Democrats pitch permanent ACA subsidies

By Jakob Emerson - U.S. Senators Jeanne Shaheen (D-N.H.) and Tammy Baldwin (D-Wis.) have introduced the Health Care Affordability Act, which aims to permanently extend the Affordable Care Act’s enhanced premium tax credits for marketplace coverage. Read Full Article… 

HVBA Article Summary

1. Impact of Expiring Tax Credits: The tax credits established by the Inflation Reduction Act are set to expire at the end of 2025, potentially increasing health insurance costs for over 20 million Americans. An estimated 3 million may lose coverage, while about 9 million will face higher premiums if these credits are not renewed.

2. Legislative Actions and Public Support: Identical legislation has been introduced in the House by Rep. Lauren Underwood to extend the subsidies, which have significantly increased enrollment in ACA marketplaces. Despite concerns about the budget impact—an estimated $335 billion addition to the national deficit between 2025 and 2034—public support for making the credits permanent remains high at 78%.

3. Shifts in Political Focus: The ongoing debates about the Affordable Care Act (ACA) have transitioned from calls for repeal to discussions about extending subsidies. While Democratic nominee Kamala Harris advocates for maintaining and expanding the ACA, Republican nominee Donald Trump's campaign suggests deregulation, which could create a disparity in insurance costs among different age groups and health conditions.

Ending ACA subsidies could affect 2 million chronically ill

By Tina Reed - A decision by Congress to let enhanced Affordable Care Act subsidies expire next year could leave 2 million people with chronic conditions uninsured, a new analysis from consulting firm Oliver Wyman shows. Read Full Article…

HVBA Article Summary

1. Potential Impact on Healthcare Access: The fate of premium tax credits, initially introduced during the pandemic and currently set to expire, could significantly affect ACA marketplace enrollment. If enhanced subsidies are allowed to expire, enrollment is projected to drop from approximately 22.8 million in 2025 to 18.9 million in 2026, particularly affecting middle-income individuals who may find health insurance unaffordable.

2. Consequences for Individuals with Chronic Conditions: A study indicated that if enhanced subsidies cease, about 2 million individuals with chronic health issues—such as asthma, arthritis, and diabetes—could leave the ACA market by 2027. Those who become uninsured may face steep increases in annual healthcare costs, potentially consuming up to 44% of their household income.

3. Political Divide on Subsidy Extensions: The debate over extending the subsidies is deeply polarized. Democrats are pushing for a permanent extension despite projected increases in the deficit, while Republicans argue that the enhanced subsidies are too costly for taxpayers and may encourage fraud, with estimates suggesting many could be misreporting their incomes to qualify for larger subsidies.

Unpacking Harris’ drug spending cap plan

By David Lim and Lauren Gardner - A proposal to cap out-of-pocket drug costs for Americans with private insurance would shift consumer spending from pharmaceuticals to insurance premiums — but some Democrats say Vice President Kamala Harris’ plan would help those who most need financial assistance paying for expensive medicines. Read Full Article… 

HVBA Article Summary

1. Focus on Vulnerable Patients: Senator Elizabeth Warren emphasizes that insurance policies, such as the proposed expansion of Medicare's $2,000 annual cap, aim to assist those facing exorbitant costs from pharmaceutical companies, particularly individuals at the lower end of the healthcare spending spectrum.

2. Potential Cost Shifts: Experts, including Cynthia Cox from KFF, warn that capping out-of-pocket expenses for prescription drugs could lead to increased out-of-pocket costs for other healthcare services, as employers are increasingly sharing a larger portion of prescription costs while paying less for hospital care.

3. Concerns from Opposition: While some Republicans support capping out-of-pocket costs in Medicare, concerns have been raised about the potential negative impact on private insurance markets, with critics arguing that such a policy could lead to higher overall healthcare costs and further destabilization of the insurance market.

Study: U.S Health Care Costs at Post-pandemic High as Employers Prioritize Affordability and Wellbeing

By Michael Webb - As the cost of health care in the U.S. rises to a record high since the COVID-19 pandemic, nearly half of employers expect health care costs will exceed budget projections this year. Read Full Article…

HVBA Article Summary

1. Rising Healthcare Costs and Employer Strategies: U.S. employers anticipate a 7.7% increase in healthcare costs for 2025, prompting more than half to implement programs aimed at reducing overall costs while maintaining employee wellbeing. Traditional cost-shifting methods are being replaced with innovative strategies that focus on directing employees toward lower-cost, higher-quality healthcare providers.

2. Proactive Measures in Prescription Drug Management: Employers are actively exploring alternative approaches to manage prescription drug costs, with 21% considering drug discount cards and direct-to-consumer delivery. Additionally, 43% plan to take vendor health plans out to bid, indicating a shift towards more competitive pricing models and tailored healthcare options.

3. Focus Areas for Employee Wellbeing: Employers are prioritizing initiatives in obesity and weight management, cancer care, cardiovascular health, and women's health, reflecting a commitment to enhancing the overall health of their workforce. There is also significant interest in exploring cost-effective alternatives for high-cost medications, such as compounded GLP-1 medications, to support employee health.

