HVBA Elevates Don Cahalan, Amy Mansfield Nelli, and Mike Hirschberg to Leadership Roles

By Health & Voluntary Benefits Association® (HVBA) – The Health & Voluntary Benefits Association® (HVBA) is thrilled to announce several Executive and Advisory Board Member promotions. It is with great pride and admiration that the HVBA congratulates Don Cahalan on his well-earned promotion from the Advisory Board to the Executive Board of the Health & Voluntary Benefits Association. Don’s unwavering commitment to the advancement of employee benefits and his deep expertise in health and voluntary programs have made him an invaluable contributor to the HVBA community. Read Full Article...

HVBA Article Summary

1. Don Cahalan Joins HVBA Executive Board: Don Cahalan, Founder of Biggin Solutions, has been promoted from the HVBA Advisory Board to the Executive Board. He was recognized for his exceptional strategic insight, unwavering integrity, and forward-thinking mindset, all of which significantly influenced the Association’s initiatives. His leadership not only shaped key strategies but also inspired collaboration and innovation among industry peers.

2. Leadership Recognitions for Amy Mansfield Nelli and Mike Hirschberg: In addition to Don’s promotion, HVBA has elevated Amy Mansfield Nelli to 1st Vice President and Mike Hirschberg to 2nd Vice President. Amy was acknowledged for her longstanding contributions, strong leadership, and strategic vision, while Mike was praised for his deep industry expertise and commitment to member-focused benefit solutions. Both are expected to play critical roles in driving innovation and collaboration within the Association.

3. Strategic Direction and Future Impact: These leadership transitions mark an exciting phase for HVBA, reinforcing its dedication to advancing sustainable, employee-centered benefit strategies. With Don, Amy, and Mike stepping into key leadership roles, the Association aims to amplify its mission, foster meaningful industry dialogue, and build a more innovative, inclusive future for health and voluntary benefits.

Self-funded plan costs stable now, but ACA market stress poses risk

By Allison Bell – An analyst at a company that helps self-funded employer plans buy care directly from health care providers thinks the plans' own costs are mostly under control. But the analyst says employers and their benefits advisors should watch carefully for signs of health care providers charging employers more to make up for federal Affordable Care Act premium tax credit subsidy cuts. For employers, "stable numbers today don't guarantee smooth sailing ahead," according to Dr. Rani Aravamudhan, a medical doctor who serves as a vice president at Nomi Health. "ACA market stress could spill over into private commercial markets." Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Current Cost Stability in Self-Funded Plans: According to Dr. Rani Aravamudhan of Nomi Health, self-funded employer plans currently experience relatively stable cost increases, with an average rise of about 5% compared to 2025. Medical care spending has increased modestly by 1.75% per member per month, and prescription drug spending rose by 8.64%, largely due to increased use of GLP-1 agonists like Wegovy. These figures suggest that employers who actively manage their self-funded plans are effectively controlling costs despite broader market pressures.

2. Potential Impact of ACA Subsidy Cuts: There is concern that cuts to the Affordable Care Act premium tax credit subsidies could lead to increased costs for employers. An AFL-CIO forecast cited by Aravamudhan estimates that such subsidy cuts could add between $182 and $485 in additional annual costs per employer plan participant in 2026. This potential spillover effect from ACA market stress could cause health care providers to charge more to employer-sponsored plans, posing a risk to cost stability in the near future.

3. Early Warning Signs for Employers: To mitigate risks associated with ACA subsidy cuts, employers and benefits advisors should monitor for early indicators of market stress. These include new disputes over provider network contracts, rising administrative fees, and the emergence of "hidden spread pricing," where undisclosed fees are taken by intermediaries in the health care payment process. Being vigilant about these signs can help employers anticipate and respond to cost pressures before they significantly impact their health plans.

