Trump picks Robert F. Kennedy Jr. to lead Department of Health and Human Services

By Emma Beavins - President-elect Donald Trump picked Robert F. Kennedy Jr. to be the next Secretary of the Department of Health and Human Services, according to a post on Truth Social Thursday afternoon. Read Full Article…

HVBA Article Summary

1. Significance of the Appointment: President-elect Trump emphasized the importance of appointing Robert F. Kennedy Jr. to lead health policy initiatives, highlighting his commitment to restoring scientific research, transparency, and addressing chronic diseases. This role would oversee critical agencies such as the FDA, CDC, CMS, and NIH, with the potential to reshape U.S. health policy.

2. Controversy and Criticism: Kennedy's appointment has drawn sharp criticism due to his history of controversial views on vaccines and public health. Experts, including Senate Finance Committee Chair Ron Wyden and Massachusetts Medical Society President Hugh Taylor, expressed concerns about his scientific qualifications, potential to spread misinformation, and alignment with evidence-based medical practices.

3. Senate Confirmation and Scrutiny: The appointment requires Senate confirmation, setting the stage for rigorous vetting. Critics, including Wyden and Taylor, urged a thorough examination of Kennedy's qualifications and the potential consequences of his leadership on public health, with implications for policies affecting healthcare access, affordability, and scientific credibility.

Prior authorizations should block health plans’ further claim review: AMA

By Allison Bell - The American Medical Association plans to fight health insurers' and health plans' post-procedure claim reviews in Congress. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Policy to Ban Retroactive Denial of Claims: The AMA voted to adopt a policy that seeks to block insurers and plans from denying payment for claims after prior authorization has been granted. The organization views this as a critical step to prevent financial burdens on physicians, patients, and families caused by unexpected non-payment for approved procedures.

2. Advocacy and Legal Action: Beyond lobbying for a federal ban on post-claim payment denials, the AMA will support physicians in taking legal action against insurers that withhold payments for authorized care or attempt to recover funds already paid. This dual approach underscores the AMA's commitment to holding insurers accountable.

3. Addressing Physician Workload and Compensation: Alongside tackling payment issues, the AMA is discussing strategies to secure compensation for physicians responding to patient messages via online portal systems, reflecting broader efforts to address administrative burdens and ensure fair remuneration for time-intensive tasks.

Payers confronted by COVID vaccine lawsuits

By Jakob Emerson - Two Blue Cross Blue Shield plans have now lost in federal court for terminating employees that refused to get vaccinated against COVID-19, and other insurers are facing similar lawsuits. Read Full Article…

HVBA Article Summary

1. Legal Challenges to Vaccine Mandates: The cases involving Blue Cross Blue Shield (BCBS) Tennessee, BCBS Michigan, and UnitedHealthcare underscore the growing legal scrutiny around COVID-19 vaccine mandates in the workplace. Courts have awarded significant damages to employees terminated after being denied religious exemptions, with BCBS Tennessee and Michigan facing verdicts of nearly $700,000 and $13 million, respectively.

2. Religious Accommodation Disputes: These lawsuits highlight a critical issue—employers’ obligations under Title VII of the Civil Rights Act to reasonably accommodate employees' religious beliefs unless it poses an undue hardship. A surge in vaccine-related religious discrimination complaints has been observed by the Equal Employment Opportunity Commission (EEOC), particularly following a 2023 Supreme Court decision bolstering employees' rights in such cases.

3. Broader Implications for Workplace Policies: The outcomes of these lawsuits signal a shift in how courts and federal agencies may evaluate vaccine mandate policies moving forward. Employers must carefully balance workplace safety with legal compliance, especially in handling exemption requests. With increased EEOC activity in this area, organizations may need to reassess their accommodation processes to mitigate legal risks.

Supreme Court Declines to Review Petition on ERISA Arbitration

By Remy Samuels - The U.S. Supreme Court once again declined to consider whether complaints under the Employee Retirement Income Security Act may be addressed by arbitration. Read Full Article…

HVBA Article Summary

1. Supreme Court Declines Review: On November 4, the Supreme Court declined Argent Trust Co.'s petition for review in Argent Trust Co. v. Ramon Cedeno et al., marking the fifth time since 2019 that the high court has refused to address arbitration-related disputes impacting ERISA-governed retirement plans. This leaves a clear circuit split unresolved, with some courts upholding arbitration provisions and others deeming them unenforceable.

