Federal judge pauses ACA rule that would have ended coverage for 1.8M people
By Alan Goforth – A federal district court judge in Maryland temporarily paused several provisions of the Trump administration’s regulatory changes to the Affordable Care Actthat were set to take effect on Monday. U.S. District Judge Brendan Hurson on Friday ruled in favor of a challenge from the city of Chicago; the Baltimore mayor and city council; and public health advocates. The plaintiffs alleged that numerous people would lose health insurance coverage if the changes were implemented.
RxDNA Summary:
A Maryland federal judge paused key ACA rule changes from the Trump administration, siding with Chicago, Baltimore, and health advocates who warned millions could lose coverage.
Blocked: penalties for auto-reenrollment, loss of subsidies over tax reconciliation, stricter income checks, loss of coverage for late payments, and tighter special-enrollment rules.
Still allowed: CMS’ new premium adjustment formula and removal of the 60-day window to fix income data issues.
👉 Bottom line: most of the controversial coverage-limiting provisions are on hold, but some technical adjustments move forward.
How tech is changing the benefits advisor-client relationship
Benefits advisors who embrace this expanded role have the chance to build deeper partnerships and become indispensable to the businesses they support.
By Andrea Dumont| July 14, 2025
As technology becomes more embedded in HR decision-making, benefits advisors are becoming more central to the client experience. What was once a transactional relationship centered on plan selection and insurance products is now a strategic partnership rooted in business guidance, data and technology.
HR leaders want advisors who can go beyond just comparing rates and carriers. They want advisors who understand their unique challenges and can help navigate everything from workforce retention to digital transformation.
And demand for that kind of partnership is growing: 88% of employers say they’re likely to combine their technology, consulting and broking needs with a single advisor in the next one to five years.
Benefits advisors who embrace this expanded role have the chance to build deeper partnerships and become indispensable to the businesses they support.
Warren Buffett's firm buys $1.6B in UnitedHealth stock, boosting stock price
By Alan Goforth – Investors have sharply different responses to UnitedHealth Group’s ongoing legal, regulatory, and financial turmoil. Although Warren Buffett’s Berkshire Hathaway has purchased a significant amount of stock, many members of Congress are selling theirs. The embattled insurance giant has weathered multiple challenges, from a massive cyberattack in early 2024 to the murder of former UnitedHealthcare CEO Brian Thompson in December.
RxDNA's Summary:
UnitedHealth is in turmoil — DOJ probes, leadership upheaval, a cyberattack, and damaging care allegations have cut its stock nearly 50% in 2025.
Investors are split — lawmakers are selling, but Buffett’s Berkshire bought $1.6B in shares, sparking a 13% rebound.
The company’s response — new CEO Stephen Hemsley is pushing reform, making a $3.3B Amedisys acquisition, and resetting guidance.
Bottom line: Wall Street is weighing Buffett’s confidence against Washington’s skepticism — a classic “buy the dip” vs. “get out early” moment.
August 2025
Medicare Report Card on its 60th Birthday: Incomplete
In the six decades since, the Medicare program has expanded to become the industry’s most important program and society’s most valued safety net
In the last 30 years, it’s become the federal governments’ Petrie dish for cost containment projects
Medicare is also political quicksand: seniors are high-propensity voters who want no part of funding cuts, access constraints, closed panels, restrictive formularies and higher co-pays and premiums in their coverage
July 2025
UnitedHealth complying with DOJ investigation: 5 things to know
By Rylee Wilson - UnitedHealth Group is complying with criminal and civil investigations into its Medicare Advantage business, the company said in a July 24 regulatory filing. The disclosure comes after The Wall Street Journal reported in May that the Justice Department has been investigatingallegations of Medicare Advantage fraud. In May, the company said it had not been notified about any investigation by the Justice Department. Read Full Article…
RxDNA Summary of Article:
UnitedHealth DOJ Investigation: 5 Key Takeaways
1. DOJ Probes Medicare Advantage Practices
UnitedHealth Group confirmed it is complying with criminal and civil investigations related to its Medicare Advantage billing. The company proactively contacted the DOJ after media reports surfaced.
2. Allegations of Upcoding
Former employees reported the DOJ has been investigating UnitedHealth’s billing and coding since at least 2024. The Wall Street Journal noted UHG received $8.7B in 2021 for diagnoses not supported by treatment claims — a common tactic in alleged “upcoding” schemes.
