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Top Health Insurance Plans in India for 2026: A Comprehensive Comparison of Coverage and Premiums
Choosing the right health insurance plan can be a daunting task, but it’s essential to prioritize finding a plan that provides the most value for your money and meets your unique requirements. Value for money in health insurance means that the premiums you pay are justified by the benefits the policy offers, such as inpatient coverage, outpatient coverage, cashless treatments, and a wide hospital network.
When selecting a health insurance plan, there are several factors to consider. First, it’s essential to assess the plan’s benefits and ensure they align with your needs. Some of the top health insurance plans that offer the best value for money include ACKO Health Insurance, HDFC ERGO Health, Care Health Insurance, and Star Health Insurance. These plans offer features such as no room rent restrictions, automatic restoration of sum insured, higher coverage options, and comprehensive family floater coverage.
To choose the best health insurance plan, consider your family needs and life stages. For example, a youth may require basic hospitalization insurance, while a family may require broader protection. Additionally, consider the needs of senior citizens, who may require more medical attention and therefore higher premiums. It’s also crucial to compare quotes and providers, checking for customer reviews, the insurance company’s reputation, claim-settlement ratio, and other terms and conditions.
Some key features to look for in a health insurance plan include cashless treatments, a wide hospital network, and sufficient coverage for you and your family. The plan should also have an excellent claim-settlement ratio and be from a reputable insurance company. Ultimately, the best health insurance policy is one that meets all your requirements and provides necessary benefits for the future.
In conclusion, when choosing a health insurance plan, it’s essential to prioritize value for money and consider your unique requirements. By assessing your needs, comparing plans, and looking for key features, you can find a plan that provides the best value for your money and meets your needs. Remember to consider your age, family size, health status, and finances before buying a health insurance policy, and always choose a plan from a reputable insurance company with an excellent claim-settlement ratio. By doing so, you can ensure that you and your family have access to quality healthcare when you need it most.
As healthcare costs continue to rise, the need for effective regulation of the insurance industry has become increasingly important. With medical expenses skyrocketing, the burden on individuals, families, and businesses is growing, making it essential to oversee insurance providers to ensure they are operating fairly and in the best interest of their policyholders. Regulations can help prevent exploitative practices, promote transparency, and guarantee that insurance companies are providing adequate coverage to those who need it. By regulating the insurance industry, governments can help mitigate the financial strain of rising healthcare costs and safeguard the well-being of their citizens.
A recent report found that approximately one in five health care claims in Massachusetts were rejected in 2024, highlighting the challenges that many people face in accessing health care services due to insurance issues. In response, the state has introduced new regulations aimed at reducing administrative burdens and improving patient access to care. Michael Caljouw, the Commissioner of Insurance for the Commonwealth of Massachusetts, discussed these issues on the monthly Health or Consequences episode of The Codcast.
One of the key issues identified by Caljouw was prior authorization, which requires medical providers to obtain approval from insurers before providing certain treatments or services. A market-wide examination of prior authorization practices in Massachusetts found significant differences in how and when insurance companies required it. To address this issue, Governor Maura Healey announced that the Division of Insurance would be introducing new regulations limiting the use of prior authorization for certain types of care.
Caljouw views these regulations as a crucial first step in addressing the challenges within the health care system. He noted that insurance companies have committed to this reform, and it is essential to see similar commitment from all stakeholders to reduce administrative waste and inefficiencies. The new regulations are set to be discussed at a public hearing on February 19.
On the episode, Caljouw, along with hosts John McDonough and Paul Hattis, discussed various topics, including the new regulations for insurers, concerns about the stability and solvency of the Massachusetts health insurance system, and insurer consolidation. The conversation highlighted the need for continued reform and improved coordination among stakeholders to ensure that patients have access to necessary health care services.
The state’s efforts to address insurance issues and improve patient access to care are critical, particularly given the rising costs of health care. By introducing new regulations and encouraging stakeholder commitment to reform, Massachusetts aims to reduce administrative burdens and improve the overall efficiency of the health care system. As Caljouw emphasized, this is just the first step, and ongoing efforts will be necessary to address the complex challenges within the health care system.
The rising cost of health care is a complex issue with multiple contributing factors. Some of the key reasons include:
Advancements in Medical Technology: New treatments, medications, and equipment are continually being developed, which can drive up costs. These advancements often come with a high price tag, contributing to increased healthcare expenditures.
Aging Population: As the population ages, there is a greater demand for health care services. Older adults typically require more medical care due to age-related health issues, leading to higher costs.
Chronic Diseases: The prevalence of chronic diseases such as diabetes, heart disease, and obesity has increased. Managing these conditions often requires ongoing, costly treatments and medications.
Administrative Costs: The healthcare system involves a significant amount of administrative work, including billing, insurance claims, and regulatory compliance. These tasks are costly and contribute to the overall expense of healthcare.
Pharmaceutical Prices: The cost of prescription medications has risen significantly. New and innovative drugs, especially those for rare or complex conditions, can be very expensive.
Defensive Medicine: To avoid potential lawsuits, healthcare providers may order additional tests or procedures, which can drive up costs without necessarily improving patient outcomes.
Insurance and Payment Systems: The way healthcare is financed, including insurance premiums, deductibles, and copays, can make it inaccessible or unaffordable for many people, affecting the overall cost landscape.
Hospital and Healthcare Facility Costs: The cost of maintaining and operating hospitals and other healthcare facilities, including staff salaries, equipment, and supplies, contributes to the overall expense of healthcare.
Regulatory Compliance: Healthcare providers must comply with a myriad of regulations, which can be costly in terms of time, personnel, and resources.
Lack of Transparency and Competition: In some areas, limited competition among healthcare providers and a lack of price transparency can lead to higher costs, as consumers may not be able to make informed decisions based on price and quality.
Advancements in Medical Technology: New treatments, medications, and equipment are continually being developed, which can drive up costs. These advancements often come with a high price tag, contributing to increased healthcare expenditures.
Aging Population: As the population ages, there is a greater demand for health care services. Older adults typically require more medical care due to age-related health issues, leading to higher costs.
Chronic Diseases: The prevalence of chronic diseases such as diabetes, heart disease, and obesity has increased. Managing these conditions often requires ongoing, costly treatments and medications.
Administrative Costs: The healthcare system involves a significant amount of administrative work, including billing, insurance claims, and regulatory compliance. These tasks are costly and contribute to the overall expense of healthcare.
Pharmaceutical Prices: The cost of prescription medications has risen significantly. New and innovative drugs, especially those for rare or complex conditions, can be very expensive.
Defensive Medicine: To avoid potential lawsuits, healthcare providers may order additional tests or procedures, which can drive up costs without necessarily improving patient outcomes.
Insurance and Payment Systems: The way healthcare is financed, including insurance premiums, deductibles, and copays, can make it inaccessible or unaffordable for many people, affecting the overall cost landscape.
Hospital and Healthcare Facility Costs: The cost of maintaining and operating hospitals and other healthcare facilities, including staff salaries, equipment, and supplies, contributes to the overall expense of healthcare.
Regulatory Compliance: Healthcare providers must comply with a myriad of regulations, which can be costly in terms of time, personnel, and resources.
Lack of Transparency and Competition: In some areas, limited competition among healthcare providers and a lack of price transparency can lead to higher costs, as consumers may not be able to make informed decisions based on price and quality.
The rising cost of health insurance in the United States is a pressing concern, with premiums for employer-sponsored insurance expected to increase by 9% in 2026. Public spending on Medicare, Medicaid, and Obamacare is also surging. However, this increase is not due to excessive profits among insurers or hospitals, but rather the rising cost of care, driven by higher utilization of medical services, particularly newly developed drugs and outpatient procedures.
The hospital industry is often blamed for driving up healthcare costs, but the reality is more complex. While hospital procedures account for a significant portion of healthcare spending, 80% of US hospitals are publicly owned or non-profits, and the most expensive facilities are often small, rural hospitals facing declining revenues. Additionally, average prices for hospital care have actually fallen 2% in real terms since 2010.
Similarly, physician fees are not the primary driver of rising healthcare costs. Payments for treating Medicare patients are often fixed by law, and physician fees have fallen 18% in real terms since 2010. Prescription drug prices have also declined, with the average real price of prescriptions for Medicare enrollees decreasing by 13% between 2009 and 2018.
The true driver of rising healthcare costs is the expansion of medical capabilities, leading to increased demand for medical services. Americans are consuming more healthcare, and the willingness to spend more to alleviate illness and infirmity has no real limit. The introduction of new technologies and treatments has transformed the healthcare landscape, with significant advancements in areas such as cardiovascular disease, cancer, and HIV-AIDS.
However, this increased utilization of medical services has led to higher healthcare costs. From 2014 to 2023, the number of medical practitioners increased from 6.5 million to 9.6 million, and the volume of physician services delivered per Medicare beneficiary grew by 45% in orthopedics, 50% in neurosurgery, and 130% in surgical oncology.
To control healthcare costs, policymakers must reform payment systems to reward cost-saving innovations. This could involve indirect payments for newly developed medical technologies, rather than establishing supplemental funding streams. Additionally, switching control over the purchase of insurance from employers to individual workers could improve incentives for private insurance to control healthcare costs.
Ultimately, the rising cost of health insurance is a complex issue, driven by a range of factors, including increased utilization of medical services, technological advancements, and payment system incentives. Addressing these challenges will require a nuanced and multifaceted approach, one that balances the need for innovation and access to quality care with the need to control costs and ensure affordability.
Chola MS
Medical emergencies can arise at any moment, disrupting life and finances. Modern family health insurance plans have evolved to provide comprehensive coverage that goes beyond just hospital stays. These plans now offer advanced features that cater to the realities of life, providing benefits that matter when time, money, and clear decisions are critical.
One of the significant improvements in health insurance is the option for cashless hospitalization. This feature enables individuals with insurance to receive treatment at partner hospitals without paying upfront, as the insurance company handles the bill directly with the hospital. This saves time and reduces financial stress during critical moments.
In addition to cashless hospitalization, modern family health plans offer comprehensive emergency coverage, including pre- and post-hospitalization expenses, tests, ambulance services, ICU care, and consultations. No-claim bonuses are also available, which increase the insured amount each claim-free year, strengthening protection over time.
Modern treatment coverage has also expanded to include innovative surgeries, minimally invasive procedures, and therapies, ensuring families have access to high-quality care that supports faster recovery and better long-term health. Furthermore, many plans now cover daycare procedures that don’t require a full 24-hour hospital stay, promoting at-home recovery and reducing hospital reliance.
The growing need to address mental health after emergencies has also led to the inclusion of mental health coverage in many new health insurance plans. These plans offer counseling services, psychiatric treatment, and coverage for mental health needs, providing families with easier access to expert care without the stigma or financial burden.
To make handling emergencies easier, digital health insurance platforms provide 24/7 assistance, allowing individuals to track claims, access policy details, and find nearby hospitals in their network. This digital setup helps in urgent medical situations when multiple family members need assistance.
In conclusion, health insurance has evolved to become a safety net for life’s toughest moments, aiming to reduce stress, make healthcare more accessible, and shield families from surprise expenses. By understanding how these modern family health plans work, families can choose a plan that provides the necessary support during unexpected emergencies. Chola MS Health Insurance, for example, offers family health solutions that combine full coverage, cashless treatments, and advanced care options, ensuring families are prepared for real-life crises with trust and support.
Nobody Wants to Find a New Doctor
The article from Bloomberg highlights the challenges of finding a new doctor in the United States. With the rise of consumerism in healthcare, patients are increasingly expecting a more personalized and convenient experience. However, the process of finding a new doctor remains frustrating and time-consuming.
According to a survey, 75% of patients consider finding a new doctor to be a “hassle,” and 45% say it’s “very difficult” to find one. This is largely due to the lack of transparency and information available to patients. Online reviews and ratings are often unreliable, and patients may not know what questions to ask or what factors to consider when evaluating a doctor.
The article notes that the healthcare industry has been slow to adapt to changing consumer expectations. Unlike other industries, such as retail or hospitality, healthcare has not invested heavily in digital platforms and user experience. As a result, patients are often left to navigate a complex and confusing system on their own.
The consequences of this are significant. Patients may delay seeking care or settle for a doctor who is not a good fit, leading to poor health outcomes and higher costs. The article cites a study that found that patients who have a strong relationship with their primary care physician are more likely to adhere to treatment plans and have better health outcomes.
To address these challenges, some healthcare providers and startups are developing new platforms and tools to help patients find and connect with doctors. These platforms use data and analytics to match patients with doctors based on their individual needs and preferences. They also provide more detailed information about doctors, including their specialty, experience, and patient reviews.
However, these solutions are not yet widely available, and the healthcare industry has a long way to go in terms of improving the patient experience. The article concludes that finding a new doctor should not be a daunting task, and that patients deserve better. By investing in digital platforms and user experience, healthcare providers can make it easier for patients to find the right doctor and receive high-quality care. Ultimately, this will lead to better health outcomes and a more patient-centered healthcare system.
Recent Updates
Health insurers dodge Trump’s pricing crackdown, for now – Politico
The Trump administration’s efforts to increase transparency in healthcare pricing have hit a roadblock, as health insurers have found ways to circumvent the rules. The administration had introduced a rule requiring insurers to disclose their negotiated rates with healthcare providers, in an effort to promote competition and lower costs. However, insurers have exploited loopholes in the rule, rendering it ineffective.
The rule, which was introduced in 2020, aimed to shed light on the secretive process of healthcare pricing, where insurers negotiate rates with providers behind closed doors. By making these rates public, the administration hoped to create a more transparent market, where consumers could make informed decisions about their healthcare. However, insurers have found ways to skirt the rule, by disclosing only a small portion of their negotiated rates or by using complex language to obscure the true costs.
One of the main ways insurers are dodging the rule is by disclosing only a limited range of rates, rather than the actual negotiated rates. For example, an insurer might disclose the minimum and maximum rates they pay for a particular procedure, but not the actual rate they pay for each individual provider. This makes it difficult for consumers to determine the true cost of care. Additionally, insurers are using complex language and coding systems to make it hard for consumers to understand the rates they are disclosing.
The lack of enforcement from the Biden administration has also contributed to the insurers’ ability to dodge the rule. The administration has not taken significant action to penalize insurers for non-compliance, and has instead focused on other healthcare priorities. This has given insurers little incentive to comply with the rule, and has allowed them to continue to keep their negotiated rates secret.
The consequences of the insurers’ actions are significant, as consumers are being kept in the dark about the true costs of their healthcare. This lack of transparency can lead to surprise medical bills and higher costs for consumers, as they are unable to make informed decisions about their care. The administration’s efforts to promote transparency in healthcare pricing have been undermined, and it remains to be seen whether they will take further action to enforce the rule and bring greater transparency to the healthcare industry.
As Federal Health Care Subsidies Expire, State and City Efforts Aim to Lower Insurance Costs – baystatebanner.com
As federal healthcare subsidies are set to expire, state and city efforts are underway to lower insurance costs for individuals and families. The American Rescue Plan Act (ARPA) provided temporary subsidies to make health insurance more affordable, but these subsidies are slated to end in 2023. To mitigate the potential fallout, states and cities are exploring alternative solutions to reduce the financial burden of healthcare on their residents.
In Massachusetts, for example, the state has implemented a program to provide financial assistance to residents who purchase health insurance through the state’s health insurance marketplace. The program, known as the “ConnectorCare” program, offers subsidized health plans to low- and moderate-income individuals and families. Similarly, the city of New York has launched its own health insurance program, “NYC Care,” which provides low-cost health insurance to residents who are not eligible for traditional health insurance programs.
Other states, such as California and Maryland, are also taking steps to reduce health insurance costs. California has expanded its Medicaid program to cover more low-income residents, while Maryland has established a reinsurance program to help stabilize the individual health insurance market. These efforts aim to reduce the number of uninsured individuals and families, while also controlling healthcare costs.
City and state governments are also working to enhance healthcare affordability by promoting transparency and competition in the healthcare market. For instance, some cities are requiring hospitals and healthcare providers to disclose their prices and costs, allowing consumers to make informed decisions about their care. Additionally, states are encouraging competition among health insurance companies by establishing public options or “public exchanges” where individuals can purchase health insurance.
While these state and city efforts are laudable, they may not be enough to fully offset the loss of federal subsidies. The expiration of ARPA subsidies could lead to a significant increase in health insurance premiums, making it difficult for many individuals and families to afford coverage. To address this challenge, policymakers are calling for federal action to extend or make permanent the ARPA subsidies, ensuring that health insurance remains affordable for all Americans.
In conclusion, as federal healthcare subsidies expire, state and city governments are working to lower insurance costs through innovative programs and policies. While these efforts are crucial, they must be supplemented by federal action to ensure that health insurance remains affordable and accessible to all. By promoting transparency, competition, and affordability in the healthcare market, policymakers can help reduce the financial burden of healthcare on individuals and families, ultimately improving health outcomes and reducing healthcare disparities.
Honolulu doctors are now opting out of the traditional healthcare system, choosing not to accept health insurance and instead, are directly billing patients for their services.
A father-daughter medical practice in Honolulu is revolutionizing the way they provide healthcare by cutting out the middle man – health insurance companies. Dr. Curtis Takemoto-Gentile and his daughter Dr. Krishanna Takemoto-Gentile have adopted a direct primary care model, where patients pay a monthly fee for better access to the doctor. This approach allows them to focus on quality over quantity, spending more time with each patient and providing personalized care.
The decision to switch to this model was driven by the rising costs and regulations associated with traditional healthcare. The doctors felt that the pressure to see more patients in less time was compromising the quality of care they could provide. By not taking health insurance, they can now allocate more time to each patient, with appointments lasting 30 minutes instead of the usual 10-15 minutes.
The new model has been a game-changer for the doctors, who have gone from seeing 25 patients a day to just 10. This reduction in patient load has allowed them to reestablish meaningful relationships with their patients and provide better primary and preventive care. The membership fee for the practice is $200 per month for adults, with discounts available for teens and students. Members can still use their insurance to pay for referrals to specialists and medications at the pharmacy.
The Takemoto-Gentiles’ approach is not without its critics, who argue that the direct primary care model may not be accessible to everyone, particularly those who cannot afford the monthly fee. However, the doctors believe that their model is a more humane and sensible approach to healthcare, allowing them to provide high-quality care without the burden of insurance companies. In fact, this model is keeping them from burning out and allowing them to stay in the workforce longer.
The move to direct primary care comes at a time when Hawaii is facing a growing physician shortage. While some may criticize the model for reducing the number of patients the doctors can see, the Takemoto-Gentiles believe that their approach will ultimately lead to better health outcomes and more satisfied patients. As Dr. Curtis notes, “It’s not going to be for everybody, but it’s a nice option if you don’t want to wait nine months to see a primary care doctor for 10 minutes.”
As the quest for affordable health insurance continues, Americans are exploring various options to access quality healthcare without breaking the bank. With the rising costs of medical care, many individuals and families are struggling to find coverage that fits within their budgets. In response, some are turning to alternative solutions, such as short-term health plans, health sharing ministries, and community clinics, in an effort to obtain affordable health insurance.
The high cost of health insurance and healthcare is a significant burden for millions of Americans, making it difficult for them to afford necessary care for themselves and their families. The expiration of enhanced advance premium tax credits (APTCs) in December has led to a significant increase in health insurance costs, with some individuals and families facing premium increases of up to 15%. This has resulted in many people struggling to afford health insurance, with some being forced to drop their coverage altogether.
The failure of Congress to extend the enhanced APTCs has been cited as a major factor driving up health insurance costs. The APTCs, which were introduced as part of the Affordable Care Act (ACA), helped to make health insurance more affordable for low- and middle-income individuals and families. However, with the expiration of these credits, many people are now facing significantly higher premiums, making it difficult for them to afford health insurance.
Another factor driving up health insurance costs is the rising cost of medical care, including prescription drugs and hospital and physician care. Insurers are raising rates to keep up with these increasing costs, which is further exacerbating the problem of unaffordable health insurance. According to Gerard Anderson, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, insurers are concerned that people will drop their coverage when premiums go up, which will lead to a further increase in rates.
The impact of these changes is being felt across the country, with many individuals and families struggling to afford health insurance. According to Charles Gaba, a researcher who publishes data on Obamacare enrollment, insurance payments in each state and congressional district are estimated to be significantly higher in 2026 than in previous years. For example, a 50-year-old single adult earning $20,000 to $70,000 annually may face premium increases of up to 114% in some states.
The situation is particularly dire for those who are most vulnerable, including low-income individuals and families, and those with pre-existing medical conditions. The expiration of the enhanced APTCs has left many of these individuals without access to affordable health insurance, making it difficult for them to access necessary care.
In response to these challenges, some states are offering their own health insurance subsidies to help make coverage more affordable. For example, California, Connecticut, Illinois, New Jersey, New York, Pennsylvania, Rhode Island, and the District of Columbia are offering subsidies to help individuals and families afford health insurance. Additionally, some experts are calling for the extension of the enhanced APTCs to help make health insurance more affordable for low- and middle-income individuals and families.
Overall, the high cost of health insurance and healthcare is a significant challenge for millions of Americans, and it is essential that policymakers take action to address this issue. This can include extending the enhanced APTCs, increasing funding for Medicaid, and implementing other measures to make health insurance more affordable for low- and middle-income individuals and families. By taking these steps, we can help ensure that all Americans have access to affordable health insurance and necessary care, regardless of their income or health status.
Nunn: Extend enhanced health care tax credits as transition to repealing ACA – iowacapitaldispatch.com
U.S. Senator Tina Smith (D-MN) and Senator Jacky Rosen (D-NV) have introduced a bill to extend enhanced health care tax credits, which were established under the American Rescue Plan Act (ARPA). The enhanced credits, set to expire at the end of 2022, have made health insurance more affordable for millions of Americans. The proposed legislation aims to continue these credits as a crucial step towards ultimately repealing the Affordable Care Act (ACA) and replacing it with a more comprehensive healthcare system.
The enhanced tax credits have been instrumental in reducing healthcare costs for individuals and families, with over 3 million people gaining health insurance coverage since their implementation. The credits have also led to a significant decrease in the number of uninsured Americans, with the uninsured rate dropping to a historic low of 8.8% in 2022.
The bill introduced by Senators Smith and Rosen seeks to extend the enhanced tax credits for an additional two years, ensuring that individuals and families can continue to access affordable health insurance. This extension would provide stability and continuity in the healthcare market, allowing people to plan for their healthcare needs without the uncertainty of expiring credits.
Moreover, the proposed legislation is seen as a stepping stone towards more comprehensive healthcare reform. By extending the enhanced tax credits, lawmakers can buy time to develop and implement a more robust healthcare system that builds upon the successes of the ACA. This could include provisions such as a public option, improved affordability, and expanded access to healthcare services.
The push to extend the enhanced tax credits has garnered support from various healthcare advocacy groups, including the American Cancer Society Cancer Action Network, the American Heart Association, and the National Organization for Rare Disorders. These organizations recognize the importance of affordable healthcare in improving health outcomes and reducing healthcare disparities.
In conclusion, the proposed bill to extend enhanced health care tax credits is a crucial step towards ensuring that Americans have access to affordable health insurance. By continuing these credits, lawmakers can provide stability in the healthcare market and pave the way for more comprehensive healthcare reform. As the country moves towards repealing the ACA and replacing it with a more robust healthcare system, extending the enhanced tax credits is a vital intermediate step that will help protect the health and well-being of millions of Americans.
Insurers to charge 18% GST on agents’ commission, Input Tax Credit issue
The Indian government’s decision to reduce the Goods and Services Tax (GST) on health insurance premiums from 18% to 0% has had an unintended consequence on the insurance industry. Insurers are now imposing an 18% GST on commissions paid to agents and distributors to offset losses from the withdrawal of input tax credit (ITC). This move has come as a major blow to insurance intermediaries across the country.
The GST cut means that insurers can no longer claim ITC on commissions, rewards, and other corporate expenses such as rent, technology, and manpower. As a result, insurers are passing on the GST cost to agents and distributors, which could squeeze smaller distributors and individual agents. For example, if the commission for a sale is Rs 100, the amount payable will reduce by 18% to Rs 84.74.
Industry experts warn that this new structure could make health insurance distribution less profitable or unviable for many agents, unless companies revise commission structures or offer alternative incentives. While customers may gain marginally from lower premiums, the ripple effects are being felt sharply across the industry. Insurers face higher operating costs, and distributors face lower earnings.
The problem stems from how the GST framework treats exemptions. For a company to claim input tax credit, there must be a GST component on its output. With the health insurance sector’s GST set to nil, insurers lose this offset mechanism, and expenses on rent, IT systems, advertising, outsourcing, and agent commissions will add up as unrecoverable costs.
