House GOP keeps NIH funding Trump wanted to cut

By Peter Sullivan – House Republicans are rejecting President Trump's nearly $20 billion proposed budget cut for the National Institutes of Health in an increasingly rare show of bipartisan support for biomedical research. Why it matters: The NIH has faced turmoil over canceled grants, staff cuts and other policy changes, but the proposal to keep funding relatively flat shows there are limits to how much House Republicans will accommodate the administration's designs for the agency. Read Full Article...

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1. NIH funding remains steady despite proposed cuts: The House Republican spending bill for fiscal year 2026 holds National Institutes of Health (NIH) funding at about $48 billion, pushing back against the Trump administration’s earlier call for a roughly 40% reduction. Support for preserving the agency’s budget also extends to the Senate, where a bipartisan proposal includes a modest increase, signaling that Congress broadly rejects deep cuts to biomedical research programs.

2. Other health programs face reductions: Although NIH funding is protected, the House GOP measure calls for notable reductions in other public health areas. This includes cuts to the Centers for Disease Control and Prevention (CDC) and to HIV/AIDS prevention programs, reflecting shifting priorities. In total, Health and Human Services (HHS) funding would decrease by about $7 billion, or 6%, compared to the previous year, raising concerns among Democrats about the broader impact on health services.

3. Political and procedural uncertainty persists: The House bill is unlikely to advance in its current form, since spending legislation requires bipartisan support in the Senate and faces strong opposition over proposed cuts. Lawmakers are expected to rely on a short-term stopgap to keep the government open past the September 30 deadline, effectively maintaining current funding levels. At the same time, questions remain about whether the administration will fully allocate NIH funds already approved, and debates continue over possible restructuring of the agency and its research authority.

Benefits Think: What we need to know about OBBBA's impact

By Jay Kirschbaum – The One Big Beautiful Bill Act signed into law by President Trump on July 4, 2025 includes several provisions that directly affect employee benefits, while other changes may have an indirect impact on employer group medical plans. Earlier versions of the bill considered a cap on the annual tax exclusion for employer-provided benefits — an idea that did not make it into the final version, thus preserving the existing tax-advantaged status of employer health benefits and avoiding a potential increase in taxable income for employees. Read Full Article... ^{_{(Subscription required)}}

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1. Telehealth and HSA Flexibility: Congress permanently allowed telehealth services to be offered at reduced or no cost under high-deductible health plans (HDHPs) without jeopardizing health savings account (HSA) eligibility, effective retroactively to January 1, 2025. This makes it easier for employers to promote cost-efficient telehealth use, though employees outside of employer-sponsored medical plans still cannot rely on telehealth-only coverage due to compliance risks and penalties.

2. Expanded HSA Eligibility and Direct Primary Care Integration: Beginning in 2026, participants in bronze and silver Affordable Care Act (ACA) exchange plans will be able to contribute to HSAs, expanding access to tax-advantaged savings beyond traditional employer plans. In addition, direct primary care models—where individuals pay physicians a set annual fee for enhanced access—can now be paired with HDHPs while preserving HSA eligibility, though covered services are restricted and further regulatory guidance will be important before employers widely adopt this option.

3. Broader Benefits and Shifts in Coverage Responsibility: The bill preserves the tax-advantaged status of employer-provided health benefits while making permanent several COVID-era provisions, such as tax-free educational loan repayment and expanded Paid Family Leave Credits. At the same time, it reduces federal Medicaid funding and tightens ACA subsidy eligibility, likely pushing more employees—particularly part-time and lower-wage workers—toward employer-sponsored health plans, potentially increasing both demand and administrative responsibility for employers.

CMS: ACOs in Shared Savings Program Saved Medicare $2.4B in 2024

By Marissa Plescia – Accountable care organizations (ACOs) in the Medicare Shared Savings Program saved $2.4 billion in 2024, according to data released last week by the Centers for Medicare and Medicaid Services (CMS). The Shared Savings Program allows healthcare providers and organizations to form an ACO, which takes responsibility for the quality, cost and patient experience of care for a group of Medicare fee-for-service beneficiaries. Read Full Article... ^{_{(Subscription required)}}

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1. Financial Performance: In 2024, 75% of the 476 participating ACOs collectively earned $4.1 billion in performance payments, which CMS described as the highest share of ACOs achieving payments and the largest overall savings since the Shared Savings Program launched in 2012. Both net and gross per capita savings increased compared to 2023, reaching $241 and $643 respectively, though not all organizations benefitted, as 16 ACOs were required to repay $20.3 million in shared losses.

