A Federal Judge Struck Down FTC’s Ban on Noncompetes. What Does This Mean for Healthcare?

By Melissa Plescia - A decision on the Federal Trade Commission’s noncompete ban came down to the wire. Read Full Article…

HVBA Article Summary

1. Implications for Healthcare Professionals: The blocked noncompete ban would have significantly impacted healthcare professionals, such as physicians, nurses, and other mid-level providers. A ban would have enhanced job mobility and potentially increased salaries, but it could also have caused management challenges and financial pressures for healthcare organizations.

2. Judge’s Decision and Legal Basis: U.S. District Judge Ada Brown blocked the FTC’s noncompete ban, citing the FTC’s lack of substantive rulemaking authority and labeling the rule as "arbitrary and capricious" due to its broad and unreasonable scope. This decision reflects concerns about the enforceability and practical implications of the proposed ban.

3. Future Prospects and State-Level Action: While the FTC is considering an appeal, the conservative stance of the Fifth Circuit Court of Appeals suggests that overturning the decision may be unlikely. Companies should remain vigilant of state-level regulations, as some states have or are considering stricter controls on noncompete agreements, which could still impact employment practices.

The Dirty Trick Health Insurers Are Playing That You Don’t Know About

By Wendell Potter - When it comes to health insurance, there’s a sneaky little metric known as the medical loss ratio (MLR). Read Full Article…

HVBA Article Summary

1. MLR Provision Overview: The Affordable Care Act (ACA) introduced the Medical Loss Ratio (MLR) to ensure insurance companies spend a substantial portion of premiums—80-85%—on direct health care services rather than administrative costs, overhead, and executive bonuses. This was intended to make insurers more accountable and transparent in their spending.

2. Insurers' Maneuvering: Despite the ACA's intention, insurance companies have cleverly navigated around MLR requirements. They exploit loopholes by redefining what constitutes "quality improvement" and by shifting costs to affiliated health care facilities, allowing them to minimize the visible percentage spent on actual patient care while maximizing their profits.

3. Impact on Consumers: These manipulations undermine the purpose of the MLR provision, affecting consumers by keeping premiums high without corresponding improvements in care. Instead of benefiting from lower costs or better coverage, consumers find themselves facing rising premiums while insurers continue to profit from the gaps in the law's enforcement.

New York health insurance rates to jump by double-digit percentage in 2025

By David Robinson - Health insurance rates in New York for individuals will increase 12.7% on average next year while small-group plan rates rise 8.4%, state records show. Read Full Article…

HVBA Article Summary

1. Approved Rate Increases: The 2025 health insurance premium rate increases are lower than the insurers' proposed hikes, which were nearly 17% for individual plans and 19% for small group plans. The final rates maintain insurers' profit margins at 1% to address inflationary pressures, despite being slightly higher than 2024's approved increases.

2. Impact on Consumers: About 1 million New Yorkers enrolled in individual and small group plans will be affected by these rate adjustments. The average rates for individual and small group plans have risen by 31.4% and 30.6%, respectively, from 2019 to 2023, reflecting a steady increase in health care costs.

3. Industry and Regulatory Perspectives: Insurers, represented by the Health Plan Association, argue that the requested rate increases account for rising hospital and drug prices. Conversely, state regulators emphasize that their lower-approved rates will prevent an additional $853 million burden on consumers, balancing industry needs with consumer protection.

CrowdStrike executive to testify on hospital IT outage

By Giles Bruce - An executive from a cybersecurity company that caused a global IT outage that affected hospitals will testify before Congress in September. Read Full Article…

HVBA Article Summary

1. Subcommittee Appearance: Adam Meyers, senior vice president of counter adversary operations at CrowdStrike, will testify at the House Subcommittee on Cybersecurity and Infrastructure Protection meeting on September 24. The hearing is in response to a July incident where a faulty software update from CrowdStrike caused widespread disruptions.

2. Impact and Response: The faulty update affected millions of computers running Microsoft Windows, including those in hospitals and health systems. The resulting outage forced some health systems to delay elective surgeries and close outpatient offices, highlighting the critical need for reliable IT infrastructure in essential services.

3. Statement and Future Actions: Subcommittee Chair Andrew Garbarino emphasized the importance of restoring confidence in IT systems, noting the incident's broader implications for sectors such as aviation and healthcare. CrowdStrike has pledged to work closely with Congressional committees to address the issue and prevent future occurrences.

A wave of change is coming for healthcare benefits — are hospitals ready?

