House Republicans launch bill to extend health subsidies past midterms

By Robert King and Benjamin Guggenheim –  Ten House Republicans are leading new legislation that would extend enhanced tax credits for coverage under the Democrats’ 2010 health law. While it’s unlikely to be enacted as a standalone proposition, it could offer the GOP a path forward on the issue, and sends an important signal that the party is increasingly seeing real political risk in letting these subsidies expire at the end of the year. Read Full Article...

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1. Bipartisan Momentum for ACA Subsidy Extension: A group of Republican lawmakers, led by Rep. Jen Kiggans of Virginia, has introduced legislation to extend the enhanced Affordable Care Act (ACA) premium tax credits for an additional year beyond their current expiration in 2025. The goal is to prevent a sharp increase in healthcare costs for middle-class families and small business owners, especially those who have come to rely on these subsidies. While the credits were originally created and extended through Democratic legislation, a few House Democrats have signed on as co-sponsors, signaling early signs of bipartisan cooperation.

2. Political and Electoral Stakes on Both Sides: The debate over ACA subsidies is taking on clear electoral significance. Many of the Republican co-sponsors of the extension bill are considered vulnerable in the upcoming election cycle and may be seeking to shield themselves from political fallout if premiums spike in 2026. On the Democratic side, leaders are actively working to force Republicans to take a stand on the issue — possibly by attaching the extension to a broader funding package — and are framing GOP resistance as a threat to affordable healthcare for millions.

3. Uncertainty Amid Broader GOP Opposition: Despite the introduction of the bill and some scattered support within the Republican ranks, most GOP lawmakers remain skeptical or opposed to extending the subsidies. Their concerns center around the cost of the tax credits, potential fraud, and the argument — supported by anti-abortion groups — that such subsidies could indirectly fund abortion services. Republican leadership in both chambers has yet to endorse a unified position, and many are placing the onus on Democrats to come up with a viable solution, leaving the future of the subsidy extension uncertain.

Cigna’s $3.5 Billion Bet Tightens Its Grip on Specialty Drugs

By Wendell Potter – Regular readers will know that we’ve harped on UnitedHealth Group’s vertical integration into care delivery, pharmacy benefits and nearly every other corner of the health care landscape. But UnitedHealth isn’t the only company guilty of vertical integration: Cigna is playing the same game. This week, Cigna’s health services arm, Evernorth, announced a $3.5 billion investment into Shields Health Solutions, a fast-growing specialty pharmacy company. Read Full Article...

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1. Cigna’s Strategic Shift Toward Integrated Health Services: Cigna has transitioned from a traditional third-party administrator into a vertically integrated health services entity. Through its Evernorth subsidiary—established after acquiring Express Scripts—the company now generates the bulk of its revenue from pharmacy-related operations. The recent investment in Shields Health Solutions, which partners with over 1,000 hospitals and clinics, deepens Cigna’s involvement in specialty pharmacy and hospital-integrated care delivery, especially for complex chronic conditions.

2. Implications of Vertical Integration on Clinical Practice: Cigna’s consolidation across the drug supply chain—owning PBMs, specialty pharmacies like Accredo, and now aligning with Shields—mirrors industry-wide trends that blur traditional boundaries between payers, providers, and suppliers. For healthcare professionals, this means clinical decision-making may be increasingly shaped by vertically aligned corporate interests, affecting drug formularies, access pathways, and care coordination within hospital systems.

3. Emerging Legislative Efforts to Protect Care Autonomy: Growing concern about the market dominance of integrated payer-provider entities has prompted proposed legislation aimed at preserving competition and clinical independence. The Patients Over Profits Act and the Patients Before Monopolies Act seek to limit insurers’ ownership of provider networks and pharmacies. While not yet law, these efforts reflect bipartisan awareness of how consolidation may disrupt patient care, inflate costs, and compromise the autonomy of healthcare professionals in delivering evidence-based treatment.

Health Care Costs for Workers Begin to Climb

By Reed Abelson – Employees of large and small companies are likely to face higher health care costs, with increases in premiums, bigger deductibles or co-pays, and will possibly lose some benefits next year, according to a large survey of companies nationwide that was released on Thursday. The survey of 1,700 companies, conducted by Mercer, a benefits consultant, indicated that employers are anticipating the sharpest increases in medical costs in about 15 years. Higher drug costs, rising hospital prices and greater demand for care are all contributing factors, experts said. Read Full Article... ^{_{(Subscription required)}}

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1. Employers Face Largest Health Insurance Cost Increase Since 2010: Health insurance costs for employers are expected to climb nearly 9% in 2025, marking the most significant annual increase in 15 years and continuing a four-year trend of rising expenses. Even after implementing plan changes — such as modifying coverage levels or introducing cost-sharing mechanisms — employers still project an average increase of 6.5%. Notably, around 25% of employers expect double-digit increases in 2026, highlighting growing concerns about the sustainability of current benefit models.