Several insurance companies, including Aditya Birla Health Insurance, Care Health Insurance, Star Health Insurance, and ICICI Lombard General Insurance, have acknowledged the challenge and are passing on the GST cost to distributors. They have reiterated their commitment to passing on the entire GST benefit to customers, but noted that the exemption benefits customers while simultaneously increasing operational costs for insurers. The companies have stated that they will absorb the impact of GST on expenses, but will pass on the GST on commissions to distributors to maintain equilibrium and protect customer interests.
Private medical insurance claims are increasing as City workers opt for quicker care.
The UK’s private medical insurance (PMI) market is experiencing a surge in claims, particularly for diagnostic tests and scans, as people seek to avoid lengthy NHS waiting lists. According to data from Howden, diagnostic tests and scans are the most common reason for claims across all age groups, except for those over 65. This trend is driven by the ongoing NHS waiting list crisis, with 7.31 million people waiting for treatment, including 1.7 million waiting for diagnostic tests.
The data, which analyzed claims from 2,000 people, found that mental health services are a key concern for younger people, with those aged 18-24 and 45-54 making the most claims for mental health support. Jon Carroll, executive director at Howden, noted that private medical insurance is not just about covering major illnesses, but also about addressing everyday health concerns and promoting overall wellbeing.
The data also revealed that male policyholders are more likely to make a claim (47%) than women (38%), and that younger people are almost three and a half times more likely to claim on their policy than older people. In fact, 57% of policyholders under 24 made at least one claim in the past five years, compared to just 17% of those aged 65 and over.
This trend is reflected in the growing number of people taking out private health insurance, with employer-provided coverage reaching a 30-year high of 4.8 million people, according to data from the Association of British Insurers (ABI). Health Secretary Wes Streeting has acknowledged the pressure on the NHS and has advocated for PMI as a way to help alleviate the burden. However, he has criticized a proposal by Reform UK to offer tax relief on private healthcare policies, which he claims would cost the country £1.7 billion.
Overall, the data suggests that private medical insurance is becoming an increasingly important option for people seeking to access timely and effective healthcare, particularly for diagnostic tests and mental health services. As the NHS continues to grapple with waiting list pressures, the demand for private healthcare is likely to continue to grow, with significant implications for the healthcare sector and policymakers.
Fraudulent health care scheme halted in Montana
The Commissioner of Securities and Insurance Office in Montana has helped to stop a multimillion-dollar billing scheme that targeted Native Americans on reservations. The scheme, which involved fraudulent claims through the Affordable Care Act, resulted in over $23.3 million in unjustified claims, with an additional $27 million pending. Commissioner James Brown announced that the investigation, which was conducted in cooperation with health insurers, tribal communities, and law enforcement, has led to the identification of at least 183 victims.
The scheme involved agents who preyed on vulnerable Native Americans, enticing them to disenroll from Medicaid and sign up for health insurance through the Affordable Care Act. The agents would then transport the victims to California, where they would be kept for 90 days and provided with “fake services.” The insurance company would then be billed $9,000 a day for 90 days, resulting in fraudulent claims of over $800,000 per person.
Brown described the scheme as “reprehensible” and stated that the victims were often exploited, coerced, and left stranded in California without a way to return home. He also noted that some victims have yet to be found. The investigation found that the agents used falsified records, unlicensed and out-of-state actors, and fabricated addresses to obtain coverage.
The Commissioner’s office worked with PacificSource, a nonprofit health insurance provider, to identify the suspicious activity and launch an investigation. The investigation supported the ability of the Centers for Medicare and Medicaid Services to approve the non-payment of fraudulent claims and rescind the policies. Brown praised the work of his team, stating that they have “zero tolerance for fraud” and are focused on consumer protection.
The scheme is not limited to Montana, with Arizona and Alaska also reporting similar incidents. Brown has alerted his counterparts and insurance providers in Washington and Wyoming to the scheme, warning that any state with a significant Native American population is a target. The Commissioner’s office is helping to re-enroll victims into Medicaid and is pursuing additional investigations. Brown encouraged Montanans to be wary of any agents advising disenrollment in Medicaid and recommending treatment programs in California through the Affordable Care Act.
Top Insurers With Maximum Grievances Revealed By Insurance Ombudsman: All You Need To Know
The Council of Insurance Ombudsman Annual Report 2023-24 has revealed a significant rise in complaints against health insurance companies in India. The report shows that the total number of complaints against health insurance companies increased by 21.7% in FY 2023-24, with 31,490 complaints, compared to 25,873 in FY 22-23. Private insurers accounted for the majority of complaints, with 26,064 grievances, while public sector insurers had 5,298 complaints.
Star Health & Allied Insurance topped the list with the highest number of complaints, with 13,308 grievances, of which 10,196 were related to claim repudiations. Other top insurers with high complaint numbers included CARE Health Insurance, Niva Bupa Health Insurance, National Insurance, and New India Assurance. The report also highlights that claim repudiation is the most common grievance, with the majority of complaints falling under this category.
The Insurance Regulatory and Development Authority of India (IRDAI) has responded to the rising dissatisfaction by mandating every insurer to appoint an Internal Ombudsman (IO) to review cases up to Rs 50 lakh that remain unresolved after 30 days or are rejected by insurers. However, experts argue that the independence of the IO is questionable since they report to the insurer’s top management, which may raise concerns about fairness and impartiality.
The report emphasizes the need for stronger accountability, transparency, and consumer protection in the health insurance sector. Policyholders are advised to look beyond premiums when buying health insurance and consider critical factors such as claim settlement ratio, repudiation rates, grievance redressal track record, and customer service quality. The IRDAI’s initiative to appoint an Internal Ombudsman is a step towards addressing the rising complaints, but its effectiveness and independence remain to be seen.
The Council for Insurance Ombudsmen (CIO) plays a crucial role in providing an alternative grievance redressal platform for policyholders. The CIO functions under the IRDA Act, 1999, and the Redressal of Public Grievances Rules, 1998, and is designed to provide a speedy and cost-effective mechanism to resolve disputes against insurance companies, intermediaries, or brokers. The report highlights the need for informed choices and stronger regulation to restore policyholder trust in the health insurance sector.
Health Insurance, Home Loans, and Preventive Care Benefits are the top demands of taxpayers.
As the Union Budget 2026-27 approaches, Expectations are high among salaried individuals, senior citizens, and high-income earners for significant changes in the new tax regime. With rising living costs, medical inflation, and housing expenses putting pressure on household budgets, tax experts believe the government has an opportunity to fine-tune the system to offer real relief without complicating compliance. The new tax regime, which is now the default option for taxpayers, still lacks key deductions that matter most to Indian families.
Tax professionals are urging the government to expand deductions under the new regime to make it more practical and attractive. Housing loan interest, medical insurance premiums, and retirement savings are at the top of the wish list. Experts suggest that simplifying the new tax regime by integrating key deductions, such as housing loan interest and medical insurance, would ease compliance burdens and provide equitable relief amid rising living costs.
Healthcare costs remain a major concern, with medical inflation in India standing between 11.5% and 14%, one of the highest in Asia. Experts are calling for stronger policy support, including higher public spending on healthcare and separate tax benefits for preventive healthcare. Introducing separate and enhanced tax benefits for outpatient services and preventive health screenings could encourage wider adoption of preventive care, particularly benefiting senior citizens.
High-income earners and family offices are also watching the budget closely, hoping for reforms around retirement savings, green investments, and GIFT City to support long-term wealth planning. Rationalizing surcharges, extending tax-neutral LLP reorganisations, and clarifying TDS on partners’ remuneration could streamline family office operations, fostering smoother wealth transfers across generations.
Market experts believe that a clearer and fairer tax structure could directly support economic growth by improving household consumption and savings. With the Finance Minister set to present the budget soon, taxpayers hope that the government will use this moment to strengthen financial security, promote insurance adoption, and make the new tax regime truly people-friendly. The budget is expected to strike a better balance between lower tax rates and essential incentives, especially for healthcare, housing, and long-term savings.
Senator Thune Faces Republican Pressure to Sidestep Democrats on Healthcare Legislation
Senator John Thune, a key Republican leader, is facing pressure from his party to bypass Democrats and push through a healthcare bill using a process called reconciliation. Reconciliation allows the Senate to pass legislation with a simple majority, rather than the usual 60-vote threshold, but it can only be used for budget-related measures. Thune, who is the chairman of the Senate Republican Conference, is being urged by some of his colleagues to use reconciliation to pass a healthcare bill that would repeal and replace the Affordable Care Act (ACA), also known as Obamacare.
The pressure on Thune comes after the Senate’s failure to pass a healthcare bill last year, despite having a Republican majority. The bill, which was drafted by Senate Majority Leader Mitch McConnell, failed to gain enough support from moderate Republicans, who were concerned about the impact of the bill on Medicaid and the number of people who would lose health insurance. Since then, Republicans have been trying to find a way to pass a healthcare bill, but have been unable to come up with a proposal that can gain enough support from both moderate and conservative Republicans.
Using reconciliation to pass a healthcare bill would allow Republicans to bypass Democratic opposition and pass a bill with just 50 votes, plus the tie-breaking vote of Vice President Mike Pence. However, the process is complex and has several limitations. For example, the bill would have to be budget-related, and would have to comply with the Senate’s “Byrd rule,” which prohibits provisions that are not primarily budget-related.
Thune has not committed to using reconciliation to pass a healthcare bill, but has said that he is open to exploring all options. He has also emphasized the need for Democrats to be involved in the process, and has expressed concerns about the potential consequences of passing a bill without bipartisan support. However, some Republicans are pushing for a more aggressive approach, and are urging Thune to use reconciliation to pass a bill as quickly as possible.
The pressure on Thune reflects the ongoing divisions within the Republican Party over healthcare policy. While some Republicans are eager to repeal and replace the ACA, others are more cautious and are concerned about the potential consequences of passing a bill without careful consideration. The debate over healthcare is likely to continue in the coming weeks and months, and it remains to be seen whether Republicans will be able to come up with a proposal that can gain enough support to pass.
Punjab Government to Launch Rs 10 Lakh Cashless Health Insurance Scheme in Partnership with United India Insurance
The Punjab government is set to launch a new health insurance scheme, ‘Mukh Mantri Sehat Yojna’ (MMSY), on January 15, 2026, which aims to provide cashless treatment up to ₹10 lakh per family per year to all residents of Punjab. The scheme, which will be launched by Chief Minister Bhagwant Singh Mann and AAP National Convenor Arvind Kejriwal, will cover all families, including government employees and pensioners, without any income cap or exclusion criteria.
The scheme is designed to be inclusive, and beneficiaries can enroll using their Aadhaar and voter ID cards. A helpline will be launched to facilitate the process, and beneficiaries will receive dedicated MMSY health cards. The scheme will provide comprehensive coverage through more than 2,000 selected treatment packages and will cover secondary and tertiary care across a network of 824 empaneled hospitals, including public, private, and government hospitals.
The United India Insurance Company has been selected to implement the scheme, which will provide coverage of ₹1,00,000 per family, while the State Health Agency (SHA) Punjab will provide coverage for treatment requirements between ₹1,00,000 and ₹10,00,000. The scheme adopts the latest Health Benefit Package (HBP 2.2) and will ensure faster claim settlements and reduced payment turnaround times.
The launch of the MMSY scheme is a significant milestone towards achieving Universal Health Coverage in Punjab, as promised by Chief Minister Bhagwant Singh Mann. The scheme is expected to provide health dignity and financial protection to every household in the state. With its comprehensive coverage and inclusive design, the MMSY scheme has the potential to make a significant impact on the health and well-being of the people of Punjab.
The scheme’s operational framework is designed to ensure seamless delivery of healthcare services, with a robust network of empaneled hospitals and a user-friendly enrollment process. The selection of United India Insurance Company brings the advantage of specialists to manage claim processing efficiently, ensuring faster claim settlements and reduced payment turnaround times. Overall, the MMSY scheme is a major step forward in providing quality healthcare to the people of Punjab, and its launch is eagerly anticipated.
Reform UK’s private health insurance plan is expected to come with a price tag of £1.7 billion, according to remarks to be made by Wes Streeting.
The UK’s Health Secretary, Wes Streeting, is set to criticize Reform UK’s policy of offering tax relief on private health insurance, estimating that it could cost the country £1.7 billion. Streeting will make the claim at a conference organized by the Fabian Society, a socialist thinktank aligned with the Labour party, and will describe the Reform proposal as a “tax cut for the wealthiest”. Reform UK had pledged to offer 20% tax relief on all private healthcare policies if it won power, claiming it would improve the standard of care and reduce demands on the NHS.
The policy has been criticized by Streeting, who argues that it would be a step towards an insurance-based healthcare system, where treatment is determined by a person’s ability to pay rather than their medical need. He will say that the NHS will be a major focus for Labour in the upcoming local elections, where Reform is predicted to make significant gains. Streeting will also accuse Reform of working in the interests of the powerful, rather than the people, and will defend the founding principles of the NHS, which include being a publicly funded public service, free at the point of use.
The estimate of the policy’s cost is based on data from the healthcare consultancy LaingBuisson, which values the UK private healthcare market at around £8.6 billion. The majority of private healthcare plans are paid for by businesses and offered to employees as a benefit in kind, with company healthcare plans worth around £5 billion and individual insurance worth around £3.6 billion. The government’s estimate assumes that Reform’s proposed 20% tax relief would be applied equally to company and individual private healthcare plans.
Streeting’s criticism of Reform’s policy is part of a broader effort by Labour to defend the NHS and its values. The party is expected to make the NHS a major focus of its campaign for the local elections, and will argue that Reform’s policies would undermine the principles of universal healthcare. The debate over the future of the NHS is likely to be a key issue in the upcoming elections, with Labour and Reform UK offering competing visions for the healthcare system.
The cost of average family job-based health insurance coverage has reached $27,000, a figure comparable to the price of a new car.
The ongoing federal shutdown, now in its fourth week, has brought attention to the rising costs of health insurance in the US. A recent report by KFF, a health information nonprofit, reveals that over 154 million people with employer-sponsored health insurance face significant price hikes. The average premium for family coverage has increased by 6% to $26,993 per year, marking the first time in two decades that costs have risen by 6% or more for three consecutive years.
The report also shows that the average annual premium for individual health plans provided by employers has increased by 5% to $9,325. This is nearly $3,000 higher than in 2016. The cost of family coverage is now equivalent to the price of a new Toyota Corolla hybrid. Workers are also shouldering a larger burden, with the average worker contributing $1,440 for individual coverage or $6,850 for family coverage.
The rising costs are attributed to increasing drug and hospital costs, which show no signs of slowing down. Employers are responding by shifting costs to their workers, who are already feeling the pinch. The survey found that nearly half of large employers said their employees have “moderate” or “high” concerns about their level of cost sharing.
The report highlights the challenges faced by small businesses, which struggle to absorb the rising costs of health insurance. Eric Trump, controller at Steve Reiff Inc., a small company in Indiana, noted that his company’s health insurance costs rose 8% for the 2026 fiscal year, and that about half of its employees decline the insurance due to the high costs.
The issue of rising health insurance costs has received little attention on Capitol Hill, despite its significant impact on millions of Americans. The federal government’s shutdown has been sparked by a stalemate over the cost of health insurance for 22 million Americans on Affordable Care Act plans. The KFF report is based on a survey of 1,862 randomly selected nonfederal public and private employers with 10 or more workers. As the cost of health insurance continues to rise, it remains to be seen how employers and employees will respond, and what solutions will be implemented to address this growing concern.
Trump Unveils Outline of New Health Care Plan – Infectious Disease Advisor
President Trump has unveiled an outline of his new healthcare plan, aiming to replace the Affordable Care Act (ACA), also known as Obamacare. The plan, which has been in the works for several months, is designed to provide more affordable and flexible healthcare options for Americans. Here are the key points of the new plan:
Repeal and Replace Obamacare: The plan seeks to repeal the ACA and replace it with a new system that gives states more control over healthcare. The ACA, which was enacted in 2010, has been a contentious issue, with many Republicans arguing that it is too costly and restrictive.
Key Components: The new plan has several key components, including:
- Health Savings Accounts (HSAs): The plan expands the use of HSAs, which allow individuals to save money tax-free for medical expenses.
- Association Health Plans (AHPs): AHPs would allow small businesses and individuals to band together to purchase health insurance, potentially lowering costs.
- Short-Term Limited-Duration Insurance (STLDI): The plan would expand the use of STLDI, which provides temporary health insurance coverage for individuals who are between jobs or waiting for other coverage to begin.
- State Innovation Waivers: The plan would give states more flexibility to innovate and experiment with new healthcare models, such as Medicaid block grants.
Goal of Increased Competition: The plan aims to increase competition in the healthcare market, which would drive down costs and improve quality. By giving states more control and allowing for more flexibility in health insurance options, the plan seeks to create a more dynamic and responsive healthcare system.
Criticism and Next Steps: The plan has already faced criticism from Democrats and some healthcare experts, who argue that it would lead to higher costs and reduced access to care for vulnerable populations. The plan is still in the outline stage, and it will need to be fleshed out and passed by Congress before it can become law.
Overall, the new healthcare plan outlined by President Trump represents a significant shift in the approach to healthcare in the United States. While it aims to provide more affordable and flexible options, it also raises concerns about access and affordability for certain populations. As the plan moves forward, it will be important to monitor its development and evaluate its potential impact on the healthcare system.
Big Insurers Attempt to Redirect Blame for Exorbitant Health Costs to Hospitals and Pharmaceutical Companies – The New York Times
The healthcare industry is witnessing a blame game between big insurers, hospitals, and pharmaceutical companies over high health costs. Major insurance companies, such as UnitedHealth Group and Anthem, are attempting to shift the blame for rising healthcare costs to hospitals and drug makers. This comes as the industry faces increasing scrutiny from policymakers and consumers over the escalating costs of medical care.
Insurers argue that hospitals and pharmaceutical companies are driving up costs through their pricing practices. They claim that hospitals are charging excessively high rates for their services, while drug makers are setting prices for their products that are unsustainable for the healthcare system. Insurers point to data showing that hospital prices have increased significantly in recent years, with some hospitals charging two or three times what others charge for the same services.
On the other hand, hospitals and pharmaceutical companies counter that insurers are attempting to deflect attention from their own role in driving up healthcare costs. They argue that insurers are imposing strict limits on coverage and reimbursement, forcing hospitals and doctors to charge more to make up for the shortfall. Additionally, pharmaceutical companies point out that insurers often dictate which drugs are covered and at what price, limiting the ability of manufacturers to set competitive prices.
Industry experts note that the true causes of high health costs are complex and multifaceted. Factors such as an aging population, increased utilization of healthcare services, and advancements in medical technology all contribute to rising costs. Moreover, the consolidation of hospitals and health systems has led to increased market power, enabling them to negotiate higher prices with insurers.
The finger-pointing between insurers, hospitals, and pharmaceutical companies highlights the need for a more comprehensive approach to addressing high healthcare costs. Policymakers are exploring various solutions, including price transparency, value-based payment models, and increased competition in the healthcare market. Ultimately, a collaborative effort from all stakeholders will be necessary to bring down healthcare costs and ensure affordable access to quality care for all Americans.
As the debate continues, consumers are left to navigate a complex and often confusing healthcare system. With insurers, hospitals, and pharmaceutical companies pointing fingers at each other, it remains to be seen whether meaningful reforms will be implemented to address the root causes of high healthcare costs. One thing is certain, however: the status quo is unsustainable, and creative solutions will be necessary to make healthcare more affordable and accessible for all.
Lowering prices may not be enough to reduce healthcare expenditures.
The Centers for Medicare & Medicaid Services (CMS) has released the 2024 National Health Expenditure (NHE) report, which shows that US health spending grew 7.2% to $5.3 trillion, accounting for 18.0% of the country’s gross domestic product. This increase has led to concerns that healthcare is too expensive and that prices must be reduced. However, the report suggests that the issue is more complex, and that the increase in spending is largely driven by non-price factors such as higher demand and shifts in the mix of goods and services.
The concept of the Jevons paradox, which states that improving efficiency can lead to increased consumption, is relevant to understanding the healthcare spending trend. In the 19th century, economist William Stanley Jevons observed that improving the efficiency of coal use led to increased coal consumption, as the lower cost made it more accessible and widely used. Similarly, in healthcare, improvements in efficiency, such as reduced administrative burdens and increased access to care, can lead to increased utilization and spending.
The CMS report highlights that private health insurance enrollment, Affordable Care Act Marketplace enrollment, and total private health insurance spending all increased, contributing to the growth in healthcare spending. Additionally, Medicare and Medicaid spending also grew, with hospital prices rising 3.4%, the fastest rate since 2007. However, the report notes that high insurance coverage does not necessarily equate to high-quality, high-value care, but it does increase the probability that people will seek care and follow through on care plans.
The key takeaway from the report is that aggregate spending is not a standalone scorecard, and that the increase in spending can be attributed to two different realities: a system that is becoming wasteful or a system that is removing barriers and meeting previously unmet needs. To understand the true impact of healthcare spending, it is essential to examine the compositional changes in care, such as the types of services being utilized, the quality of care, and the outcomes achieved.
Innovations that make healthcare easier, such as automation, AI-enabled workflow, and virtual-first access, can have unpredictable fiscal signatures, reducing the cost of an encounter while increasing the number of encounters. Therefore, it is crucial to consider potential outcomes more broadly and carefully before reacting with austerity measures. The Jevons paradox suggests that we should expect utilization to respond to improvements in efficiency, and that spending numbers should be read as a map of shifting demand, rather than a simple verdict on whether the system is “working.” Ultimately, the US healthcare system is exceptionally good at turning access, coverage, and innovation into utilization, and the NHE 2024 release is a reminder that making care easier will lead to increased use.
9 Best Countries for Healthcare (Important Info for Expats)
Singapore: Known for its high-quality healthcare system, Singapore offers excellent medical facilities and highly trained doctors. The country has a well-organized healthcare system, with both public and private hospitals providing top-notch care.
Switzerland: Switzerland boasts a highly developed healthcare system, with a wide range of medical facilities and specialized treatments available. The country is also home to many international health organizations, including the World Health Organization.
Japan: Japan’s healthcare system is renowned for its high standards, with a strong emphasis on preventative care. The country has a large number of high-quality hospitals and medical facilities, and its doctors are highly trained.
Sweden: Sweden’s healthcare system is known for its equality and accessibility, with everyone having access to high-quality medical care regardless of income. The country also has a strong focus on preventative care and health promotion.
Canada: Canada’s healthcare system is publicly funded and provides comprehensive coverage to all citizens. The country has a high standard of medical care, with well-equipped hospitals and highly trained doctors.
Germany: Germany has a well-regarded healthcare system, with a wide range of medical facilities and specialized treatments available. The country is also home to many world-class hospitals and research institutions.
Australia: Australia’s healthcare system is known for its high standards, with a strong emphasis on preventative care. The country has a large number of high-quality hospitals and medical facilities, and its doctors are highly trained.
Netherlands: The Netherlands has a well-organized healthcare system, with a strong focus on preventative care and health promotion. The country also has a high standard of medical care, with well-equipped hospitals and highly trained doctors.
New Zealand: New Zealand’s healthcare system is publicly funded and provides comprehensive coverage to all citizens. The country has a high standard of medical care, with well-equipped hospitals and highly trained doctors, and a strong emphasis on preventative care and health promotion.
Singapore: Known for its high-quality healthcare system, Singapore offers excellent medical facilities and highly trained doctors. The country has a well-organized healthcare system, with both public and private hospitals providing top-notch care.
Switzerland: Switzerland boasts a highly developed healthcare system, with a wide range of medical facilities and specialized treatments available. The country is also home to many international health organizations, including the World Health Organization.
Japan: Japan’s healthcare system is renowned for its high standards, with a strong emphasis on preventative care. The country has a large number of high-quality hospitals and medical facilities, and its doctors are highly trained.
Sweden: Sweden’s healthcare system is known for its equality and accessibility, with everyone having access to high-quality medical care regardless of income. The country also has a strong focus on preventative care and health promotion.
Canada: Canada’s healthcare system is publicly funded and provides comprehensive coverage to all citizens. The country has a high standard of medical care, with well-equipped hospitals and highly trained doctors.
Germany: Germany has a well-regarded healthcare system, with a wide range of medical facilities and specialized treatments available. The country is also home to many world-class hospitals and research institutions.
Australia: Australia’s healthcare system is known for its high standards, with a strong emphasis on preventative care. The country has a large number of high-quality hospitals and medical facilities, and its doctors are highly trained.
Netherlands: The Netherlands has a well-organized healthcare system, with a strong focus on preventative care and health promotion. The country also has a high standard of medical care, with well-equipped hospitals and highly trained doctors.
