Veterans Deserve Better: The VA’s Quiet March Toward Privatization is Hurting Those Who Served Us

By Wendell Potter - As we honor the brave men and women who have served in our nation’s military, it is important to understand how they’re all too often being ill-served by the very institutions meant to support them. Read Full Article…

HVBA Article Summary

1. Impact of Privatization on Veterans’ Care: The VA's gradual shift toward privatizing veterans' healthcare by involving large private insurers has led to significant challenges, including fragmented care, increased out-of-pocket costs, and complex billing processes. This shift has raised concerns about the quality of care and accessibility for veterans who may face barriers in getting timely and adequate treatment.

2. Comparisons to Civilian Healthcare Struggles: Veterans now face issues similar to those in civilian insurance, such as prior authorizations, denied claims, and higher premiums, as private health insurers prioritize profit over patient care. Narrow provider networks further restrict veterans' access to essential specialists and therapies, often requiring long travel distances and wait times.

3. Call to Strengthen the VA System: Studies indicate that the VA system generally provides better-quality care than the private sector, highlighting the need to reinforce rather than diminish it. On Veterans Day, it’s crucial to recognize that prioritizing veterans' health requires keeping their care within a dedicated, quality-focused VA system, rather than outsourcing it to profit-driven insurers.

ACA's future in Trump's 2nd term: 17 things to know

By Laura Dyrda - The Affordable Care Act has been through many iterations since being signed into law in 2010. Donald Trump's second presidential term could bring about more changes. Read Full Article…

HVBA Article Summary

1. Renewed Push for ACA Reform: Experts suggest that a Trump administration with Republican Congressional support may aim to reshape the ACA, possibly phasing out key subsidies, which could impact affordable health coverage for millions. The CBO projects that about 4 million could lose their insurance by 2026 due to affordability issues without these subsidies.

2. Subsidy Expiration and Coverage Impact: Enhanced subsidies introduced by the Biden administration may expire without Congressional action, potentially leaving millions uninsured. ACA enrollment could drop as premium costs rise, particularly affecting low- and middle-income individuals reliant on ACA marketplaces for affordable insurance.

3. Medicaid Expansion at Risk: Significant Medicaid cuts, a GOP proposal from 2017, may resurface to fund tax cuts, which could jeopardize coverage for low-income populations in states with high ACA enrollment. Experts highlight that rural and Southern states could see increased financial strain if Medicaid funding is curtailed or eligibility rules are tightened.

Will Congress Save Telehealth?

By Eric Wicklund - Pandemic-era telehealth waivers that allowed providers to expand their virtual care footprint will end this year unless Congress takes action. The Centers for Medicare & Medicaid Services (CMS) announced in its finalized 2025 Physician Fee Schedule that it won’t extend most of those waivers any longer, putting back in place pre-COVID telehealth limitations. Read Full Article…

HVBA Article Summary

1. Pandemic-Era Telehealth Flexibilities Ending: The 2025 Physician Fee Schedule from CMS will phase out pandemic-era waivers that expanded telehealth access by removing geographic and location restrictions and allowing various types of providers to deliver virtual care. This change will limit telehealth availability for certain providers, including specialists and therapists, and restrict telehealth delivery locations to CMS-approved sites.

2. Extended and New Telehealth Provisions for 2025: CMS introduced several updates to maintain some telehealth flexibility, such as a one-year extension allowing providers to bill Medicare using their practice address, adding services like caregiver training and PrEP counseling to the Medicare Telehealth Services List, and making audio-only telehealth services permanent for patients without video access.

3. Advocacy for Further Telehealth Legislation: Over 100 organizations are pressing CMS to maintain telehealth flexibilities, including allowing providers to work from home. Several bills in Congress aim to further expand telehealth options, such as extending Medicare telehealth flexibility through 2026 and enhancing telehealth access for workers and those with high-deductible health plans.

Where does each health care dollar go?

By Alan Goforth - The phrase “health care dollar” is commonly used when talking about overall medical-related expenses. But where does that health care dollar actually go? Total hospital costs account for 40.7 cents of each dollar, according to AHIP. It breaks this expense into three categories. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Major Cost Categories: Outpatient hospital costs make up 19.9 cents of each healthcare dollar, covering physician and facility payments for non-drug-related outpatient treatments (excluding emergency room visits). Inpatient hospital costs comprise 17.6 cents, including facility payments, physician fees, and drug administration during hospital stays. Emergency room costs account for 3.2 cents, covering physician and facility non-drug payments for emergency care and ambulance services.