State agencies collect $100 million from insurance assessments, drive up premiums

By Marc E. Fitch - A new working group established under the 2024 budget is looking at more than $100 million per year in assessments levied on Connecticut insurance companies which supports state agencies and employees, as the General Assembly continues to search for ways to lower Connecticut’s health insurance costs. Read Full Article…

HVBA Article Summary

1. Funding Distribution and Usage: The Insurance Fund collects approximately $103 million annually from assessments and fees on insurance companies, primarily allocated to the Insurance Department and the Department of Public Health. These funds support various health initiatives but are also being used to finance personnel in several state agencies, raising concerns about their impact on consumer premiums.

2. Concerns Over Rising Costs and Agency Efficiency: Working group members have expressed apprehension about how the increased reliance on the Insurance Fund for agency staffing, particularly at the Office of Health Strategy, could lead to higher health insurance costs without demonstrable benefits. Critiques have highlighted poor management of funds, including issues with unperformed contract work and inadequate oversight.

3. Legislative Accountability and Future Projections: Lawmakers are questioning the appropriateness of funding agency expansions through the Insurance Fund instead of the General Fund. Projections indicate that costs for immunization services will significantly rise, prompting calls for more responsible funding practices to avoid further increasing insurance premiums for consumers.

Providers say claims denials are increasing: survey

By Susanna Vogel - Providers have recently sounded the alarm over growing strife in their relations with payers. The Experian Health report, which surveyed 210 healthcare staff between June and July of this year, confirms an escalation of tensions. Read Full Article…

HVBA Article Summary

1. Increase in Claims Denials: A significant rise in claims denials has been reported, with nearly 75% of respondents indicating an increase over the past two years. Approximately 40% of these respondents experience denials in at least 10% of their claims, with 11% reporting denials in 15% or more of their claims.

2. Challenges in Revenue Cycle Management: Providers are facing ongoing challenges in claims processing, including issues such as incomplete data, coding errors, and staffing shortages. As a result, 67% of respondents noted that the time taken to receive reimbursements is also increasing. To combat these issues, 84% of organizations have made reducing denials a priority, and 73% have evaluated their claims processes in the past year.

3. Reluctance to Embrace Automation: Despite the pressing need for improvement, only 31% of providers are utilizing automation or AI in their claims processing, a significant drop from 62% in 2022. This decline reflects a growing discomfort with automation technologies, as confidence in understanding AI and machine learning has decreased from 68% to 28% in the same timeframe. In contrast, payers have successfully adopted automation for claims reviews, raising concerns over the implications of algorithmic decision-making.

Are RPM Programs Riddled With Fraud?

By Eric Wicklund - The federal government’s call for more oversight of remote patient monitoring (RPM) programs isn’t sitting well with digital health advocates. Read Full Article…

HVBA Article Summary

1. Criticism of OIG Report: The Alliance for Connected Care has publicly criticized the Office of the Inspector General's report for its "inaccuracies and subjective nature," calling for its retraction. The report suggests potential fraud in Medicare reimbursement for Remote Patient Monitoring (RPM) programs, which the Alliance disputes, asserting that the reported findings lack substantial evidence of wrongdoing.

2. Growth of RPM Programs: RPM programs have experienced rapid growth, particularly due to Medicare reimbursement introduced in 2018 and the increased adoption of telehealth during the pandemic. Enrollment in RPM rose dramatically from 55,000 to over 570,000 between 2019 and 2022, with Medicare reimbursement climbing from $15 million to over $300 million in that period.

3. Concerns Over Medicare Compliance: The OIG report highlights that a significant percentage (43%) of RPM enrollees may not meet Medicare's requirements for reimbursement, including proper device setup and monitoring. However, the Alliance argues that many claims made in the report are inaccurate and calls for a more nuanced approach to addressing actual fraud within the Medicare system rather than targeting RPM indiscriminately.

Considering Covering GLP-1s? Here’s What You Need to Know

By Tim Church - Employer healthcare costs are expected to increase by 9% next year, with pricey pharmacy expenses such as GLP-1s being the main driver. Read Full Article… 

HVBA Article Summary

1. Expansion of GLP-1 Indications and Coverage: As GLP-1 medications demonstrate effectiveness beyond weight loss, including conditions like kidney and heart disease, employers need to assess the potential benefits and costs of offering GLP-1 coverage, particularly as healthcare budgets tighten.

2. Importance of Behavior Change and Personalization: Implementing effective behavior-change programs is crucial for improving employee health and can mitigate costs associated with chronic conditions. Personalized wellness plans that consider individual lifestyle and health needs enhance engagement and support long-term behavior change.

3. Strategies for Cost Management and Care Improvement: Employers should focus on preventive care, offer a variety of weight-loss medications, implement a stepped-care approach, and utilize data for health outcomes tracking. Integrating GLP-1s into a comprehensive wellness strategy ensures that they complement other health initiatives, improving overall health outcomes while managing costs.