New Zealand: New Zealand’s healthcare system is publicly funded and provides comprehensive coverage to all citizens. The country has a high standard of medical care, with well-equipped hospitals and highly trained doctors, and a strong emphasis on preventative care and health promotion.
Comparing healthcare systems internationally is a valuable tool for identifying areas of strength and weakness. These comparisons often evaluate various aspects of healthcare, including the delivery of care, patient outcomes, healthcare expenditures, mortality rates, and access to preventive care. However, it’s challenging to determine the “best” healthcare system using a single metric, as each country has its unique priorities and strengths.
Rankings can provide insights into different healthcare systems, but they don’t necessarily define which system is superior. For instance, some countries may excel in cost control, while others may prioritize access to care or innovation in medical treatments. Despite these differences, there are common characteristics that unite top-performing healthcare systems. These include universal access to healthcare, strong primary care, and a commitment to providing high-quality medical care.
Universal access ensures that all citizens have access to necessary healthcare services, regardless of their income or social status. Strong primary care is also crucial, as it provides a foundation for preventive care, early intervention, and management of chronic conditions. A commitment to quality medical care is equally important, as it ensures that patients receive evidence-based treatments and have access to the latest medical technologies and innovations.
Ultimately, the best healthcare system depends on a country’s priorities and values. While some countries may prioritize cost control, others may focus on providing comprehensive coverage and access to care. By studying international health comparisons and identifying best practices, countries can learn from each other and improve their own healthcare systems. By doing so, they can provide better care to their citizens and improve overall health outcomes. This article was created with the help of AI technology and thoroughly fact-checked and edited to ensure accuracy and reliability.
Health insurance CEOs to testify before House committees amid rising premium costs
The CEOs of five major health insurance companies, including UnitedHealth Group, CVS Health, and Cigna, are set to testify before two House committees on Thursday, facing questions about rising healthcare costs. The hearings come after Republicans allowed enhanced Affordable Care Act (ACA) subsidies to expire, leading to sharp premium increases for millions of Americans. Despite the urgency of the issue, Congress has few immediate plans to address the lapse in tax credits, and the odds of passing a bill to lower premiums anytime soon are slim.
The hearings are expected to focus on the “root causes” of higher healthcare prices, with Republicans blaming the ACA for driving up costs. However, experts argue that the expired enhanced ACA tax credit is the main culprit behind the current affordability crisis. Gideon Lukens, a senior fellow at the Center on Budget and Policy Priorities, said that the ACA fixed issues around coverage for people with pre-existing conditions and made the insurance market “functional and stable.”
Insurers, on the other hand, argue that premium hikes reflect rising costs elsewhere in the healthcare system, particularly hospital and prescription drug costs. Stephen Hemsley, CEO of UnitedHealth Group, plans to tell lawmakers that insurers “compete aggressively” to keep premiums affordable, but the cost is largely determined by the broader healthcare system. David Joyner, CEO of CVS Health, said that the company helps families struggling with the rising cost of healthcare, driven by factors such as greater demand for care, growing medical provider costs, and high prices for hospital care and prescription drugs.
The hearings are seen as an attempt by Republicans to shift blame for rising healthcare costs away from their own policies and onto the insurance companies. President Donald Trump has also rolled out a healthcare plan that includes redirecting funding for ACA subsidies into health savings accounts, but the plan has drawn criticism for lacking details and restating previous ideas. With the Senate out this week and the House set to go into recess next week, it is unlikely that any meaningful legislation will be passed to address the issue of rising healthcare costs.
Bajaj General Insurance Introduces Fetal Health Insurance Rider
Bajaj General Insurance has introduced a new insurance rider called Fetal Flourish, designed to provide financial support for advanced fetal care during pregnancy. The rider is offered in conjunction with the company’s health insurance products, My Health Care Plan and Health Guard. Fetal Flourish focuses on covering specialized medical interventions required before birth, including in-utero procedures and high-risk pregnancies.
The key features of the rider include coverage of up to Rs. 2 lakh per maternity event for the first two events, coverage for 16 specialized in-utero procedures, and eligibility for women aged 18 to 45 years. There is a nine-month waiting period from the start of the policy. The covered procedures include tests and surgeries such as amniocentesis, fetoscopic laser surgery, fetal reduction, and intrauterine transfusion.
According to Dr. Tapan Singhel, MD & CEO of Bajaj General Insurance, the Fetal Flourish rider aims to ease the financial burden on families facing medical complexities during pregnancy. The company believes that care and protection should begin at the earliest stage of life, and this rider reflects that commitment. By providing financial support for essential procedures, parents can focus on treatment and outcomes rather than costs.
The introduction of Fetal Flourish is a significant development in the insurance industry, as it addresses a critical need for specialized fetal care during pregnancy. With advances in medical technology, it is now possible to intervene earlier and improve outcomes, but the financial strain can be significant. Bajaj General Insurance’s new rider helps to bridge this gap, providing families with the financial support they need to access specialized care.
Overall, the Fetal Flourish rider is a welcome innovation in the insurance industry, and it is likely to be well-received by families who are planning to start or expand their families. By providing financial support for advanced fetal care, Bajaj General Insurance is helping to ensure that parents can access the best possible care for their unborn children, without worrying about the financial implications.
International Comparison of Health Systems
The performance of healthcare systems varies significantly across countries. Factors such as access to care, quality of care, and health outcomes are often used to compare health systems internationally.
Key Indicators:
- Life Expectancy: Average number of years a person is expected to live.
- Infant Mortality Rate: Number of deaths per 1,000 live births.
- Mortality Amenable to Healthcare: Deaths from conditions that are treatable with timely and effective healthcare.
- Patient Satisfaction: Patients’ perceived quality of care and satisfaction with healthcare services.
- Healthcare Spending: Percentage of GDP spent on healthcare.
Country Comparison:
- United States:
- High healthcare spending (17.1% of GDP)
- Average life expectancy (78.7 years)
- High infant mortality rate (5.8 per 1,000 live births)
- Canada:
- Universal healthcare system
- Lower healthcare spending (10.4% of GDP)
- Higher life expectancy (81.9 years)
- Lower infant mortality rate (4.5 per 1,000 live births)
- United Kingdom:
- National Health Service (NHS) provides universal coverage
- Lower healthcare spending (9.8% of GDP)
- Higher life expectancy (80.7 years)
- Lower infant mortality rate (3.9 per 1,000 live births)
- Australia:
- Mixed public-private healthcare system
- Higher healthcare spending (9.5% of GDP)
- Higher life expectancy (82.5 years)
- Lower infant mortality rate (3.2 per 1,000 live births)
- Japan:
- Universal healthcare system
- High life expectancy (84.7 years)
- Low infant mortality rate (2.1 per 1,000 live births)
- High healthcare spending (11.4% of GDP)
Common Challenges:
- Aging Populations: Increasing demand for healthcare services.
- Rising Healthcare Costs: Balancing quality and affordability.
- Health Inequalities: Disparities in access to care and health outcomes.
- Workforce Shortages: Attracting and retaining healthcare professionals.
Best Practices:
- Primary Care: Emphasizing preventive care and community-based services.
- Integrated Care: Coordinating care across settings and providers.
- Patient-Centered Care: Focusing on patient needs and preferences.
- Innovative Technologies: Leveraging digital health and data analytics to improve care.
- High healthcare spending (17.1% of GDP)
- Average life expectancy (78.7 years)
- High infant mortality rate (5.8 per 1,000 live births)
- Universal healthcare system
- Lower healthcare spending (10.4% of GDP)
- Higher life expectancy (81.9 years)
- Lower infant mortality rate (4.5 per 1,000 live births)
- National Health Service (NHS) provides universal coverage
- Lower healthcare spending (9.8% of GDP)
- Higher life expectancy (80.7 years)
- Lower infant mortality rate (3.9 per 1,000 live births)
- Mixed public-private healthcare system
- Higher healthcare spending (9.5% of GDP)
- Higher life expectancy (82.5 years)
- Lower infant mortality rate (3.2 per 1,000 live births)
- Universal healthcare system
- High life expectancy (84.7 years)
- Low infant mortality rate (2.1 per 1,000 live births)
- High healthcare spending (11.4% of GDP)
The United States spends significantly more on healthcare per person compared to other high-income countries. In 2020, the US spent 19.5% of its GDP on healthcare, which is substantially higher than other peer countries. This gap has been widening over the past five decades, with the US spending about 7% of its GDP on healthcare in 1970, similar to other comparable countries. The main drivers of high healthcare spending in the US are inpatient and outpatient care, prescription drugs, and administrative costs.
The US spends more on inpatient and outpatient care, with Americans spending $8,353 per person on these services, compared to $3,636 in peer countries. This is driven more by higher prices rather than higher utilization of care. The cost of prescription drugs is also higher in the US, with the country spending $1,765 per capita on prescription drugs and other medical goods. Additionally, administrative costs are much higher in the US, with the country spending $1,078.44 per capita on administrative expenses.
The US also spends more on preventive care, with spending in this category more than doubling between 2019 and 2020. However, the only area where the US spends less than peer countries is on long-term care, with spending in this category declining by 4.9% between 2020 and 2021.
The high healthcare spending in the US is not necessarily translating to better health outcomes. The country’s healthcare system is complex and multifaceted, with many factors contributing to its high costs. To reduce healthcare spending, policymakers may need to address issues such as high prices, administrative inefficiencies, and the cost of prescription drugs. By understanding the drivers of high healthcare spending, policymakers can develop targeted solutions to reduce costs and improve the overall efficiency of the healthcare system.
It’s worth noting that the US healthcare system is unique compared to other countries, with a mix of private and public payers, and a complex network of providers and insurers. This complexity can contribute to higher administrative costs and inefficiencies in the system. However, by learning from other countries and implementing policies to reduce costs and improve efficiency, the US can work towards a more sustainable and effective healthcare system.
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The healthcare industry is experiencing a significant transformation with the introduction of technologically advanced products and services by startups. Despite being governed by regulations, these startups are revolutionizing the sector by leveraging technologies like artificial intelligence, blockchain, and data analysis to disrupt inefficient processes. As a result, healthcare professionals can now access patient information more easily, detect diseases early, and promote healthier habits.
Some notable healthcare startups include Verily, which develops digital health tools for disease detection and prevention, and Tempus, which creates data-harnessing technology to personalize cancer treatment. Other startups like GRAIL, Zocdoc, and Strata are also making significant contributions to the industry. GRAIL focuses on cancer diagnosis, Zocdoc provides a platform for patients to find medical providers, and Strata develops SaaS solutions for finance analytics and business intelligence.
These startups are redefining the relationships between healthcare professionals and patients by utilizing digital information and resources. They are also improving patient outcomes, reducing costs, and enhancing the overall healthcare experience. For instance, K Health provides an AI-powered symptom checker, while Headspace offers meditation and mindfulness exercises to promote mental well-being.
Other startups, such as RethinkFirst, PatientPoint, and Nourish, are addressing specific needs in the healthcare sector, including behavioral health, patient engagement, and nutrition. Additionally, companies like Arcadia, Flatiron, and SOPHiA GENETICS are working on big data, cancer care, and genomic analytics.
The healthcare startup ecosystem is diverse, with companies like Alector, Kalderos, and WHOOP working on neurodegenerative diseases, pharmaceuticals, and wearable technology. Others, such as Spring Health, Gusto, and Healthee, are focused on telehealth, benefits management, and employee benefits.
In conclusion, the healthcare startup landscape is rapidly evolving, with innovative companies introducing new products and services to improve patient care, reduce costs, and enhance the overall healthcare experience. These startups are leveraging cutting-edge technologies to disrupt traditional processes and create a more efficient, patient-centric healthcare system. With the pace of innovation accelerating, it will be exciting to see the impact these startups have on the future of healthcare.
The list of startups provided showcases the breadth of innovation in the healthcare industry, with companies working on various aspects of healthcare, including mental health, telehealth, and medical devices. As the healthcare industry continues to evolve, it is likely that we will see even more innovative solutions emerge, driven by the creative and innovative spirit of these startups.
Overall, the healthcare startup ecosystem is thriving, with companies like MedTrans Go, eClinical Solutions, and TigerConnect working on telehealth, clinical trials, and collaboration platforms. The future of healthcare looks promising, with these startups at the forefront of innovation and transformation.
In the next few years, we can expect to see even more exciting developments in the healthcare startup space, with a focus on emerging technologies like AI, blockchain, and the Internet of Things (IoT). As these technologies continue to mature, we can expect to see even more innovative solutions emerge, transforming the healthcare industry and improving patient outcomes.
The healthcare startup landscape is constantly evolving, with new companies emerging and existing ones expanding their offerings. With the demand for innovative healthcare solutions continuing to grow, it is likely that we will see even more investment in the healthcare startup space, driving further innovation and transformation.
As the healthcare industry continues to shift towards a more patient-centric, technology-driven model, startups will play an increasingly important role in shaping the future of healthcare. With their innovative spirit, creative solutions, and commitment to improving patient outcomes, these startups are poised to make a significant impact on the healthcare industry in the years to come.
In conclusion, the healthcare startup ecosystem is a vibrant and dynamic space, with companies working on a wide range of innovative solutions to improve patient care and transform the healthcare industry. As the industry continues to evolve, it will be exciting to see the impact these startups have on the future of healthcare.
The future of healthcare is bright, with startups like these leading the way in innovation and transformation. As we look to the future, it is clear that the healthcare industry will continue to be shaped by the creative and innovative spirit of these startups, driving better patient outcomes, improving the overall healthcare experience, and transforming the industry as a whole.
The healthcare startup landscape is a rapidly evolving space, with new companies emerging and existing ones expanding their offerings. With the demand for innovative healthcare solutions continuing to grow, it is likely that we will see even more investment in the healthcare startup space, driving further innovation and transformation.
As the healthcare industry continues to shift towards a more patient-centric, technology-driven model, startups will play an increasingly important role in shaping the future of healthcare. With their innovative spirit, creative solutions, and commitment to improving patient outcomes, these startups are poised to make a significant impact on the healthcare industry in the years to come.
In the end, the healthcare startup ecosystem is a vibrant and dynamic space, with companies working on a wide range of innovative solutions to improve patient care and transform the healthcare industry. As the industry continues to evolve, it will be exciting to see the impact these startups have on the future of healthcare.
North Korea is preparing to transition from its current free care system to a mandatory medical insurance program.
North Korea is planning to transition from its nominally free healthcare system to a medical insurance model. The regime has assigned the task of rebuilding the healthcare system to the Cabinet’s Health Ministry and Workers’ Party departments. The new system will require employees at various agencies and enterprises to enroll in medical insurance, with premiums deducted from their monthly wages. The regime is also considering allowing North Koreans without an official workplace to receive insurance benefits through working family members who are insured.
The introduction of medical insurance represents a shift from the state covering the entirety of medical expenses to a system in which costs are split with individuals. People enrolled in basic insurance will receive basic treatment at prices set by the state, but out-of-pocket costs may increase for hospitalization or specialized treatment. The regime is also planning to issue “social security medical insurance cards” to manage individuals’ medical history and treatment records.
The adoption of medical insurance is seen as a way to stabilize medical expenses and address the operational difficulties faced by new hospitals and pharmacies. The regime has concluded that the current system is not viable and has decided to introduce medical health insurance to address these challenges. The introduction of medical insurance may be connected to the vision of a “public health revolution” announced by North Korean leader Kim Jong Un.
The key variables in the new system will be the level of insurance premiums and the level of out-of-pocket spending for treatment and medication. The regime has not yet made concrete decisions on these matters, and struggling households and those without an official job may be skeptical about the introduction of medical insurance. Despite the introduction of medical insurance, the regime is expected to continue to espouse the socialist vision of free care, even as the country moves to a system of managed public health care based on medical insurance.
The use of medical insurance cards will enable the medical authorities to track treatment and integrate medical records at all levels, from neighborhood clinics to top-tier hospitals. This will give the authorities a top-down view of who has been treated, what treatment they’ve received, and where they got it. The introduction of medical insurance is a significant development in North Korea’s healthcare system, and its impact will depend on the details of the new system and how it is implemented.
Today marks the last day to enroll in Affordable Care Act (ACA) health plans in most states, as the deadline arrives without a subsidy deal in place.
The deadline to select an Affordable Care Act (ACA) health insurance plan has passed in most states, leaving millions of Americans to make difficult decisions about their health coverage. The expiration of federal subsidies at the start of the year has driven up health costs, and lawmakers are still debating how to address the issue. The subsidies, which were expanded during the COVID-19 pandemic, offset costs for over 90% of enrollees, but their expiration has left the average subsidized enrollee with more than double the monthly premium costs.
As a result, enrollment in ACA plans is lagging behind last year’s numbers, with approximately 22.8 million Americans having signed up so far, compared to a record 24 million last year. Many people are delaying signing up for coverage or signing up with plans they intend to cancel, as they wait to see what Congress will do. The uncertainty has been particularly challenging for small business owners, gig workers, farmers, and others who rely on marketplace plans for their health insurance.
In an effort to address the issue, the House passed a three-year extension of the subsidies, but the Senate has yet to take action. A bipartisan group of senators, led by Sen. Bernie Moreno, is working on a compromise proposal that would extend the enhanced subsidies for two years, while adding new limits on who can receive them. The proposal would also create a new health savings account option, which President Donald Trump and Republicans have expressed support for.
However, Democrats and Republicans have yet to agree on the details of the plan, including whether to impose new limits on state funding for abortion coverage. President Trump has also proposed redirecting ACA subsidies into health savings accounts, which Democrats have criticized as inadequate for offsetting health costs for most people.
The deadline for selecting an ACA plan has been extended to the end of the month in about 10 states that run their own marketplaces, giving residents more time to make decisions about their health coverage. The ongoing debate in Congress has left many Americans uncertain about their health insurance options, and the outcome of the negotiations will have a significant impact on the affordability and accessibility of healthcare for millions of people. As the situation continues to unfold, many are watching anxiously to see what the future holds for the ACA and the millions of Americans who rely on it for their health insurance.
Map: See Where ACA Health Insurance Enrollment Dropped in 2026
The disappearance of Affordable Care Act (ACA) subsidies has left millions of households facing significant increases in health insurance costs. According to a report by the Centers for Medicare & Medicaid, there are 1.4 million fewer people enrolled in insurance through ACA marketplaces compared to January 2025. This decline is most pronounced in states such as Florida, Ohio, North Carolina, and Georgia, where enrollment has dropped by over 260,000 people. The majority of states have reported a decline in enrollment, with only a few states like Texas and California seeing an increase.
The enhanced ACA subsidies, which were passed in 2021 and expired on December 31, made health insurance more affordable for low- and middle-income Americans. Without these credits, Americans in the marketplace may see their out-of-pocket premium costs more than double compared to last year. This has left many households feeling health insurance sticker shock, with experts warning that people may have to choose between paying their health insurance premiums or skimping on other essential expenses.
The White House has attributed the decline in enrollment to efforts to remove people who were improperly enrolled on highly-subsidized ACA plans. However, experts argue that the lapse of ACA credits will have significant consequences for patients and hospitals. Matthew Fiedler, a senior fellow at The Brookings Institution, notes that people may have less access to care, leading to worse health outcomes, and that many households’ financial security is at risk.
Analysts expect a steeper decline in ACA enrollment over the next few months, as people may drop coverage once they start receiving bills. The latest data only captures the number of people who selected a marketplace plan during open enrollment or were automatically renewed for their existing ACA coverage, but does not account for those who may have paid their health insurance premiums. A recent Congressional Budget Office report estimates that nearly 4 million Americans will lose or drop insurance over the next decade.
The lapse of ACA credits may also put more pressure on hospitals, as providers could see an influx of uninsured patients, and people may be less likely to seek care in the first place. Experts warn that this could have significant consequences for the healthcare system, particularly for facilities that are already financially fragile. As the debate over healthcare continues, lawmakers must consider the impact of their decisions on millions of Americans who rely on the ACA for access to affordable healthcare.
California bill aims to rein in mental health coverage denials that leave kids without care
California is facing a mental health crisis, particularly among its young people. A recent study found that 94% of those surveyed between the ages of 14 and 25 reported struggling with mental health challenges, and one-third rated their mental health as fair or poor. However, accessing mental health care is a significant challenge due to a lack of providers, defunding of Medicaid and Obamacare, and insurance companies denying care.
The Oakland-based advocacy group Children Now has consistently given California low grades for supporting kids’ mental health needs. To address this issue, state Senator Scott Wiener introduced the Health Insurance Accountability Act, which would require insurers to publicly disclose how often they deny care and face fines if their denials are overturned too often upon appeal.
The stakes are high, with inadequate access to mental health care services having a domino effect on families. Kaiser Permanente, the state’s largest health program, has been fined and cited repeatedly for its failure to provide sufficient mental health services. When someone is denied medical care, they can appeal, but the process is opaque and time-consuming, and most people don’t even attempt it.
A review of federal data found that fewer than 1% of denied claims are ever appealed, resulting in a massive financial win for insurers. The appeals process also disproportionately affects immigrant and English-second-language families, who are less likely to appeal their cases. However, when appeals do make it to the state level, patients are approved for the medical care they need 73% of the time, suggesting that insurers are engaging in widespread violations of state law.
Wiener’s bill aims to hold health plans accountable for unwarranted denials by requiring them to disclose denial rates and imposing fines for excessive denials. However, the bill’s prospects for passage are uncertain, with the health insurance lobby expected to push back. The California Association of Health Plans opposes the bill, citing concerns about duplicated reporting requirements and excessive penalties.
The issue of health care access is critical, particularly with expiring federal subsidies and skyrocketing premiums leading to a decline in Affordable Care Act enrollments. Officials say that reducing access to care is worrisome, especially for California’s kids and their mental health. Forcing insurers to make public their denial rates is a first step towards greater accountability, and Wiener’s bill is a crucial step in addressing the state’s mental health crisis.
The ‘Great Healthcare Plan’ Leaves Open Questions for People with Pre-existing Conditions
President Trump has announced a new healthcare framework aimed at lowering costs and holding insurance companies accountable. The plan, dubbed the “Great Healthcare Plan,” includes provisions that resemble those already in the Affordable Care Act (ACA), such as requiring hospitals and insurers to reveal prices and providing “plain-English” insurance coverage summaries. However, other aspects of the plan appear to be a departure from the ACA.
One notable provision is the proposal to “send the money directly to the American people,” which would allow individuals to use taxpayer-funded subsidies to purchase the health insurance of their choice. This could potentially be achieved through Health Savings Accounts (HSAs), but the details are unclear. Some Congressional Republicans have proposed expanding or funding HSAs, but these proposals vary significantly.
The plan’s implications for people with pre-existing conditions are uncertain, as it does not explicitly protect them. The framework leaves open key questions, such as who is eligible for financial help, how it would be calculated and dispersed, and whether the funds would be limited to out-of-pocket costs or used for premiums. Additionally, it is unclear whether the new financial support would be available only on the ACA Marketplaces or could be used to purchase health insurance that discriminates against people with pre-existing conditions.
The plan also proposes to reinstate payments to insurers for cost-sharing reductions, which were halted during Trump’s first administration. However, this could potentially leave many ACA enrollees paying more, not less. The plan’s vagueness makes it difficult to determine its potential impact on out-of-pocket costs, premiums, federal spending, and health coverage for people with pre-existing conditions.
Overall, the “Great Healthcare Plan” raises more questions than it answers, and its details will need to be fleshed out before its implications can be fully understood. The plan’s potential impact on the ACA and the healthcare system as a whole is uncertain, and it is unclear whether it will achieve its goals of lowering costs and holding insurance companies accountable. Until more information is available, the plan’s effects on healthcare coverage and affordability remain uncertain.
Fears intensify for Minnesota families due to health concerns and insurance issues amid ICE operations.
A recent surge in Immigration and Customs Enforcement (ICE) operations in Minnesota has left many families in the state fearful and anxious about their health and well-being. The operations, which have resulted in the detention and deportation of many undocumented immigrants, have had a ripple effect on the entire community, particularly on families with mixed immigration status. One of the most significant concerns for these families is access to healthcare. Many undocumented immigrants are ineligible for public health insurance programs, such as Medicaid, and are often forced to rely on emergency rooms or community clinics for medical care.
The fear of being detained or deported has led many families to avoid seeking medical attention, even when they desperately need it. This has resulted in delayed diagnoses, untreated illnesses, and worsening health conditions. Additionally, the stress and anxiety caused by the ICE operations have taken a toll on the mental health of many family members, particularly children. The uncertainty and fear of being separated from their loved ones have led to increased anxiety, depression, and post-traumatic stress disorder (PTSD) among many community members.
The insurance woes faced by these families are further complicated by the fact that many are ineligible for public health insurance programs. Those who are eligible often face barriers to enrollment, such as language barriers, lack of documentation, or fear of providing personal information. As a result, many families are forced to rely on private insurance, which can be unaffordable for low-income families. The Minnesota government has attempted to address some of these concerns by providing emergency medical assistance to undocumented immigrants, but the program is limited and does not provide comprehensive coverage.
