News Archive

"The survey of health insurers found that the average cost of medical health benefits will increase by 10.3% globally next year. This follows rises of 10% in 2025 and 9.5% in 2024.... [O]ver half (55%) of insurers that expect higher trends expect these elevated levels to persist for more than three years, driven by high medical costs, regional pressures on pharmacy and outpatient services and global structural factors."  MORE >>

"[T]he key isn't just knowing that pooling exists; it's understanding how to manage it strategically: [1] Track large claims proactively ... [2] Evaluate pooling levels ... [3] Understand carrier behavior ... [4] Plan for the inevitable."  MORE >>

"HB 1437 delays the date that contractors must begin paying apprentices full journeyworker fringe benefits on public works projects to July 1, 2026.... HB 1437 has not been signed into law by Governor Pritzker, but he is expected to do so in the coming weeks."  MORE >>

"A major challenge with the Transparency in Coverage (TiC) data ... is that many rates relate to providers and groups that do not provide those services.... These negotiated rates -- known as ghost rates -- undermine the goals of transparency data ... Across a combination of all 61 insurers, 91.8% of all the negotiated rates were ghost rates.... To maximize the potential of the TiC data, CMS 8 should require payers to include volume information, allowing users to quickly identify ghost rates."  MORE >>

"For years, the conversation around health insurer consolidation and vertical integration has simmered through antitrust inquiries, oversight hearings, and policy papers. The Patients Over Profit Act [HR 5433; S 2836] ... marks a decisive shift. Rather than regulating insurer-provider integration, the POP Act proposes to ban it outright."  MORE >>

"Almost 4 in 10 disputes submitted to the IDR process are deemed ineligible by insurers, often due to errors such as resubmitted cases, claims covered by state laws, or services involving in-network providers. Both payers and providers face mounting costs and delays as IDR entities struggle to filter invalid cases, complicating cash flow for health systems. CFOs should tighten eligibility checks, track dispute-to-payment metrics, and align closely with revenue cycle teams to minimize rejected filings and improve reimbursement efficiency."  MORE >>

"Health systems, doctor groups, and insurers are merging and coalescing into ever-bigger giants. While these mergers are good for business, studies show the escalating consolidation in health care is driving up prices, harming patient outcomes, and decreasing choice for people who need care. A recent study found that six years after hospitals acquired other hospitals, they had raised prices by 12.9%, with hospitals that engaged in multiple acquisitions raising their prices by 16.3%."  MORE >>

"[B]etter questions can unlock better results -- for employers, employees, and consultants alike. [1] Understanding the real drivers of cost ... [2] Rethinking navigation and employee experience ... [3] Evaluating ROI and value ... [4] Strengthening the employer -- consultant partnership ... [5] Future-proofing your benefits strategy."  MORE >>

"For plan years ending January 2026 through September 2026, PCORI fees are not due until July 31, 2027. This breaks down more specifically as follows: $3.47 per covered life for plan years ending in January through September of 2025 ... $3.84 per covered life for plan years ending in October through December of 2025  ... $3.84 per covered life for plan years ending January through September of 2026."  MORE >>

"Employers with a calendar-year health plan should have procedures in place to make sure they file IRS Form 720, Quarterly Federal Excise Tax Return, and pay their PCORI fee at a rate of $3.84 per covered life on or before July 31, 2026."  MORE >>

"The applicable dollar amount that must be used to calculate the fee imposed by sections 4375 and 4376 for policy years and plan years that end on or after October 1, 2025, and before October 1, 2026, is $3.84. The increase from the prior applicable dollar amount is calculated by multiplying $3.47 ... by the percentage increase of the projected per capita amount of National Health Expenditures published by HHS on June 24, 2025.... The percentage increase is calculated after adjustment to reflect updates to the data used to calculate the prior applicable dollar amount, $3.47[.]"  MORE >>

"Early detection is great, isn’t it? It will save money down the road, so shouldn’t we cover it? Before you decide to do so, consider these six points that the Validation Institute would argue go exactly the other way."  MORE >>

"Accelerating healthcare costs have less to do with hospital and physician services than with surging drug spending ... [Data suggests] advanced therapies increasingly are taking the place of procedure-based care. For example, whereas GLP-1 use increased by more than 700% during a recent five-year period, bariatric surgery rates were flat to declining. Similarly, SGLT2 inhibitor patients more than tripled, while cardiac catheterization volumes declined slightly."  MORE >>

