Trust in U.S. health insurers is critically low

By Michael Popke – A new survey from research and advisory firm Forrester reveals that trust is critically low for health insurers, with only 25% of noncustomers and 54% of customers describing health insurers as trustworthy. That’s one alarming takeaway from “The Trust Foundation is Fractured for US Health Insurers, 2025” report, which also reveals that generational differences in trust are stark. Only 35% of Gen Z-ers trust health insurance companies to keep their personal information secure, compared to 63% of the Silent Generation (typically defined as those born between 1928 and 1945). Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Trust Significantly Impacts Customer Behavior and Experience: The survey reveals that high-trust health insurance customers are 5.5 times more likely to share personal data than those with low trust. These individuals also report significantly higher satisfaction across three core dimensions of customer experience: ease, effectiveness, and emotional connection. This highlights how trust not only enhances willingness to engage but also improves the perceived quality of service.

2. Health Insurers Must Shift From Transactions to Relationships: The 14-page report warns that health insurers are at a crossroads, needing to evolve from transactional interactions to meaningful, lasting relationships to maintain relevance. Without this shift, they risk disruption driven by increasingly frustrated and disengaged stakeholders. As trust is described as an essential component of both brand experience and customer experience, this transformation is seen as urgent and necessary.

3. Building Trust Requires a Strategic, Multi-Faceted Approach: Forrester analyst Arielle Trzcinski notes that while health insurers are experiencing a crisis in trust, there is a viable path forward. That includes investing in transparency, strengthening data security, and focusing on seven key "trust levers": competence, dependability, accountability, consistency, integrity, empathy, and transparency. The benefits are substantial: 65% of high-trust customers believe their insurer stands out from competitors, and 53% say they would pay a premium for their insurer’s overall experience — demonstrating how trust can directly influence competitive advantage and revenue potential.

US court rejects Novo Nordisk's challenge to Medicare drug pricing plan | Reuters

By Diana Novak Jones – A federal appeals court on Monday rejected Novo Nordisk's (NOVOb.CO), challenge to the U.S. government’s program that gives its Medicare health insurance plan the power to negotiate lower drug prices, the latest in a barrage of lawsuits brought by drugmakers to fail. The Philadelphia-based 3rd U.S. Circuit Court of Appeals affirmed a lower court’s ruling dismissing the Danish drugmaker’s challenge to the program and the Centers for Medicare and Medicaid Services' selection of six of its insulin products for price negotiations. A unanimous three-judge panel rejected Novo’s constitutional challenges to the program, which was part of Democratic former President Joe Biden’s Inflation Reduction Act, and said the law specifically bars courts from reviewing the drugs selected. Read Full Article...

HVBA Article Summary

1. Court Decision and Legal Context: The 3rd U.S. Circuit Court of Appeals unanimously rejected Novo Nordisk's constitutional challenge to the Medicare drug pricing negotiation program. This program, part of the Inflation Reduction Act, empowers Medicare to negotiate lower drug prices and bars courts from reviewing the selected drugs. The ruling affirms the government's authority to implement this program despite opposition from pharmaceutical companies.

2. Industry Challenges and Previous Rulings: Novo Nordisk is among several pharmaceutical companies that have challenged the program, claiming violations of due process and free speech rights. However, nearly all such lawsuits have failed in appellate courts, including challenges from AstraZeneca, Bristol Myers Squibb, and Novartis. These consistent rulings indicate strong judicial support for the Medicare negotiation program.

3. Political and Market Implications: The Inflation Reduction Act aims to reduce drug costs for Medicare's 66 million beneficiaries by requiring pharmaceutical companies to negotiate prices. The program's implementation proceeds despite legal challenges, reflecting political pressure from both Democratic and Republican figures to lower drug prices in the U.S., where pharmaceutical costs are notably higher than in other countries.