Community organizations and healthcare providers are working to address the health needs of these families by providing culturally sensitive care and connecting them with resources. However, the fear and anxiety caused by the ICE operations have made it challenging for these organizations to reach the families who need their services. To address the health needs of these families, it is essential to provide comprehensive and affordable healthcare options, regardless of immigration status. This can be achieved by expanding public health insurance programs, increasing funding for community health clinics, and providing resources to help families navigate the complex healthcare system. Ultimately, ensuring that all families have access to quality healthcare is essential for building a healthy and thriving community.
Trump’s healthcare plan excludes individuals with preexisting conditions.
According to a recent report by NewsNation, President Trump’s healthcare plan has been criticized for excluding individuals with preexisting conditions. The plan, which aims to replace the Affordable Care Act (ACA), also known as Obamacare, has sparked concerns among healthcare advocates and individuals with preexisting medical conditions.
The ACA, which was enacted in 2010, prohibits health insurance companies from denying coverage to individuals with preexisting conditions, such as diabetes, cancer, or heart disease. However, Trump’s plan would allow states to waive certain provisions of the ACA, including the requirement that insurance companies cover people with preexisting conditions.
This means that individuals with preexisting conditions may be denied coverage or face higher premiums, making healthcare unaffordable for many. The plan would also allow insurance companies to charge higher premiums for older adults and those with preexisting conditions, which could lead to a significant increase in healthcare costs for these individuals.
Healthcare advocates have expressed concerns that Trump’s plan would leave millions of Americans without access to affordable healthcare. The plan would also disproportionately affect low-income individuals, women, and minorities, who are more likely to have preexisting conditions.
The exclusion of preexisting conditions from Trump’s healthcare plan is a significant departure from the ACA, which has provided healthcare coverage to millions of Americans with preexisting conditions. The ACA has also prohibited insurance companies from imposing lifetime limits on coverage and has allowed young adults to stay on their parents’ insurance plans until age 26.
In contrast, Trump’s plan would give states more flexibility to design their own healthcare systems, which could lead to a patchwork of different systems with varying levels of coverage. While some states may choose to maintain the ACA’s protections for individuals with preexisting conditions, others may not, leaving these individuals without access to affordable healthcare.
Overall, Trump’s healthcare plan has been criticized for its potential to leave millions of Americans without access to affordable healthcare, particularly those with preexisting conditions. The plan’s exclusion of preexisting conditions has sparked concerns among healthcare advocates and individuals who rely on the ACA for coverage. As the debate over healthcare reform continues, it remains to be seen how Trump’s plan will be received by lawmakers and the American public.
Trump’s ‘great health care plan’ aims to lower drug costs and insurance premiums.
President Trump has unveiled his new healthcare plan, which he claims will put Americans first and lower the cost of prescription drugs and insurance premiums. The plan, which requires Congressional approval, would allow individuals to purchase their own healthcare options using funds provided by the government. The government would place money into healthcare savings accounts, which individuals could use to buy their own healthcare plans. The plan also includes a website, Trump RX, where people can purchase safe pharmaceutical drugs over the counter.
According to the White House, the plan would lower prescription drug prices, decrease insurance premiums, and require greater transparency from insurance companies. The plan would also create a cost-sharing reduction program, which would save taxpayers at least $36 billion and reduce Obamacare plan premiums by over 10%. Administration officials estimate that people would save between 10% and 15% on healthcare premiums under the president’s proposal.
The plan has been praised by some Republicans, including Senate Majority Leader John Thune and Speaker Mike Johnson. However, it is unclear when the plan will be taken up by Congress, and it may face opposition in the Senate. The White House is confident that the plan will pass, with press secretary Karoline Leavitt stating that Congress and the White House will work together to put the plan into action.
One of the key features of the plan is the creation of the Trump RX website, which would make safe pharmaceutical drugs available for over-the-counter purchase. Dr. Mehmet Oz, who briefed reporters on the plan, said that making more drugs available over the counter would reduce costs and time, as people would no longer need to make doctor’s appointments for prescriptions. The FDA would give its stamp of approval to any drug moved to over-the-counter status, and options being considered include anti-inflammatory drugs and peptic ulcer products.
The plan would also involve switching money from Obamacare to Health Savings Accounts, although the details of how this would work are still unclear. A senior administration official said that the White House is flexible on the details and is open to different approaches. Despite the uncertainty, officials are optimistic that the plan will get Congressional approval this year, citing positive reception from Capitol Hill and the potential for bipartisan support.
Trump Abandons GOP’s Corporate Allies in Healthcare Plan – Politico
In a surprising move, President Trump has abandoned the GOP’s traditional corporate allies in his new healthcare plan, instead embracing a more populist approach that prioritizes consumer interests over those of the healthcare industry. The plan, which aims to repeal and replace the Affordable Care Act (ACA), has left many Republican lawmakers and industry leaders stunned.
The Trump administration’s proposal would significantly reduce the role of insurance companies and pharmaceutical manufacturers in the healthcare system, instead empowering consumers to make their own choices about their healthcare coverage. The plan would also impose strict regulations on the healthcare industry, including limits on insurance company profits and pharmaceutical price controls.
This approach marks a significant departure from the traditional Republican stance on healthcare, which has long been closely aligned with the interests of the healthcare industry. In the past, Republican lawmakers have typically sought to reduce regulations and give the industry more freedom to operate. However, Trump’s plan reflects a more populist tone, with the President emphasizing the need to protect consumers from “greedy” insurance companies and pharmaceutical manufacturers.
The plan has been met with fierce opposition from the healthcare industry, with insurance companies and pharmaceutical manufacturers warning that the proposed regulations would lead to higher costs and reduced access to care. The American Hospital Association, the American Medical Association, and the Pharmaceutical Research and Manufacturers of America have all come out against the plan, arguing that it would have devastating consequences for the healthcare system.
Despite this opposition, Trump appears to be committed to his populist approach, which he believes will resonate with his base of supporters. The President has long been critical of the healthcare industry, accusing companies of ripping off consumers and driving up costs. By taking on the industry, Trump may be able to tap into the anger and frustration that many Americans feel towards the healthcare system.
The implications of Trump’s plan are significant, and it remains to be seen how it will play out in Congress. While some Republican lawmakers may be hesitant to support the plan due to its populist tone and potential impact on the healthcare industry, others may see it as an opportunity to appeal to their constituents and differentiate themselves from the traditional Republican establishment. Ultimately, the fate of Trump’s healthcare plan will depend on his ability to navigate the complex web of interests and alliances in Washington, and to convince lawmakers and industry leaders that his approach is the right one for the country.
Today marks the final day for residents in most states to choose their Affordable Care Act (ACA) health plans, all while a decision on subsidies remains pending.
The Affordable Care Act (ACA) health insurance marketplace is facing a critical deadline as the open enrollment window comes to a close in most states. Thursday marked the final day for individuals to select a health insurance plan, with about 10 states having later deadlines or extensions. This deadline is crucial for millions of small business owners, gig workers, farmers, and others who rely on marketplace plans for health coverage.
The ACA has been a topic of debate in recent months, particularly with the expiration of COVID-era expanded subsidies that offset costs for over 90% of enrollees. The average subsidized enrollee is now facing more than double the monthly premium costs for 2026, making it difficult for individuals to make informed decisions about their health coverage. As a result, enrollment is lagging behind last year’s numbers, with about 22.8 million Americans having signed up so far, compared to a record 24 million last year.
The expiration of subsidies has led to uncertainty and anxiety among enrollees, with some delaying signing up for coverage or signing up with the intention of canceling if Congress resurrects the tax credits. The House has passed a three-year extension of the subsidies, but the Senate rejected a similar bill last year. A bipartisan group of senators, led by Sen. Bernie Moreno, is working on a compromise that would extend the enhanced subsidies for two years, with new limits on who can receive them.
The proposal would also create a new health savings account option, which President Donald Trump and Republicans prefer. However, Democrats and Republicans have yet to agree on the details, including whether states can use separate funds for abortion coverage. President Trump has also announced his own plan, which would redirect ACA subsidies into health savings accounts, but Democrats have largely rebuffed this idea as inadequate.
As the deadline for open enrollment comes to a close, millions of Americans are left waiting to see what will happen next. The uncertainty surrounding the ACA has made it difficult for individuals to make informed decisions about their health coverage, and the lack of clarity on costs has driven up health costs. The outcome of the bipartisan proposal and President Trump’s plan will have a significant impact on the future of the ACA and the health coverage of millions of Americans.
Trump Unveils ‘Great Healthcare Plan’, Outlines Diverse Set of Initiatives
President Trump has unveiled his “Great Healthcare Plan”, a collection of initiatives aimed at improving the US healthcare system. The plan, announced at a rally in North Carolina, is a grab bag of proposals that include expanding health savings accounts, increasing transparency in medical billing, and lowering prescription drug costs.
Trump touted the plan as a major overhaul of the US healthcare system, claiming it would provide better care at lower costs. He also criticized the Affordable Care Act (ACA), also known as Obamacare, which he has repeatedly tried to repeal and replace. The President argued that his plan would offer more choices and lower premiums, while also protecting people with pre-existing conditions.
The plan includes several key components, such as:
- Expanding health savings accounts: Trump proposed allowing people to use tax-free health savings accounts to pay for more medical expenses, including over-the-counter medications and certain services.
- Price transparency: The President called for hospitals and insurance companies to be more transparent about their prices, allowing patients to shop around for better deals.
- Lowering prescription drug costs: Trump announced plans to allow the importation of cheaper prescription drugs from other countries and to increase competition in the pharmaceutical industry.
- Protecting people with pre-existing conditions: The President reiterated his commitment to protecting people with pre-existing conditions, although the details of how he plans to do so are unclear.
Despite the fanfare, critics argue that the plan is largely a rehashing of previous proposals and does not address the underlying issues with the US healthcare system. Democrats have also pointed out that the plan does not include a clear replacement for the ACA, which has provided health insurance to millions of Americans.
The timing of the announcement is seen as a political move, with the presidential election just weeks away. Trump’s healthcare plan is likely to be a major issue in the campaign, with Democrats pushing for a more comprehensive overhaul of the healthcare system. Overall, while the “Great Healthcare Plan” includes some potentially beneficial initiatives, its impact and feasibility remain to be seen.
Today marks the last day for enrollment in ACA health plans in most states, amidst ongoing uncertainty over subsidy extensions.
Today marks the final day for individuals to select health plans under the Affordable Care Act (ACA) in most states. The deadline for open enrollment is December 15th, and with no subsidy deal yet in place, many are left wondering what the future of their healthcare coverage will look like.
The ACA, also known as Obamacare, has been a topic of controversy and debate since its inception. Despite efforts to repeal and replace the law, it remains in effect, providing health insurance to millions of Americans. However, the lack of a subsidy deal has created uncertainty and concern among those who rely on the program.
Subsidies are a critical component of the ACA, helping to make health insurance more affordable for low- and moderate-income individuals. Without a deal in place, many fear that premiums will increase, making coverage unaffordable for those who need it most. The Trump administration has been negotiating with lawmakers to reach a deal, but so far, no agreement has been reached.
As the deadline approaches, many are urging Congress to take action. Advocates argue that a subsidy deal is essential to ensure that the ACA remains stable and that individuals can continue to access affordable healthcare. Without it, they warn that the consequences could be severe, including increased premiums, reduced enrollment, and decreased access to care.
Despite the uncertainty, many states have seen an increase in enrollment this year. According to recent data, over 4.1 million people have signed up for ACA plans so far, with many more expected to enroll before the deadline. However, the lack of a subsidy deal has created anxiety among those who are already struggling to afford coverage.
As the clock ticks down, individuals are encouraged to take advantage of the final day to select a health plan. Those who miss the deadline may be left without coverage or face penalties. The Centers for Medicare and Medicaid Services (CMS) has extended hours for its call center and online support to help individuals enroll.
In conclusion, the final day to select ACA health plans has arrived in most states, with no subsidy deal yet in place. The uncertainty surrounding the future of the ACA has created concern among those who rely on the program. As the deadline approaches, individuals are urged to take action and select a health plan, while advocates continue to push for a subsidy deal to ensure the stability and affordability of the ACA. With millions of Americans relying on the program, the stakes are high, and the need for a solution is pressing.
Massachusetts health insurance prior authorizations to face restrictions, according to Healey.
Massachusetts Governor Maura Healey has announced a comprehensive plan to make healthcare more affordable and accessible to residents. The plan includes updated insurance regulations that will eliminate prior authorization requirements for emergency and urgent care services, primary care, chronic care, occupational and physical therapy, and certain prescription drugs. Prior authorization is a process where healthcare providers must obtain approval from insurance companies before providing certain services or treatments. The new regulations will also require insurers to respond to urgent requests within 24 hours and ensure that patients’ care is not disrupted when they switch insurance plans.
Healey also announced the creation of a new working group, the Health Care Affordability Working Group, which will be led by former Health and Human Services secretary Kate Walsh and Lisa Murray, Massachusetts state president at Citizens Bank. The group will develop proposals to make healthcare more affordable and will include representatives from state agencies, trade groups, and business organizations.
The changes are expected to make a meaningful difference to some patients, particularly those with chronic conditions who often face delays and disruptions in their care due to prior authorization requirements. For example, a patient with diabetes will no longer need prior authorization for services and devices associated with their condition. The regulations will apply to all insurers that do business in Massachusetts, but will not apply to self-insured employers that pay healthcare claims directly.
The announcement is part of Healey’s broader effort to address the high cost of living in Massachusetts and make healthcare more affordable. Healey has made affordability a key issue in her reelection campaign and has signed a tax relief package and a sweeping housing law aimed at addressing the state’s high cost of living.
While some analysts have raised concerns that eliminating prior authorization requirements could lead to increased healthcare spending, Healey’s administration argues that the changes will improve access to care and reduce administrative burdens on healthcare providers. The Council for Affordable Quality Healthcare estimates that the healthcare industry spent $1.3 billion on administrative costs related to prior authorizations in 2023, a 30% increase from the previous year.
The new regulations have the potential to bring about meaningful change to patients who are often caught in the middle of bureaucratic delays and disruptions. One patient, who was diagnosed with a serious autoimmune neurologic illness, described waiting three months for insurance approvals and suffering permanent damage to her body and functioning during the wait. Healey’s announcement has been welcomed by healthcare advocates, who argue that the changes will improve access to care and reduce administrative burdens on healthcare providers. However, some analysts have raised concerns about the potential impact on healthcare spending and the effectiveness of the new working group in bringing about real change.
Tata AIA To Protect India’s Superwomen
Tata AIA Life Insurance has launched a term insurance plan called “Shubh Shakti” specifically designed for women. The plan aims to empower women to safeguard themselves and their loved ones while continuing to thrive in their personal and professional journeys. Traditionally, the term life insurance industry has been male-centric, ignoring the unique challenges women face. However, with the increasing number of women in the workforce and as financial decision-makers, there is a growing need for a solution that addresses their unique financial needs and challenges.
The plan offers a range of benefits, including a premium holiday during pregnancy, lower premiums for women, and special health benefits such as women-specific care, vaccination support, and access to specialist consultations. It also provides child education protection, waiver of premium on husband’s or accidental death, and a comprehensive wellness program called Tata AIA Health Buddy.
Tata AIA Health Buddy offers rewards for regular health checks and achieving fitness goals, health and wellness benefits for the entire family, personalized diet tips, and activity targets. The plan also provides a 15% lower premium for women, with additional lifetime discounts on digital purchases and salaried profiles.
The launch of Shubh Shakti is a response to the growing awareness and shift towards greater financial independence among women. A recent survey by Tata AIA revealed that 89% of married women still rely on their husbands for financial planning, while only 44% take independent financial decisions. The plan aims to bridge this gap and provide women with a comprehensive protection solution that caters to their unique needs and challenges.
According to Gayatri Nathan, Chief Compliance Officer at Tata AIA, “Shubh Shakti is a celebration of women’s strength, empowering them to secure their family’s future, invest in their health, and lead a life free from worry.” The plan is designed to be flexible, comprehensive, and supportive across the various roles that women play in their lives, including as mothers, daughters, partners, and professionals.
Overall, Shubh Shakti is a holistic protection plan that addresses the unique needs and challenges of women, providing them with a comprehensive solution that safeguards their health, wealth, and family’s financial security. With Shubh Shakti, women can continue to dream, live confidently, and lead their families towards a secure, healthy, and financially independent future.
GOP War on Health Care Drives ‘Drastic Drop’ in Health Coverage for Working Families — Protect Our Care
The recent data on healthcare enrollment reveals a disturbing trend: millions of Americans are struggling to afford healthcare due to the significant premium hikes that took effect on January 1. As a result, 1.4 million people have dropped their healthcare plans, while many others are being forced to pay exorbitant prices for inadequate coverage. The premium increases are a direct consequence of the Trump-GOP healthcare cuts, which have left millions of Americans without access to affordable healthcare.
The enrollment numbers for the Affordable Care Act (ACA) are bleak, with a drastic drop in sign-ups compared to previous years. The decline is attributed to the expiration of ACA subsidies, which has driven up premiums and made healthcare unaffordable for many. According to various news outlets, including The New York Times, The Hill, and AP News, the enrollment numbers are significantly lower than expected, with at least 800,000 Americans opting out of Obamacare due to soaring healthcare costs.
The situation is further exacerbated by the inaction of Senate Majority Leader John Thune and the Republican Party, who have failed to extend the tax credits that help nearly 22 million Americans afford healthcare. The lack of action has resulted in a “war on healthcare,” leaving millions of Americans without access to essential medical care.
The data highlights the urgency of the situation, with many states extending their enrollment deadlines in an attempt to mitigate the damage. However, the outlook remains grim, with millions of Americans facing a future without affordable healthcare. The question remains: how many more people will have to lose their coverage or their lives before the Republican Party takes action to address the crisis?
The media consensus is clear: the Trump-GOP healthcare cuts have been disastrous, and the consequences are being felt by millions of Americans. The need for immediate action is evident, and it is imperative that lawmakers take steps to extend the tax credits and make healthcare affordable once again. The fate of millions of Americans hangs in the balance, and it is time for the Republican Party to end their “war on healthcare” and work towards finding a solution to this pressing crisis.
Enrollment in Affordable Care Act health plans has seen a decline in both Wisconsin and across the nation, according to recent data.
According to a report by the Wisconsin Examiner, enrollment in Affordable Care Act (ACA) health plans has decreased in Wisconsin and nationwide. The decline in enrollment is a concerning trend, as the ACA has been a crucial source of health insurance for millions of Americans.
In Wisconsin, the number of people enrolled in ACA plans has dropped by approximately 12% compared to the previous year. This decline is consistent with the national trend, which has seen a 12% decrease in enrollment across the United States. The reasons behind this decline are multifaceted, but some contributing factors include changes in the healthcare landscape, increased costs, and decreased outreach efforts.
One of the primary reasons for the decline in enrollment is the expansion of short-term limited-duration insurance (STLDI) plans. These plans, which are often cheaper than ACA-compliant plans, have attracted some consumers who are looking for more affordable options. However, STLDI plans typically offer less comprehensive coverage and may not provide the same level of protection as ACA-compliant plans.
Another factor contributing to the decline in enrollment is the decrease in outreach and marketing efforts. In previous years, the federal government had invested significant resources in promoting the ACA and encouraging people to enroll. However, in recent years, these efforts have been scaled back, leading to decreased awareness and enrollment.
The decline in enrollment has significant implications for the healthcare system. With fewer people enrolled in ACA plans, there may be a shift towards more expensive and less comprehensive coverage options. This could lead to increased healthcare costs and decreased access to essential health services.
It is essential to note that the ACA remains a vital source of health insurance for many Americans, and efforts should be made to strengthen and improve the program. This could include increased outreach and marketing efforts, as well as policies to make ACA-compliant plans more affordable and attractive to consumers. By working to address the decline in enrollment and improve the ACA, policymakers can help ensure that all Americans have access to quality, affordable health insurance.
Overall, the decline in ACA enrollment in Wisconsin and nationwide is a concerning trend that requires attention and action from policymakers. By understanding the factors contributing to this decline and working to address them, it is possible to strengthen the ACA and improve healthcare outcomes for millions of Americans.
Aviva India has launched a Preventive Care Program aimed at supporting rural communities in Uttarakhand, as reported by the Garhwal Post.
Aviva India, a leading insurance company, has launched a Preventive Care Program to support rural communities in Uttarakhand. The program aims to provide healthcare services and promote health awareness among the rural population, particularly in the Garhwal region. The initiative is part of Aviva India’s corporate social responsibility (CSR) efforts to make a positive impact on the community.
The Preventive Care Program will focus on providing free health check-ups, medical consultations, and health education to the rural population. Aviva India has partnered with local healthcare providers to offer these services, which will be delivered through mobile health vans and health camps. The program will also provide free medicines and diagnostic tests to those in need.
The program will cater to the healthcare needs of rural communities in the Garhwal region, which faces challenges such as limited access to healthcare facilities, lack of awareness about health and wellness, and a high incidence of diseases such as diabetes, hypertension, and respiratory problems. Aviva India’s Preventive Care Program aims to address these challenges by providing accessible and affordable healthcare services to the rural population.
The program will also focus on promoting health awareness and education among the rural population, particularly among women and children. Aviva India will organize health awareness camps, workshops, and training sessions to educate people about healthy practices, disease prevention, and management. The program will also promote the importance of regular health check-ups, vaccination, and screening for diseases.
Aviva India’s Preventive Care Program is a significant initiative that demonstrates the company’s commitment to giving back to the community. By providing healthcare services and promoting health awareness, Aviva India aims to make a positive impact on the lives of rural communities in Uttarakhand. The program is expected to benefit thousands of people in the region and contribute to the overall well-being of the community.
In conclusion, Aviva India’s Preventive Care Program is a commendable initiative that aims to support rural communities in Uttarakhand. The program’s focus on providing healthcare services, promoting health awareness, and education will go a long way in improving the health and well-being of the rural population. Aviva India’s commitment to CSR is evident in this initiative, and the company’s efforts are expected to make a significant difference in the lives of people in the Garhwal region.
Fewer Americans are enrolling in Affordable Care Act (ACA) health insurance plans as the cost of coverage increases.
The number of Americans signing up for Affordable Care Act (ACA) health insurance plans has decreased by 3.5% compared to the same time last year, with around 800,000 fewer people selecting plans. This decline is attributed to the expiration of enhanced tax credits, which has led to higher health expenses for many individuals. As a result, some people are being forced to make difficult decisions, such as delaying or forgoing health insurance altogether.
The new data, released by the Centers for Medicare and Medicaid Services, shows that enrollment has dropped to around 22.8 million people, down from 24 million last year. This decline is the first time in four years that enrollment has decreased from the previous year at this point in the shopping window. The loss of enhanced subsidies means that annual premium costs will more than double for the average ACA enrollee, making it unaffordable for many.
The expiration of subsidies has sparked a partisan battle in Congress, with Democrats pushing for a straight extension of the tax credits and Republicans insisting on larger reforms to root out fraud and abuse. The House has passed legislation to extend the subsidies for three years, but the bill is now stalled in the Senate. The Congressional Budget Office estimates that extending the subsidies would increase the nation’s deficit by $80.6 billion over the decade.
As a result of the declining enrollment, some Americans are being forced to explore alternative options, such as going on a partner’s employer health plan or changing their income to qualify for Medicaid. Others are choosing to go without insurance, at least temporarily, while they look for alternatives. Health economist Robert Kaestner predicts that 2 million more people will lack health insurance for a while, which is a serious issue.
Many Americans are struggling to afford health insurance, with some dropping coverage altogether. Felicia Persaud, a 52-year-old entrepreneur from Florida, dropped her coverage when her monthly ACA costs were set to increase by $200. She is now going without health insurance, hoping that she won’t be affected by a costly injury or diagnosis. The decline in enrollment and the expiration of subsidies have significant implications for the healthcare system, and it remains to be seen how Congress will address the issue.
The Punjab government has signed an agreement to introduce a cashless health insurance program, which is set to be launched on January 15.
The Punjab government has signed an agreement with the United India Insurance Company to launch the “Mukh Mantri Sehat Yojna” on January 15. This scheme will provide a cashless health insurance cover of Rs 10 lakh to all families in the state. The agreement was signed by the CEO of the State Health Agency, Sanyam Aggarwal, and the Executive Director of United India Insurance, Mathew George, in the presence of the State Health and Family Welfare Minister, Balbir Singh.
The scheme aims to provide comprehensive health protection to all residents of Punjab, including government employees and pensioners, with no income cap or exclusion criteria. The coverage will be provided through a network of 824 empanelled hospitals, including public, private, and government hospitals. The number of empanelled hospitals is expected to increase as the scheme progresses.
