With government reopened, healthcare orgs press lawmakers to act swiftly on ACA subsidies

By Paige Minemyer – Now that the longest government shutdown in U.S. history has come to an end, healthcare organizations are urging lawmakers to act quickly to extend the enhanced Affordable Care Act subsidies. Charlene MacDonald, executive vice president for public affairs at the Federation of American Hospitals, said in a statement that extending the tax credits is "the only mechanism to immediately cut costs for hardworking families already struggling to make ends meet." Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Healthcare Tax Credits Left Out of Budget Deal: The recent budget deal, passed after a government shutdown, did not include an extension of the ACA premium subsidies set to expire this year. Senate Democrats had pushed to include them due to their role in reducing costs and boosting enrollment. Without the extension, many individuals are now encountering much higher premiums during open enrollment. Senate Republicans committed to a future vote, but no immediate action was taken.

2. Strong Public and Industry Support for Extension: Extending the tax credits has widespread backing. A KFF poll shows 74% of voters support the extension, including 94% of Democrats, 76% of independents, and 50% of Republicans. Major healthcare groups like Blue Cross Blue Shield and ACHP warn that without the credits, millions could be priced out or face doubled premiums. They called the failure to extend them a setback for affordability and market stability.

3. Unclear Path Forward Amid Partisan Divides: Democrats favor a full extension, while some Republicans advocate for changes to how subsidies are calculated. Former President Trump proposed direct payments to help people buy coverage but offered no details. Healthcare leaders urge bipartisan action, stressing that timely legislation is vital to keep coverage affordable for millions beyond 2026.

Rage over rebates: Hospitals oppose 340B pilot program

By Ron Southwick – The federal government is testing a new method of delivering discounts in a program aimed to help hospitals buy certain drugs at lower prices, and health systems aren’t happy about it. The government is testing a new pilot program that would move from hospitals simply buying the drugs at lower prices in the federal 340B Drug Discount Program. The Health Resources and Services Administration said late last month it’s testing a new program with eight companies that would offer rebates to hospitals after they have purchased the drugs. Read Full Article...

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1. HRSA Plans a Rebate Model Pilot with Pharma Participation: The U.S. government, through the Health Resources and Services Administration (HRSA), plans to launch a pilot rebate model for the 340B drug pricing program on January 1, with participation from large pharmaceutical companies like Bristol Myers Squibb, AstraZeneca, and Novo Nordisk. The program aims to gather data that could inform broader changes to the 340B program and align with policy goals set during the Trump administration.

2. Hospitals Strongly Oppose the Rebate Model Over Cost and Burden: Hospital groups, including the American Hospital Association and America's Essential Hospitals, argue that the rebate model will impose significant financial and administrative burdens, estimating up to $500,000 in operating costs per hospital and requiring over 11 million labor hours system-wide. They are also concerned that the shift to a rebate system benefits drug manufacturers disproportionately and undermines the support hospitals provide to vulnerable communities.

3. Ongoing Tensions Between Hospitals and Drugmakers Over 340B Program: The debate underscores long-standing friction between hospitals and pharmaceutical companies over the purpose and management of the 340B program. While hospitals emphasize the program’s role in delivering affordable care to underserved populations, drugmakers advocate for rebate-based alternatives, citing broader industry practices and the need for transparency and efficiency.

The Path to Fair PBM Competition

By Christine Johnston – Across industries, competition between a few dominant players is not unusual, but in healthcare, its effects extend well beyond standard business rivalry. When control over prescription drug access rests with only a few players, the result is not just market imbalance — it is higher plan costs, increased financial pressures, and ultimately reduced affordability for patients. Read Full Article...

HVBA Article Summary

1. Market Concentration in PBMs Limits Competition and Increases Costs: The U.S. pharmacy benefit management (PBM) market is highly concentrated, with three companies controlling over 80% of the market. This dominance, reinforced by vertical integration with health insurers, reduces competition and limits options for employers and plan sponsors. As a result, it can drive up drug prices and reduce transparency, ultimately impacting patients' access to affordable medications.