"This year's enrollment period is especially significant, as a record number of new entrepreneurs are not only expected to navigate the Health Insurance Marketplace for the first time, but many entrepreneurs could face higher health care premiums given the premium tax credits are set to expire this year unless Congress acts to renew them."  MORE >>

"Similar to 2025, on average, tax credits are projected to cover 91% of the lowest cost plan premium in 2026 for eligible enrollees. This compares to 85% in the 2020 coverage year, which was the last coverage year not impacted by temporary COVID-19 pandemic policies. The average Marketplace premium after tax credits is projected to be $50 per month for the lowest cost plan in 2026 for eligible enrollees."  MORE >>

"Hospitals can do math. Combating a clear, prompt, and defensible payment requires staff time, letters, appeals, and sometimes legal counsel.... If your plan pays a transparent multiple of Medicare, if your language is precise, if your appeals correspondence is professional, and if your member advocacy is proactive, the hospital's marginal ROI on fighting you is poor. They often accept ... because you act like a payer with a system, and the effort isn't worth the benefit."  MORE >>

"[A recent GAO report's] recommendations were structured around five pre-identified areas of potential reform: strengthening primary care; expanding the health care workforce; reforming pricing to better align with high value care; revising Medicare physician payments; and mitigating anticompetitive actions and practices.... [The authors] the areas []they] believe are most critical for policymakers to consider and offer new insights that have gained salience given shifts in the policy landscape since the forum was conducted."  MORE >>

"[DOL FAQs Part 72 provide] a road-map for companies to offer fertility health benefits for employees using existing regulations, promising new regulations to continue making the process easier. Coverage for these treatments has become more and more popular among large companies, but management-side attorneys say many questions remain about how it can be offered in a way that's useful for employees without being cost prohibitive for their employers."  MORE >>

"Now, following a petition for rehearing, the Fifth Circuit has withdrawn its August opinion and issued a revised decision ... The new opinion keeps the same outcome -- largely favorable to the physician groups -- but clarifies the legal reasoning and provides a more detailed explanation of how equitable estoppel and assignment principles apply under ERISA." [Angelina Emerg. Med. Assocs. PA v. Blue Cross & Blue Shield of Alabama, No. 24-10306 (5th Cir. Oct. 23, 2025)]  MORE >>

"U.S. consumers across the political spectrum are largely in favor of new legal protections against medical debt, and the majority are laying blame at the feet of the insurance industry rather than other healthcare players like hospitals or drugmakers ... [A recent survey] found about 35% currently owed money or have debts due to medical and dental expenses. Eighty-four percent said they believed having health insurance should protect people from medical debt, and 74% said the country's current health insurance system is 'mostly failing' in protecting from medical debt."  MORE >>

"The IDR process should not be exploited as a default pricing mechanism. Guardrails must be implemented to prevent abuse and ensure it remains a last resort. We urge the Departments to adopt reforms that ensure timely, transparent, and predictable resolution of payment disputes to protect plan sponsors and their enrollees."  MORE >>

"For a covered service provider's compensation to be considered reasonable, the service provider must disclose specified information in advance and in writing to a responsible plan fiduciary. Broadly, the disclosure must describe the services to be provided, indicate whether the service provider expects to be a plan fiduciary, and describe all forms of direct and indirect compensation the service provider expects to receive in connection with the arrangement, including the manner in which compensation will be received."  MORE >>

"Overall, 18 percent was spent on inpatient services, 51 percent on outpatient services, and 31 percent on prescription drugs ... For enrollees with under $50,000 in spending, inpatient services represented only 9 percent of their total health care expenditure. This jumped to 58 percent for those with $2 million or more in spending.... [P}rescription drug spending as a proportion of total health care spending peaked in the middle-to-higher spending tiers (from $50,000 to $250,000) and then decreased for the very highest-spending enrollees."  MORE >>

"The growing volume of ineligible claims from out-of-network providers and private equity firms amounts to one of the most persistent abuses of the federal IDR process, according to researchers. Recent data ... estimates that the systemic flaws with arbitration and rampant misuse of the process have led to $5 billion in wasteful spending to date."  MORE >>

"[1] Prepare for record-setting renewals ... [2] Data is the most critical input ... [4] Vendor fatigue is real, and consolidation is coming ... [4] Communication is a year-round priority ... [5] Align benefits to business goals, not just renewal rates ... [6] Move from reactive to multi-year planning."  MORE >>