Trump-linked think tank has plan to transform ACA premium subsidies

By Allison Bell – If Republicans in Washington try to change or replace the current Affordable Care Act health insurance premium subsidy program, what could that look like? Brian Blase, president of the Paragon Health Institute, talked about one possible subsidy shift proposal in a commentary he posted Thursday. In that proposal, he is not saying Congress should repeal the Affordable Care Act altogether or eliminate all ACA subsidies. Instead, he is suggesting that Congress could send some subsidy cash aimed at low-income people into accounts resembling health savings accounts established for those people. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Paragon's Proposal Shifts Subsidy Control to Consumers: A proposal by Paragon, a nonpartisan research institute with ties to former President Trump, suggests redirecting Affordable Care Act (ACA) cost-sharing reduction subsidies into Health Savings Accounts (HSAs) for low-income individuals. This would allow recipients to manage funds directly for their health care expenses, potentially giving them greater control over how and where to spend their health care dollars. Supporters argue that such consumer-directed spending could enhance price transparency and accountability within the healthcare system.

2. Potential Economic Impact and Policy Implications: According to Paragon President Brian Blase, restoring and redirecting the CSR subsidies into HSAs could reduce federal spending by $30 billion and increase average annual HSA contributions to over $2,000 for low-income individuals. Actuarial analysis indicates that 70% of low-income enrollees could benefit, with average gains of $1,500. The proposal may also influence employer-sponsored plan structures, particularly regarding the use of HSAs and health reimbursement arrangements (HRAs).

3. Republican Interest in Alternatives to ACA Subsidies: The proposal reflects a broader Republican interest in shifting from traditional ACA subsidy models to "cash-for-coverage" approaches. Donald Trump publicly supported this idea, arguing it would provide Americans with more affordable and higher-quality care by replacing payments to insurers with direct payments to individuals. This marks a notable departure from current policy, which many Democrats and health insurance groups support, signaling a potentially contentious policy debate ahead.

ACA push enters new phase with clock ticking

By Peter Sullivan - The battle over renewing Affordable Care Act tax credits is entering a new phase, with shifting alliances and a tight timetable complicating prospects for any bipartisan deal. Why it matters: Without an extension by the end of the year, premiums will more than double on average for roughly 20 million Americans on the ACA marketplaces. Read Full Article…

HVBA Article Summary

1. Senate Negotiations on Subsidy Extensions Are Complex and Politically Divided: Efforts to extend health care subsidies are shifting from a bipartisan Senate group to the Senate Finance Committee, with key players including Senators Mike Crapo, Bill Cassidy, Ron Wyden, and Chuck Schumer. There is significant skepticism about reaching a deal, as it would require 60 votes in the Senate to overcome a filibuster, and the House and White House appear even less likely to support a bipartisan resolution.

2. Democrats and Republicans Have Diverging Priorities for Health Subsidies: Democrats are pushing for a clean extension of subsidies and see rising health care costs as a winning election issue. Republicans, however, want changes such as income caps and minimum premium requirements to prevent abuse and reduce costs. While some Democrats, like Sen. Jeanne Shaheen, are open to these changes, broader agreement remains uncertain.

3. Abortion Funding Restrictions Are a Major Sticking Point: A significant barrier to bipartisan agreement is the GOP’s insistence on applying the Hyde Amendment (restricting federal funding for abortion) to ACA plans. Democrats argue that existing ACA safeguards already prevent taxpayer money from funding abortions, viewing the GOP push as an effort to expand abortion restrictions. This issue could derail negotiations altogether.

DEA to publish 4th extension of telehealth prescribing rule in wave of relief for virtual care providers

By Emma Beavins – Telehealth providers are receiving a flood of federal relief this week. As the government reopens its doors, the Drug Enforcement Administration (DEA) also appears ready to issue another temporary extension of pandemic-era prescribing flexibilities. Medicare telehealth providers will soon start to receive back pay for the last 42 days of the government shutdown. Many Medicare doctors have continued seeing patients via telehealth since Congress let the clock run out on government funding. Read Full Article...

HVBA Article Summary

1. Ongoing Uncertainty Around Permanent Telehealth Rules: The healthcare industry continues to face ambiguity as it waits for definitive guidance from the Centers for Medicare & Medicaid Services (CMS) and the Drug Enforcement Administration (DEA) on the future of telehealth prescribing for controlled substances. Although the DEA has signaled that another temporary extension is likely, the absence of a long-term policy framework leaves providers and stakeholders uncertain about how to plan for the future, particularly after the current authority expires on December 31.