2. Structural Barriers Impede Switching to Alternative PBMs: Despite the existence of over 75 PBMs in the U.S., structural issues such as biased RFP processes, excessive carveout fees, financial incentives favoring large PBMs, and entrenched perceptions of smaller PBMs’ credibility make it difficult for plan sponsors to consider alternative providers. These barriers discourage innovation and prevent widespread adoption of potentially more cost-effective PBM models.

3. Strategic Reforms and Transparency Can Foster a More Competitive PBM Market: To address the competition gap, plan sponsors are encouraged to vet consultants for conflicts of interest, redesign RFP criteria to focus on long-term clinical and cost outcomes, and consider managed PBMs that emphasize value-based care. At the policy level, increased financial transparency and reforms to limit vertical integration are seen as crucial steps toward a more equitable and competitive PBM system.

ICHRA users favor bronze plans as enrollment begins

By Allison Bell – Workers with cash from individual coverage health reimbursement arrangements might be more likely to choose lean bronze plans this year and less likely to choose rich gold plans. HealthSherpa — a company that helps insurance brokers sell individual major medical coverage and Medicare plans — has raised that possibility in an early ICHRA market data snapshot. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Shift Toward Bronze Plans Among ICHRA Users: HealthSherpa data shows a notable shift in plan selection among ICHRA users during the first week of the enrollment period: enrollment in bronze plans increased from 35% to 42%, while gold plan selection dropped from 38% to 28%, and silver plan enrollment saw a minor increase from 27% to 28%. This shift may be driven by higher gold plan prices and new legislative incentives, such as HSA eligibility and benefits associated with bronze plans under the One Big Beautiful Bill Act. If these trends continue, it could influence how insurers price and position their offerings across metal tiers in the ICHRA space.

2. Majority of ICHRA Users Choose Off-Exchange Coverage: Approximately 60% of ICHRA participants observed by HealthSherpa are purchasing their insurance plans outside of the ACA exchange system. This trend suggests that many employees value the flexibility or offerings of off-exchange plans when using employer-provided ICHRA funds. It also raises potential questions about the visibility and accessibility of exchange-based options for individuals using ICHRAs.

3. Geographic Trends and ICHRA Market Evolution: Florida has emerged as the leading state for ICHRA enrollments, rising from third place last year, while Arizona has dropped from fifth to eleventh. These early state-level shifts highlight the evolving nature of the ICHRA market as it potentially moves toward becoming a more mainstream employee health benefits option in 2025. As more data becomes available throughout the enrollment period, regional differences may provide insight into employer strategies and consumer preferences.

How Trump's GLP-1 agreements will impact benefit costs

By Jimmy Nesbitt – A growing number of employers are offering weight loss drugs as part of their healthcare plans, while still promoting holistic programs and lifestyle changes as a long-term solution to physical fitness. Four benefit leaders discussed this trend and more on Nov. 12 during a panel discussion titled "From ROI to Retention: The Case for Comprehensive Weight Management Benefits," at EBN's virtual Next-Gen benefits summit.  Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Cost Reduction May Increase Access, but Employers Remain Cautious: The Trump administration’s move to lower the cost of GLP-1 drugs such as Wegovy and Zepbound has the potential to increase access, especially through government programs and direct-to-consumer markets. However, many employer benefit leaders, like Shawn Behrens of American Seafoods Group, express skepticism about the actual impact on their bottom line. Until concrete savings are realized, companies plan to maintain structured, guided weight loss programs rather than relying solely on reduced drug prices.

2. Employers Are Adjusting Strategies Amid Uncertainty Over Drug Costs: Despite the anticipated pressure on insurers and employers to broaden coverage for GLP-1 medications, organizations are approaching the situation differently based on their financial realities. For example, Lumen Technologies has modified its eligibility requirements for weight loss drugs due to rising costs, while simultaneously enhancing alternative wellness initiatives like reimbursement programs. This highlights the uncertainty surrounding the downstream effects of the pricing deal on employer-sponsored healthcare plans.

