"Employers and their advisors should be aware that HHS will not take action based on the gender identity provisions of the 2024 regulations while the vacatur remains in effect, but the remainder of the 2024 regulations continues to apply, and other federal nondiscrimination laws -- including Title VII of the Civil Rights Act, as interpreted by the U.S. Supreme Court -- may independently address gender identity discrimination in certain contexts"  MORE >>

"Starting June 11, 2026, the fee for IDR disputes will be lowered from $115 to $15, making the process more accessible for smaller disputes but potentially increasing the system backlog. Health plans and insurers must register in a new IDR registry to help providers correctly identify payors, potentially reducing ineligible or misdirected disputes. The open negotiation period will be managed through the federal IDR portal using standardized forms, with a fifteen-business-day response window, aiming to reduce disputes that are ineligible for IDR."  MORE >>

"According to the Departments, the final rules are designed to improve how the IDR process functions through better communication and streamlining the processes. However, the final rules do not address many of the existing issues with the current IDR process that have been identified as increasing costs for employer group health plan (plan) sponsors.  The final rules also impose additional registration obligations for plans and may make it easier for more claims to be submitted to the IDR process."  MORE >>

"The plaintiffs allege that the 2027 Payment Notice Final Rule is contrary to the goals of the ACA, will cause millions of Americans to lose coverage on the ACA's Exchanges and will increase premiums and out-of-pocket costs for the remaining enrollees, causing irreparable harm. The plaintiffs allege that many of the provisions of the 2027 Payment Notice Final Rule are in direct conflict with federal law and that HHS failed to adequately consider public comments or provide adequate reasoning for many final policies." [City of Columbus v. Kennedy, No. 26-2215 (D. Md. complaint filed Jun. 3, 2026)]  MORE >>

Video of June 10 hearing, with testimony from [1] Carol Skenes, Turquoise Health; [2] Shawn Gremminger, National Alliance of Healthcare Purchaser Coalitions; [3] Benedic Ippolito, Ph.D., American Enterprise Institute; [4] Christopher Whaley, Ph.D., Brown University School of Public Health; and [5] Sophia Tripoli, MPH, Families USA.  MORE >>

"Payers' perception of value in unbundled PBM service arrangements increased year-over-year, and over half say they would pursue a partially or fully unbundled model if they were to conduct a procurement today ... Affordability continues to be a major concern for coverage of GLP-1s for obesity ... 1 in 10 payers have a cost-plus arrangement or PMPM pricing guarantee, and the primary factors influencing decisions about these alternative pricing models are impact on total net pharmacy cost and member affordability and experience."  MORE >>

"Industry audits regularly reveal that 70% to 90% of benefits carrier invoices contain at least one discrepancy. These errors can include billing for employees who have already left the company, incorrect coverage levels, dependents who should have been removed from plans, outdated premium rates, or duplicate enrollments. Individually, these mistakes may appear small. Collectively, they represent one of the most significant hidden financial leaks in corporate America."  MORE >>

"The purpose of the [Patient Refunds for Bad Denials Act (HR 8442)] is to punish health insurers by imposing millions of dollars in fines for claim denial rates exceeding 25%. The bill would not apply to self-insured health plans. The U.S. Department of Health and Human Services (HHS) would increase the maximum fine by $2 million for each percentage point above a 25% claim denial rate, up to a maximum of $10 million. Any fines collected would be distributed to the people covered under the insurer's health policies."  MORE >>

"49% of Americans with health insurance have used artificial intelligence (AI) platforms to seek out medical advice, and most of these (63%) are acting on the advice they receive without consulting a doctor.... 53% of insured Americans avoided medical care in the past 12 months due to cost concerns, with 32% saying they avoided care two or more times for this reason. 53% avoided medical care in the past 12 months due to uncertainty about their benefits."  MORE >>

"Severance agreements can serve both employers and employees. You can obtain closure, reduce risk, and protect legitimate business interests. Employees can receive transition pay, benefits, and certainty. But these agreements shouldn't be treated as forms pulled from an old filing cabinet. You should confirm compliance with current law, and employees should understand what they are receiving, what they are releasing, and what obligations will continue."  MORE >>

"The classic cost-disease cure is to 'productize' what used to be a service by substituting scalable goods. But in health care, the opportunity lies not in replacing services with goods but in raising productivity across labor-intensive workflows."  MORE >>