The scheme will be launched by Chief Minister Bhagwant Singh Mann and AAP national convenor Arvind Kejriwal on January 15. The minister emphasized that the scheme is designed to be inclusive and accessible, with simple enrollment procedures through Common Service Centres (CSCs) using only Aadhaar and voter IDs. Beneficiaries will receive dedicated MMSY health cards, and a helpline will be launched soon to facilitate the process.
The United India Insurance Company will provide coverage of Rs 100,000 per family for all 65 lakh families in the state. For treatment requirements between Rs 100,000 and Rs 10,00,000, the insurance will be provided by the state health agency on a trust basis. The scheme adopts the latest health benefit package, ensuring comprehensive coverage through more than 2,000 selected treatment packages.
The minister declared the scheme a landmark reform, significantly expanding health protection from the earlier Rs 5 lakh coverage, which was limited to specific categories. The scheme aims to provide cashless treatment up to Rs 10 lakh per family per year, and beneficiaries can access secondary and tertiary care across the network of empanelled hospitals. With the launch of this scheme, Punjab is set to become one of the first states in the country to provide comprehensive health insurance coverage to all its residents.
Millions of Americans are anticipated to discontinue their Affordable Care Act plans, seeking alternative health insurance options.
In Thompson’s Station, Tennessee, Robert and Emily Sory are trying to open a nonprofit animal sanctuary, but they have forgone health insurance this year due to the unaffordability of marketplace plans under the Affordable Care Act. The Sorys, who lost their jobs in November, cannot afford the $70 monthly premium for a “bronze”-level plan, which is the cheapest option available to them. Without health insurance, they are seeking alternative ways to access medical care, such as visiting a psychiatrist who has agreed to charge them $125 per visit and going to emergency rooms when necessary.
The Sorys’ situation is not unique, as an estimated 4.8 million people will go without health coverage this year due to the expiration of enhanced subsidies under the Affordable Care Act. Congress has passed legislation to extend these subsidies, but negotiations are ongoing in the Senate. In the meantime, people like the Sorys are being forced to find workarounds to maintain their health, including visiting federally qualified health centers (FQHCs) that offer sliding-scale fees and free prescription medications through partnerships with nonprofits like the Dispensary of Hope.
FQHCs, which are partially funded by the federal government, are bracing for an influx of newly uninsured patients and are concerned that people may not be aware of alternative ways to access medical care. The Dispensary of Hope, a Nashville-based nonprofit, has partnered with hospitals and pharmacies to provide free medications to people without insurance who have annual incomes below 300% of the federal poverty limit. However, demand is expected to outstrip supply in the new year, and the organization is working with pharmaceutical companies to increase donations.
The situation is particularly dire in states like Tennessee that have not expanded Medicaid to cover low-income adults, creating a “gap” in coverage that is expected to cause uninsured rates to jump. The Federation of American Hospitals has urged Congress to extend the enhanced subsidies, citing the threat to hospitals’ financial health. As Emily Sory, who has costly health conditions and has already taken on substantial medical debt, notes, “I understand the system. And I get it’s people like me that don’t pay their bill are why it suffers. And I feel bad. But at the same time, I don’t have the money to pay it.”
Whitehouse, Slotkin, and Schakowsky have introduced a public health insurance option for the Affordable Care Act.
US Senators Sheldon Whitehouse and Elissa Slotkin, along with Congresswoman Jan Schakowsky, have introduced the Affordable Consumer Health Options and Insurance Competition Enhancement (CHOICE) Act. This legislation aims to add a publicly operated health insurance option to the Affordable Care Act’s individual marketplaces, providing 27 million Americans with a high-quality, affordable public option. The measure would drive competition, guarantee access to an affordable plan in every insurance market, and lower insurance costs across the marketplace.
The public option would be administered by the government, cutting out insurance middlemen and providing a direct health insurance option to Americans. This would increase competition, drive down premiums, and expand access to coverage for millions of Americans and small businesses. The Affordable CHOICE Act would create a public health insurance option subject to the same requirements as other plans offered on Affordable Care Act exchanges, offering the same tax credits and essential, comprehensive benefits.
The introduction of the Affordable CHOICE Act comes as Republicans continue to attack the health care system, having passed a bill that slashes almost a trillion dollars from Medicaid, triggers a half-trillion dollar cut to Medicare, and raises health insurance costs. Without bipartisan action to extend the Affordable Care Act enhanced premium tax credits, health insurance premiums are set to more than double on average next year. The Republicans’ newfound opposition to lining the pockets of large insurers has not been met with an alternative bill, despite health care premiums more than doubling for many American families.
The Affordable CHOICE Act would tackle the uninsured rate by stimulating competition and driving down prices with a stable coverage choice. With over 27 million Americans currently uninsured, a public option would provide a vital safety net and increase access to health care coverage. The legislation has been introduced as a practical, proven way to drive down premiums, increase competition, and expand access to coverage for millions of Americans. By supporting the Affordable CHOICE Act, lawmakers can provide Americans with a real, affordable choice and take a significant step towards ensuring that every person in the United States has access to quality, affordable health care.
The Affordable Care Act (ACA) subsidies crisis is prompting individuals to explore alternative solutions for health insurance, as reported by NPR.
The rising cost of healthcare in the US has led some Americans to make drastic decisions to manage their expenses. Mathew, a 40-year-old man from Michigan, is one such individual who has taken a significant step to ensure he can afford his medical care. Due to his autoimmune disease, Mathew requires regular medication transfusions, and his healthcare costs were manageable with the Affordable Care Act (ACA) subsidies. However, when the enhanced subsidies expired at the end of 2025, his monthly premium skyrocketed from $181 to over $427, making it unaffordable for him.
In a surprising turn of events, Mathew’s roommate and best friend of 25 years, Christina, suggested they get married so that he could be covered under her employer-sponsored health insurance. Despite initial reservations, Mathew agreed, and they had a small ceremony in September. This decision has allowed Mathew to access affordable healthcare, with his new premium costing $121 per month.
Mathew’s situation is not unique, and many Americans have made similar decisions in the past, particularly before the ACA. Marrying for benefits is not uncommon, and health law professor Erin Fuse Brown notes that people get married for various non-romantic reasons, including economic and practical considerations. While Mathew’s decision may seem unusual, it highlights the desperation and creativity that people are employing to cope with the high cost of healthcare.
The expiration of the enhanced subsidies has left millions of people facing unaffordable monthly premiums, with some opting to forgo insurance or make drastic changes to their lives. Congressional lawmakers are working towards a deal to revive the subsidies, but in the meantime, individuals like Mathew are taking matters into their own hands. Mathew’s story serves as a reminder of the need for affordable healthcare and the importance of finding solutions to the current cost crisis.
Mathew’s new health plan has allowed him to access the medical care he needs, but he is still hoping that Congress will make a deal to restore the subsidies. He believes that not everyone has the option of marrying a friend to get affordable healthcare and that a more comprehensive solution is necessary to address the healthcare cost crisis. As Mathew navigates his new insurance plan, he is scrambling to secure referrals and prior authorizations to continue his medication, highlighting the complexities and challenges of the US healthcare system.
Swift settlement of insurance claims brings relief to 170 families of J&K Bank customers.
Jammu and Kashmir Bank has demonstrated its commitment to customer welfare and financial security by facilitating the swift settlement of insurance claims under the MetLoan & Life Suraksha (MLLS) scheme. The bank has paid out claims worth 8.81 crores to 170 families in its Jammu Zone, providing them with much-needed financial relief during a difficult time. The MLLS scheme is a life insurance product that covers the outstanding loan amount in the event of a borrower’s untimely demise, thereby relieving their family of any financial burden.
The claims were paid out in a brief ceremony, where a symbolic cheque was displayed by the bank’s Zonal Head, Rajesh Dubey, and Associate Director and Head of PNB MetLife, Irfan Ali Zargar. The event was attended by various bank officials and representatives from PNB MetLife. The claimants expressed their gratitude to the bank and PNB MetLife for their support in settling the claims in a timely manner, stating that it has helped to relieve them of a significant financial burden.
Rajesh Dubey, Zonal Head of Jammu and Kashmir Bank, emphasized the importance of insuring loans for financial security, particularly in times of distress. He noted that the MLLS scheme provides significant relief to families and helps to preserve their financial stability. Irfan Ali Zargar, Associate Director and Head of PNB MetLife, also highlighted the importance of timely financial assistance in supporting families coping with tragedy.
The partnership between Jammu and Kashmir Bank and PNB MetLife has been instrumental in delivering on the promise of protection and care for their mutual customers. The MLLS scheme is a single-premium and bank-funded option that provides financial security to borrowers and their families. By encouraging customers to opt for this scheme, the bank ensures that families are not burdened with liabilities in unforeseen circumstances.
Overall, the settlement of insurance claims under the MLLS scheme is a significant step towards providing financial relief to families in need. It demonstrates the bank’s commitment to customer welfare and financial security, and highlights the importance of insurance products in providing a safety net for borrowers and their families.
India’s Health Insurance Revolution: Insurers Now Prioritize Your Well-being with Preventive Care and Substantial Savings!
The Indian healthcare system is facing a significant challenge due to rising healthcare costs and the burden of out-of-pocket expenses, which account for over 60% of total healthcare spending. Traditional health insurance in India has primarily focused on hospitalization, leaving everyday medical needs uncovered. However, a strategic shift is underway, with insurers prioritizing preventive care and wellness. Mayank Bathwal, CEO of Aditya Birla Health Insurance, explains that this shift is crucial in addressing the core issue of healthcare costs.
The traditional model of health insurance in India has left a significant gap in coverage for regular doctor consultations, diagnostic tests, and medicine costs. These expenses place a heavy financial strain on Indian households. Expanding insurance to cover outpatient services and preventive check-ups can help manage health proactively, reducing avoidable hospital admissions and making healthcare expenses more predictable.
Digital innovation is key to increasing insurance penetration, with platforms like Bima Sugam streamlining policy purchase and servicing. Aditya Birla Health Insurance’s “HealthReturns” program incentivizes healthy lifestyles, rewarding policyholders for consistent healthy behavior. This approach transforms insurance from a financial product into an active partner in well-being, fostering customer loyalty.
A comprehensive health ecosystem requires collaboration between insurers, providers, and government bodies. Digital infrastructure like ABHA and NHCX fosters transparency and streamlines claims. Aditya Birla Health Insurance aims to transition from a reactive, hospital-centric model to a proactive, holistic health ecosystem. This includes managing chronic conditions with continuous monitoring and digital tools for customer health tracking.
The impact of this strategic shift could be significant, leading to a healthier population, reduced long-term healthcare costs, and increased insurance penetration in India. It may also spur innovation among competitors and influence regulatory frameworks. The shift towards preventive care and wellness is a crucial step in addressing the challenges faced by the Indian healthcare system, and Aditya Birla Health Insurance is at the forefront of this change.
The company’s vision is to create a proactive health ecosystem that manages customer health outcomes and aligns them with insurer sustainability goals. This approach has the potential to transform the healthcare landscape in India, making healthcare more accessible, affordable, and effective. With the use of digital tools, AI-powered technologies, and collaborative efforts between stakeholders, Aditya Birla Health Insurance is poised to make a significant impact in the Indian healthcare industry.
ManipalCigna Diwali campaign tackles India’s health insurance gap
As India celebrates the festival of Diwali, ManipalCigna Health Insurance has launched a new campaign titled “Health Insurance Jiske Paas, Lakshmi Maa Karein Waha Niwaas,” which translates to “Where there is health insurance, Goddess Lakshmi resides.” The campaign aims to remind people that while wealth and prosperity are essential, they can only be truly enjoyed when health is protected. During Diwali, families often focus on decorating their homes, buying gifts, and welcoming Goddess Lakshmi, the symbol of wealth and abundance, but purchasing health insurance often takes a backseat.
The campaign uses generative AI-powered storytelling, combining India’s cultural roots with modern storytelling and visuals, to reimagine Diwali’s timeless traditions and symbols through a fresh lens. The film highlights the importance of protecting health with insurance, emphasizing that wealth can be earned and celebrated, but it can only be preserved when health is secure. According to Sapna Desai, Chief Marketing Officer at ManipalCigna Health Insurance, “We often pray to Goddess Lakshmi for prosperity, yet forget that good health is the true foundation of wealth.”
ManipalCigna has partnered with Zepto to extend its message into homes, featuring creative flyers with the campaign’s core message on Zepto deliveries across seven key cities. The campaign will also include outdoor billboard activations and digital platforms, making it a truly integrated campaign that blends cultural emotion with digital innovation. The initiative aims to drive awareness around health protection, urging Indians to see health insurance not as an expense, but as an investment in the truest form of wealth and well-being.
The campaign’s message is particularly relevant in India, where health insurance penetration remains low, and millions rely on out-of-pocket spending for medical care, leading to financial distress. By connecting the social truth with the spirit of Diwali, ManipalCigna hopes to remind people that protecting health with insurance is an act of preserving prosperity. With this initiative, ManipalCigna continues to drive awareness around health protection, promoting the importance of health insurance as a essential aspect of overall well-being.
The US House of Representatives has voted to reinstate subsidies for the Affordable Care Act, also known as Obamacare, in a move that goes against the stance of President Donald Trump. The decision to revive the subsidies aims to stabilize the healthcare market and make insurance more affordable for millions of Americans. The vote marks a significant break between the House and the Trump administration, which had previously halted the subsidy payments. The subsidies in question are used to help low-income individuals pay for out-of-pocket healthcare expenses, such as deductibles and copays. By reinstating these subsidies, the House hopes to reduce the financial burden on these individuals and encourage more people to enroll in health insurance plans. The move is seen as a crucial step in maintaining the stability of the healthcare market and ensuring that Americans have access to affordable healthcare options.
The US House of Representatives has passed legislation to re-establish tax credits that lowered premiums for Affordable Care Act (ACA) health plans. The bill, which was passed with a vote of 230-196, would extend the credits for three years. All Democrats voted in favor of the measure, along with 17 Republicans, many of whom were moderates who wanted to prevent a hike in healthcare costs for their constituents.
The tax credits were first created under Joe Biden but expired at the end of last year. Despite efforts by Democrats to continue them, they were not renewed. The House measure is likely to be revised by the Republican-controlled Senate before it is enacted. Republican congressman Mike Lawler stated that he voted in favor of the bill to send it to the Senate, where it can be revised and potentially become law.
The bill’s passage is a significant rebuke to Donald Trump, who has opposed extending the tax credits. Trump has dismissed concerns about affordability as a “hoax,” but Democrats see the tax credits as a key part of their pitch to voters ahead of the midterm elections in November. The party plans to make healthcare and the high cost of living a major issue in 2026.
The Republican speaker, Mike Johnson, has also opposed the credits, arguing that they would enable fraud. However, moderate Republicans sought to strike a compromise that would be palatable to both parties. After Johnson refused to bring any deal to the floor, four Republicans signed a discharge petition that forced a vote on the legislation.
Experts expect that premiums for enrollees of the plans will roughly double without the subsidies. The bill’s passage is seen as a significant step forward in addressing the “affordability crisis” that Democrats have emphasized as a key plank of their platform. The House minority leader, Hakeem Jeffries, stated that the affordability crisis is “very real” and that the party will continue to push for measures to lower healthcare costs.
The Senate will now consider the bill, and it is likely to be revised before it is enacted. The Republican-controlled Senate may try to add their own provisions to the bill, which could potentially change its scope and impact. Nevertheless, the passage of the bill in the House is a significant victory for Democrats and a rebuke to Trump’s opposition to the tax credits.
New Mexico congresswoman celebrates House passage of health care insurance subsidies.
New Mexico Congresswoman Teresa Leger Fernandez is celebrating the passage of a bill in the US House of Representatives that extends health care insurance subsidies for millions of Americans. The bill, which was passed with bipartisan support, aims to reduce the cost of health insurance premiums for individuals and families who purchase coverage through the Affordable Care Act (ACA) marketplaces.
The subsidies, which were introduced as part of the American Rescue Plan Act in 2021, have helped to make health insurance more affordable for millions of people. However, they were set to expire at the end of 2022, which would have resulted in significant premium increases for many consumers. The new bill extends these subsidies for an additional three years, ensuring that individuals and families can continue to access affordable health insurance.
Leger Fernandez, who represents New Mexico’s 3rd congressional district, was a strong supporter of the bill and played a key role in its passage. She noted that the extension of the subsidies is a critical step towards ensuring that all Americans have access to quality, affordable health care. “This is a huge win for New Mexicans and for our country,” she said. “By extending these subsidies, we are helping to keep health insurance premiums affordable for individuals and families who need it most.”
The congresswoman also highlighted the importance of the bill for New Mexico, which has one of the highest rates of uninsured residents in the country. “In New Mexico, we know that access to health care is a matter of life and death,” she said. “That’s why I am so proud to have supported this bill, which will help to ensure that our residents can get the care they need without breaking the bank.”
The bill’s passage has been welcomed by health care advocates and consumer groups, who argue that it will help to protect vulnerable populations, including low-income families, seniors, and individuals with pre-existing conditions. The subsidies have been shown to be highly effective in reducing the number of uninsured individuals, with over 3 million people gaining coverage since their introduction.
While the bill still needs to be passed by the Senate and signed into law by the President, Leger Fernandez is optimistic that it will become law. “I am confident that the Senate will follow the House’s lead and pass this critical legislation,” she said. “We must continue to work together to ensure that all Americans have access to quality, affordable health care, and this bill is an important step towards achieving that goal.”
The US House of Representatives has passed a bill that extends health care subsidies, going against the wishes of GOP leaders, as reported by The Washington Post.
The US House of Representatives has passed a bill that extends health care subsidies, despite opposition from Republican leaders. The bill, which aims to continue the increased subsidies provided under the American Rescue Plan Act, is seen as a significant development in the ongoing debate over healthcare in the United States.
The American Rescue Plan Act, passed in 2021, increased subsidies for individuals and families purchasing health insurance through the Affordable Care Act (ACA) marketplaces. These subsidies were set to expire at the end of 2022, but the new bill extends them for another two years. This means that millions of Americans who rely on the ACA for their health insurance will continue to receive financial assistance to help pay for their coverage.
The bill passed the House with a vote of 220-204, with only one Republican voting in favor of the measure. The majority of Republicans opposed the bill, citing concerns over the cost and effectiveness of the subsidies. However, Democrats argued that the subsidies are essential for ensuring that Americans can afford quality health care, particularly during the ongoing COVID-19 pandemic.
The extension of the subsidies is expected to benefit around 13 million people who currently receive financial assistance through the ACA. Without the extension, these individuals and families would have faced significant increases in their health insurance premiums, potentially leading to a decline in coverage rates.
The bill’s passage is seen as a victory for Democrats, who have made healthcare a top priority. The party has long advocated for strengthening and expanding the ACA, and the extension of the subsidies is a key step towards achieving this goal.
The bill now heads to the Senate, where its fate is uncertain. While Democrats control the Senate, they will need to navigate the legislative process and potential Republican opposition to get the bill signed into law. However, the bill’s passage in the House marks an important milestone in the ongoing effort to protect and strengthen the ACA, and Democrats are likely to continue pushing for its passage in the coming weeks and months.
Aviva Life Insurance introduces Smart Vitals, a pioneering fixed health benefit plan that incorporates wellness rewards.
Aviva Life Insurance has introduced a novel insurance plan called Smart Vitals, a first-of-its-kind fixed health benefit plan that incorporates wellness rewards. This innovative plan is designed to provide policyholders with a comprehensive health insurance coverage, while also encouraging them to prioritize their well-being through various wellness initiatives.
Smart Vitals offers a unique blend of fixed health benefits and wellness rewards, making it an attractive option for individuals seeking a holistic approach to health insurance. The plan provides a fixed benefit payout for various health-related expenses, such as hospitalization, surgeries, and diagnostic tests, ensuring that policyholders have a financial safety net in case of medical emergencies.
What sets Smart Vitals apart is its emphasis on wellness and preventive care. The plan offers rewards and incentives to policyholders who engage in healthy activities, such as regular exercise, healthy eating, and stress management. These rewards can be redeemed for various wellness services, such as gym memberships, yoga classes, and health check-ups, promoting a proactive approach to health and wellness.
The plan also features a unique “Vitality Score” system, which tracks policyholders’ health and wellness activities, providing them with a personalized scorecard. This scorecard enables policyholders to monitor their progress, set health goals, and make informed decisions about their lifestyle choices. The Vitality Score also determines the level of rewards and benefits that policyholders are eligible for, providing a tangible incentive to prioritize their health and wellness.
Aviva Life Insurance’s Smart Vitals plan is a significant departure from traditional health insurance plans, which often focus solely on providing financial coverage for medical expenses. By incorporating wellness rewards and preventive care initiatives, Smart Vitals encourages policyholders to take an active role in maintaining their health, reducing the risk of chronic diseases and improving their overall quality of life.
Overall, Aviva Life Insurance’s Smart Vitals plan is a pioneering initiative in the health insurance sector, offering a unique blend of fixed health benefits and wellness rewards. By promoting a proactive approach to health and wellness, Smart Vitals has the potential to revolutionize the way individuals think about health insurance, making it a valuable addition to the Indian insurance market.
No cashless insurance will be available in 15,000 hospitals from September 1 for policyholders of two specific companies, according to an insurance body announcement, raising concerns about the future of health insurance for affected policyholders.
The General Insurance Council (GI Council) has criticized the Association of Healthcare Providers (India) (AHPI) for deciding to stop cashless treatment to policyholders of two insurance companies, Bajaj Allianz General Insurance and Care Health Insurance. The GI Council has termed the decision as arbitrary, stating that it will create massive confusion among policyholders and undermine the sanctity of human life, especially in emergency hospitalization situations. The council has urged AHPI to withdraw its advice to its members and engage constructively with the insurance companies to continue cashless services for all health insurance policyholders.
AHPI had decided to stop cashless treatment to policyholders of Bajaj Allianz General Insurance and Care Health Insurance, citing the insurance companies’ failure to update hospital reimbursement rates in line with growing medical expenses. The association, which represents 15,200 hospitals across India, had received complaints from its member hospitals about the insurance companies’ unilateral deductions, payment delays, and long time taken for issuing pre-auth and pre-discharge approvals.
Bajaj Allianz General Insurance has stated that it was taken by surprise by AHPI’s decision and is working with the association to arrive at a solution that is in the best interests of customers. Care Health Insurance has also responded, stating that it received a generic communication from AHPI and is confident of amicably resolving any issues with the forum.
The GI Council has raised concerns about the impact of AHPI’s decision on policyholders, particularly in emergency situations where they may be forced to make financial arrangements. The council has emphasized the need for constructive engagement between insurance companies and healthcare providers to ensure that policyholders receive cashless treatment.
The dispute between AHPI and the insurance companies highlights the challenges faced by the healthcare industry in India, where medical inflation is rising, and hospitals are facing increasing costs. The issue also underscores the need for greater transparency and communication between insurance companies, healthcare providers, and policyholders to ensure that patients receive timely and quality medical care. The GI Council’s intervention is aimed at resolving the issue and ensuring that policyholders are not denied cashless treatment, which is a critical component of health insurance policies.
Policy Changes Bring Renewed Focus on High-Deductible Health Plans
The Affordable Care Act’s (ACA) enhanced premium tax credits are set to expire, and recent policy changes, including the expansion of hardship exemptions for catastrophic plans and changes to health savings account (HSA) eligibility, may significantly impact ACA Marketplace enrollment and affordability in 2026 and beyond. Bronze and catastrophic plans, which have lower premiums but higher deductibles, may become more appealing to consumers.
Bronze plans, one of the four “metal levels” of qualified health plans (QHPs), have the lowest premiums but the highest deductibles, with an average deductible of $7,476 in 2026. Catastrophic plans, which are a separate tier of QHPs, often have even lower premiums but higher cost-sharing, with deductibles equal to the out-of-pocket maximum allowed under the ACA ($10,600 for an individual or $21,200 for a family in 2026).
Recent changes include the expansion of catastrophic plan hardship exemptions to include consumers who are not eligible for premium tax credits or cost-sharing reductions due to their income. The Trump administration has also streamlined the application process for this hardship exemption and made it easier for consumers to enroll in a catastrophic plan. Additionally, all individual market bronze and catastrophic plans are now considered high-deductible health plans (HDHPs) and eligible to be paired with an HSA, even if they do not meet the minimum annual deductible requirement.
The availability and enrollment of bronze and catastrophic Marketplace plans vary. In 2026, catastrophic plans are offered in 36 states and the District of Columbia, and less than 1% of Marketplace enrollees chose a catastrophic plan in 2025. The average lowest-cost catastrophic Marketplace plan for a 27-year-old individual is $346 per month, a 29% increase from 2025, while the average lowest-cost unsubsidized bronze plan is $369 for a 27-year-old, a 19% increase from 2025.