Democratic AGs lose bid to halt ACA marketplace changes

By Diana Novak Jones – A group of 20 Democratic attorneys general and one Democratic governor have lost their bid to block portions of a U.S. Department of Health and Human Services rule that they say could lead to nearly 2 million people losing their health insurance. U.S. District Judge Nathaniel Gorton in Boston on Wednesday denied, the states' motion for a preliminary injunction against certain provisions of a new HHS regulation they claim illegally changed the rules governing health insurance marketplaces created under the Affordable Care Act (ACA). Gorton said the states' concerns that the changes would push more healthcare costs onto them were overblown. Read Full Article...

HVBA Article Summary

1. Court Upholds New HHS Rule Temporarily: A federal judge ruled that the Marketplace Affordability and Integrity Rule, issued by the Department of Health and Human Services (HHS), can remain in effect while ongoing legal challenges proceed. The judge noted that claims from states about reduced health insurance enrollments and added financial burdens were premature, as the provisions had only recently taken effect and open enrollment periods are still active through mid-January.

2. States Challenge the Rule's Impact on Health Coverage: Multiple states, led by Democratic attorneys general and joined by the Governor of Pennsylvania, filed a lawsuit arguing that key provisions of the rule restrict access to marketplace health insurance. They claim it will shorten enrollment windows, introduce new fees, exclude certain groups like DACA recipients, and remove essential benefits such as transgender healthcare—ultimately increasing costs and reducing coverage for millions.

3. HHS Defends Rule as a Guard Against Improper Use of Funds: The Centers for Medicare & Medicaid Services (CMS) finalized the rule to enhance the accuracy of income and eligibility verification, aiming to prevent improper enrollments and misuse of federal subsidies. HHS contends the rule is a necessary safeguard for program integrity and does not foresee the significant negative impact on coverage that the opposing states claim.

Oz: CMS staff could ease sting of rising ACA premiums, but only if gov reopens

By Paige Minemyer – The looming expiration of enhanced Affordable Care Act (ACA) premium subsidies is at the center of the ongoing government shutdown, with Republicans now pushing to reopen and negotiate a potential extension afterward. Mehmet Oz, M.D., administrator of the Centers for Medicare & Medicaid Services (CMS), echoed that sentiment in an appearance at the Aspen Institute on Monday afternoon, calling the government shutdown a "public health emergency." Read Full Article...

HVBA Article Summary

1. Impact of Government Shutdown on ACA Premiums: The ongoing government shutdown has hindered the Centers for Medicare & Medicaid Services (CMS) from deploying strategies to mitigate rising Affordable Care Act (ACA) premiums. CMS Administrator Mehmet Oz described the shutdown as a "public health emergency" because many expert staff are unavailable to work on solutions. This lack of workforce availability complicates timely decisions that could ease the financial burden on exchange enrollees as premium subsidies are set to expire.

2. Political Negotiations and Timeline: Republicans, including House Speaker Mike Johnson, are advocating for reopening the government to allow negotiations on extending ACA premium subsidies. Johnson highlighted that there is effectively a three-month window to negotiate before the subsidies expire at the end of the year. However, open enrollment begins November 1, and many individuals will face higher premiums due to the likely expiration of tax credits, with a KFF analysis showing a median premium increase request of 18% for 2026.

3. Concerns Over Fraud and Enrollment Issues: CMS is also focusing on fraudulent sign-ups and broker misconduct on the ACA exchanges, which may contribute to rising premiums. Oz noted that half of ACA enrollees filed no medical claims last year, suggesting some may be unaware of their enrollment or coverage level. Data from the Paragon Health Institute estimates up to 5 million people may have been improperly enrolled in 2024, and CMS has implemented changes to address these issues, which could reduce enrollment but also influence premium costs.

