Affordable Care Act insurance premiums and government subsidies were among the most-clicked stories for SmartBrief readers in November. Subscribers also turned their attention to employer plans’ coverage of GLP-1 drugs, and how patients’ use of the medications for weight loss is expected to keep rising. Read SmartBrief Originals on education and support for people using GLP-1s and the wider effects of the treatments.
Unsure about insurance
What happened: The federal government funding bill signed into law in November did not mention any extension of the enhanced Affordable Care Act subsidies that most marketplace enrollees have depended on to keep premiums manageable. About 22 million of the nation’s 24 million ACA insurance holders could face doubling premiums if the tax credits expire, and 5 million likely would lose coverage altogether.
What’s next: Some legislators still hope to come up with a bipartisan deal to solve the issue. Besides much higher costs for consumers, potential fallout from expiring subsidies also includes a sharp hike in hospitals’ charity and emergency department care, and less flexibility for them to pay employees competitively.
Facing a tight deadline
What happened: The consequences of Congress deciding not to renew the ACA tax credits that are expected to expire at year’s end were examined. Democrats had been urging a straightforward extension of the credits, while Republicans had been calling for changes including income caps and minimum premium requirements.
What’s next: A proposal to extend enhanced ACA subsidies was recently blocked in the Senate, and a proposal to replace the subsidies with direct payments to basic coverage buyers and a health savings account also failed. Legislative debate on the subject is ongoing as the end of the year approaches.
Paying for weight-loss drugs
What happened: Employers are facing a new dilemma, and they may eventually be required to cover GLP-1 weight loss medications under their benefit plans. Nearly 20% of large US employers currently do, while about 60% of companies in a survey said the drugs cost more than they were expecting, and two-thirds said the medications had significantly affected their spending. Still, many said covering the drugs is a productive way to improve their workers’ health and job satisfaction.
The White House had signed deals with Novo Nordisk and Eli Lilly & Co. to cut the prices of their weight loss drugs, with out-of-pocket costs expected to range between $50 and $350 per month under the initiative. Current list prices for the drugs range around $1,000 a month or more. Under the new arrangements, Medicare is expected to start covering the drugs for obesity by the middle of next year.
What’s next: Other drugs such as Lilly’s injectable retatrutide are showing promise for weight loss. Retatrutide mimics three hunger-regulating hormones in the body, compared with one or two for other drugs. Novo Nordisk and Lilly are also developing new obesity drugs in pill form.
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