3. UnitedHealth Defends Accuracy
Despite the probe, UnitedHealth maintains its coding practices are among the most accurate in the industry, citing CMS audits. A long-standing DOJ lawsuit was recommended for dismissal in March.
4. Independent Review Initiative Launched
UnitedHealth is conducting third-party reviews of its risk coding, managed care, and pharmacy operations. CEO Stephen Hemsley (recently reappointed) said independent experts will assess and adjust strategies as needed.
5. Broader Company Turmoil
As the largest Medicare Advantage insurer (8.2M members), UnitedHealth is under pressure. It recently withdrew 2025 earnings guidance and has been reeling from both a high-profile cyberattack and the murder of former CEO Brian Thompson in late 2024.
July 2025
New Jersey public employees face major premium rate increases in 2026
By Jakob Emerson - New Jersey public employees are facing an up to 36.5% rise in health insurance premiums in 2026. The State Health Benefits Program for county and local employees could see costs rise 36.5%, school employees’ premiums could rise 29.7%, and state workers could see a 21% increase, according to an analysis by Aon published by Gov. Phil Murphy’s office on July 9. Read Full Article…
The Official Website of Governor Phil Murphy
📰 Summary by RxDNA: NJ Public Employees Face Major Health Insurance Premium Increases in 2026
Aon, the actuary for New Jersey’s public health plans, has recommended double-digit premium hikes across all three major state-administered plans for plan year 2026:
SHBP-LG (Local Government): +36.5%
SEHBP (School Employees): +29.7%
SHBP-State (State Employees): +21.0%
🚨 Key Drivers Behind the Increases:
Rising prescription drug costs, especially GLP-1 drugs (e.g., Wegovy, Ozempic), now top spend drivers.
Medical inflation and increased use of complex or high-cost care settings.
Adverse selection, as healthier employer groups exit the plans.
Significant financial losses across 2024–2025 (totaling hundreds of millions).
Depleted cash reserves now needing replenishment.
Debt repayment: SHBP-LG owes $150M to SHBP-State due to a state-authorized loan.
These increases reflect broader systemic issues, including outdated plan design, weak utilization controls, and governance challenges. While inflation is impacting healthcare nationwide, New Jersey's public plan cost increases outpace national trends.
Note: These are recommended increases and must still be approved by the relevant state commissions.
Employers Will Likely Reduce Health Benefits in 2026, New Mercer Survey Reveals
July 2025
By Marissa Plescia - To combat rising healthcare costs, employers may be looking to reduce healthcare benefits in 2026, according to a new survey from consulting firm Mercer. The survey, released Wednesday, revealed that 51% of large employers (500 employees or more) said they are likely or very likely to make changes that would shift more costs to employees. This includes increasing deductibles or out-of-pocket maximums. In last year’s survey, 45% of employers said this. Read Full Article…
Summary - 2026 Employer Health Benefits – Mercer Survey Highlights:
51% of large employers plan to shift more healthcare costs to employees (e.g., higher deductibles, OOP max).
35% will offer non-traditional plans like variable copay plans (pay varies by provider).
44% currently cover GLP-1s for weight loss, but many are reconsidering due to rising costs.
77% say managing GLP-1 costs is a top priority.
61% are exploring transparent PBM alternatives to traditional pharmacy contracts.
Mental health focus:
~75% offering digital tools (mindfulness, CBT apps).
50% providing live training or coaching.
40% training managers to identify mental health issues.
Employers expect 6% cost increase in 2025; 2026 may be worse.
**RxDNA can help drive costs down with our RxDNA PBM Rapid Quote Platform and our clinical solutions focused on PBM alternatives, lowest net cost, GLP1 management, and mental health therapy.
Pfizer and BMS Prepare to Launch a Cash-Pay Option for Eliquis
July 2025
Pharm-to-Table Trend Expands…
If you wanted to be a cynic about the “pharm-to-table” trend in which companies bring medicines directly to patients, you could suggest that the model works only in very narrow cases. Sure, obesity makes sense. And, yup, you can see how it would work for generics.
But for everything else, it gets kind of dicey.
That’s what makes today’s announcement out of BMS and Pfizer so interesting. They’re going to start pushing their blood thinner, Eliquis, in a pharm-to-table model, offering it directly to Americans for 40% off of list. The WSJ was given the exclusive.