2. Rising Costs Likely to Affect Workers Despite Recent Stability in Premiums: While workers have been somewhat shielded from steep premium hikes in recent years, that protection may be diminishing. In 2024, the total cost of family coverage reached $25,572, with employees contributing about $6,000 annually on average. However, in response to escalating costs, employers are expected to pass more financial responsibility to employees — either by increasing paycheck deductions, raising co-pays and deductibles, or offering plans with fewer choices. These changes may hit workers harder in the current inflationary environment, where everyday expenses like groceries and housing are already stretching budgets.

3. Multiple Factors Fueling Higher Health Care Costs: A range of structural and economic forces are contributing to rising health care costs. These include post-pandemic labor shortages in the health sector, surging prices from hospitals and providers, the introduction of high-cost treatments (like new weight-loss medications), and increased overall utilization of health services. In addition, policy shifts — including potential reductions in Medicaid and ACA subsidies — could leave more people uninsured, prompting providers to recoup losses by charging higher prices to employer-sponsored plans. Some companies are beginning to explore cost-control strategies such as network tiering and independent pharmacy benefit managers to gain more transparency and control.

Trump prioritizing PBM reform to cut drug prices, RFK says

By Allison Bell – The administration of President Donald Trump is moving ahead with efforts to bring down U.S. prescription prices and make sure pharmacy benefit managers are helping with that, Robert F. Kennedy Jr. said Thursday at a Senate Finance Committee hearing. Kennedy, the secretary of the U.S. Department of Health and Human Services, told Sen. James Lankford, R-Okla., that the PBM issue is a priority for Trump. Read Full Article... ^{_{(Subscription required)}}

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1. Ongoing Government Efforts Toward PBM Reform: The Trump administration is actively working to reform the role of Pharmacy Benefit Managers (PBMs) in the healthcare system. According to Kennedy, there are frequent high-level discussions with PBMs, sometimes occurring late at night, and the PBMs have committed to implementing greater transparency protocols. Pharmaceutical companies are also involved in these talks, expressing strong interest in improving the clarity and cost-effectiveness of PBM services.

2. Bipartisan Legislative Support for Drug Pricing Transparency: There is notable bipartisan momentum in Congress to increase transparency in prescription drug pricing and curb potential PBM overreach. Senator Marsha Blackburn highlighted her proposed bill with Senator Ron Wyden, which aims to ensure PBMs do not profit beyond their service fees and must disclose pricing structures. Kennedy indicated support for this legislation, as well as for a separate bipartisan initiative led by Senator Charles Grassley requiring drug advertisements to disclose drug prices to consumers.

3. Broader Health Policy Initiatives and Criticism: The Senate Finance Committee hearing also addressed several broader healthcare initiatives pursued by the Trump administration. These include expanding access to telehealth services and improving the prior authorization process for medical treatments. However, some proposals—such as changes to Medicaid and Affordable Care Act enrollment rules—faced criticism. Senator Wyden warned that these changes could backfire by increasing the financial burden on individuals and employers who rely on commercial health insurance coverage.

As Insurers Struggle with GLP-1 Drug Costs, Some Seek to Wean Patients Off

By Jamie Ducharme – After losing 50 pounds on the injectable weight loss medication Zepbound, Kyra Wensley received a surprising letter from her pharmacy benefit manager in April. Her request for coverage had been denied, the letter said, because she'd had a body mass index of less than 35 when she started Zepbound. The 25-year-old who lives in New York had been taking Zepbound without incident for months, so she was confused: Why was her BMI, which had been around 32 when she started, becoming an issue only now? Read Full Article... ^{_{(Subscription required)}}

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1. High Demand and Rising Costs Are Forcing Coverage Cuts: GLP-1 drugs like Ozempic, Wegovy, Mounjaro, and Zepbound are effective for weight loss and Type 2 diabetes, but their high monthly cost (around $1,000) is straining public and private insurance plans. As a result, some states and employers are limiting or ending coverage, with North Carolina Medicaid terminating coverage and Pennsylvania planning restrictions based on risk level.

