Trump delays 2-year ACA subsidy extension proposal: Report

By Jacob Emerson – President Donald Trump has postponed a planned announcement of a proposal to extend enhanced ACA subsidies, CNN reported Nov. 24. Trump was expected to unveil a proposal as early as Nov. 24 that would extend the subsidies for two years while introducing new eligibility restrictions, according to earlier reports from Politico and MS Now. Read Full Article...

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1. Subsidy Limits and Premium Contributions: The proposed Healthcare Price Cuts Act would introduce an income cap limiting eligibility for ACA subsidies to individuals earning up to 700% of the federal poverty level. Additionally, it would require all enrollees—regardless of income level—to contribute a minimum premium payment. This represents a policy shift from the broader subsidy access currently in place, aiming to balance government support with individual financial responsibility.

2. Introduction of Health Savings Accounts (HSAs): A new component of the proposal would allow enrollees who choose lower-cost marketplace plans to divert the difference in premium savings into tax-advantaged health savings accounts (HSAs). These accounts would be funded using their subsidy dollars, providing enrollees with more flexibility and incentives to select cost-effective plans while building reserves for future healthcare expenses.

3. Expiration of Enhanced Subsidies and Legislative Outlook: The enhanced ACA subsidies—which expanded eligibility beyond 400% of the federal poverty limit and capped premiums at 8.5% of income—are scheduled to expire on December 31. These subsidies have played a major role in expanding ACA enrollment from 11.4 million in 2020 to 24.3 million in 2025. With millions facing potential premium increases, the White House is seeking congressional funding for cost-sharing reductions and an extension of the subsidies. Public sentiment remains strongly in favor, with over 75% of adults supporting the continuation of the tax credits, according to recent polling.

Could Trump do for Branded Expensive Drugs What He Just Did for GLP-1s?

By Marissa Plescia - When the Trump administration announced earlier this year that it would not finalize a provision proposed by the Biden administration to expand Medicare and Medicaid coverage of GLP-1s, many advocates responded with deep disappointment. But this month, the Trump administration unveiled its own efforts to expand access to the popular weight loss drugs, announcing an agreement with GLP-1 manufacturers Eli Lilly and Novo Nordisk. Read Full Article…

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1. The Trump Administration’s Deal Significantly Lowers GLP-1 Drug Prices but Is Narrow in Scope: A new agreement with pharmaceutical companies Eli Lilly and Novo Nordisk allows consumers to access popular GLP-1 drugs like Ozempic and Wegovy at substantially reduced prices via TrumpRx, a government-run platform. The deal also permits Medicare to cover these drugs for obesity for the first time and provides price reductions under Medicaid. However, experts caution that this initiative is narrowly focused on a single class of medications and does not address systemic issues in the broader U.S. pharmaceutical pricing landscape.

2. Eli Lilly Expands Access Through Employer-Focused Models Set for 2026: In addition to the federal deal, Eli Lilly announced plans to launch an employer-focused program that offers flexible benefit designs, a dedicated pharmacy network, and third-party obesity management options. While this may expand access in employer-sponsored insurance markets, it still targets obesity drugs specifically, not the wider problem of high prescription costs.

3. Experts Call for Broader Reforms Beyond GLP-1s: Policy analysts and healthcare advocates view the GLP-1 price cuts as a positive but insufficient step. They argue that real progress requires structural reforms like broader Medicare drug negotiations and greater pricing transparency. Concerns persist about relying on voluntary deals with manufacturers and focusing too narrowly on popular weight-loss drugs, which may leave other high-cost treatments—such as cancer medications—unaddressed.

White House poised to reveal healthcare cost plan: media reports

By Paige Minemyer – The White House is expected to reveal a plan to address rising medical costs under the expiry of the Affordable Care Act's (ACA's) enhanced premium tax credits, but the rollout has been delayed due to pushback from the GOP, according to media reports. MS Now reported that the plan was initially set to be unveiled Monday, but the administration has pushed back the announcement while it reworks the plan to address concerns from the party. Read Full Article...