2. Temporary Flexibilities Likely to Be Extended Again: The DEA appears poised to issue a fourth extension of the temporary COVID-era rules that allow DEA-registered providers to prescribe Schedule 2-5 controlled substances via telehealth without an in-person examination. While details are still pending, industry sources anticipate a clean one-year extension. This move is widely viewed as a critical stopgap to ensure continuity of care and prevent disruption to telehealth services while the agency works toward finalizing permanent regulations.

3. Stakeholder Tensions Reflect Broader Policy Debates: The debate over how telehealth prescribing should be regulated highlights broader ideological and policy divides. Many medical associations and telehealth advocates argue that physicians should retain the discretion to decide when in-person visits are necessary, warning that overly restrictive rules could undermine access to essential treatments and damage the industry. Meanwhile, the DEA and others express concern about the potential for misuse and diversion of highly addictive Schedule 2 drugs, pushing for stricter oversight to align with their mandate to prevent substance abuse.

Voluntary benefits improve employee morale, retention, and performance

By Joel Kranc – Benefits programs are being used to improve employee satisfaction, retention and performance, according to a new report from the Employee Benefit Research Institute. The report, Expanding the Benefits Horizon: How Employers View Voluntary Offerings, reports that improving worker morale is the top-cited reason organizations offer employee benefits, as 85% of organizations say they see a positive impact on employee satisfaction as a result. Nearly three quarters of employers also see an impact on recruiting, retention and employee performance, while 70% see a positive impact on employee health. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Expanding Role of Voluntary Benefits: Employers are increasingly prioritizing voluntary benefits as part of a more holistic approach to employee support. These benefits go beyond traditional offerings like 401(k) plans and basic health insurance, addressing broader financial wellness issues such as high living expenses, rising health care costs, and the mental toll of financial stress. Their flexibility allows employees to tailor benefits to their specific needs and life situations, helping them feel more secure and supported.

2. Limited Adoption of Supplemental Health Insurance: Although core health benefits such as medical (93%), dental (83%), and vision (80%) insurance are widely offered, the adoption of supplemental health insurance remains relatively limited. Accident insurance is the most commonly offered supplemental benefit at 46%, while critical illness and hospital indemnity insurance are provided by only 27% and 25% of employers, respectively. Just 11% of organizations offer all three types, highlighting a gap between core coverage and extended health protection.

3. Perceived Impact on Productivity and Costs: Employers who do offer voluntary and supplemental health benefits report that these offerings contribute to greater employee satisfaction and organizational efficiency. They believe such benefits help reduce absenteeism, boost productivity, and mitigate turnover. Employees appear to value these offerings as well, as shown by higher-than-anticipated enrollment rates. Overall, these benefits are seen as a cost-effective strategy to support employees while managing rising healthcare expenses.

The 340B Program’s New Rebate Pilot Won’t Fix Its Problems

By Katie Adams – The 340B Drug Pricing Program has become one of the most controversial programs in the U.S. healthcare system. The program was established in 1992 to help safety net providers stretch federal resources and better serve vulnerable populations by allowing eligible hospitals and clinics to purchase outpatient drugs at steeply discounted prices. However, disputes over the program’s money flow, oversight and misuse have fueled decades of conflict among providers, pharmaceutical manufacturers and lawmakers. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. The 340B Program Has Grown and Remains Opaque, Sparking Debate About Its True Beneficiaries: Originally intended to support safety net providers serving low-income patients, the 340B program now includes many large, well-capitalized nonprofit health systems. Critics argue the lack of transparency around how savings are used allows hospitals to profit without ensuring those benefits reach patients, especially since hospitals are not required to disclose how 340B discounts are applied.

2. New Rebate-Based Pilot Aims to Improve Transparency but May Hurt Smaller Clinics: In an effort to increase oversight and reduce duplicate discounts, HRSA is launching a voluntary rebate-based pilot where 340B drug discounts are applied post-purchase through rebates rather than upfront. While pharmaceutical companies support this shift, smaller and rural providers warn that the delayed financial relief and added administrative workload could be unsustainable. These changes could jeopardize their ability to afford critical medications and maintain essential services, potentially undermining the original purpose of the 340B program.

