UnitedHealth, Cigna and Elevance's House of Cards Is Wobbling

By Wendell Potter – We’ve reported over the past few weeks about actions being taken by UnitedHealth Group, Cigna and Elevance, three of the giants in the for-profit health insurance business, that undoubtedly will push independent physician practices to the brink of bankruptcy and closure – or force them to sell out to either an insurance conglomerate or big hospital system – and severely restrict Americans’ access to the doctors and hospitals of their choice. Other Big Insurance companies undoubtedly will follow suit. Even President Trump is getting the message: These truly are “BIG, BAD” “money-sucking” companies. Read Full Article...

HVBA Article Summary

1. Insurers Shift to Vertical Integration Amid Struggles in Commercial Market: Major health insurers like UnitedHealth, Cigna, and Elevance are increasingly relying on vertical integration—owning physician practices, clinics, and pharmacy benefit managers—as their traditional insurance models face profitability challenges. For instance, UnitedHealth pays its owned physician practices up to 61% more than independent ones, raising concerns about fairness and market distortion. This shift reflects a broader industry response to declining commercial enrollment and rising reliance on government-funded programs like Medicare Advantage and Medicaid to sustain revenue growth.

2. Government-Funded Plans and Self-Dealing Drive Revenue Growth: With millions priced out of private insurance due to relentless premium hikes, insurers have turned to taxpayer-funded programs for growth. UnitedHealthcare, for example, saw no increase in commercial enrollment from 2013 to 2023 despite an 18 million population increase. Elevance’s commercial enrollment dropped by 265,000 in a year, while Medicare Advantage enrollment rose by 198,000. Internal divisions like Carelon now account for a larger share of profits, though much of their revenue comes from the company’s own health plans—raising concerns about self-dealing and financial opacity.

3. Political and Market Pressures Threaten Industry Stability: As bipartisan lawmakers introduce bills to curb vertical integration and Medicare Advantage abuses, insurers face growing scrutiny over practices seen as unsustainable. Simultaneously, investor confidence is wavering—Elevance shares have dropped nearly one-third since April, and operating earnings in its core health benefits unit fell 63% year-over-year. With both Washington and Wall Street applying pressure, the long-term viability of insurers’ current business models may hinge on regulatory outcomes and the public’s tolerance for continued premium increases and provider network restrictions.

House bill could slow high-cost health and labor rules

By Allison Bell - Members of the U.S. House are considering a bill that could help employers, brokers, insurers and others fight off what they believe to be burdensome legislation. The Unfunded Mandates Accountability and Transparency Act of 2025 bill would require the Employee Benefits Security Administration, the Centers for Medicare and Medicaid Services and other federal agencies to publish a regulatory impact analysis for most rules with an anticipated annual economic impact of $100 million or more. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Enhanced Scrutiny and Transparency for Federal Regulations: The proposed legislation mandates that federal agencies engage with impacted private-sector parties—including small businesses—when drafting new regulations. This requirement aims to ensure that those who would bear the costs of regulation have a voice in shaping them. Agencies would also need to conduct and report detailed cost-benefit analyses and consider alternative approaches to any proposed rule. Oversight of these procedures would fall to the Office of Information and Regulatory Affairs, ensuring accountability and compliance with the new transparency standards.

2. Congressional Oversight on Costly Mandates: The bill includes a provision allowing members of Congress to delay or block regulatory proposals that could result in high costs for the private sector. This mechanism would create a formal check on regulatory power, enabling lawmakers to intervene before costly mandates are enacted. It builds on the intent of the existing Unfunded Mandates Reform Act of 1995 but introduces more enforceable transparency requirements. The goal is to prevent the imposition of expensive or burdensome regulations without sufficient scrutiny and legislative awareness.

3. Potential Impact on Health and Labor Regulations: Although the Congressional Budget Office expects the bill to have limited direct impact on federal spending or revenue, it could significantly influence how regulations in health and labor sectors are developed. Rules related to employer health plans, behavioral health standards, and pharmacy benefit management could face greater scrutiny and slower implementation timelines. Past opposition to similar regulations by employer groups and pharmaceutical companies indicates that such stakeholders may actively leverage the new framework to shape outcomes. As a result, this bill could affect how future healthcare-related regulations are analyzed, debated, and enforced.

Medicare Supplement or Medicare Advantage? Which is best for you?

By Cynthia Pruemm – Annual enrollment period for Medicare runs through Dec. 7. You’ve likely heard about original Medicare, or Parts A and B, which provide hospital and medical insurance. And Part D, which provides prescription drug coverage. But what about Medicare Advantage and Supplemental Plans? What do these plans include and who are they for? A Medicare Advantage Plan, also known as Part C, is a government plan that groups Parts A, B and D, while offering additional benefits such as dental, vision or even hearing. Read Full Article...