3. Comprehensive Wellness Programs Remain Essential Alongside GLP-1s: Benefit leaders agree that while GLP-1 medications are becoming a prominent tool in addressing obesity and weight-related issues, they are not a standalone solution. To support long-term health outcomes, companies are continuing to invest in complementary programs such as mental health services, nutrition counseling, and fitness incentives. These holistic approaches are seen as essential to fostering sustainable lifestyle changes among employees.

Rising employee health costs becomes top priority for hospitals in 2025: Report

By Jakob Emerson - Managing rising health benefits costs has surpassed talent retention as the top strategic priority for health systems in 2025, according to Aon’s twentieth annual Benefits Survey of Hospitals. The report includes insights from 155 health systems, representing more than 1,500 hospitals and 3.6 million employees nationwide. Read Full Article…

HVBA Article Summary

1. Rising Healthcare Costs Are a Major Concern: In 2025, 93% of health systems identified cost management as their top priority due to a 9.2% increase in per-employee healthcare spending. This spike is fueled by inflation, high-cost therapies, and the growing complexity of managing chronic conditions. To contain these costs, systems are employing strategies such as tighter drug formularies, the adoption of biosimilars, and tools like predictive analytics and stop-loss insurance to manage high-cost medical claims.

2. Employee Benefit Understanding and Engagement Are Low: Only 14% of health systems believe their employees fully understand the value of their total benefits package—down significantly from 25% the previous year. This gap in awareness underscores the importance of improving how benefits are communicated. Health systems are urged to pair robust employee feedback mechanisms with targeted improvements in messaging and engagement tactics to maximize the return on their benefits investment.

3. Inclusive and Adaptive Benefits Strategies Are Emerging: Health systems are actively adjusting their benefits to better meet the needs of a diverse, multigenerational workforce. This includes salary-based contributions, company-paid supplemental benefits, and financial support programs for lower-wage employees. Additionally, there’s increased adoption of digital health tools, expansion of mental health and family-building benefits, and efforts to improve affordability and accessibility for all employee groups.

Care for America’s Caregivers

By AARP – When a loved one needs care, family members, friends and neighbors step up. That’s what Americans do: We take care of our own. But too often, society and elected officials overlook the critical role family caregivers serve. That must change. We must help family caregivers save money and time and provide the support they need. Today, 63 million Americans — 1 in 4 adults — are caring for older parents, spouses and other loved ones. Read Full Article...

HVBA Article Summary

1. Family Caregivers Deliver Critical, Unpaid Support Amid a Fragile Care System: Family caregivers provide $600 billion in unpaid care annually, enabling older adults to remain in their homes and communities instead of moving into costly nursing homes. This informal support system helps reduce taxpayer-funded institutional care. However, caregivers face major personal costs — 80% pay out-of-pocket, averaging $7,200 per year, or 25% of their income, often resulting in financial strain, debt, and compromised basic needs like food and medicine.

2. Rising Demand and Caregiver Strain Threaten Sustainability of Home-Based Care: With adults 65 and older expected to outnumber children under 18 by 2034, demand for caregiving is rising sharply. Meanwhile, the pool of potential caregivers is shrinking. Many current caregivers must reduce work hours or leave the workforce entirely, jeopardizing their own financial futures and weakening the broader care infrastructure that supports aging in place.

3. Policy Solutions Aim to Relieve Financial Pressure and Improve Caregiver Support: Proposals such as the Credit for Caring Act (up to $5,000 in annual tax credits) and the Lowering Costs for Caregivers Act (expanding eligible expenses for flexible spending and health savings accounts) seek to ease financial burdens. Additional measures include integrating caregivers into Medicare care planning, expanding respite care, conducting caregiver needs assessments, and reducing administrative barriers through legislation like the ABC Act and Connecting Caregivers to Medicare Act.