"By breaking down silos between medical and disability data, absence management leaders can uncover actionable insights that improve employee outcomes and reduce organizational risk. This analysis sets out to: [1] Quantify how chronic and complex conditions influence both medical spend and absence patterns. [2] -- Identify which conditions have the greatest impact on cost and workforce availability. [3] Translate these findings into practical strategies for absence programs." MORE >>
"In 2026, states will receive first-year awards from CMS averaging $200 million within a range of $147 million to $281 million. This unprecedented federal investment will help states expand access to care in rural communities, strengthen the rural health workforce, modernize rural facilities and technology, and support innovative models that bring high-quality, dependable care closer to home." MORE >>
"[T]he new guidance [1] clarifies that the safe harbor does not extend to in-person services, medical equipment, or drugs furnished in connection with telehealth or other remote care services.... [2] clarifies how Direct Primary Care Service Arrangements (DPCSAs) interact with HSAs.... [3] provides that beginning January 1, 2026, bronze and catastrophic health plans, including those obtained through a health insurance exchange, will be treated as HSA-compatible, even if they don't meet the traditional high-deductible requirements." MORE >>
"For economic growth to meaningfully improve America's long-term fiscal outlook, Medicare spending would need to grow more slowly than GDP. But under the program's current structure, it will continue to grow faster than GDP for the foreseeable future. Every pathway through which growth occurs -- innovation, longer lives, cost disease -- feeds directly into higher Medicare spending. The conclusion is inescapable: we cannot grow our way out of the Medicare-driven debt crisis without reforming Medicare itself." MORE >>
"This Fact Sheet updates frequently asked questions (FAQs) about the Premium Tax Credit. The revisions and additions are as follows: [1] Updates to questions related to the limitations on repayment of excess advance payment of the premium tax credit due to the removal of the limitations for tax years beginning after Dec. 31, 2025. [2] Updates throughout for minor style clarifications and topic/question renumbering. [3] Deletion of questions Q 32 and Qs 35-49 about certain Premium Tax Credit rules that do not apply after tax years 2020 and 2021." MORE >>
"A number of national employers (and consultants) found some coal in their Christmas stocking yesterday -- courtesy of Schlichter Bogard LLC. While it is not the healthcare fiduciary litigation many have been expecting, it does deal with benefits, and charges of a breach of fiduciary duty in what were allegedly excessive premiums in accident, critical illness, cancer, and hospital indemnity insurance -- voluntary benefits that are not subsidized by employers." MORE >>
19 pages. "The need for long-term reforms to Medicare has been repeatedly raised. One is to raise the eligibility age from 65 to the Social Security full retirement age of 67, then tie it to increases in longevity.... In this paper, [the authors] estimate the coverage and spending effects of eliminating Medicare coverage for those ages 65 to 66[.]" MORE >>
241 pages. "These proposed rules set forth proposed requirements that would amend the regulations under the Public Health Service Act, [ERISA] and the Internal Revenue Code regarding price transparency reporting requirements for non-grandfathered group health plans and health insurance issuers offering non-grandfathered group and individual health insurance coverage. Specifically, these proposed rules would improve the standardization, accuracy, and accessibility of public pricing disclosures in line with the goals of the Executive Order 14221. With respect to the in-network rate and out-of-network allowed amount machine-readable files, these proposed rules would achieve these goals by adding new contextual files and additional data elements like product type, network name, and enrollment counts; changing the reporting level for aggregation of data; removing in-network rates for unlikely provider-to-service mappings; increasing the reporting period and lowering the claims threshold for out-of-network historical data; and reducing the reporting cadence. These proposed rules would also improve the findability of all of the publicly disclosed machine- readable files required under the Transparency in Coverage rules, including the prescription drug file, by requiring a text file and footer with website URLs and contact information for the files. These proposed rules would also require pricing information that is made available through an online consumer tool and paper (upon request), to also be made available by phone, and establish that the satisfaction of such requirement also satisfies the requirements of section 114 of the No Surprises Act (including for grandfathered group health plans and health insurance issuers offering grandfathered group and individual health insurance coverage that are not otherwise subject to these proposed rules)." MORE >>
"Eligible small employers (defined later) use Form 8941 to figure the credit for small employer health insurance premiums for tax years beginning after 2009. For tax years beginning after 2013, the credit is only available for a 2-consecutive-tax-year credit period. " [Also available: 2025 IRS Form 8941] MORE >>
"Employers can reduce hidden healthcare costs by using claims and pharmacy data to identify wasteful spend, steering members to high-value providers, tightening pharmacy benefit design, and investing in population health, care navigation, and social determinants of health strategies that improve outcomes and reduce avoidable utilization. [This article unpacks] what is driving costs, where waste hides in your plan, and the practical steps employers can take now to break the cycle." MORE >>
"Under the bill [HR 6703] ... lawmakers would lean on association health plans ... and individual coverage health reimbursement arrangements, or ICHRA, to offer additional options for enrollees....The bill also seeks to broaden access to stop-loss coverage to mid-size and small employers ... [Th]he legislation aims to address premiums by allocating for cost-sharing reduction payments beginning in 2027.... The bill also includes provisions to increase the transparency around pharmacy benefits[.]" MORE >>