HVBA Article Summary

1. Medicare Advantage vs. Medicare Supplement Plans
   Medicare Advantage Plans (run by private insurers) deliver benefits through provider networks like HMOs or PPOs and may offer “all-in-one” convenience but often limit provider choice and change annually. In contrast, Medicare Supplement (Medigap) plans work alongside Original Medicare, offer more flexibility in choosing doctors and hospitals, and remain consistent from year to year.

2. Plan Types and Suitability
   Different plan types serve different needs:

   • Private-Fee-For-Service (PFFS) plans offer provider flexibility but determine their own payment terms.

   • Special Needs Plans (SNPs) cater to specific groups, such as those with chronic conditions, dual eligibility (Medicare + Medicaid), or residents of long-term care facilities.

   • Medigap plans are standardized and best suited for those who value provider freedom, travel often, or want coverage outside the U.S.

3. Choosing the Right Coverage Depends on Personal Needs
   Key decision factors include your preferred providers’ network status, frequency of doctor visits, medication needs, upcoming procedures, and travel habits. Consulting a financial or healthcare professional can help tailor your choice to your unique medical and lifestyle circumstances.

Dr. Oz says ‘there are discussions’ on extending Affordable Care Act subsidies as Republicans scramble to address soaring healthcare costs

By Jason Ma – Centers for Medicare and Medicaid Services Administrator Dr. Mehmet Oz indicated enhanced subsidies under the Affordable Care Act may be extended after all. In an interview Sunday on CNN’s State of the Union, he was asked if there are any conversations about extending them, even on a short-term basis, given that insurance costs will more than double if the new year begins without the subsidies. “There are discussions around extending the subsidies, if we deal with the fraud, waste, and abuse that right now is paralyzing the system,” he replied. Read Full Article...

HVBA Article Summary

1. Healthcare Costs and ACA Subsidies Are Central Political Issues: The looming expiration of enhanced Affordable Care Act (ACA) subsidies, enacted during the pandemic, has become a major point of contention in ongoing healthcare policy debates. Democrats are strongly advocating for an extension, warning that failure to act could result in significantly higher insurance premiums and as many as 4 million additional uninsured Americans by 2034. This issue holds particular urgency in Republican-leaning Southern states, where ACA enrollment is disproportionately high, highlighting a complex overlap of policy impact and political geography.

2. Divergent Policy Approaches Between Parties: Republicans and Democrats are pursuing distinctly different strategies to address healthcare affordability. While Democrats emphasize maintaining or expanding subsidies, Republicans—including former President Trump and allies like Dr. Oz—are promoting alternative mechanisms like reinsurance and prescription drug reforms aimed at lowering costs. However, Republican-led proposals have so far avoided reinstating ACA subsidies, even though their expiration would hit GOP strongholds hardest. This reflects a broader philosophical divide over how best to achieve long-term sustainability and cost reduction in the healthcare system.

3. Political Stakes Are High Ahead of Elections: With recent off-year elections signaling voter frustration—particularly around affordability issues—rising ACA premiums are becoming a potential electoral liability. The political consequences of higher healthcare costs could be significant in competitive congressional districts, especially those with high ACA marketplace participation. Experts suggest that these financial pressures may sway closely contested races, prompting both parties to intensify efforts toward developing durable, voter-friendly healthcare solutions that go beyond short-term fixes and appeal to a broad base.

Many truck drivers don’t live past 61. Could digital health help?

By Katie Palmer – When Steve Jones started driving trucks nearly two decades ago, he fell into a pattern. To help stay awake on the road, he’d drink a 2-liter bottle of Mountain Dew in a day, and keep a loaf of bread in the passenger seat for energy. At truck stops, he’d grab whatever was quick, often a couple of hot dogs. Before long, he had gained 70 pounds. It’s a common story among the 3.5 million truck drivers that work in the United States, more than two-thirds of whom are obese. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Truck Drivers Face Severe Health Risks Due to Occupational Realities: The trucking profession imposes extreme physical and mental health challenges due to long sedentary hours, poor sleep quality, and limited access to nutritious food. These conditions contribute to truck drivers being twice as likely to develop type 2 diabetes as the general population, with an average life expectancy of just 61 years. Despite these risks, health considerations are often sidelined in favor of operational priorities like timely deliveries, highlighting a disconnect between industry demands and worker well-being.