ACA subsidies expiration will cause 114% average premium increase in 2026

By Alan Goforth – Premium payments will more than double in 2026 if enhanced premium tax credits are allowed to expire at the end of this year as scheduled, a KFF analysis found. “There is a hot debate in Washington about the looming ACA premium hikes, but our poll shows that most people in the Marketplaces don’t know about them yet and are in for a shock when they learn about them in November,” said Drew Altman, president and CEO of KFF. Extension of the tax credits has been a major point of contention during the ongoing federal government shutdown. Much of the debate centers on balancing greater coverage with substantially higher costs. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Significant Premium Increase if Credits Expire: The expiration of enhanced premium tax credits at the end of 2025 is projected to more than double premium payments for ACA Marketplace enrollees in 2026, resulting in an average increase of 114%. For example, an individual earning $28,000 would see their annual premium payment rise from about 1% of their income ($325) to nearly 6% ($1,562), an increase of $1,238. This dramatic rise could lead to many enrollees facing unaffordable premiums and potentially losing coverage.

2. Political Debate and Timing: The extension of these tax credits has become a contentious issue amid the federal government shutdown, with Republicans and Democrats holding differing views on timing and fiscal impact. House Speaker Mike Johnson suggested negotiations could occur after the government reopens, while Democrats, including Sen. Amy Klobuchar, emphasize the urgency of renewing the credits before the November open enrollment period to prevent premium shocks for consumers. The Congressional Budget Office estimates that not extending the credits could increase the uninsured population by about four million by 2034, while extending them would add $350 billion to the federal debt over the same period.

3. Public Support and Potential Impact on Consumers: A recent KFF poll indicates strong bipartisan support for extending the enhanced tax credits, with nearly 8 in 10 Americans in favor, including a majority of Republicans, Democrats, and independents. The poll also reveals that 7 in 10 individuals who purchase their own insurance would struggle financially if premiums doubled, and about 40% of Marketplace enrollees might forgo insurance altogether under such circumstances. This highlights the critical role these subsidies play in maintaining health insurance affordability for millions of Americans.

Expenses per physician top $1.1M, up 15% in 2 years: 4 notes

By Laura Dyrda – Physician practice expense growth is driving additional investment across the U.S., according to Strata. The analytics firm surveyed more than 135,000 physicians and 1,850 hospitals to gather financial data every month. Expenses per physician practice have been climbing over the last few years and continued to grow in August, according to the report. Read Full Article...

HVBA Article Summary

1. Rising Physician Expenses: Average annual expenses per full-time physician reached $1.1 million, marking a 5.8% increase year-over-year and a 15.4% rise since 2023. Regional differences were notable — expenses rose the most in the Midwest (9.5%), while the West saw a 1.1% decline.

2. Higher Hospital Investments: Per-physician investments grew 4.7% from last year to $326,199, with hospitals in the Northeast showing the strongest growth (11%). In contrast, the West again saw a slight 0.2% decrease, indicating uneven investment patterns across regions.

3. Improved Productivity and Revenue: Net patient service revenue rose 4% year-over-year to $776,129, alongside a 1.7% increase in productivity(measured by work relative value units). Despite these gains, staffing efficiency improved slightly, as staff full-time equivalents per productivity unit declined nearly 1%.

With much to win (or lose), drugmakers and European officials bear down on major policy overhaul

By Andrew Joseph – After years of work, European officials are nearing the finish line on the biggest shakeup to European pharmaceutical policy in decades, with major impacts on everything from how quickly new medicines are rolled out across the continent to how willing drugmakers are to invest in the E.U. Looming in the background is the campaign from the U.S. to get Europe to pay more for medicines. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. E.U. Pharma Reform Negotiations and Goals: European Union lawmakers are in “trilogue” talks to reconcile three competing versions of sweeping pharmaceutical reform legislation. The effort aims to modernize rules on drug access, shortages, antimicrobial resistance, and environmental impacts, with a target of finalizing a compromise by year’s end. A central objective is to make medicines available more equitably across all member states, particularly in less wealthy regions.

2. Core Dispute: Market Exclusivity vs. Access: A major sticking point is how long drugmakers can keep market exclusivity before generics enter. The European Commission proposes eight years, the Council nine, and the Parliament nine-and-a-half, each offering incentives for actions like conducting E.U.-based trials or expanding launches across member states. Advocates for shorter exclusivity cite affordability and access, while the industry warns stricter rules could deter innovation and investment in Europe.