2. Growing Debate Over Long-Term Use vs. Time-Limited Access: While evidence suggests that long-term use of GLP-1s is necessary to maintain weight loss, many plans are exploring “deprescription” strategies—limiting how long patients can take the drugs. Some experts argue that tapering off could allow broader access by lowering costs, though there is no standardized approach to weaning, and many patients regain weight after stopping the drugs.

3. Patients Face Uneven Access and Outcomes: Individuals like Wensley and Lily have experienced disruptions in care due to coverage changes, with some forced to switch medications or discontinue use entirely. Despite alternatives like behavioral programs, some patients report difficulty maintaining weight loss without GLP-1s, highlighting the complex balance between affordability, access, and effectiveness in obesity treatment.

Patients suffer as insurers and hospitals spar over contracts

By Bram Sable-Smith – Amy Frank said it took 17 hours on the phone over nearly three weeks, bouncing between her insurer and her local hospital system, to make sure her plan would cover her husband’s post-surgery care. Many of her calls never got past the hold music. When they did, the hospital told her to call her insurer. The insurer told her to have the hospital fax a form to a special number. The hospital responded that they’d been instructed to send faxes to a different number. Read Full Article... ^{_{(Subscription required)}}

HVBA Article Summary

1. Contract Disputes Between Hospitals and Insurers Are Increasingly Common and Disruptive: Across the U.S., stalled negotiations between hospitals and insurance providers are increasingly placing patients in precarious positions. In Missouri, over 90,000 patients lost in-network access when MU Health Care and Anthem failed to renew their contract in April, forcing them to either delay care, switch providers, or pay higher out-of-pocket costs. This issue isn’t isolated: between June 2021 and May 2025, 18% of non-federal hospitals engaged in public disputes with insurers, and 8% went out-of-network temporarily. Patients in other states, including New York and North Carolina, have faced similar uncertainty during these contract standoffs.

2. Hospital Consolidation and Rising Costs Are Major Drivers of Conflict: With more than 2,000 hospital mergers since 1998 — including 428 between 2018 and 2023 — hospital systems now hold more bargaining power, especially in regions where they dominate care options. Meanwhile, hospital costs surged by 5.1% in 2024, outpacing general inflation at 2.9%. Labor costs are the largest factor, with advertised nursing wages rising 26.6% faster than inflation from 2020 to 2024. As a result, hospitals are seeking significantly higher reimbursement rates. In the Missouri case, MU Health Care reportedly asked for a 39% rate increase over three years, while Anthem countered with only a 1%–2% increase — a stark gap that fueled a three-month stalemate.

3. Patients Bear the Burden of These Disputes Despite Regulatory Protections: Even with protections like the No Surprises Act — which grants patients up to 90 days of in-network rates during active treatment — the burden of navigating contract disputes often falls heavily on patients. The Franks, for example, spent hours on the phone to secure coverage for post-surgical care amid the dispute. Errors in communication between insurer and provider further delayed treatment. Nationally, the stress on patients could intensify as hospitals brace for nearly $1 trillion in federal health care spending cuts under a recent budget law, including a $911 billion reduction in Medicaid. These financial pressures may lead to even more aggressive negotiations and disruptions in the future.

What One Investor Believes Is the Key to Healthcare AI Success

By Katie Adams – Artificial intelligence in the healthcare field is full of promise but still under-adopted, according to Chirag Shah, partner at Define Ventures. Last month, the venture capital firm published its AI thesis, arguing that the healthcare industry must start moving beyond narrow use cases for AI and embrace more workflow-integrated platforms in order to achieve lasting impact. Read Full Article...

HVBA Article Summary

1. AI is Transforming Healthcare Across the Entire System: Define Ventures uses the "house of healthcare" metaphor to illustrate AI's impact across three core areas: the front door (patient engagement), the foundation (data infrastructure), and the rooms (care delivery). AI is enhancing personalization at patient entry points, extracting insights from digitized data, and automating administrative tasks like charting and documentation to free up providers for direct care.

2. Workflow Integration is Critical for AI Startup Success: According to Shah, the most promising AI startups will be those that can seamlessly integrate into healthcare workflows—whether for providers, payers, or pharma—without adding friction. Point solutions may solve specific problems, but long-term success will come from evolving into platforms that address multiple use cases and adapt quickly to shifting customer needs.

3. Speed, Expansion, and Customer Understanding are Competitive Advantages: In a rapidly advancing AI landscape, startups must innovate faster and expand beyond their initial niche. Companies like Cohere Health exemplify this strategy by growing from a narrow focus (musculoskeletal care prior authorization) into broader domains. Shah emphasizes that understanding future customer needs and accelerating product development cycles are essential to staying ahead of the competition.