2. Targeted Digital Health Programs Offer Promising, Flexible Solutions: Offshift, a digital health app tailored to the trucking lifestyle, is addressing health barriers by offering brief, practical workouts, nutrition advice suited to truck stops, and remote coaching. Unlike traditional wellness programs, which often fail due to their incompatibility with non-traditional work schedules, Offshift integrates health strategies directly into drivers’ routines. Early results show higher engagement, suggesting that personalized, context-aware tools may be more effective in promoting long-term behavior change among mobile and underserved populations.

3. Scalability and Sustainability Challenges Underscore the Need for Broader Support: Despite promising outcomes, digital health programs like Offshift face adoption and funding challenges. High turnover rates in trucking and limited employer incentives make it difficult to justify long-term investment in preventive health benefits. Transitioning to a nonprofit model under Project 61, Offshift now offers a free version of its app through industry sponsorships to expand access. However, this shift trades personalized coaching—key to effectiveness—for broader reach, underscoring the persistent tension between scalability and individualized support in public health efforts.

Prescription drug costs remain a top concern for Americans amidst policy proposals

By Alan Goforth – With enhanced Affordable Care Act premium subsidies set to expire at the end of this year, health care affordability was a contentious issue in the recent government shutdown. Both political parties are making policy proposals aimed at lowering prescription drug costs for American families. The Trump administration recently announced several actions addressing the cost of prescription drugs. The latest KFF Health Tracking Poll found that prescription drug costs remain a problem for many Americans. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Prescription Drug Affordability Remains a Widespread Issue: About 1 in 4 adults (25%) report that they or someone in their household has had trouble paying for prescription medications in the past year. This issue is especially pronounced among uninsured adults (41%), and among Hispanic and Black adults, as well as those with household incomes under $40,000, where approximately one-third report difficulty affording medications—highlighting significant disparities in access to affordable prescription drugs.

2. Public Skepticism Toward Federal Efforts to Lower Drug Costs: While the administration has proposed measures to lower prescription drug prices, public confidence in these efforts varies greatly by political affiliation. A large majority of Republicans (75%), and even more among MAGA-supporting Republicans (over 80%), believe it is likely these efforts will benefit people like them. In contrast, only about one-third of independents and a mere 9% of Democrats share that belief—indicating a deep partisan divide in trust over proposed healthcare reforms.

3. Use and Access to GLP-1 Medications is Increasing, But Costs Remain a Barrier: One in five adults (20%) reports having used a GLP-1 medication, such as those for weight loss, diabetes, or heart disease, with 12% currently using them—marking a 6-point increase over the past 18 months. Despite insurance often covering part of the cost, over 50% of users still find them difficult to afford, and about 25% report paying the full cost themselves even when insured. Usage is highest among adults aged 50–64, and 84% of GLP-1 users report a formal diagnosis related to obesity, diabetes, or heart disease. However, 15% say they have not been diagnosed with any of these conditions, raising potential concerns about off-label or non-medically guided use.

Health data staggers back post-shutdown

By Adriel Bettelheim and Maya Goldman – Some closely watched federal health websites and datasets that went dark during the government shutdown haven't been updated since the reopening. Why it matters: The pause in critical information leaves the public and providers in the dark about threats with the holidays approaching. The big picture: With vaccination rates falling, a new flu strain on the rise and bird flu returning, public health authorities need reliable data to make timely decisions, especially as more people gather indoors. Read Full Article...

HVBA Article Summary

1. Lapses in CDC Data Updates Raise Public Health Concerns: Multiple CDC data trackers — such as the Morbidity and Mortality Weekly Report, COVID-19 vaccine coverage estimates, and wastewater surveillance for viruses like COVID-19, flu, and RSV — have not been updated for several weeks or even months. These delays have occurred during a critical time, particularly as flu season intensifies. Public health experts express concern that the absence of timely federal data may compromise the nation’s ability to detect and respond to emerging health threats effectively.

2. Criticism of CDC Transparency and Coordination Post-Shutdown: Following a Democrat-led government shutdown and notable leadership departures at the CDC, experts are questioning the agency’s commitment to data transparency and scientific collaboration. Concerns have been raised that the CDC's diminished ability to engage with outside researchers and other government entities may weaken public trust and hinder rapid, data-driven responses to evolving health risks. Some see the slow data recovery as symptomatic of deeper organizational challenges.

3. Private Sector and Academic Institutions Fill Monitoring Gaps: With federal health data updates lagging, academic institutions and companies like Walgreens have launched independent tools to monitor virus activity, including flu and COVID-19 hotspots. These efforts have helped bridge information gaps at a time when accurate, real-time surveillance is critical. Experts are particularly focused on avian flu risks during bird migration season and warn of a potentially severe flu outbreak due to the emergence of an H3N2 strain not covered by this year’s flu vaccine.