3. External Pressures and Broader Implications: The debate is influenced by global pricing tensions, notably former U.S. President Trump’s push for Europe to pay more for drugs and his “most-favored nation” pricing plan tying U.S. prices to other wealthy countries. This dynamic may make pharmaceutical firms more resistant to European price constraints, complicating efforts to improve access without discouraging new drug launches.

Preventive and primary care are key to staying on top of healthcare costs

By Paola Peralta – As healthcare costs continue to climb, leaders face mounting pressure to balance affordability with quality care, and strategic action can keep both within reach. Currently, healthcare costs are projected to rise about 6% annually from 2023 to 2033, according to the Centers for Medicare and Medicaid Services. As a result, healthcare will consume a larger share of the U.S. economy, which will in-turn drive up expenses for employers and potentially limit coverage options for employees. However, new findings from professional services firm Deloitte reveal ways in which organizations can manage those new costs through a few key changes to their healthcare strategies. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Rising Healthcare Costs and Economic Impact: Healthcare spending in the U.S. is expected to increase by approximately 6% annually from 2023 through 2033. This growth will cause healthcare to take up a larger portion of the national economy, leading to higher costs for employers and potentially restricting the coverage options available to employees. Organizations need to address these rising costs proactively to maintain affordability and quality care for their workforce.

2. Preventive and Primary Care as Cost-Management Strategies: Deloitte's research highlights that investing in disease prevention, early detection, and proactive healthcare measures can lead to significant cost savings—up to $2.2 trillion annually by 2040. Employers can reduce long-term medical expenses, decrease absenteeism, and enhance employee well-being by supporting preventive care such as medical screenings, immunizations, and routine check-ups. Encouraging employees to have a primary care provider is also suggested to improve health outcomes and productivity.

3. Chronic Condition Management and Employee Support: Prioritizing the management of chronic diseases like diabetes and vascular conditions through preventive treatments and lifestyle changes can improve workforce health and reduce costly insurance claims. Employers should assess their current healthcare plans to include coverage for preventive services and provide targeted educational resources to help employees navigate healthcare complexities. Tailored interventions for employees managing chronic illnesses can increase their engagement and effectiveness in maintaining their health.

California to make dental plans warn dentists about payment network fees

By Allison Bell – State-regulated dental plans in California will soon have to comply with new dentist payment rules. California Gov. Gavin Newsom last week signed a dental plan payment rule bill. The law created by the bill will require a dental plan to make the default payment system a system that imposes no service fees on the dentists. A dental plan can also use a payment network that imposes service fees, such as a virtual credit card network. But, before connecting a dentist to a system that charges services, the plan will have to tell the dentist about the fees and get the dentist's permission to switch the dentist to the fee-based network. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. New Payment Rules for Dental Plans: The new California law mandates that state-regulated dental plans must use a default payment system that does not charge service fees to dentists. If a dental plan opts to use a fee-based payment network, such as a virtual credit card system, it must inform the dentist and obtain their consent before switching. This rule applies to dental coverage starting or charging on or after April 1, 2026. The law aims to increase transparency and protect dentists from unexpected fees.

2. Debate Over Payment Systems: There is a divide between advocates of virtual credit card payment systems and dentists. Payment firms argue that virtual credit card networks offer faster, simpler, and more flexible payment processing compared to older methods like paper checks or the ACH network, justifying the higher fees. However, dentists and the California Dental Association oppose making virtual credit card networks the default due to concerns about high processing fees, which can be as much as 5% of the reimbursement amount, adding to standard merchant fees.

3. Legislative Context and Impact: The bill signed by Governor Newsom follows a similar bill vetoed in 2024, with the key difference being that dentists can now consent to fee-based payment networks via email rather than requiring written paper consent. While the law applies to fully insured group dental plans, it does not cover self-insured plans due to federal preemption under ERISA. The signing of this bill may indicate Newsom's openness to other health-related legislation, such as a pending pharmacy benefit manager regulation bill.