HVBA Article Summary

1. Debate Over ACA Subsidy Extension: The Trump administration introduced a proposal to extend the Affordable Care Act (ACA) premium subsidies that were initially put in place during the COVID-19 pandemic. However, the plan includes potential restrictions such as income limits, which has sparked internal Republican criticism. Some conservative lawmakers view this as a departure from traditional GOP health policy, labeling it as too similar to "Obamacare-lite."

2. Urgency as Deadline Nears: Congress is facing a tight deadline of December 15, the end of the open enrollment period for ACA plans. Without action, millions of Americans who have relied on the temporary subsidies will see significant increases in their premiums starting next year. Despite the looming consequences, there has been little progress toward a resolution, raising concerns about affordability and access to coverage.

3. Partisan Divide on Healthcare Solutions: A clear partisan split has emerged over how to address rising healthcare costs. Democrats are pushing for a clean, short-term extension of the subsidies to avoid immediate premium hikes and buy time for broader negotiations. In contrast, Republican senators are advocating for structural changes like funding health savings accounts (HSAs) instead, making it difficult to reach a bipartisan agreement in time.

Comprehensive Set of Bills Introduced to Take on Medicare Advantage

By Wendell Potter – Representative Mark Pocan (D-WI) [Thursday] introduced eight bills aimed at strengthening traditional Medicare and reining in some of the worst practices in the privately-run Medicare Advantage business. For years, lawmakers have danced around the mounting evidence that private Medicare Advantage plans overbill taxpayers between $80 and $140 billion annually and quietly impose barriers to seniors’ care to boost profits. Read Full Article...

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1. Concerns Over Medicare Advantage's Impact on Care Access: Traditional Medicare has long been praised for its straightforward approach: if a doctor determines care is necessary, patients receive it. However, the rise of Medicare Advantage (MA), managed by large private insurers, has introduced significant changes. These plans often impose prior authorization requirements, limit access to certain providers, and potentially delay or deny services. Critics argue that these barriers may compromise the quality and timeliness of care for millions of older Americans.

2. Federal Scrutiny of Medicare Advantage Practices: The Medicare Advantage program has attracted growing attention from federal authorities. The U.S. Department of Justice has launched both civil and criminal investigations into UnitedHealth Group—the largest MA provider—over allegations that the company manipulated diagnoses to increase payments from Medicare. These investigations suggest serious concerns about whether some MA insurers may be prioritizing profits over proper patient care.

3. Legislative Efforts to Reform Medicare Advantage: In response to ongoing issues within MA, lawmakers have proposed a set of bills aimed at protecting patients and ensuring accountability among insurers. The Denials Don’t Pay Act would penalize insurers with high rates of overturned care denials, the RAPID Act would automate the appeals process to ease the burden on vulnerable patients, and the Protect Medicare Choice Act would restrict aggressive marketing tactics that steer seniors into MA plans. Supporters of these reforms argue they are necessary to safeguard the integrity of Medicare and ensure patients receive timely, physician-recommended care.

Employers split with PBMs to secure direct deals for cost-saving biosimilars

By Allison Bell – The ERISA Industry Committee — a group for employers with large, self-insured benefit plans — says many of its members are questioning how their pharmacy benefit managers are handling expensive "biologic" drugs like Humira. PBMs often get paid based on the size of the rebates and drug discounts they negotiate for employers. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Rebate Incentives May Hinder Biosimilar Adoption: Although lawmakers at both federal and state levels have criticized rebate-based compensation practices, some pharmacy benefit managers (PBMs) continue to emphasize high-cost biologics like Humira. This approach appears to prioritize maximizing rebate-linked revenue over promoting more affordable biosimilar alternatives, potentially limiting cost-effective options for patients and employers.

2. Employer Plan Sponsors Are Exploring Alternatives: A number of ERISA Industry Committee (ERIC) members are beginning to diverge from their PBMs by negotiating biosimilar purchasing agreements directly with manufacturers. ERIC is actively encouraging other employer plan sponsors to consider similar strategies, suggesting that this independent approach could lead to significant savings and increased control over prescription drug spending.

