Health Insurance Industry Issues and Legislation

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State lawmakers are pushing for greater authority to regulate self-funded employer health plans, which are currently protected from state oversight under the Employee Retirement Income Security Act (ERISA). At the National Council of Insurance Legislators meeting, a draft resolution was introduced seeking amendments to ERISA, aiming to grant states increased regulatory power. Proponents of the resolution argue that ERISA has hindered state efforts to implement healthcare reforms.

Powerful weight-loss drugs like GLP-1s are expanding healthcare use as patients seek treatment for obesity-related conditions or aim to qualify for procedures like organ transplants and joint replacements, according to a Truveta analysis. Between 2020 and 2024, diagnoses of sleep apnea, cardiovascular disease, and type 2 diabetes rose among patients prescribed GLP-1s, highlighting their role as both a treatment and preventative tool. Experts note these medications are encouraging preventive care and engagement with primary healthcare, but their long-term impact on overall costs remains unclear.

The term "health care dollar" is often used to discuss overall medical expenses, but where does that money actually go? According to AHIP, total hospital costs make up 40.7 cents of every dollar spent and prescription drugs make up nearly a quarter, or 24.2 cents, of every dollar spent.