Onshoring could threaten the resilient supply chain for biosimilars and generics

By Gillian Woollett – Over the past six months, numerous pharmaceutical companies have announced plans to invest in new U.S. manufacturing facilities within the next decade. This so-called “onshoring,” motivated by the Trump administration’s announcement of sector-specific tariffs, seems to make sense on the surface: strengthen domestic manufacturing capabilities and mitigate potential risks of supply disruption. Given the years of time it takes to build a new manufacturing facility, the president signed a separate order to hasten the FDA approval process for domestic drug manufacturing plants, while simultaneously increasing fees and inspections for foreign facilities. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Market-Driven Solutions Are Preferred Over Protectionist Policies: The article argues that while the goal of prioritizing domestic interests — such as "putting America first" — is understandable, it can be achieved more effectively through healthy market competition rather than through protectionist measures like tariffs or forced onshoring. Such policies may unintentionally hinder competition, raise operational inefficiencies, and lead to increased drug prices, particularly affecting generics and biosimilars, which already operate on razor-thin margins and provide critical savings for patients and health systems.

2. Global Supply Chains Are Essential for Biologics and Biosimilars: The manufacturing and distribution of biosimilars depend on complex, globally optimized supply chains that span both emerging and developed economies. Each step in this process — from sourcing raw materials to final packaging — is critical to maintaining cost efficiency and quality. Disrupting these international supply networks in favor of purely domestic production, especially without appropriate infrastructure and policy support, could increase costs, reduce resilience, and lead to drug shortages that directly harm patients.

3. Sustainability of the Biosimilar Industry Is at Risk Without Supportive Policy: Despite their proven ability to reduce costs and expand treatment access, biosimilars face major challenges in gaining sufficient market share due to high development costs, limited pricing flexibility, and unpredictable policy environments. The article cautions that unless these issues are addressed through supportive and commercially sustainable policies, the U.S. may experience a lack of biosimilar development — a “biosimilar void” — which would allow branded biologics to maintain monopolies and continue raising prices, ultimately burdening patients and healthcare providers alike.

UnitedHealth taps Duke scientist to lead AI efforts

By Casey Ross – UnitedHealth Group has tapped a Duke University artificial intelligence expert to be its chief AI scientist as the health care giant ramps up the use of the technology across its sprawling network of businesses, according to a memo obtained by STAT. Michael Pencina, chief data scientist for Duke Health, stepped down from his role at Duke on Wednesday to take the job at UnitedHealth, according to the memo from Mary Klotman, dean of the Duke University School of Medicine. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. UnitedHealth Hires AI Oversight Advocate: UnitedHealth Group has appointed Michael Pencina, a prominent figure in health care AI transparency and regulation, to support its growing use of artificial intelligence. Pencina, who previously worked at Duke University and co-founded the Coalition for Health AI, has long advocated for creating national standards and registries to track AI tools used in patient care. His hiring suggests UnitedHealth may be aiming to strengthen the credibility and governance of its AI initiatives, although the company has not disclosed whether he is filling a new or existing role.

2. Rapid AI Expansion Amid Minimal Federal Oversight: UnitedHealth is rapidly expanding its use of AI across more than 500 tasks, including code generation and decisions about patient access to expensive treatments. Company executives claim that each use case is producing double-digit efficiency gains. This growth, however, is unfolding in a regulatory gray zone, as federal agencies struggle to keep pace with the technology’s deployment in the health care sector. A few states have introduced laws to restrict insurers from using AI to make unilateral care decisions, but comprehensive national oversight remains limited.

3. Ongoing Legal and Ethical Scrutiny: UnitedHealth is currently facing a class-action lawsuit related to its use of an AI tool to deny payment for care to older, seriously ill patients. Reporting has shown that this tool was sometimes used even when doctors disagreed with its recommendations. Additionally, a Senate investigation found a broader pattern of AI-driven care denials in Medicare Advantage plans. These developments have raised ethical and legal concerns about the role of AI in clinical decision-making, particularly when financial efficiency may conflict with patient well-being.