2. Quality of Care and Patient Outcomes: ACOs reported measurable improvements in patient health outcomes and care quality. For example, the percentage of beneficiaries with controlled blood pressure rose from 77.8% in 2023 to 79.49% in 2024, while the proportion with poor hemoglobin A1c control fell slightly to 9.44%. Beyond these clinical outcomes, ACOs consistently outperformed comparable physician groups in quality measures, including significantly higher rates of depression screening and follow-up planning.

3. Broader Implications and Support: CMS and the National Association of ACOs framed these results as evidence that accountable care models are delivering meaningful financial and clinical benefits. Leaders highlighted that the success reflects progress in preventive care, chronic disease management, and addressing root causes of illness, while also stressing the importance of continuing to develop value-based models that ensure long-term financial stability, reduce provider burden, and expand access for Medicare beneficiaries.

Employers double down on stop-loss coverage

By Allison Bell – U.S. employers may have been a little more likely to use self-insured health plans in 2024 and a lot more likely to use stop-loss insurance to protect whatever self-insured plans they offered. Paul Fronstin, an analyst at the Employee Benefit Research Institute, reports in EBRI's latest self-insured market review that the percentage of employers with health plans that offered workers at least one self-insured coverage option increased to 40% last year, up from 38% in 2023. Read Full Article... ^{_{(Subscription required)}}

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1. Reported Increase in Stop-Loss Use: The Employee Benefit Research Institute (EBRI) reported that the percentage of self-insured employers using stop-loss insurance may have risen sharply to 74% in 2023, up from 65% the year before. This represents a significant one-year jump compared with the relatively small increases seen in earlier years. However, EBRI cautioned against taking this change at face value, as it could be a statistical anomaly. Researchers emphasized the need to review data from 2025 before drawing firm conclusions about whether this surge reflects a lasting trend or simply short-term survey variation.

2. Trends by Employer Size: The adoption of stop-loss insurance showed different patterns depending on employer size. Usage remained steady at a high level of 93% among mid-sized employers (100–999 employees). However, significant growth was reported in other categories: from 60% to 71% among large employers, from 63% to 70% among employers with 25–99 employees, and from 34% to 52% among those with 10–24 employees. Even the smallest self-insured employers, with fewer than 10 employees, reported an increase in stop-loss use, rising from 21% to 29%. These shifts suggest that organizations across the spectrum are looking for stronger financial protection against catastrophic claims.

3. Industry Context and Insurer Outlook: The EBRI findings come at a time when insurers are expressing concerns about rising costs in employer-sponsored health plans. Executives at large insurers such as Aetna, Cigna, Elevance, UnitedHealth, and Voya have all noted that claims are increasing more quickly than initially expected, even though such levels are now considered part of the “new normal.” While some insurers remain cautious about expanding their stop-loss sales, others like Sun Life have highlighted confidence in their pricing and underwriting strategies. Sun Life executives in particular have suggested they are well-positioned to compete for both renewals and new business, signaling a split in how insurers are approaching growth in the stop-loss market.

Pharmacy costs drive health care trend to nearly 10%

By Lucy Peterson – Accurate trend projections are critical for effective renewal planning and budget forecasting, and according to HUB International’s 2026 Trend study, health care costs will only continue to rise throughout 2026. Key regional observations for 2025 reveal that the east region consistently shows the highest medical trends across all plan types, with Med/Rx combined at 10.04%, nearly two percentage points above the national average. Read Full Article... ^{_{(Subscription required)}}

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1. Regional Variations in Healthcare Trends: The Pacific region continues to show elevated growth across most plan categories, ranking second overall, with indemnity plans (11.05%) and pharmacy costs (11.08%) leading the increases. In contrast, the South and Central regions demonstrate consistently lower trends compared to national averages. The South remains about 0.8–1.0% below average for medical coverage, while the Central region generally records the lowest trends across most plan types, except in dental coverage, where it stands out by exceeding the national average.