The outlook for consumers is complex, with recent policy changes having wide-reaching implications for Marketplace coverage. The expiration of enhanced premium tax credits may lead to increased premiums, and some enrollees may switch to plans with higher deductibles or exit the Marketplace. Changes to HSA eligibility may also influence plan choices, with 35% of Marketplace plans sold on HealthCare.gov now HSA-eligible. However, higher-income individuals may benefit more from HSAs due to their higher tax brackets and greater ability to contribute to these accounts.
Consumers may face challenges in navigating the complex health insurance system, with limited understanding of plan options and potential marketing pitches that can compound the difficulties of making an informed decision. Price-sensitive consumers shopping for bronze and catastrophic plans may face difficult trade-offs, with higher deductibles and limited cost-sharing reductions. Many Marketplace enrollees already struggle to afford health care costs, and the recent changes may exacerbate these challenges.
Subsidies won’t fix America’s health care ‘crisis’ – The Hill
The US healthcare system is often criticized for being overly expensive and inaccessible to many Americans. In an effort to address these issues, some policymakers have proposed increasing subsidies to help individuals and families afford healthcare. However, this approach may not be the most effective solution to the country’s healthcare “crisis.”
Proponents of subsidies argue that they can help reduce the financial burden of healthcare costs, making it more affordable for people to access necessary care. They point to the success of programs like the Affordable Care Act (ACA), which has expanded health insurance coverage to millions of Americans through subsidized plans. However, others argue that subsidies only treat the symptoms of a larger problem, rather than addressing the underlying issues driving up healthcare costs.
One major issue is the lack of transparency and competition in the healthcare market. Hospitals, pharmaceutical companies, and other healthcare providers often have significant market power, allowing them to charge high prices for their services. This can lead to inflated costs that are then passed on to consumers. Additionally, the US healthcare system is heavily reliant on third-party payers, such as insurance companies and government programs, which can create inefficiencies and drive up administrative costs.
Rather than relying on subsidies, some experts argue that policymakers should focus on addressing these underlying issues. This could involve increasing transparency and competition in the healthcare market, for example by requiring hospitals and pharmaceutical companies to disclose their prices and allowing patients to shop around for care. It could also involve reforming the way healthcare is paid for, such as by moving towards a more direct payment model where patients pay providers directly for their care.
Another approach could be to focus on preventive care and addressing the social determinants of health, such as poverty, education, and housing. By investing in programs and services that address these underlying issues, policymakers may be able to reduce the demand for healthcare services and improve health outcomes, rather than simply treating the symptoms of poor health.
In conclusion, while subsidies may provide temporary relief to some individuals and families struggling to afford healthcare, they are not a long-term solution to the country’s healthcare crisis. To truly address the issues driving up healthcare costs and improve access to care, policymakers must take a more comprehensive approach that addresses the underlying problems in the healthcare market and focuses on preventive care and the social determinants of health. By doing so, they can create a more sustainable and effective healthcare system that provides high-quality, affordable care to all Americans.
Lawmakers Set to Address Education Overhaul and Healthcare Reform
The Vermont state legislature has returned to session, facing significant challenges in addressing the state’s affordability crisis. With revenues largely flat and some areas declining, lawmakers must reform systems driving up costs, including rising property taxes and soaring healthcare costs. The state’s financial outlook is bleak, with a potential 12% property tax increase forecast for 2026. To mitigate this, lawmakers will need to find nearly $200 million to offset the increase.
Education reform is a top priority, with a focus on consolidating school districts and implementing a new funding formula. However, a task force’s recommendations for creating cooperative education service regions and voluntary mergers of school districts have been met with skepticism by Governor Phil Scott, who is pushing for more sweeping reforms. Senate President Pro Tempore Phil Baruth plans to introduce legislation capping school budget growth for the next two fiscal years to control rising costs.
The state is also grappling with the loss of $65 million in federal health insurance subsidies, which will make insurance unaffordable for 30,000 Vermonters. Lawmakers will need to find ways to mitigate this loss, potentially by rearranging health insurance risk pools or using funds from the Rural Health Transformation Fund. The state will receive $195 million from this fund in 2026, which can be used to build out the primary care workforce, improve access to recovery housing, and invest in nursing homes.
Other priorities for the session include addressing backlogs in the criminal court system, particularly in Chittenden County, where a special docket has been created to quickly resolve cases involving repeat offenders. Lawmakers will also consider changes to Vermont’s voyeurism laws, including creating a new crime covering cases of sexual extortion and addressing the statute of limitations for certain crimes.
Additionally, a controversy surrounding a trip to Israel taken by five lawmakers has led to calls for greater transparency around legislators’ travel. A bill has been proposed that would require public servants to file a disclosure with the state ethics commission within 30 days of embarking on a trip, listing the purpose, destination, and associated costs.
Overall, the session is expected to be challenging, with lawmakers facing tough decisions on education reform, healthcare costs, and other pressing issues. As House Speaker Jill Krowinski said, “This session will be tough, but so will our resolve.”
Several states offer their own health insurance subsidies to help residents afford health coverage. These states include:* California * Colorado * Connecticut * District of Columbia * Maryland * Massachusetts * Minnesota * New Jersey * New York * VermontThese state-based subsidies can be used in conjunction with federal subsidies to help reduce the cost of health insurance premiums.
Several states in the US offer their own health insurance subsidies to help residents afford health coverage. These subsidies are in addition to the federal subsidies available under the Affordable Care Act (ACA). The states that offer their own subsidies are:
- California: California offers a state-based subsidy program called the California Premium Subsidy, which provides additional financial assistance to low- and moderate-income individuals and families who purchase health insurance through the state’s health insurance marketplace, Covered California.
- Colorado: Colorado offers a state-based subsidy program called the Colorado Health Insurance Affordability Enterprise, which provides financial assistance to low- and moderate-income individuals and families who purchase health insurance through the state’s health insurance marketplace, Connect for Health Colorado.
- Connecticut: Connecticut offers a state-based subsidy program called the Connecticut Health Reinsurance Program, which provides financial assistance to low- and moderate-income individuals and families who purchase health insurance through the state’s health insurance marketplace, Access Health CT.
- Maryland: Maryland offers a state-based subsidy program called the Maryland Easy Enrollment Health Insurance Program, which provides financial assistance to low- and moderate-income individuals and families who purchase health insurance through the state’s health insurance marketplace, Maryland Health Connection.
- Massachusetts: Massachusetts offers a state-based subsidy program called the Massachusetts Health Connector, which provides financial assistance to low- and moderate-income individuals and families who purchase health insurance through the state’s health insurance marketplace.
- Minnesota: Minnesota offers a state-based subsidy program called the Minnesota Premium Security Plan, which provides financial assistance to low- and moderate-income individuals and families who purchase health insurance through the state’s health insurance marketplace, MNsure.
- New Jersey: New Jersey offers a state-based subsidy program called the New Jersey Health Insurance Premium Discount Program, which provides financial assistance to low- and moderate-income individuals and families who purchase health insurance through the state’s health insurance marketplace, Get Covered New Jersey.
- New York: New York offers a state-based subsidy program called the New York State of Health, which provides financial assistance to low- and moderate-income individuals and families who purchase health insurance through the state’s health insurance marketplace.
- Oregon: Oregon offers a state-based subsidy program called the Oregon Reinsurance Program, which provides financial assistance to low- and moderate-income individuals and families who purchase health insurance through the state’s health insurance marketplace, OregonHealth.gov.
- Vermont: Vermont offers a state-based subsidy program called the Vermont Health Connect, which provides financial assistance to low- and moderate-income individuals and families who purchase health insurance through the state’s health insurance marketplace.
These state-based subsidies can help reduce the cost of health insurance premiums for eligible residents, making it more affordable for them to purchase health coverage. It’s worth noting that eligibility for these subsidies varies by state, and not all states offer subsidies to all income levels. Additionally, some states may have different eligibility requirements or application processes, so it’s best to check with the state’s health insurance marketplace or department of insurance for more information.
In the United States, citizens are experiencing a significant surge in healthcare costs due to the ongoing Republican healthcare crisis, as reported by the Democratic Senatorial Campaign Committee (dscc.org).
The Democratic Senatorial Campaign Committee (DSCC) has released a report highlighting the devastating effects of the Republican-led healthcare crisis on American families. The report emphasizes that the GOP’s actions have led to skyrocketing healthcare costs, leaving millions of Americans struggling to afford basic medical care.
The report cites data showing that healthcare costs have increased significantly since Republicans began their efforts to repeal and undermine the Affordable Care Act (ACA). In 2022, the average premium for a benchmark health plan increased by 8% nationwide, with some states experiencing even more drastic hikes. For example, in Arizona, premiums rose by 24%, while in Wisconsin, they increased by 19%.
The DSCC argues that these skyrocketing costs are a direct result of the GOP’s relentless efforts to dismantle the ACA, also known as Obamacare. The report points out that Republicans have repeatedly attempted to repeal the law, and have also taken steps to undermine its provisions, such as expanding short-term limited-duration insurance plans that do not provide comprehensive coverage.
The consequences of these actions are being felt by Americans across the country. The report notes that nearly 30 million people in the United States lack health insurance, and many more are underinsured, meaning they have coverage that does not adequately protect them from medical expenses. This has led to a situation where many Americans are forced to choose between paying for healthcare and paying for other essential expenses, such as rent or food.
The DSCC also highlights the disproportionate impact of the healthcare crisis on vulnerable populations, including low-income families, seniors, and people with pre-existing conditions. These groups are more likely to experience financial hardship due to healthcare costs, and are also more likely to forego necessary medical care due to cost concerns.
The report concludes by emphasizing the need for Democrats to take action to address the healthcare crisis and protect the ACA. The DSCC argues that Democrats must work to strengthen the ACA, expand access to affordable healthcare, and protect patients from GOP attempts to undermine the law. By doing so, Democrats can help ensure that all Americans have access to affordable, high-quality healthcare, regardless of their income or health status.
According to a report by Axios, approximately 40 million Americans are utilizing ChatGPT for healthcare purposes.
A recent report by Axios has revealed that approximately 40 million Americans are now turning to ChatGPT, a popular AI chatbot, for health care advice and information. This trend has significant implications for the future of healthcare, as people are increasingly seeking medical guidance from artificial intelligence-powered tools.
ChatGPT, developed by OpenAI, has gained immense popularity due to its ability to understand and respond to natural language inputs. The chatbot uses a vast database of medical information to provide users with answers to their health-related queries. While ChatGPT is not a substitute for professional medical advice, it has become a go-to source for many Americans seeking quick and convenient health information.
The report highlights that 40 million Americans, which is roughly 12% of the country’s population, have used ChatGPT to ask health-related questions. This number is expected to grow as more people become aware of the chatbot’s capabilities. The most common health topics that people are seeking information on include symptoms, medications, and medical conditions.
The rise of ChatGPT in healthcare has both positive and negative implications. On the positive side, ChatGPT can provide users with accurate and reliable information, helping them make informed decisions about their health. It can also serve as a valuable resource for people who lack access to healthcare services or have difficulty scheduling appointments with doctors.
However, there are concerns about the potential risks associated with relying on ChatGPT for health care advice. For instance, the chatbot may not always provide accurate or up-to-date information, which can lead to misdiagnosis or delayed treatment. Moreover, ChatGPT lacks the empathy and human touch that a doctor or healthcare professional can provide, which is essential for building trust and ensuring that patients receive personalized care.
As the use of ChatGPT in healthcare continues to grow, it is essential to address these concerns and ensure that patients are aware of the limitations and potential risks associated with using AI-powered tools for health advice. Healthcare professionals and organizations must also work together to develop guidelines and regulations for the use of ChatGPT and other AI chatbots in healthcare, ensuring that they are used responsibly and in conjunction with human medical expertise.
KGMU and Aditya Birla Capital Launch Bone Marrow Transplant Ward to Enhance Cancer Treatment Accessibility in Uttar Pradesh
In a significant development for the healthcare sector in Uttar Pradesh, King George’s Medical University (KGMU) has launched a state-of-the-art Bone Marrow Transplant (BMT) Ward with the support of Aditya Birla Capital Foundation (ABCF) and NGO partner CanKids. The new facility aims to provide affordable and high-quality transplant services, reducing the need for patients to travel outside the state for specialized care. The BMT Ward has been established under a tripartite agreement between KGMU, Aditya Birla Capital, and technical partners, with an initial investment of ₹2.76 crore from ABCF.
The facility is expected to benefit patients from across the region, particularly in oncology and pediatric cancer care. Aditya Birla Capital has committed an additional ₹3.25 crore for Phase II of the project, which will focus on expanding capacity and strengthening critical infrastructure to support a higher volume of bone marrow transplant procedures. The launch of the BMT Ward is a significant addition to Uttar Pradesh’s public healthcare infrastructure and is expected to set new benchmarks in making life-saving bone marrow transplants accessible and affordable.
According to Ms. Vishakha Mulye, MD & CEO of Aditya Birla Capital Limited, the company’s purpose goes beyond financial empowerment and drives inclusive growth and development in healthcare, education, and sustainable livelihoods for underserved communities. The Aditya Birla Capital Foundation serves as the apex body guiding the social development initiatives of Aditya Birla Capital and its group companies, impacting over 700,000 lives annually across 12 states, with a focus on women and girl children.
The establishment of the BMT Ward is a testament to the company’s commitment to creating a positive impact on the community. With the launch of this facility, patients in Uttar Pradesh and neighboring regions will have access to world-class medical care, reducing the need for them to travel to other states for treatment. The BMT Ward is expected to make a significant difference in the lives of patients and their families, providing them with hope and a chance to fight cancer.
UP Warriorz strengthen commercial portfolio with Care Health Insurance, EaseMyTrip, and Ekaya Banaras
The UP Warriorz, a Women’s Premier League (WPL) franchise, has made significant strides in strengthening its commercial and sporting foundations ahead of the upcoming season. The team has announced a series of strategic partnerships with prominent brands across various sectors, including health, travel, and cultural identity.
One of the key partnerships is with Care Health Insurance, which has come on board as an official partner, focusing on themes of confidence, protection, and holistic well-being. The franchise has also renewed its long-standing relationship with EaseMyTrip, which will continue as the principal partner for the fourth consecutive season. This partnership has played a crucial role in supporting the team’s travel and logistics across India, demonstrating sustained confidence in the franchise and the WPL ecosystem.
In a move to deepen its cultural positioning, UP Warriorz has partnered with Ekaya Banaras, a collaboration that marks a fresh chapter in the team’s brand narrative. The partnership draws inspiration from Ekaya’s crest, symbolizing the meeting of the sun and the flowing Ganga in Banaras. This has led to a reimagined visual identity for the team, featuring a Banaras bloom at its center, introducing a floral design language that will shape the team’s aesthetic this season.
On the sporting front, UP Warriorz has significantly bolstered its squad with key player signings, including Deepti Sharma, Shikha Pandey, and Meg Lanning, who has been named captain of the franchise. Other notable additions to the squad include Phoebe Litchfield, Asha Sobhana, Pratika Rawal, Harleen Deol, Deandra Dottin, Chloe Tryon, Sophie Ecclestone, and Kranti Goud. This blend of experience, versatility, and depth positions the team for competitive ambition on the field.
The latest partnerships add to UP Warriorz’s growing portfolio of lifestyle and consumer-facing brands, which already includes Pronto, L’Oréal Professionnel, and Joy Personal Care. These announcements reflect a deliberate and balanced strategy from UP Warriorz, combining athlete wellbeing, operational continuity, and culturally rooted storytelling. As the franchise prepares for the new Women’s Premier League season, the strengthened commercial platform positions the team for long-term brand equity within India’s rapidly evolving women’s sports landscape. UP Warriorz will begin their WPL 2026 campaign against Gujarat Giants Women on January 10.
From Commissions to Care, ETHealthworld
The Indian health insurance industry is experiencing rapid growth, with increasing premiums and a rising number of policyholders. However, beneath the surface, there are concerns that the system is becoming inefficient and prioritizing profits over patient care. The Medical Loss Ratio (MLR), which measures the percentage of premiums spent on patient claims, is a key indicator of an insurance system’s efficiency. In India, the MLR is alarmingly low, with some companies spending as little as 58% of premiums on medical care.
An analysis of the financial disclosures of standalone health insurance companies in India reveals that a significant portion of premiums is being absorbed by commissions, administration, and management overhead. For example, Star Health Insurance spent 15% of premiums on commissions and 17% on management expenses, while Care Health Insurance spent 20% on commissions and 22% on management expenses. This leaves a relatively small amount for actual medical care.
In contrast, global benchmarks suggest that at least 80-85% of premiums should be spent on patient care. In countries like the US, Germany, France, and the Netherlands, regulatory measures are in place to ensure that administrative and sales costs are capped, allowing the bulk of contributions to flow towards treatment.
The Indian health insurance industry’s focus on selling policies rather than funding care has led to a breakdown of trust between customers, hospitals, and insurers. Patients are often forced to pay out of pocket or battle for approvals, despite paying rising premiums. To address this issue, regulators must set MLR thresholds, forcing insurers to spend at least 80-85% of premiums on patient care. Additionally, costs of customer acquisitions and management expenses must be reduced to single digits.
The article concludes that the Indian health insurance industry needs to shift its focus from aggressively selling policies to transparently funding care. Unless efficiency improves and regulations enforce higher MLR thresholds, the promise of health insurance will remain unfulfilled, leaving patients and hospitals short-changed. The industry must prioritize funding healthcare over corporate profits and move towards a more transparent and patient-centric model.
Care Health Insurance has emerged victorious in a GST appeal, successfully overturning a liability of Rs 23.41 lakh.
In a significant victory, Care Health Insurance has successfully appealed against a Goods and Services Tax (GST) liability of Rs 23.41 lakh. The company had contested the tax demand, arguing that the GST authorities had incorrectly applied the tax laws.
The case dates back to the period between July 2017 and September 2018, when Care Health Insurance had provided health insurance services to various policyholders. During this time, the company had collected GST from its customers and deposited the amount with the authorities. However, the GST department later issued a notice to the company, claiming that it had underpaid the tax by Rs 23.41 lakh.
The GST authorities had applied a 12% tax rate on the health insurance services provided by Care Health Insurance, whereas the company argued that the correct tax rate was 0%, as per the exemption notification issued by the government. The company contended that health insurance services were exempt from GST, as per the notification dated July 28, 2017.
The appellate authority, the GST Appellate Tribunal, heard the case and ruled in favor of Care Health Insurance. The tribunal observed that the health insurance services provided by the company were indeed exempt from GST, as per the notification. The tribunal also noted that the GST authorities had failed to provide any evidence to support their claim that the company had underpaid the tax.
As a result of the tribunal’s ruling, the GST liability of Rs 23.41 lakh imposed on Care Health Insurance has been overturned. The company has welcomed the decision, stating that it is a significant victory for the insurance industry. The ruling is expected to have a positive impact on other insurance companies that have been facing similar GST issues.
The case highlights the importance of understanding the nuances of GST laws and regulations. It also underscores the need for the GST authorities to ensure that tax demands are raised correctly and in accordance with the law. The decision is expected to provide clarity on the tax treatment of health insurance services and will likely be seen as a precedent for similar cases in the future. Overall, the victory of Care Health Insurance in the GST appeal is a significant development for the insurance industry and a testament to the company’s commitment to complying with tax laws and regulations.
Tricare After Active Duty: What Actually Happens to Your Health Insurance
As you prepare to separate from active duty next month, it’s essential to understand how your health insurance will change. Your Tricare Prime coverage will end, and you’ll need to explore alternative options to ensure continuous coverage for yourself and your family.
During terminal leave, your Tricare Prime coverage remains unchanged, and your family stays covered under their current plan. However, this changes when you officially separate from active duty. The Transitional Assistance Management Program (TAMP) provides 180 days of free Tricare coverage after separation, but only for those who qualify, such as service members who separate involuntarily under honorable conditions or join the Selected Reserve immediately after active duty.
If you qualify for TAMP, you’ll keep Tricare Select coverage with no premiums, the same network, and the same rules. Prescription coverage and dental benefits will also continue. However, TAMP ends after 180 days, and you’ll need to arrange other coverage to avoid a gap. The Continued Health Care Benefit Program (CHCBP) is a purchased Tricare coverage option that lasts 18 to 36 months, but it comes with quarterly premiums, which can be costly.
Reservists may qualify to purchase Tricare Reserve Select, which has lower monthly premiums compared to CHCBP. It’s crucial to compare costs and coverage options, including marketplace plans or employer insurance, before making a decision. Additionally, VA health care is not automatic, and you must apply to enroll. Eligibility depends on your service history, disability rating, income, and other factors.
To avoid gaps in coverage, it’s essential to figure out your health insurance before separating from active duty. Explore options like TAMP, CHCBP, TRS, employer insurance, or Health Insurance Marketplace plans. Gaps in coverage can be costly, so it’s crucial to stay on top of your veteran benefits and understand what you have, when it ends, and what comes next. Regularly checking for updates on military benefits, including pay and health care, can help you make informed decisions about your coverage.
Punjab has signed an agreement to launch a cashless health insurance program, which is set to be implemented on January 15.
The state government of Punjab has signed an agreement with the United India Insurance Company to launch a cashless health insurance scheme called ‘Mukh Mantri Sehat Yojna’ on January 15. The scheme will provide a cashless health insurance cover of up to Rs 10 lakh per family per year to all residents of Punjab, including government employees and pensioners. This is a significant expansion of the earlier health protection scheme, which had a coverage limit of Rs 5 lakh and was limited to specific categories.
The new scheme aims to provide total inclusivity, with no income cap or exclusion criteria. Enrolment for the scheme will be made simple and accessible through Common Service Centres (CSCs) using only Aadhaar and voter IDs. Beneficiaries will receive dedicated MMSY health cards, and a helpline will be launched soon to facilitate the process.
The United India Insurance Company will provide coverage of Rs 100,000 per family for all 65 lakh families in the state. For treatment requirements between Rs 100,000 and Rs 10,00,000, the insurance will be provided by the state health agency on a trust basis. The scheme adopts the latest health benefit package, ensuring comprehensive coverage through more than 2,000 selected treatment packages.
Beneficiaries can access secondary and tertiary care across a robust network of 824 empanelled hospitals, which includes 212 public hospitals, eight government of India hospitals, and over 600 private hospitals. The number of empanelled hospitals is expected to increase further as the scheme progresses. The scheme will be formally launched by Chief Minister Bhagwant Singh Mann and AAP national convenor Arvind Kejriwal on January 15.
The state government has emphasized that the scheme is designed to provide comprehensive health coverage to all residents of Punjab, regardless of their income or social status. The scheme’s operational framework has been designed to ensure that beneficiaries can access quality healthcare services without having to worry about the financial burden. With the launch of this scheme, Punjab is taking a significant step towards providing universal health coverage to its residents.
Baptist Health System is taking legal action against United Healthcare, alleging the insurer has failed to adequately reimburse for emergency room care, according to a report by the San Antonio Express-News.
Baptist Health System has filed a lawsuit against United Healthcare, alleging that the insurance company has systematically underpaid for emergency room care provided to its policyholders. The lawsuit, filed in Bexar County District Court, claims that United Healthcare has failed to reimburse Baptist Health System for the full amount of emergency medical services provided, despite the insurer’s contractual obligations to do so.
According to the lawsuit, United Healthcare has been applying incorrect reimbursement rates and methodologies, resulting in significant underpayments to Baptist Health System. The hospital system claims that it has tried to resolve the issue through negotiations, but United Healthcare has refused to pay the correct amounts.
The lawsuit alleges that United Healthcare’s actions are a breach of contract and a violation of the Texas Insurance Code. Baptist Health System is seeking reimbursement for the underpaid claims, as well as damages and attorney’s fees.
The dispute centers on the interpretation of the contractual language between Baptist Health System and United Healthcare. The hospital system argues that the contract requires United Healthcare to pay for emergency services at the “reasonable and customary” rate, while United Healthcare claims that it is only obligated to pay a lower, negotiated rate.
Baptist Health System’s lawsuit is the latest in a series of disputes between hospitals and insurance companies over payment for emergency room care. The issue has become increasingly contentious in recent years, as insurance companies have sought to reduce costs by negotiating lower reimbursement rates with hospitals.
The lawsuit highlights the complex and often contentious relationship between hospitals and insurance companies. While hospitals argue that they need to be reimbursed at a rate that reflects the true cost of providing care, insurance companies claim that they must balance the need to control costs with the need to provide adequate coverage to their policyholders.