Life, disability insurance remain 'bread and butter' of workplace benefits

By Alan Goforth – Life insurance and disability insurance remain the bread and butter of workplace benefits, new research from LIMRA confirmed. Two-thirds of employers and a majority of workers value these benefits, and sales of both products rebounded in the second quarter of this year. “In the first half of 2025, we see sales stabilizing,” said Grace Rafferty, corporate vice president and director of LIMRA’s workplace benefits research program. “We expect this to continue through the rest of the year.” Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Life Insurance Market Trends: Workplace life insurance new premium reached $666 million in Q2 2025, marking a 1% increase year over year, although year-to-date premiums declined 7% compared to 2024. Term life insurance premiums fell 4% in Q2, but permanent life insurance sales showed a slight rebound with a 1% increase. Group life insurance, which makes up 92% of the market, saw a 6% decrease year to date, while individual sales dropped 8%. These figures indicate a mixed but stabilizing market for life insurance products in the workplace benefits sector.

2. Disability Insurance Sales and Market Share: Total workplace disability insurance new premium was $618 million in Q2 2025, a 3% increase year over year, driven by a 7% rise in short-term disability insurance premiums despite a 3% decline in long-term disability premiums. However, year-to-date disability insurance premiums were down 7% compared to the previous year, with short-term and long-term disability premiums falling 5% and 9%, respectively. The top 10 carriers dominate the market, accounting for 75% of total new disability insurance premium sales in the first half of 2025, highlighting market concentration.

3. Supplemental Health Insurance and Future Outlook: Supplemental health insurance product sales, including accident, critical illness, cancer, and hospital indemnity, totaled $541 million in Q2 2025, remaining steady compared to the previous year. Year-to-date sales for supplemental health products declined 5%, with the top 10 carriers representing 66% of sales. Despite economic pressures such as inflation and a softening economy, LIMRA research suggests most employers plan to maintain competitive benefits packages in 2026 to attract and retain employees, indicating continued support for these insurance benefits.

Pick GLP-1s as First Drug Option in Obesity, Guidelines From Abroad Say

By Kristen Monaco – A new treatment algorithm from the European Association for the Study of Obesity (EASO) recommends opting for semaglutide (Wegovy) or tirzepatide (Zepbound) first when "substantial" weight loss is needed in a patient. The two GLP-1-agonist containing injectables yielded much more weight loss in trial data than other agents on the market, including orlistat, naltrexone-bupropion, liraglutide (Saxenda), and phentermine-topiramate (Qsymia), which can be considered when patients need to lose a more moderate amount of weight, said Barbara McGowan, MBBS, PhD, of Guy's & St Thomas' Hospital NHS Trust in London, and co-authors in Nature Medicine. "Even though there are several options on the market, the reality is that semaglutide and tirzepatide are so effective that they should be the first choice in almost all cases," added co-author Andreea Ciudin, MD, PhD, of Vall d'Hebron University Hospital in Barcelona, Spain, in a statement. Read Full Article...

HVBA Article Summary

1. EASO Recommends GLP-1 Agonists as First-Line Treatment: The European Association for the Study of Obesity (EASO) advises using semaglutide and tirzepatide as the initial pharmacological treatment for patients requiring substantial weight loss. These drugs have demonstrated significantly greater efficacy in clinical trials compared to other obesity medications such as orlistat and liraglutide. This recommendation marks a shift towards prioritizing these newer agents due to their superior weight loss outcomes.

2. Treatment Should Be Individualized: Despite the strong endorsement of GLP-1 agonists, the guidelines emphasize tailoring obesity treatment to each patient's unique circumstances. Factors such as comorbidities, socioeconomic context, patient preferences, and specific obesity-related complications should guide therapeutic decisions. This approach recognizes the complexity of obesity management and the need for personalized care plans rather than a one-size-fits-all strategy.

3. Obesity-Related Complications Influence Medication Choice: The EASO algorithm categorizes obesity complications into fat mass diseases and sick fat diseases, recommending specific drugs accordingly. For example, tirzepatide is preferred for obstructive sleep apnea, while semaglutide is favored for knee osteoarthritis and cardiovascular disease. The guidelines also highlight that the benefits of medications may extend beyond weight loss, affecting complications differently, and ongoing research is needed to fully understand these effects.