2. Pharmacy Costs as the Main Driver: Pharmacy costs are becoming the most significant factor shaping overall healthcare trends. National Rx spending rose sharply, from 10.43% to 11.26% in one year (+0.83 percentage points), making it the category with the steepest year-over-year increase. This growth is largely driven by specialty medications, which now account for more than half of total pharmacy expenditures. Within this, GLP-1 drugs for diabetes and obesity are emerging as particularly influential, creating both financial strain and opportunities for intervention in cost management strategies.

3. Cost Drivers and Mitigation Strategies: Healthcare costs overall are projected to grow at 8–10% for combined Medical and Rx coverage in 2026, fueled by multiple converging pressures. Key drivers include increased patient utilization, the rising cost of specialty and branded drugs, inflationary effects, worsening population health, and the higher severity of facility-based claims. At the same time, carrier partners identify a number of measures helping to reduce the pace of growth, such as site-of-care optimization, biosimilars adoption, more structured GLP-1 drug management, medical and risk management practices, and restrictive coverage policies. Together, these strategies provide some balance against the otherwise upward momentum.

Healthcare Price Transparency is Not Enough

By Roki Chauhan and Beth Corvette – Healthcare is the only industry in which consumers are completely unaware about the price of a service they are purchasing until after the fact, when the medical bills arrive. Patients, however, want transparency regarding the expected costs of office visits, diagnostic tests, imaging studies, surgical procedures, hospital services, and more. Read Full Article... ^{_{(Subscription required)}}

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1. Price transparency rules are a positive but incomplete step: Federal mandates now require hospitals (since 2021) and health plans (since 2022, expanded in 2024) to disclose prices so patients can better understand the costs of care. However, compliance has been uneven—nearly half of hospitals fail to meet the standards—and even when data is available, tools provided by insurers are often hard to use or don’t reflect real-time pricing. As a result, transparency efforts, while important, have not yet achieved their full potential in helping patients make informed choices.

2. Costs vary widely and depend on multiple factors: A patient’s out-of-pocket expenses are shaped not only by the provider’s negotiated rates with insurers but also by the specifics of their insurance plan, such as deductibles, co-pays, coinsurance, and annual out-of-pocket maximums. Additionally, providers may not know in advance which tests or procedures will be needed until after seeing the patient, which makes estimating costs ahead of time difficult. This variability means patients often face uncertainty and complexity when trying to plan for healthcare expenses.

3. True value requires integrating cost with quality and appropriateness of care: Price alone does not indicate whether patients will receive the best outcomes. High-value care comes from weighing cost alongside provider quality, efficiency, and whether procedures are medically necessary. Focusing only on low prices could lead patients to providers with poorer results or to unnecessary tests and treatments. To be effective, transparency efforts must integrate both cost and quality data into the tools patients and providers already use, making the information accessible and actionable during care decisions.

Oregon Drug Pricing Transparency Law Remains In Effect

By Pietje Kobus – A Ninth Circuit panel on Tuesday cleared the way for Oregon to enforce its Prescription Drug Price Transparency Act of 2018, which requires pharmaceutical companies to disclose specific information about when their drug prices change and why, Hillel Aron reported for Courthouse News Service. Read Full Article...

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1. Legal Challenge and Initial Ruling: In 2019, the Pharmaceutical Research and Manufacturers of America (PhRMA), representing companies like Eli Lilly, Gilead, and Bayer, filed a lawsuit against Oregon, claiming that the state’s drug price transparency law (HB 4005) forced companies to disclose information in a way that violated their First Amendment rights. In 2024, U.S. District Judge Michael Mosman, appointed by President George W. Bush, agreed with the drugmakers and granted their motion for summary judgment.

2. Appeal and Circuit Court Decision: Oregon chose to appeal the lower court’s ruling, leading to a review by the U.S. Circuit Court. In a lengthy 114-page opinion, Judge Lucy Koh wrote that the state has a legitimate and substantial interest in addressing informational imbalances in the pharmaceutical industry. By requiring price transparency, Oregon sought to make transactions more informed, promote accountability, and improve overall market efficiency.

3. Broader Support and Ongoing Debate: Oregon’s efforts were bolstered by a coalition of more than 21 state attorneys general, who filed a supporting brief arguing that the transparency law provides essential data for states trying to design policies to control rising drug costs. However, the court was not fully united—Circuit Judge Carlos Bea issued a partial dissent, siding with PhRMA’s position that the law impinged on the First Amendment, highlighting the ongoing constitutional debate over compelled disclosures.