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Industry Updates

This broad category includes articles concerning health insurance costs, carrier and health plan news, changing benefits technology, and surveys by the Kaiser Family Foundation and others on employee benefits.

Setting the Record Straight: Separating Fact from Fiction on Health Insurance Marketplace Fraud

The Paragon Health Institute has published a series of new reports once again alleging large-scale “fraud” in health care. This time their target is enrollment in the Insurance Marketplace. They then use these allegations as rationale for a set of policy recommendations, including allowing the enhanced premium tax credits to expire at the end of ...

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Employers Face Vaccine Coverage Chaos As FDA Sets New Rules For COVID Vaccines

For employers, covering COVID-19 shots and other vaccinations is now a lot more complicated. Officials at the U.S. Food and Drug Administration took vaccinations off the auto-pilot list Wednesday, by withdrawing emergency use rules for COVID vaccinations like Novavax’s Nuvaxovid vaccine and tightening access rules for other COVID vaccinations. A team at the Pandemic Mitigation Collaborative says wastewater ...

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Study Suggests No Surprises Act Protections Are Reducing Patients’ Out-Of-Pocket Costs

While data released earlier this week raised questions about the administrative costs associated with No Surprises Act (NSA) arbitrations, a second study suggests the legislation is working to reduce out-of-pocket costs for members. Researchers at Harvard University and Mass General Brigham examined a sample of 17,351 privately insured adults, 8,204 of which lived in states that gained ...

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Trump Says CDC Is ‘Being Ripped Apart’ Over Covid Products, Calls For Drugmakers To Prove Their Benefits

President appears divided between RFK Jr. and detractors, despite clear evidence favoring vaccines

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Who Is Jim O’Neill, Trump’s New CDC Director

The White House quickly named a new leader of the Centers for Disease Control and Prevention (CDC) after Health and Human Services Secretary Robert F. Kennedy Jr. pushed out Director Susan Monarez this week. Jim O’Neill, a senior Department of Health and Human Services (HHS) official with deep ties to President Trump donor Peter Thiel, will take over the agency amid ...

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New Medicare Pilot Under Trump Would Require Prior Approval

Prior authorization is similar to how private insurers operate, often resulting in a delay or denial of treatments

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Could GLP-1 Weight-Loss Medications Like Ozempic Become The ‘Everything Drug’?

GLP-1 agonists — including semaglutides like Ozempic and Wegovy and tirzepatides like Mounjaro and Zepbound — were originally intended to treat type 2 diabetes and obesity. But in recent months, studies have shown that these popular medications can have numerous other health benefits. Some have even claimed that GLP-1s could eventually become the new “everything drug.” Dr. ...

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These Are The Conditions That Make You Eligible For An Updated Covid-19 Vaccine

This year’s updated Covid-19 vaccines have been approved by the US Food and Drug Administration for adults 65 and older and younger people with certain medical conditions that put them at a higher risk of a severe Covid-19 infection. Although federal officials have emphasized that people who want a Covid-19 vaccine can get one after ...

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How To Navigate Soaring Stop-Loss Rates

Benefits advisors and self-funded clients are entering a challenging renewal season. “Stop-loss premium increases in 2026 are likely to be the biggest in recent memory, and it’s because of increasingly frequent and severe high-dollar claims,” Richard Fleder, a longtime investor and executive in the self-funded space, recently told me. The stop-loss market grew to $35.4 ...

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Courts Press Pause On Key Elements Of Trump Administration’s ACA Rule

A federal judge has blocked multiple provisions of the Trump administration’s Affordable Care Act (ACA) overhaul from taking effect Monday as scheduled. The plaintiffs, including multiple large cities like Baltimore and Columbus, Ohio, as well as organizations like the Main Street Alliance, sued in an attempt to block the regulations in early July, arguing they could ...

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