2. Prescription Drugs and Doctor Visits: Prescription drugs represent 24.2 cents of each dollar, covering payments for outpatient and physician-administered medications. Doctor visits make up 11.6 cents, including all non-drug outpatient services provided in various healthcare settings like clinics and urgent-care facilities. Additional outpatient care outside hospitals and clinics, such as labs and dialysis, adds 7.1 cents.

3. Administrative and Overhead Expenses: Overhead costs include taxes and fees (3.4 cents), other business expenses like agent commissions and insurance rebates (3.3 cents), and insurance plan profits (2.4 cents). Cost containment activities account for 2.2 cents, with quality improvement efforts taking up 0.8 cents. Finally, general administrative costs, including salaries and office expenses, use up 4.3 cents per dollar spent on healthcare.

Millions at risk of losing health insurance after Trump's victory

By Berkeley Lovelace Jr. - Millions of Americans risk losing subsidies next year that help them pay for health insurance following President-elect Donald Trump’s election win and Republicans’ victory in the Senate. Read Full Article…

HVBA Article Summary

1. Expiration of ACA Subsidies in 2025 and Potential Political Impacts: Subsidies introduced under the American Rescue Plan, aimed at making ACA health insurance more affordable and accessible, are set to expire at the end of 2025. Future extensions of these subsidies hinge on Congressional and Presidential decisions, with Republicans, including former President Trump, expressing opposition to extending them.

2. Significant Enrollment and Potential Coverage Loss: The subsidies have led to a surge in ACA enrollment, particularly in Southern states. If these subsidies expire, the Congressional Budget Office projects that nearly 4 million people will lose coverage in 2026, with further enrollment drops in subsequent years.

3. Republican Agenda and ACA Challenges: Should Republicans gain full control, experts predict efforts to reduce ACA funding, limit Medicaid expansion, and potentially dismantle elements of the ACA, including the preventive services mandate. However, complete repeal remains unlikely, with a minimal, stripped-down version of the ACA likely to persist.

Voya is doubling stop-loss price increases for 2025

By Allison Bell - Voya Financial is unhappy with the performance of its stop-loss insurance business, and the company is prepared to lose customers to get prices up to profitable levels, executives said Tuesday. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Substantial Rate Increases for 2025: Voya plans to implement stop-loss coverage rate increases for January 2025 that are double those of January 2024. The strategy prioritizes profitability over sales volume, aiming to improve underwriting results by focusing on retaining well-performing cases and raising prices on underperforming segments.

2. Competitive Landscape and Underpricing: Rival company Sun Life Financial suggested that competitors may have underpriced their stop-loss policies, potentially underestimating post-pandemic healthcare utilization. Sun Life’s approach, based on a return to pre-pandemic utilization rates, has kept its pricing aligned with current market conditions.

3. Third-Quarter Financials and Industry Context: Voya’s third-quarter performance saw a reduced operating gain in its stop-loss segment due to increased claim frequency, though total premiums still exceeded benefits payments. Despite lower stop-loss sales, industry analysis predicts a hardening of stop-loss pricing across the market as insurers recalibrate for higher healthcare usage.

Tirzepatide Slashes Progression From Prediabetes to T2D

By Miriam E. Tucker - Once-weekly tirzepatide (Zepbound) reduced the risk for progression from prediabetes to type 2 diabetes (T2D) by more than 90% at 3 years and continued to maintain dramatic levels of weight loss achieved earlier, but these benefits began reversing when the drug was stopped. Read Full Article… 

HVBA Article Summary

1. Long-term Weight Loss and Diabetes Prevention: The SURMOUNT-1 trial demonstrated that individuals with prediabetes maintained substantial weight loss and a low progression to diabetes over 3 years and 4 months. Only 1.2% of participants on tirzepatide developed type 2 diabetes (T2D), compared to 12.6% of those on placebo, yielding a 94% reduction in diabetes risk.

2. Health Improvements and Stability: Beyond weight loss, participants on tirzepatide experienced consistent improvements in waist circumference, blood pressure, and lipid levels, maintained throughout the 176-week treatment period. Patient-reported outcomes indicated continued benefits, and adverse events were mild to moderate, mostly gastrointestinal, occurring mainly during dose escalation.

3. Challenges and Precision Medicine Prospects: Some weight regain and increases in A1c were observed after a 17-week off-drug period, suggesting a need for chronic management. Experts, including Francesco Rubino, MD, and Susan Yanovski, MD, emphasized the potential for precision medicine to personalize obesity treatments, addressing individual needs and optimizing long-term effectiveness of medications like GLP-1 drugs.