liraglutide, semaglutide, or tirzepatide) among adults with overweight or obesity and without type 2 diabetes. Gastrointestinal (GI) side effects topped the list of reasons for dropping the medications. Read Full Article...

HVBA Article Summary

1. NG101 Substantially Reduces GLP-1-Related Nausea and Vomiting: In a randomized study of 90 adults with overweight or obesity, those who received a single 0.5 mg dose of semaglutide along with NG101 (20 mg twice daily for 5 days) experienced significantly fewer gastrointestinal side effects than those given semaglutide with placebo. NG101 reduced the incidence of nausea by 40% and vomiting by 67% compared to placebo. Furthermore, only 22% of NG101-treated participants reported nausea or vomiting lasting more than one day, compared to 51% in the placebo group. These results indicate NG101 may play a key role in enhancing GLP-1 therapy tolerability.

2. Favorable Safety Profile and Reduced Adverse Events: Patients in the NG101 group experienced a 70% reduction in nausea severity from baseline and reported significantly fewer total adverse events (74) than those in the placebo group (135). Importantly, no serious adverse events related to the study drugs occurred in either group. These findings suggest that NG101 not only mitigates side effects associated with semaglutide use but also offers a safer experience overall, potentially improving patient adherence and comfort during treatment.

3. Encouraging Early Results Require Broader Validation: While the findings support NG101’s effectiveness and safety, the study’s scope was limited—featuring a relatively small sample size, short duration, and single-dose design. The trial focused solely on existing GLP-1 agonists and did not account for newer agents that may have inherently lower side effect profiles. Further research involving larger populations, longer follow-up periods, and varied GLP-1 regimens, including real-world titration schedules, is needed to confirm NG101’s potential to help patients remain on therapy and achieve greater long-term cardiometabolic benefits.