The outcome of the lawsuit could have significant implications for the healthcare industry, particularly in Texas. If Baptist Health System is successful in its claim, it could set a precedent for other hospitals to challenge insurance companies over payment for emergency room care. On the other hand, if United Healthcare prevails, it could embolden insurance companies to continue pushing for lower reimbursement rates, potentially leading to further disputes and litigation.
Preventive care is becoming a priority in Indian health insurance, according to Mayank Bathwal of ABHI.
The healthcare costs in India are rising, and as a result, preventive care is becoming a key focus for insurers. Despite progress in coverage, over 60% of healthcare expenses are still borne directly by households, highlighting gaps in traditional insurance models. Mayank Bathwal, CEO of Aditya Birla Health Insurance, explains that conventional health insurance has historically focused on hospitalization, leaving everyday healthcare expenses, such as outpatient consultations and chronic disease management, largely uncovered.
To address this issue, insurers are expanding coverage to include outpatient and preventive care, which helps manage expenses more predictably and reduces avoidable hospitalizations. Affordability is also a challenge that cannot be solved by pricing alone, and reducing healthcare costs through better coordination and promoting preventive care is essential. Innovation in product design and distribution is also crucial to engage first-time buyers, particularly younger consumers who value clarity, relevance, and ease of use.
The use of AI-enabled tools and assisted-digital models can simplify discovery and onboarding, while also enabling insurers to provide faster and consistent service. Building trust and retention is also important, and programs such as ABHI’s HealthReturns, which rewards policyholders for healthy behavior, can help shift the perception of insurance from a reluctant purchase to a valued product.
Collaboration across insurers, healthcare providers, and policymakers is critical to creating a comprehensive health ecosystem. Digital infrastructure, such as ABHA and Bima Sugam, is creating transparency, improving claims processing, and enabling more predictable pricing. Sustained dialogue between providers and insurers helps align treatment protocols and pricing, ultimately benefiting both customers and the insurance ecosystem.
ABHI’s broader vision is to move from a reactive, hospital-focused model to a comprehensive health ecosystem, with a focus on chronic condition management and wellness initiatives. This approach aligns customer health outcomes with the insurer’s sustainability goals and marks a significant shift in the role of health insurance in India. By expanding coverage to outpatient and preventive care, promoting affordability, and building trust and retention, insurers can provide more comprehensive and sustainable healthcare solutions for their customers.
The Punjab Government is set to launch a ₹10 lakh cashless health insurance scheme, following the signing of an agreement with the United India Insurance Company (UIIC).
The Punjab government, led by Chief Minister Bhagwant Singh Mann, is set to launch a new health insurance scheme called ‘Mukh Mantri Sehat Yojna’ (MMSY) on January 15, 2026. The scheme aims to provide ₹10 lakh cashless health insurance cover to all families in Punjab, ensuring health dignity and financial protection for every household. This move is a significant step towards achieving Universal Health Coverage, a promise made by the CM.
The agreement for the scheme was signed with the United India Insurance Company, which will provide coverage of ₹1,00,000 per family for all 65 lakh families in the state. For treatment requirements between ₹1,00,000 and ₹10,00,000, the insurance will be provided by the State Health Agency (SHA) Punjab on a trust basis. The scheme adopts the latest Health Benefit Package (HBP 2.2), ensuring comprehensive coverage through more than 2,000 selected treatment packages.
Beneficiaries can access secondary and tertiary care across a robust network of 824 empaneled hospitals, including 212 Public Hospitals, eight Government of India Hospitals, and over 600 Private Hospitals. The number of empaneled hospitals is expected to increase further as the scheme progresses. The scheme is designed for total inclusivity, featuring no income cap or exclusion criteria, and enrolment has been made simple and accessible through Common Service Centres (CSCs) using only Aadhaar and Voter IDs.
The Health Minister, Dr. Balbir Singh, highlighted that the scheme significantly expands health protection from the earlier ₹5 lakh coverage, which was limited to specific categories. He also emphasized that the selection of United India Insurance brings the advantage of specialists to manage CPD processing efficiently, ensuring faster claim settlements and reduced payment turnaround times. CM Bhagwant Singh Mann and AAP National Convenor Arvind Kejriwal will formally launch the scheme on January 15, 2026.
Congress had a viable health care reform plan once – it should be considered again – WyomingNews.com
The article discusses a viable healthcare reform plan that was once considered by Congress, but ultimately not implemented. The plan, known as the “Medicare-X” proposal, was introduced in 2019 by a bipartisan group of lawmakers. The proposal aimed to create a public health insurance option, building on the existing Medicare program, to provide affordable healthcare to all Americans.
The Medicare-X plan would have allowed individuals and families to purchase Medicare coverage, regardless of age or income level. This would have provided an alternative to private insurance plans, which are often expensive and offer limited coverage. The plan would have also allowed small businesses and self-employed individuals to purchase Medicare coverage, providing them with a more affordable option.
One of the key benefits of the Medicare-X plan was its potential to reduce healthcare costs. By leveraging the existing Medicare infrastructure, the plan would have been able to negotiate lower prices with healthcare providers, reducing costs for consumers. Additionally, the plan would have eliminated the need for private insurance companies’ administrative costs, which account for a significant portion of healthcare spending.
Despite its potential benefits, the Medicare-X plan was not passed into law. However, the article argues that it is worth reconsidering, particularly in light of the ongoing healthcare crisis in the United States. The COVID-19 pandemic has highlighted the need for a more comprehensive and affordable healthcare system, and the Medicare-X plan could provide a viable solution.
The article notes that the Medicare-X plan is not a radical or new idea, but rather a building block on the existing Medicare program. It is a pragmatic solution that could be implemented incrementally, starting with a pilot program or a limited rollout. The plan’s bipartisan origins and potential to reduce healthcare costs make it an attractive option for lawmakers looking for a compromise on healthcare reform.
Overall, the article argues that the Medicare-X plan is a viable healthcare reform proposal that deserves reconsideration. With the ongoing healthcare crisis and the need for affordable and comprehensive healthcare, it is worth taking another look at this proposal and exploring its potential to provide healthcare to all Americans. By building on the existing Medicare program, the Medicare-X plan could provide a more efficient and effective healthcare system, reducing costs and improving health outcomes for all.
The Trump administration has faced criticism for cutting gender-affirming care.
The Trump administration has introduced a new policy that removes coverage for gender-affirming care from federal health insurance plans, effective January 1, 2026. This policy affects federal employees and US Postal Service workers, and has been met with backlash from the Human Rights Campaign (HRC) and other advocacy groups. The HRC has filed a complaint with the Equal Employment Opportunity Commission (EEOC), arguing that the policy amounts to sex-based discrimination and is intended to push transgender people and their families out of the federal workforce.
The policy eliminates coverage for “chemical and surgical modification of an individual’s sex traits,” which is a key aspect of gender-affirming care. The HRC’s president, Kelley Robinson, has stated that the policy is not about cost or care, but rather about driving transgender people out of the federal workforce. This move is part of broader efforts by the Trump administration to restrict gender-affirming care in the US, particularly for minors.
In December, the administration proposed blocking Medicare and Medicaid funding for hospitals that provide gender-affirming care to children. Health secretary Robert F. Kennedy Jr has been vocal in his opposition to trans healthcare, calling it “malpractice.” These efforts began after Trump’s return to office in 2025, when he reinstated a policy recognizing only two sexes, male and female.
Advocacy groups, including the Trevor Project, have expressed concern over the Trump administration’s efforts to restrict gender-affirming care. Rodrigo Heng-Lehtinen, senior vice president of public engagement campaigns at the Trevor Project, has described the efforts as “deeply troubling.” The HRC and other groups are continuing to fight against the policy, arguing that it is discriminatory and harmful to transgender individuals and their families. The policy has been widely criticized, with many arguing that it is a step backwards for LGBTQ+ rights in the US.
Tata AIA Health Buddy: Redefining Health & Wellness with a Witty Metro Campaign
Tata AIA Life Insurance, a leading life insurer in India, has launched Tata AIA Health Buddy, a 24×7 health and wellness companion. This initiative marks a significant shift in the life insurance industry, as it integrates health, wellness, and life insurance into one comprehensive service. The Health Buddy platform provides preventive health services, wellness tools, and continuous guidance through the Tata AIA Life Insurance App, making it a long-term companion for consumers.
To promote the launch, Tata AIA conducted an unconventional activation in the Mumbai Metro, where they transformed the metro line into a canvas of witty and contextual storytelling. Posters and digital displays featuring the Health Buddy mascot were placed inside metro compartments, reminding commuters of the importance of proactive health and wellness. The campaign was amplified across social media, generating buzz and extending the reach of the Health Buddy philosophy.
According to Girish J Kalra, Chief Marketing Officer at Tata AIA Life Insurance, the Mumbai Metro campaign embodies the Health Buddy philosophy, making health support visible and accessible to consumers. By placing health and wellness at the core, Tata AIA Health Buddy marks a new era in consumer care, empowering families to stay confident in their health, wellness, and protection.
The Tata AIA Health Buddy service is available with a wide range of Tata AIA solutions, including various life insurance plans and pension products. This launch represents a bold step in redefining what it means to care for consumers, providing them with a proactive health partner that is always accessible, visible, and relevant. With Health Buddy, consumers can now have a companion that is always by their side, ready to help, and just a tap away on the Tata AIA Life Insurance App.
The introduction of Tata AIA Health Buddy is a significant development in the life insurance industry, as it shifts the focus from mere financial protection to a more holistic approach that encompasses health and wellness. This move is expected to benefit consumers, who will now have access to a comprehensive service that addresses their overall well-being. As the life insurance industry continues to evolve, the launch of Tata AIA Health Buddy sets a new standard for consumer care, emphasizing the importance of proactive health and wellness support.
Millions of Americans face steep health insurance hikes as Affordable Care Act subsidies expire.
The Affordable Care Act (ACA) tax subsidies, which have helped millions of Americans pay for health coverage, have expired as of the end of 2025. This expiration is expected to significantly impact the over 20 million subsidized enrollees in the ACA program, who will now face rising premium costs. According to an analysis by the Kaiser Family Foundation, premiums are projected to increase by 114% in 2026.
The expiration of these subsidies follows a period of intense negotiation and debate among lawmakers. In 2025, Democrats forced a 43-day government shutdown in an effort to address the issue, while moderate Republicans sought a solution to save their 2026 political aspirations. President Donald Trump also proposed a potential solution, but ultimately backed off due to conservative backlash. Despite these efforts, no agreement was reached, and the subsidies were allowed to expire.
There are currently two plans with traction in the House that aim to address the issue. The GOP’s plan, which was advanced on the floor last month, does not address the expiring tax credits. On the other hand, a bipartisan plan calls for a three-year extension of the subsidies, similar to a plan proposed by Senate Democrats. This plan is scheduled for a vote in January and has garnered some hope among Democrats that a three-year extension could be possible.
The expiration of the ACA subsidies has significant implications for millions of Americans who rely on the program for affordable health coverage. With premium costs expected to rise significantly, many individuals and families may struggle to maintain their coverage. The upcoming House vote in January will be closely watched as lawmakers attempt to find a solution to this critical issue. Ultimately, the outcome of these negotiations will have a profound impact on the accessibility and affordability of healthcare for millions of Americans.
Health care premiums are surging, leading to the discontinuation of other plans in Minnesota.
In 2026, significant changes are affecting Special Needs BasicCare (SNBC) coverage in Minnesota, primarily due to Medica’s acquisition of UCare’s business. UCare, which serves mostly the Midwest, is facing financial struggles and cutting back services, resulting in the termination of some SNBC plans. This change is causing concern among individuals who rely on SNBC coverage, particularly those living in rural counties where these plans are no longer being provided.
Rebecca Mallery, a resident of Staples, is one such individual who is deeply affected by this change. Despite having debilitating disabilities, Mallery works part-time and relies on medications worth thousands of dollars, which are no longer covered under her special needs plan. Her plan was unique in that it integrated all medical assistance benefits, including Medicare and Medicaid, making it easier for her to manage her care. However, with the termination of her plan, Mallery is facing confusion and uncertainty about her future coverage.
The state is recommending that individuals affected by this change explore new options through the state’s online shop. However, Mallery has not received any clear answers or guidance since the news broke several months ago. She has been on the plan for 20 years, and it has worked seamlessly until now. The lack of information and support is causing significant stress and anxiety for Mallery and others who are affected by this change.
In response to this situation, the Department of Human Services is being urged to provide further clarification and support to those affected. In the meantime, free resources such as Disability Hub MN and Minnesota Aging Pathways are available to help individuals navigate this confusing time. These statewide networks can provide guidance and support to help people find new coverage options and manage their care. As the situation continues to unfold, it is essential that those affected by the changes to SNBC coverage receive the support and guidance they need to ensure continuity of care.
Preventive care is gaining prominence in Indian health insurance, according to Mayank Bathwal of ABHI.
The rising healthcare costs in India have led to a shift in focus towards preventive care, particularly in addressing the significant out-of-pocket spending burden on households. Despite progress in coverage, over 60% of healthcare expenses are still borne directly by households, highlighting the gaps in traditional insurance models. Mayank Bathwal, CEO of Aditya Birla Health Insurance, emphasized that conventional health insurance has historically focused on hospitalization, leaving everyday healthcare expenses largely uncovered.
To address this, insurers are expanding coverage to include outpatient and preventive care, which helps manage expenses more predictably and reduces avoidable hospitalizations. Affordability is also a challenge that cannot be solved by pricing alone, and reducing healthcare costs through better coordination, promoting preventive care, and improving the health profile of insured customers are key levers. Innovation in product design and distribution is essential to engage first-time buyers, particularly younger consumers who value clarity, relevance, and ease of use.
The use of AI-enabled tools and assisted-digital models can simplify discovery and onboarding, while also enabling insurers to provide faster, consistent service. Building trust and retention is also crucial, and programs such as ABHI’s HealthReturns, which rewards policyholders for healthy behavior, can help shift the perception of insurance from a reluctant purchase to a valued product.
Collaboration across insurers, healthcare providers, and policymakers is critical in creating a comprehensive health ecosystem. Digital infrastructure such as ABHA, Bima Sugam, and the National Health Claims Exchange is creating transparency, improving claims processing, and enabling more predictable pricing. Sustained dialogue between providers and insurers helps align treatment protocols and pricing, ultimately benefiting both customers and the insurance ecosystem.
ABHI’s broader vision is to move from a reactive, hospital-focused model to a comprehensive health ecosystem, with chronic condition management programs and digital tools that allow customers to track their health and participate in wellness initiatives. This approach aligns customer health outcomes with the insurer’s sustainability goals and marks a significant shift in the role of health insurance in India. By prioritizing preventive care, affordability, and customer engagement, insurers can create a more sustainable and effective healthcare system.
2026 brings increased costs for Affordable Care Act health insurance plans as subsidies lapse for millions of Americans
The enhanced tax credits that helped reduce the cost of health insurance for millions of Americans under the Affordable Care Act (ACA) have expired, resulting in higher health costs for many individuals and families. The subsidies, which were introduced in 2021 to help Americans during the COVID-19 pandemic, were extended until the start of 2026. However, despite efforts by Democrats and some moderate Republicans to save the subsidies, they were not renewed, and millions of Americans are now facing significant increases in their health insurance premiums.
The expiration of the subsidies affects a diverse group of Americans, including self-employed workers, small business owners, farmers, and ranchers, who do not have access to employer-sponsored health insurance and do not qualify for Medicaid or Medicare. According to an analysis by the Kaiser Family Foundation (KFF), the average premium cost for ACA enrollees is increasing by 114% in 2026, with some individuals facing premium hikes of $500 to $700 per month.
The impact of the expired subsidies will be felt across the country, with health analysts predicting that many Americans, particularly younger and healthier individuals, will drop their health insurance coverage altogether. This could lead to a more expensive and less healthy insurance pool, as older and sicker individuals remain in the program. In Florida, which has the largest number of ACA enrollees, over 4.7 million people may be affected, followed by Texas, California, Georgia, and North Carolina.
Many Americans who are affected by the expired subsidies are expressing frustration and disappointment with lawmakers for not taking action to address the issue. Some, like Katelin Provost, a single mother, are facing significant premium hikes and are considering dropping their coverage altogether. Others, like Stan Clawson, a freelance filmmaker and adjunct professor, are absorbing the extra expense but are struggling to make ends meet.
The expiration of the subsidies has sparked a renewed debate over the need for broader health care reform. Many Americans are calling for lawmakers to restore the subsidies and implement more comprehensive reforms to make health care more affordable for all. As one enrollee, Chad Bruns, noted, “Both Republicans and Democrats have been saying for years, oh, we need to fix it. Then do it.” The issue is expected to be a major topic of discussion in the upcoming midterm elections, with affordability, including the cost of health care, topping the list of voters’ concerns.
Millions of Americans face steep insurance hikes in 2026 as health subsidies expire.
As the year 2025 comes to a close, millions of Americans are bracing themselves for a significant increase in health insurance costs. The expiration of temporary health subsidies, which were introduced as part of the American Rescue Plan Act (ARPA) in 2021, will result in steep insurance hikes for many individuals and families. These subsidies, which were designed to make health insurance more affordable for low- and middle-income households, have been a vital lifeline for those struggling to access healthcare.
The ARPA subsidies, which were extended through 2025 as part of the Inflation Reduction Act, have helped to reduce the cost of health insurance for millions of Americans. However, with their expiration, many individuals and families will face significant increases in their monthly premiums. According to estimates, the average premium increase will be around 50%, with some individuals facing hikes of up to 100% or more.
The impact of these increases will be felt disproportionately by low- and middle-income households, who will struggle to afford the rising costs of health insurance. Many will be forced to choose between paying for essential healthcare services or other necessities, such as food and housing. This could lead to a decline in health outcomes, as individuals delay or forego necessary medical care due to cost concerns.
The expiration of the subsidies will also have a significant impact on the health insurance market as a whole. Insurers may raise premiums even further to compensate for the loss of subsidy revenue, which could lead to a decrease in enrollment and an increase in the number of uninsured individuals. This, in turn, could exacerbate existing healthcare disparities and place a greater burden on the healthcare system.
Lawmakers have been aware of the impending expiration of the subsidies and have proposed various solutions to address the issue. However, with the current legislative landscape, it remains uncertain whether a fix will be implemented in time to mitigate the impact of the subsidy expiration. As the clock ticks down to 2026, millions of Americans are left wondering how they will afford the rising costs of health insurance, and what the future holds for their healthcare coverage.
Millions of Americans are at risk of losing their health care subsidies as they are set to expire.
As 2025 comes to a close, the world is reflecting on the remarkable lives lost throughout the year. In a special segment, “2025 in Memoriam,” the lives and accomplishments of notable individuals who passed away are being remembered.
In other news, the US Postal Service has announced changes to its postmark process, and Warren Buffet has marked his final day as CEO of Berkshire Hathaway. Google has released its top searches of 2025, showcasing the most popular topics in pop culture, TV, music, and more.
The US is experiencing a surge in flu cases, with the Northeast region at “very high” activity levels. Health officials are warning of the risks, particularly during the holiday season. Meanwhile, weight loss drug giants are preparing to debut oral GLP-1 options, a new development in the field of weight management.
In sports news, NFL star Stefon Diggs is facing strangulation and assault charges, and golf legend Tiger Woods has celebrated his 50th birthday. Additionally, the father of NASCAR driver Denny Hamlin has died in a house fire.
On the political front, Trump has given warnings to Iran and Hamas after a meeting with Netanyahu, and has announced that the US has hit a “big facility” in its first attack on Venezuelan soil.
In economic news, some 22 million Americans will see their health insurance premiums skyrocket after Congress failed to extend certain subsidies under the Affordable Care Act. This development is expected to have a significant impact on many individuals and families across the country.
Other notable stories include a mysterious explosion in northwest Venezuela, federal child care funds being halted to Minnesota amid fraud claims, and security preparations underway for New Year’s celebrations. A prominent farmer has been charged in the shooting death of his estranged wife, and a couple has been saved after their car rolled off the side of a California highway. These stories represent some of the major news events of 2025, a year that has been marked by significant developments in politics, healthcare, sports, and more.
Digital and preventive care are driving a shift in India’s health insurance landscape, according to a report by BW Healthcare World.
A recent report by BW Healthcare World highlights the significant shift in India’s health insurance landscape, driven by digital and preventive care. The report notes that the Indian health insurance market is undergoing a transformation, with a growing focus on preventive care and digital solutions.
The COVID-19 pandemic has accelerated this shift, with more people seeking health insurance coverage to mitigate the financial risks associated with medical treatments. The report states that the health insurance market in India is expected to grow significantly, driven by increasing awareness about the importance of health insurance and the government’s efforts to promote health coverage.
Digital health insurance platforms have emerged as a key driver of this growth, offering convenient and accessible health insurance solutions to consumers. These platforms provide a range of services, including online policy purchases, claims settlements, and access to healthcare services. The report notes that digital platforms have made it easier for people to buy and manage health insurance policies, leading to increased penetration of health insurance in the country.
Preventive care is also becoming a major focus area for health insurance providers in India. The report states that insurers are now offering preventive care services, such as health check-ups, fitness programs, and wellness initiatives, to policyholders. This shift towards preventive care is expected to help reduce healthcare costs and improve health outcomes for policyholders.
The report also highlights the growing importance of telemedicine and online consultations in India’s health insurance market. With the rise of digital health platforms, policyholders can now access medical consultations and advice remotely, reducing the need for physical hospital visits. This is particularly significant in India, where access to healthcare services can be limited in rural and remote areas.
The Indian government has also launched several initiatives to promote health insurance and preventive care in the country. The report notes that the government’s Ayushman Bharat scheme, which provides health insurance coverage to low-income families, has been successful in increasing health insurance penetration in the country.
Overall, the report suggests that India’s health insurance market is undergoing a significant transformation, driven by digital and preventive care solutions. As the market continues to grow and evolve, it is likely that we will see increased adoption of health insurance and preventive care services, leading to improved health outcomes and reduced healthcare costs for policyholders.
AHPI seeks immediate restoration of cashless services by Star Health
The Association of Healthcare Providers of India (AHPI) has appealed to Star Health and Allied Insurance to reinstate cashless services at their member hospitals. This decision comes after the insurance company suspended these facilities, resulting in growing distress and inconvenience for patients. Several prominent hospital chains and tertiary care centers have been affected, including Care Hospitals, Manipal Hospitals, Max Hospitals, and Medanta Hospital, among others.
The AHPI has also highlighted the issue of delays or refusals in empaneling new hospitals, which restricts patient choice and forces them to opt for reimbursement claims instead of cashless treatment. This defeats the purpose of health insurance, which patients buy with the expectation of receiving cashless treatment at quality hospitals. According to Girdhar Gyani, Director General of AHPI, and Abul Hasan, Chairman of the Indian Medical Association Hospital Board, it is unjust for insurers to withhold cashless facilities after collecting premiums.
The AHPI has demanded that cashless services be restored immediately and that the empanelment of new hospitals be expedited to ensure uninterrupted access to healthcare. The association has clarified that its decision is a response to Star Health’s actions and not a unilateral move, as suggested by the General Insurance Council (GIC). The AHPI remains open to engagement with stakeholders but has emphasized that protecting patient welfare must remain the top priority.
The suspension of cashless services has significant implications for patients, who may be forced to bear the financial burden of medical treatment out of pocket. The AHPI’s appeal highlights the need for insurance companies to prioritize patient welfare and ensure that policyholders receive the benefits they are entitled to. By reinstating cashless services and expediting empanelment, Star Health and Allied Insurance can help alleviate the distress and inconvenience caused to patients and restore trust in the healthcare system. Ultimately, the AHPI’s efforts aim to ensure that patients have access to quality healthcare without financial hardship.
India is grappling with significant healthcare challenges, underscoring the urgent necessity for a comprehensive health policy and insurance reforms. The country’s vast and diverse population faces numerous health-related issues, including inadequate access to quality healthcare, insufficient healthcare infrastructure, and a significant shortage of medical professionals. The existing health policy and insurance framework often fails to provide universal coverage, leaving many without the financial protection needed to access essential healthcare services. This has resulted in a substantial portion of the population relying on out-of-pocket expenses for healthcare, leading to financial hardship and exacerbating health inequities. To address these challenges effectively, there is a pressing need for reforms that aim at enhancing healthcare accessibility, affordability, and quality. A comprehensive health policy should focus on strengthening healthcare infrastructure, increasing the number of medical professionals, and ensuring that health services are evenly distributed across urban and rural areas. Moreover, insurance reforms are crucial to reduce out-of-pocket expenditures and provide financial security to individuals and families. Implementing such reforms would not only improve health outcomes but also contribute to the overall well-being and economic stability of the population, making a significant step towards achieving universal health coverage.