3. Biosimilars Offer Significant Cost Savings: The financial gap between Humira and its biosimilars is stark. In 2023, a single carton of Humira cost approximately $7,300, making it one of the most expensive drugs for employer-sponsored health plans—averaging $145 per participant annually. In contrast, some biosimilars are available for under $700 per carton, presenting a major opportunity to reduce healthcare costs without compromising treatment quality.

Nearly 1 in 10 Americans report a cancer diagnosis: Gallup

By Avery Lotz – Nearly one in ten U.S. adults have been diagnosed with cancer in their lifetime, a new high in Gallup's surveys dating back nearly two decades. The big picture: Cancer death rates have declined in recent decades, along with incidences of certain types of cancer like lung cancer. But other cancers, notably those associated with obesity, have seen an uptick. Read Full Article...

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1. Lifetime Cancer Diagnoses Are Rising, Especially Among Older Adults: Gallup data shows that the percentage of U.S. adults reporting a cancer diagnosis has increased steadily, reaching a peak in the 2024–2025 period. Rates among those 65 and older rose by 3.4 percentage points since 2008–2009, now at 21.5%, compared to nearly 9% among adults aged 45–64. The increase aligns with trends in aging and the growing share of older Americans.

2. Higher Prevalence Linked to Better Survival, Though Disparities Persist: The rise in lifetime cancer diagnoses partly reflects improved survival rates. However, racial and insurance-related disparities still limit access to care and affect outcomes. Additionally, some cancers, like colorectal cancer, are rising among younger adults, suggesting shifting trends beyond aging alone.

3. Research Gains at Risk Amid Public Health Funding Cuts: Men now report slightly higher cancer diagnosis rates than women (9.8% vs. 9.6%), with a 3.6-point rise since 2008–2009. Mortality has dropped for certain cancers due to prevention and screening, but experts warn that cuts to NIH and CDC programs could hinder future progress, despite 73 new lung cancer treatments developed in the last decade.

Small businesses are cutting healthcare costs — without cutting benefits

By Paola Peralta – Small businesses are shouldering disproportionately higher healthcare costs as prices continue to climb, but they're refusing to cut their workforce's access to benefits. The median health insurance premium for small businesses in America has risen 23% since 2022, according to recent data from payroll and HR management platform Gusto, outpacing inflation by 13% over that same period. Still, 22% of those small businesses are committed to providing their workforces with robust benefit packages. Providing adequate coverage with limited resources is difficult, but not impossible with the right strategy. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Adoption of Cost-Conscious Health Benefits: To manage rising healthcare costs, small businesses are increasingly turning to more affordable insurance options. High-deductible health plans (HDHPs) with Health Savings Accounts (HSAs) have grown in popularity—offered by about 33% of companies in 2020 and nearly 48% by 2025. Employers are also adopting level-funded plans, which involve paying a fixed monthly amount to better manage annual cost increases. Additionally, Health Reimbursement Arrangements (HRAs) are gaining traction, allowing employers to provide tax-free funds for employees to purchase individual insurance or pay for medical expenses.

2. Technology as a Support Tool: With limited resources and staff, small businesses are turning to technology to help streamline the process of selecting and managing employee health plans. Modern platforms can efficiently analyze and compare thousands of insurance options—evaluating premiums, deductibles, and provider networks—to recommend cost-effective plans. These tools make it easier for small businesses to make informed decisions and implement strategies traditionally reserved for larger employers.

3. Persistent Employee-Centric Values Despite Financial Pressure: Even with tight budgets and ongoing cost increases, small businesses remain committed to supporting their employees' health and well-being. They are actively seeking sustainable alternatives that allow them to continue offering access to health insurance. While the cost of coverage is rising and long-term systemic solutions remain uncertain, these businesses are adapting with resourceful strategies to maintain care without compromising financial stability.