3. Industry and Experts See Trade-Offs; Questions Remain on Effectiveness of Reform: Supporters, including major pharmaceutical firms, see the rebate model as a way to promote accountability and reduce misuse of 340B discounts. Policy experts acknowledge potential integrity benefits but caution that the new approach may not address the broader problems tied to drug pricing, hospital billing practices, and program expansion beyond true safety-net providers. The reform’s impact is expected to vary — large health systems will likely adapt with minimal disruption, while smaller clinics may face significant financial and operational strain.

CMS: Medicare Part B premiums set to rise in 2026

By Paige Minemyer – Medicare beneficiaries are set to see their Part B premiums rise significantly next year, according to an announcement from the Trump administration. The Centers for Medicare & Medicaid Services (CMS) revealed late Friday that total monthly premiums for Part B will be $202.90. By comparison, the premium for 2025 was $185. In addition, the deductible in Part B will rise to $283, up from $257 in 2025. Read Full Article...

HVBA Article Summary

1. Increases in Medicare Part B Deductibles for 2026: The deductible for Medicare Part B will increase to $283 in 2026, up from $257 in 2025. According to the Centers for Medicare & Medicaid Services (CMS), this rise reflects expected changes in healthcare prices and usage patterns based on historical data. Notably, CMS actions to curb spending on skin substitutes within the Physician Fee Schedule helped prevent an additional $11 hike in premiums.

2. Higher Hospital and Skilled Nursing Facility Costs Under Traditional Medicare: Beneficiaries of traditional Medicare will face higher out-of-pocket costs for inpatient care in 2026. The deductible for a hospital stay will increase from $1,676 to $1,736. Additionally, coinsurance payments will rise to $434 per day for hospital stays beyond 60 days (up from $419), and to $868 per day for lifetime reserve days. In skilled nursing facilities, coinsurance from days 21 through 100 will be $217 per day, slightly down from $219.50 in 2025.

3. Part A Premiums to Rise for a Minority Without Work History Eligibility: While 99% of Medicare beneficiaries are exempt from Part A premiums due to working at least 40 quarters in Medicare-covered employment, the small portion who are not eligible will see premiums increase. In 2026, the monthly premium will rise from $285 to $311, reflecting broader cost adjustments in the Medicare program.

Are Lifestyle Changes Needed in the Age of Obesity Drugs?

By Marilynn Larkin – Obesity medications such as semaglutide and tirzepatide are fueling unprecedented weight loss for many patients as well as improving chronic obesity-associated conditions such as diabetes, fatty liver disease, and cardiovascular risks. “If these medications are so effective, why do we need to bother with lifestyle changes? Why can’t we just set the drug dose, give patients the prescription, and then just let them go?,” Ariana Chao, PhD, director of research, Johns Hopkins Healthful Eating Activity and Weight Program, Baltimore, posed those questions somewhat rhetorically in her presentation at Obesity Week 2025 in Atlanta. Read Full Article...

HVBA Article Summary

1. Lifestyle Changes and Medications Are Both Crucial Pillars in Obesity Treatment: Historically, lifestyle changes — including diet, exercise, and behavioral therapy — were seen as the foundation of obesity care. However, modern obesity management treats lifestyle changes as one of several essential pillars alongside medications, surgery, and devices. While lifestyle interventions alone often yield limited weight loss, medications can more effectively help patients meet their goals, especially when used in combination.

2. Combining Treatments May Improve Outcomes Through Multiple Effects: There are several hypotheses for integrating medications with lifestyle changes:

   • Facilitation: Medications may reduce biological barriers (like hunger) that make lifestyle changes hard to maintain.

   • Additive and Synergistic Effects: Each method may target different aspects of obesity, potentially enhancing each other's effectiveness.

   • Compensatory Benefits: Lifestyle changes may help offset side effects of medications.
     Experts recommend combining or sequencing these interventions, even without extensive trial data, as a pragmatic strategy to enhance results.

3. Implementation Is Complex and Evidence Is Still Evolving: There is limited trial data guiding how best to combine or sequence lifestyle and medication approaches. More research is needed on optimal counseling frequency, effective lifestyle intervention specifics, and implementation strategies. A multidisciplinary care team is seen as vital, and behavioral support is emphasized as essential — since knowledge alone doesn’t translate into action. Overall, the article promotes an integrated, individualized, and realistic approach to long-term obesity care.