"Health care spending data from five states show health care spending exceeded each state's target in 2023 ... Those five states are among nine that, since 2012, have established targets to contain rising health costs.... [T]he research reveals how health insurers that acquire physician groups and other provider organizations increase health care costs and avoid paying rebates to consumers under the medical loss ratio (MLR) rule in the [ACA]." MORE >>
14 pages. "[Annual Wellness Visits (AWVs)] are considerably underused, with 45 percent of Medicare beneficiaries not engaging with their AWVs.... [Fee-for-service] beneficiaries who were more engaged with their AWVs (had at least four AWVs from 2018 to 2023) had a lower annual trend in their total cost of care (TCOC) and considerably lower inpatient and emergency department spending.... [B]eneficiaries who received an AWV were associated with an average of $885 reduction in TCOC per beneficiary per year compared to years without an AWV." MORE >>
"In the latest survey of leading health care policy scholars ... [most] agreed that proposals to convert enhanced subsidies for [ACA] Marketplace plans into contributions for health savings accounts (HSAs) would have an overall effect of worsening health care affordability for enrollees. There was also consensus that requiring small-dollar premiums (instead of permitting fully subsidized plans with no net premium) would measurably reduce Marketplace enrollment; there was further consensus that a scheduled policy change that will effectively end automatic renewals with subsidy will substantially reduce Marketplace enrollment." MORE >>
16 pages. "Approximately 1% of an employer's health plan members have annual claims higher than $100,000, but they account for 33% of total spend.... The proportion of claimants with annual costs exceeding $1M rose by more than 45% from 2022 to 2024, with the steepest growth among million-dollar claimants, particularly those exceeding $2M.... Only 21% of high-cost claimants (HCCs) persist year over year, increasing renewal uncertainty and complicating forecasting" MORE >>
24 pages. "[T]his report outlines five key recommendations for employers designing sustainable GLP-1 coverage: [1] Establish clear, clinically driven eligibility pathways for GLP-1 coverage. [2] Require participation in behavior, nutrition, or lifestyle change programs as a condition of coverage. [3] Provide structured support for employees who choose to taper or discontinue GLP-1 therapy. [4] Review existing vendor capabilities before adding additional point solutions. [5] Contract with vendors to drive outcomes while examining overall program costs." MORE >>
"Forward-thinking companies are beginning to view benefits through a new lens -- not focused solely on network accessibility, size or discounts, but on total cost of care.... Just as HDHPs ushered in a new era of consumerism by encouraging employees to weigh cost in their decisions, today's value-driven health plans build on that foundation -- offering smarter choices through transparency, incentives and guided navigation, without sacrificing access or quality." MORE >>
"Data-driven well-being programs use employee data to personalize benefits that best fit their needs. By partnering with these vendors, leaders gain insights ... and match employees with the right resources at the right moment ... [A] platform might flag rising burnout risk and automatically recommend mental health coaching, suggest adjustments to workloads, or prompt managers to step in. Other data-driven tools can even guide employees to the most effective medical providers." MORE >>
"California, Massachusetts, Connecticut, and five other states have set caps on health care spending in a bid to rein in the intense financial pressure felt by many families, individuals, and employers who every year face increases in premiums, deductibles, and other health-related expenses. Hospitals and other health care providers are citing Republicans' One Big Beautiful Bill Act ... as one more reason to challenge those limits." MORE >>
"Healthcare deal activity cooled off in 2025, but the sector is poised to bounce back next year driven by investments in artificial intelligence, an improved exit environment and policy shifts driving buyers to move quickly." MORE >>
"Implementing a value-based contract that ties payments to quality metrics or population health outcomes creates several fiduciary questions. Does shifting risk to a provider expose plan participants to narrower networks or limited access that may conflict with fiduciary obligations? How should fiduciaries evaluate whether the incentive structures truly benefit plan participants rather than merely reduce employer costs? ... Using standardized CMS data sets minimizes ambiguity and improves objective benchmarking. From a legal point of view, incorporating CMS data sets requires careful implementation. " MORE >>
"Private health insurers play a central role in determining the cost and quantity of health care in the United States. Despite this centrality, there has been limited empirical work studying how insurers differentially affect spending and consumption, especially for expensive and pervasive chronic conditions. [The authors] use hundreds of natural experiments involving employers switching their primary health insurer, together with a movers design, to estimate these causal effects." MORE >>
16 pages. "With enhanced subsidies expiring, benchmark silver premiums rising by an average of 30%, and consumer purchasing patterns expected to shift dramatically, health insurers in 2026 face both unprecedented challenges and strategic opportunities." MORE >>
"Under the Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence, or MAHA ELEVATE, model, the Centers for Medicare & Medicaid Services (CMS) will make $100 million available to support as many as 30 proposals to promote health and preventive care in three-year agreements." MORE >>
"To help employers determine whether an ICHRA offer is considered affordable for purposes of validating they are making affordable offers of coverage to their employees and avoiding the employer responsibility payment, CMS is publishing the ICHRA Employer LCSP Premium Look-up Table [XLSM]. The table allows users in states participating in the Federally-facilitated Exchange (FFEs) and State-based Exchanges on the Federal Platform (SBE-FPs) to access individual market Qualified Health Plans (QHP) lowest cost silver plan (LCSP) data by geographic location." [Also available: Plan Year 2026 ICHRA Employer Lowest Cost Silver Plan Premium Look-up Table Data Dictionary (PDF)]MORE >>