2. Circuit Court Disagreement on ERISA Arbitration: Argent Trust argued that ERISA does not preclude individual arbitration of statutory claims, citing support from the 9th and 7th Circuits. However, other circuits, including the 2nd, 3rd, 6th, and 10th, have ruled against arbitration provisions, emphasizing ERISA's requirement for plan-wide remedies. This split underpins the broader legal debate over the enforceability of mandatory arbitration in retirement plan disputes.

3. Legislative and Broader Implications: The introduction of the Employee and Retiree Access to Justice Act in September seeks to ban mandatory arbitration clauses in ERISA-covered plans. Supporters of arbitration argue it avoids costly litigation, while opponents contend it undermines participants’ rights. Legal experts like Lee Polk suggest the Supreme Court’s reluctance to address the issue reflects competing priorities, signaling that the arbitration debate will persist in courts and Congress alike.

DOJ Sues to Block UnitedHealth Group’s Acquisition of Amedisys

By Petite Kobus - The U.S. Department of Justice (DOJ) announced in a November 12 press release that it, together with the Attorneys General of Maryland, Illinois, New Jersey, and New York, filed a civil antitrust lawsuit to block UnitedHealth Group’s proposed $3.3 billion acquisition of the Louisiana-based home health and hospice services provider Amedisys Inc. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Antitrust Concerns Over Consolidation: The Department of Justice (DOJ) argues that the proposed $3.3 billion acquisition of Amedisys by UnitedHealth Group would significantly reduce competition in the home health and hospice care sectors. This reduction in competition could harm patients, insurers, and healthcare workers by limiting options, raising costs, and potentially diminishing service quality.

2. Regulatory Scrutiny and Statements: Attorney General Merrick B. Garland emphasized the DOJ’s commitment to preventing harmful monopolization in healthcare markets, particularly those affecting vulnerable populations. Assistant Attorney General Jonathan Kanter echoed these concerns, warning that the transaction would expand UnitedHealth’s dominance in home health and hospice care, further threatening seniors and other patients reliant on these services.

3. Proposed Divestiture Insufficient: To address antitrust concerns, UnitedHealth proposed divesting certain facilities to VitalCaring Group. However, the DOJ's complaint highlights that this measure fails to mitigate harm in over 100 affected markets, undermining its effectiveness in preserving competition and safeguarding the interests of patients and healthcare workers.

Eli Lilly's weight-loss drug helps nearly 99% of patients remain diabetes-free

By Reuters - Eli Lilly (LLY.N), said on Wednesday its weight-loss drug helped nearly 99% of patients remain diabetes-free after three years of weekly injections. Read Full Article…

HVBA Article Summary

1. Significant Diabetes Prevention Results: A late-stage trial with 1,032 participants showed that tirzepatide, the active ingredient in Eli Lilly's Mounjaro and Zepbound, reduced the risk of progression to type 2 diabetes by 94% in adults with prediabetes and obesity. The findings suggest one new case of diabetes could be prevented for every nine patients treated, highlighting its potential as a preventive treatment.

2. Sustained Health Improvements: Over three years, patients treated with weekly injections of tirzepatide experienced up to a 22.9% average weight reduction, alongside improvements in blood glucose levels, cardiometabolic risk factors, and health-related quality of life. These sustained effects underscore the drug's long-term health benefits, as detailed in The New England Journal of Medicine.

3. Expanding Clinical Applications: Beyond diabetes and obesity, Eli Lilly is pursuing regulatory approval for additional conditions, including obstructive sleep apnea and heart failure with preserved ejection fraction. These efforts, alongside similar initiatives by rival Novo Nordisk, reflect a growing focus on the broader therapeutic potential of these drugs.

Why Oscar Health co-founder Mario Schlosser is bullish on ICHRA

By Paige Minemyer - Employers' healthcare costs continue to rise, leading them to seek new alternatives to drive down expenses while avoiding steps to shift additional costs to workers. Read Full Article… 

HVBA Article Summary

1. ICHRA's Personalization Potential: ICHRA provides employees with tax-free stipends to choose individualized coverage in the stable and competitive individual market. Oscar Health’s specialized plans, such as those for diabetes, reduce costs and over-insurance, making healthcare more targeted and affordable.

2. Employer Advantages and Long-Term Coverage: ICHRA simplifies healthcare management for employers by reducing vendor reliance while allowing employees to retain the same insurer when changing jobs. This continuity enables better long-term tracking of health trends and outcomes, such as the effects of GLP-1 drugs.

3. Shifting Strategies and Market Opportunities: ICHRA's growth hinges on involvement from CEOs and CFOs, highlighting the individual market’s stability and flexibility. By freeing plans from ACA exchange limitations, insurers can innovate with technology-driven, tailored options to meet diverse employee needs.