By Jakob Emerson - Surveys of employers are making one thing clear: Healthcare costs are rising faster than they did before the pandemic, and those costs are being driven by inflation, the increasing use of weight loss medications, and higher overall medical expenses. Read Full Article…

HVBA Article Summary

1. Financial Pressure on Hospitals: Hospitals are facing increasing financial pressure as employers and insurers explore alternative payment and coverage models to manage rising healthcare costs. This trend could significantly impact hospital revenue streams, particularly as commercial reimbursement, which is crucial for offsetting lower government program payments, becomes less stable.

2. Shift in Healthcare Financing: Employers are adopting various strategies to manage healthcare costs, such as shifting more expenses to employees, implementing narrow network plans, and increasing the use of reference-based pricing. Direct contracting with healthcare providers and the adoption of Individual Coverage Health Reimbursement Arrangements (ICHRAs) are also growing trends aimed at controlling costs and improving quality.

3. Legal and Regulatory Challenges: Rising healthcare costs and legal pressures are contributing to a complex landscape for hospitals and employers. Self-insured employers are facing potential lawsuits related to the mismanagement of healthcare benefits, with high-profile cases highlighting increasing employee activism and demands for accountability in healthcare financing.

Self-insured health plan market tilted toward large employers in 2023: EBRI

By Allison Bell - Small and midsize employers' efforts to start their own health plans have collided with regulatory and market reality. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. Decline in Self-Insurance Among Small Employers: The percentage of U.S. employers with fewer than 100 employees who self-insure at least one health plan decreased to 16% in 2023, down from 18% in 2022. This decline reflects broader trends among small and mid-sized employers moving away from self-insurance options.

2. Increase in Self-Insurance Among Large Employers: In contrast, the percentage of employers with 500 or more employees who utilized self-insured health plans rose to 74% in 2023, up from 72% the previous year. This indicates a growing preference for self-insurance among larger organizations.

3. Challenges for Micro Employers: Self-insured employers with fewer than 10 employees, known as micro employers, saw a significant drop in the use of stop-loss insurance. Only 21% of these employers had stop-loss coverage in 2023, a marked decrease from 42% in 2022. This decline may be attributed to regulatory challenges and increased cost pressures.

Novo Nordisk's Ozempic shortage expected to continue into Q4

By Reuters - Novo Nordisk (NOVOb.CO), said the shortage of lower strengths of its diabetes drug Ozempic has deteriorated, with intermittent shortages for all strengths expected into the final quarter of 2024 due to increased demand and along with capacity constraints at some of its manufacturing sites. Read Full Article…

HVBA Article Summary

1. Continued Limitation on New Prescriptions: The European Medicines Agency (EMA) advises healthcare professionals to keep limiting the initiation of Ozempic and Victoza for new patients. This recommendation is due to ongoing supply issues affecting these drugs.

2. Supply Situation: The EMA's guidance highlights that the supply of Ozempic and Victoza remains constrained. This situation has led to the need for careful management of existing inventories and prioritization of current patients.

3. Impact on Treatment: The restriction on new patient prescriptions is intended to ensure that current users continue to have access to their medications while the supply situation is resolved. The EMA is monitoring the situation closely and will update recommendations as needed.

4 ways advisors can support transformative health coverage changes

By Robert Andrews - When I completed my service in Congress in 2014, it was evident that much more work needed to be done to fix the broken U.S. system. Read Full Article… ^{_{(Subscription required)}}

HVBA Article Summary

1. The Importance of Quality and Cost-Effective Health Care: Employers, as the largest payers in the U.S. health care system, have a unique opportunity to enhance health outcomes for their employees while managing costs. By focusing on high-quality care, employers can provide valuable health coverage without sacrificing affordability, countering the false choice between good and inexpensive health care.

2. Employee Health Coverage as a Key Factor in Job Decisions: Health coverage is crucial for employees’ overall wellbeing and is a significant factor in their job decisions. The ERBI Greenwald Workplace Wellness Study reveals that 83% of employees prioritize health coverage when considering job options, and 70% view health insurance as the most critical benefit influencing their employment decisions.

3. Strategies for Benefits Advisors to Drive Transformative Change: Benefits advisors can play a pivotal role in advancing health care strategies by evaluating provider networks, implementing value-based care models, creating personalized health plans, and fostering employee engagement. These strategies not only improve employee health outcomes but can also lead to cost savings and contribute to broader health care system improvements, as demonstrated by large employers who have saved over $1 billion annually through such initiatives.