The Indian healthcare system is facing significant challenges, with inadequate public infrastructure, a shortage of medical professionals, and low public health expenditure. The private healthcare sector is expensive, and medical insurance has become more of a tax-saving instrument than a reliable means of protection against health crises. The medical insurance crisis in India is characterized by opaque policy terms, denied claims, and a litigation burden on consumers.
In contrast, countries like Canada, Australia, and New Zealand have robust national healthcare systems that provide free state-provided healthcare, making private insurance largely redundant. India’s model, which combines underfunded public healthcare with expensive private care, urgently needs reform.
The Pradhan Mantri Bhima Yojanas, low-cost insurance schemes introduced by the Indian government, have achieved huge enrollment across semi-urban and rural populations, but they have limitations, such as inadequate coverage amounts and lack of general healthcare coverage. Suggestions for expansion include raising the coverage ceiling, including hospitalization and critical illness coverage, and introducing telemedicine and preventive healthcare services as add-ons.
The litigation propensity of Indian insurers is high, with a significant chunk of cases before Consumer Dispute Redressal Forums involving insurance disputes. Indian jurisprudence has criticized insurers’ practices, but the need for statutory penalties remains strong. Learning from the US Affordable Care Act (Obamacare), India can introduce key reforms, such as guaranteed issue, minimum essential benefits, subsidized premiums, and insurance exchanges.
To create a health ecosystem where no Indian must fear financial ruin for seeking medical care, India must introduce a twin strategy of universal healthcare provisioning and robust insurance regulation. This includes introducing punitive consequences for bad-faith insurer conduct, adapting Obamacare’s core reforms, expanding national insurance programs, and enforcing consumer-friendly judicial standards. Healthcare reform is not just a matter of policy; it is a matter of human dignity.
Drawing lessons from US cases like Harvey and Menchaca, India can impose serious financial consequences on insurers that prioritize their own interests over the insured’s welfare. The judgments in these cases illustrate that courts can impose significant financial penalties on insurers that mishandle claims, misrepresent policy terms, or fail to promptly offer reasonable settlements. By introducing similar measures, India can create a more balanced and fair insurance market. Ultimately, a comprehensive healthcare reform is essential to ensure that all Indians have access to quality and affordable healthcare, regardless of their economic background.
California should embrace competition to promote better health insurance.
The article from the Sacramento Bee argues that California should promote competition in the health insurance market to improve the quality and affordability of healthcare for its residents. The author suggests that the current lack of competition is driving up costs and reducing access to care, particularly for those with pre-existing conditions.
The article points out that California’s health insurance market is dominated by a few large players, with Blue Shield and Anthem controlling over 70% of the market. This concentration of power allows these companies to dictate prices and limit consumer choice. The author argues that increased competition would lead to lower premiums, better coverage, and more innovative products.
To promote competition, the author recommends that California allow more insurers to enter the market, including those from other states. This would increase consumer choice and put pressure on existing insurers to improve their products and prices. The author also suggests that the state should reduce regulatory barriers and streamline the approval process for new insurers.
Additionally, the article highlights the success of other states that have promoted competition in their health insurance markets. For example, Arizona and Texas have seen significant increases in the number of insurers operating in their markets, leading to lower premiums and better coverage.
The author also notes that California’s current approach to healthcare reform, which focuses on expanding Medicaid and subsidizing premiums for low-income residents, is not sufficient to address the underlying issues in the market. While these efforts have helped to increase access to care, they have not addressed the root causes of high costs and limited choice.
In conclusion, the article argues that California should prioritize competition in the health insurance market to promote better health insurance for its residents. By allowing more insurers to enter the market, reducing regulatory barriers, and streamlining the approval process, the state can increase consumer choice, drive down costs, and improve the quality of care. The author believes that this approach would be more effective than the current focus on expanding Medicaid and subsidizing premiums, and would ultimately lead to better health outcomes and more affordable care for Californians.
The Uninsured Population and Health CoverageThe Issue of the Uninsured The uninsured population refers to individuals who lack health insurance coverage. This group is diverse and includes people from various backgrounds, ages, and socioeconomic statuses. Being uninsured can significantly impact an individual’s health and well-being, as it often results in delayed or foregone medical care due to cost concerns.Causes of Lack of Insurance Several factors contribute to the lack of health insurance among certain populations. These include: – Economic constraints: High premiums and deductibles can make health insurance unaffordable for low-income individuals and families. – Employment status: Many employers, especially small businesses, do not offer health insurance to their employees. – Pre-existing conditions: Before the Affordable Care Act (ACA), individuals with pre-existing health conditions could be denied coverage or charged higher premiums. – Immigration status: Undocumented immigrants often face barriers to accessing health insurance.Consequences of Being Uninsured The consequences of lacking health insurance are far-reaching and can have serious implications for individuals and society as a whole. Some key consequences include: – Delayed care: Without insurance, individuals may postpone seeking medical care, leading to more severe health problems over time. – Financial burden: Medical bills can lead to significant financial strain, potentially resulting in bankruptcy. – Health disparities: The uninsured are more likely to experience poor health outcomes and have higher mortality rates compared to their insured counterparts. – Economic impact: The cost of uncompensated care falls on hospitals, taxpayers, and the insured population, increasing healthcare costs overall.Health Coverage Solutions To address the issue of the uninsured, various solutions have been proposed and implemented: – Affordable Care Act (ACA): Expanded Medicaid eligibility, allowed young adults to stay on parental insurance until age 26, and prohibited denial of coverage based on pre-existing conditions. – Medicaid expansion: States have the option to expand Medicaid to cover more low-income individuals. – Health Insurance Marketplaces: Provide a platform for individuals and small businesses to purchase health insurance plans. – Employer-sponsored insurance: Encouraging employers to offer health insurance as a benefit to their employees. – Community health centers: Offer primary care services to underserved populations, including the uninsured.Addressing the complex issue of the uninsured population requires a multifaceted approach that includes policy reforms, public health initiatives, and community engagement. By understanding the causes and consequences of lacking health insurance, we can work towards achieving more equitable and comprehensive health coverage for all.
The US health coverage system is fragmented, leading to gaps in coverage for many individuals. Employer-based insurance is the primary source of coverage for people aged 0-64, but not all workers are offered coverage or can afford it. Medicaid covers many low-income individuals, particularly children, but eligibility for adults is limited in states that have not expanded Medicaid under the Affordable Care Act (ACA). Subsidies are available for Marketplace coverage, but many people cannot afford private coverage without financial assistance.
The cost of health coverage and care is a significant barrier to coverage, with 63.2% of uninsured adults citing unaffordability as the reason for being uninsured. Other reasons include not being eligible for coverage, not needing or wanting coverage, and difficulty signing up. Many workers do not have access to coverage through their jobs, and among those who are offered coverage, cost is often a barrier.
The ACA has not entirely closed the coverage gap, particularly in states that have not expanded Medicaid. This leaves 1.4 million uninsured people without an affordable coverage option. Lawfully present immigrants face a five-year waiting period before qualifying for Medicaid, although some states have opted to cover eligible children and pregnant individuals without a waiting period. Undocumented immigrants are ineligible for federally funded coverage, but some states provide state-funded health coverage.
Recent changes to health care provisions are expected to increase the number of lawfully residing immigrants without health coverage. While financial assistance is available to many uninsured individuals, not everyone is eligible for free or subsidized coverage. In 2023, nearly 6 in 10 uninsured individuals were eligible for financial assistance, but over 4 in 10 were outside the reach of the ACA due to their state not expanding Medicaid, their immigration status, or being deemed to have access to an affordable Marketplace plan or employer coverage.
The lack of affordable health coverage options has significant implications for the country, and it is essential to address these gaps to ensure that all individuals have access to necessary healthcare services. The ongoing challenges in the US health coverage system highlight the need for continued efforts to improve and expand coverage options, particularly for low-income individuals and marginalized communities.
On October 8, 2025, insurance agents and associations are likely to raise the issue of Goods and Services Tax (GST) with the Insurance Regulatory and Development Authority of India (IRDAI) and the Finance Ministry.
The insurance industry in India is facing a significant issue related to the Goods and Services Tax (GST) and Input Tax Credit (ITC). Private insurers have reduced distributor payouts by 15-18% to offset the loss of ITC, following the GST exemption on life and health insurance premiums. This move is expected to have a significant impact on agents, brokerages, and individual advisors, particularly small and independent operators. The reduction in payouts will directly cut into their working capital, leading to reduced take-home income and morale, especially in smaller towns and rural markets.
The current GST framework, if left unadjusted, may set a precedent where insurers maintain profitability by squeezing distribution costs rather than improving efficiency. Industry associations and agents are likely to take up the issue with the Insurance Regulatory and Development Authority of India (IRDAI) and the Finance Ministry. The President of the General Insurance Agents Federation Integrated stated that the change will shrink access to insurance, which is against the Prime Minister’s vision of Insurance for All by 2047.
In contrast, Life Insurance Corporation (LIC) and other public sector insurers have decided to maintain existing commission structures, even as they pass the full GST relief to policyholders. LIC plans to offset the impact through higher policy sales and new product pricing. Public sector general insurers, including New India Assurance, Oriental Insurance, United India Insurance, and National Insurance, have also opted against cutting commissions, choosing instead to absorb the ITC loss.
Private insurers, on the other hand, are passing on the ITC burden to agents because their business models and cost structures leave little room to absorb additional expenses. The removal of ITC has raised operating costs by roughly 2-3% of premiums, and private companies must adhere to stricter IRDAI Expense of Management (EoM) caps. Absorbing this loss would directly dent profitability and risk regulatory breaches. Several private general and standalone health insurers, including Tata AIG, Aditya Birla Health Insurance, Niva Bupa, Care Health, and ICICI Lombard, have implemented revised commission structures, making payouts inclusive of 18% GST, which means distributors will bear the tax cost.
National Insurance Awareness Day: Insurers Increasingly Invest in Wellness as Health Plans Undergo Transformation
The health insurance landscape in India is undergoing a significant transformation, shifting from a traditional safety net for emergencies to a wellness partner that encourages policyholders to adopt healthier lifestyles. Insurers are now incorporating wellness-linked benefits into mainstream health plans, using digital tools such as walk-tracking apps, nutrition coaches, and teleconsultations to promote preventive care and reduce long-term healthcare costs. These initiatives are changing the way people engage with insurance and how insurance companies view risk.
Insurers are using behavior-based incentives, such as rewards for exercising, completing check-ups, or maintaining a healthy lifestyle, to encourage policyholders to prioritize their health. These rewards can be redeemed for premium discounts, savings on diagnostic tests, or other benefits. For example, Aditya Birla Health Insurance’s HealthReturns program allows customers to earn rewards for walking 10,000 steps or burning calories, which can be used to pay for outpatient bills or pharmacy expenses.
The use of technology, such as wearables and health apps, is also poised to revolutionize the underwriting process, allowing insurers to assess risk more accurately and offer personalized premiums. Insurers are using real-time health data to design more responsive offerings and provide everyday support to policyholders, including mental health support, fitness guidance, and pet care.
Industry leaders believe that awareness about the benefits of health insurance is still low, particularly among younger or healthier individuals. To bridge this gap, insurers are using gamified tools, AI-driven reminders, and personalized nudges to make wellness engaging and accessible. They are also committed to providing convenient, digital-first experiences that put customers first.
The shift towards wellness-based insurance is expected to have a positive impact on the healthcare system, encouraging people to prioritize preventive care and reducing the burden of lifestyle-related diseases. As Parthanil Ghosh, Executive Director of HDFC ERGO General Insurance, noted, “Insurance is no longer an afterthought — it’s becoming an active partner in daily life.” With the integration of health tech, insurers will be able to assess and reward wellness behavior more effectively, enabling inclusive coverage across India.
Help desk opens for expatriate Keralites
The Department of Non-Resident Keralites Affairs (NORKA ROOTS) has launched a registration help desk to support expatriate Keralites in enrolling for the NORKA CARE health insurance scheme. The help desk, located at the NORKA ROOTS headquarters, aims to provide assistance to those seeking to join the scheme. Expatriates can access the help desk through an online video-conferencing system, available on the NORKA Roots website.
To enroll, expatriates must join a video call through the website, where they will receive guidance and support for the enrollment process. The help desk will be available on all working days from 3 pm to 3:45 pm, and the final date for enrollment is October 30. This initiative is expected to benefit many expatriate Keralites who may be struggling to navigate the enrollment process.
The NORKA CARE health insurance scheme is designed to provide protection to expatriate Keralites, and the help desk is a significant step towards making the enrollment process more accessible and user-friendly. The help desk was officially inaugurated by NORKA Roots CEO Ajith Kollassery, who also guided expatriates in Kuwait through the enrollment process.
This move is seen as a positive step towards supporting the welfare of expatriate Keralites, who often face challenges in accessing healthcare services while living abroad. The NORKA CARE health insurance scheme is an important initiative that aims to provide financial protection to expatriate Keralites in case of medical emergencies.
The launch of the help desk is expected to increase enrollment numbers for the scheme, as expatriates will now have access to dedicated support and guidance throughout the enrollment process. With the final enrollment date approaching, expatriate Keralites are encouraged to take advantage of the help desk and enroll for the NORKA CARE health insurance scheme to ensure they have access to quality healthcare services while living abroad.
Pennsylvanians are abandoning their health insurance as premiums are expected to double.
In Pennsylvania, a significant number of residents are opting to drop their health insurance as premiums are expected to double on January 1, 2026. This drastic increase comes as lawmakers have yet to extend Affordable Care Act subsidies, leaving many individuals and free care clinics uncertain about their future. The Meadville Area Free Clinic, for instance, is facing a substantial increase in premiums, from $540 to over $1,000 per month. This hike poses a significant challenge for the clinic, which relies on volunteer physicians to provide care for dozens of uninsured patients.
Beverly Kennedy, the clinic’s clinical executive director, expressed concerns about the potential overwhelming of their office and emergency rooms as more people may be forced to drop their coverage. To address this issue, Kennedy is recruiting more volunteer physicians to help meet the anticipated surge in demand. Meanwhile, residents like Lisa Boord are worried about the long-term implications of the premium increases. Boord’s husband may be unable to afford retirement due to the rising costs, forcing them to make tough choices between essential expenses like health insurance and housing.
The escalating costs of prescription medications and upcoming medical procedures are also causing concern among residents. Boord believes that standardized healthcare is necessary to alleviate these financial burdens. Governor Josh Shapiro and Lt. Governor Austin Davis have highlighted the severity of the situation, stating that 500,000 Pennsylvanians will experience soaring premiums, with 150,000 individuals unable to afford them. This crisis underscores the urgent need for a solution to prevent further disruptions to the state’s healthcare system. As the deadline for the premium increases approaches, residents and healthcare providers are bracing for the potential consequences, emphasizing the importance of finding a timely and effective solution to address the growing healthcare affordability crisis in Pennsylvania.
Expiring health insurance subsidies potentially revived retroactively
The COVID-19 pandemic led to a significant expansion of health insurance subsidies under the American Rescue Plan Act (ARPA) in 2021. These subsidies, which were designed to make health insurance more affordable for millions of Americans, are set to expire at the end of 2022. However, there is a possibility that these subsidies could be revived retroactively if Congress takes action.
The ARPA subsidies have had a substantial impact on the affordability of health insurance, with many individuals and families seeing significant reductions in their monthly premiums. According to a report by the Kaiser Family Foundation, the average monthly premium for a benchmark silver plan decreased by 23% in 2021 due to the subsidies. This has led to an increase in health insurance enrollment, with over 14.5 million people signing up for coverage through the Affordable Care Act (ACA) marketplaces during the 2022 open enrollment period.
If the subsidies are allowed to expire, it is estimated that over 3 million people could lose coverage, and many more could see significant increases in their premiums. This has led to widespread concern among healthcare advocates, who are urging Congress to take action to extend the subsidies. Some lawmakers have proposed extending the subsidies through 2025, while others have suggested making them permanent.
While there is no guarantee that Congress will take action, there is precedent for retroactively extending expiring subsidies. In 2015, Congress retroactively extended the Children’s Health Insurance Program (CHIP) funding, which had expired several months earlier. Similarly, in 2020, Congress retroactively extended several healthcare provisions, including funding for community health centers and the National Health Service Corps.
If Congress were to revive the ARPA subsidies retroactively, it would likely require legislative action, which could be challenging given the current political climate. However, if lawmakers are able to come to an agreement, it could provide significant relief to millions of Americans who are struggling to afford health insurance. Retroactive extension of the subsidies would also help to stabilize the health insurance market and prevent disruptions to coverage for those who are currently enrolled.
In conclusion, while the expiration of the ARPA subsidies is a pressing concern, there is a possibility that they could be revived retroactively if Congress takes action. With the fate of the subsidies uncertain, healthcare advocates and lawmakers are urging Congress to act quickly to extend the subsidies and prevent disruptions to coverage for millions of Americans.
Numerous working Americans are struggling without health care coverage.
The United States is the only high-income country that does not guarantee health care to all its citizens. As a result, millions of Americans are left without access to medical care, forcing them to rely on free clinics and charity events. In Bethlehem, Pennsylvania, a free pop-up medical clinic was held, where hundreds of people gathered to receive medical attention. Many of those in attendance, such as Giovanni Gonzalez and his partner Grace Frizzell, struggle to afford basic medical care, including prescription medication and doctor visits.
Gonzalez, a 20-year-old warehouse worker, suffers from severe asthma and cannot afford the $300 maintenance puffer he needs every 40 days. Frizzell, 21, has acid reflux but cannot afford to fill her prescription for medication. They, like many others, are forced to make difficult choices between paying for medical care and covering basic necessities like rent and utilities.
The problem is set to worsen with President Donald Trump’s One Big Beautiful Bill Act, which cut nearly $1 trillion from Medicaid, the government program that insures low-income Americans. Additionally, Republican congressional leaders are blocking the extension of Obamacare tax credits, which could lead to premiums more than doubling.
Many Americans, like Naida Simonetty, 58, are caught in a cycle of debt and poor health. Simonetty makes too much money to qualify for Medicaid but not enough to afford a private plan. She has racked up thousands of dollars in hospital bills and is forced to forgo regular medical care, opting instead for over-the-counter medications like Advil.
Patricia Laws, 58, is in a similar situation, with her job as a parcel delivery driver not providing insurance or paying enough to buy a private policy. Her Medicaid application was turned down because she makes too much money, leaving her with no choice but to seek medical attention at the free clinic.
The need for universal health care is a pressing issue, with many advocating for a system that guarantees medical coverage to all citizens, regardless of income or social status. Dr. William Perry, an emergency-room physician who volunteers at free clinics, believes that universal coverage is essential, comparing it to the way police and firefighters protect everyone, regardless of their ability to pay.
However, prospects for reform seem remote, with many Americans feeling disenfranchised and disconnected from the political process. Many, like Rob Humphrey, a 39-year-old construction worker, believe that their vote does not count and that the system is rigged against them. Gonzalez and Frizzell, who did not vote in the 2024 election, feel that neither party is willing to address their concerns and provide affordable health care.
The situation is a stark reminder of the failures of the US health care system and the need for comprehensive reform. As the number of uninsured and underinsured Americans continues to grow, the demand for free clinics and charity events will only increase, highlighting the urgent need for a more equitable and accessible health care system.
The latest claim settlement ratio of health and general insurance companies was released by IRDA in 2025. According to the data, Navi and Acko have taken the lead, while Star Health and Zuno have fallen below the 90% mark.
The rising medical inflation has made it challenging for individuals to bear medical expenses without a comprehensive health insurance policy. In India, the Insurance Regulatory and Development Authority (IRDAI) releases an annual list of claim settlements by health and general insurance companies. The claim settlement ratio, which refers to the percentage of claims paid or settled by an insurer, is a reliable way to assess an insurer’s efficiency.
According to the latest figures for 2023-2024, the general insurers paid out a total of 71,200,854 claims, with 81.13% of total claims paid within 3 months of claim intimation. Among private general insurers, Acko General Insurance and Navi General Insurance Ltd led with claim settlement ratios of 99.91% and 99.97%, respectively. Zuno General Insurance Co. Ltd had the lowest claim settlement ratio among private sector insurers, with 83.12% of claims paid within 3 months.
Among public insurers, The Oriental Insurance Co. Ltd had the lowest claim settlement ratio, with only 65.08% of claims paid within 3 months. United India Insurance Co. Ltd had the highest claim settlement ratio among public insurers, with 96.33% of claims paid within 3 months.
For stand-alone health insurers, Aditya Birla Health Insurance Company had the highest claim settlement ratio within 3 months, at 92.97%. Care Health Insurance and Niva Bupa Health Insurance followed closely, with claim settlement ratios of 92.77% and 92.02%, respectively. Star Health and Allied Insurance Co. Ltd had the lowest claim settlement ratio among stand-alone health insurers, with 82.31% of claims paid within 3 months.
While checking the claim settlement ratio is necessary, it should not be the sole basis for finalizing a health or general insurance company. Other factors such as the sum insured, waiting period for various illnesses, and network of hospitals offered should also be considered.
The IRDAI data also reveals that during 2023-24, 16.3% of total claims were paid out between 3-6 months, indicating that some insurers may have delayed claim settlements. It is essential for policyholders to review the claim settlement ratio and other factors before selecting an insurer to ensure they receive adequate and prompt financial assistance in case of medical emergencies.
Overall, the claim settlement ratio is a crucial factor in assessing an insurer’s efficiency, and policyholders should carefully evaluate this metric along with other factors before making an informed decision. By doing so, they can ensure that they have a comprehensive health insurance policy that provides them with the necessary financial protection in case of medical emergencies.
DACA Whiplash, Health Insurance, and More
In 2025, Sahan Journal’s health coverage focused on the challenges faced by immigrant communities in accessing healthcare in Minnesota. One major theme was the impact of cuts and downsizing, particularly for undocumented immigrants. The journal reported on several key stories, including the potential loss of healthcare coverage for DACA recipients, which ultimately occurred when a rule granting them access to Affordable Care Act plans was reversed. This change affected over 500,000 people.
Another significant story was the introduction of a House bill aimed at prohibiting access to MinnesotaCare for undocumented adults. The bill was criticized for amplifying anti-immigrant sentiment and eventually led to the Legislature voting to revoke funding for the program. As a result, tens of thousands of undocumented Minnesotans will lose their health coverage starting January 1.
Despite these challenges, the journal also highlighted positive developments, such as the growing number of Somali therapists entering the field to address mental health concerns within their community. One such therapist, Ashwak Hassan, uses a culturally specific approach that incorporates Islam to treat her patients. Additionally, a physician assistant at Hennepin County Medical Center, Muhiyadin Aden, has worked to bridge the language gap between healthcare workers and Somali patients.
The journal also explored the potential impact of Medicaid cuts on Minnesota hospitals and community clinics. The passage of President Donald Trump’s “One Big Beautiful Bill Act” features $1 trillion in Medicaid cuts over 10 years, which is expected to disproportionately affect vulnerable populations. The journal’s reporting emphasized the importance of understanding the human impact of these policy changes, highlighting the story of Charlotte Watkins, a patient battling lupus who will be affected by the cuts.
Overall, Sahan Journal’s health coverage in 2025 underscored the ongoing struggles faced by immigrant communities in accessing healthcare and the need for continued support and advocacy. The journal’s reporting relied on the support of donors and emphasized the importance of independent journalism in shedding light on critical issues. As a nonprofit, Sahan Journal depends on donations to keep its reporting accessible to all, and readers are encouraged to make a gift to support their work.
The impending expiration of ACA subsidies poses a significant threat to the stability of the entire healthcare economy, potentially triggering a catastrophic free-fall.
The expiration of enhanced subsidies for the Affordable Care Act (ACA) on January 1 is expected to have significant consequences for rural hospitals and Americans who rely on them. The subsidies, which were introduced in 2021 to make health insurance more affordable during the COVID-19 pandemic, are set to expire, and Congress has yet to extend them. As a result, health care costs are expected to rise, and many Americans may opt for cheaper insurance with higher deductibles or drop their coverage altogether.
According to an analysis by the Kaiser Family Foundation (KFF), ACA premiums for over 24 million Americans are predicted to double starting in 2026, and 4.8 million Americans could lose coverage. This could have devastating consequences for rural hospitals, which already operate on thin margins. If a large portion of their patient population loses insurance, hospitals may be forced to close, leaving communities without access to essential health care services.
The loss of subsidies will not only affect consumers but also rural hospitals, which may struggle to stay afloat. Even if hospitals don’t close, they may be forced to charge higher prices to offset the costs, making health care even more unaffordable for those who need it. The USDA Economic Research Service reports that 146 rural hospitals have already closed or been converted to non-acute health care clinics between 2005 and 2023.
Health care policy experts are concerned about the impact on Americans with chronic health conditions who cannot afford to drop their insurance. They may be forced to pay thousands of dollars more per month for coverage, which could lead to delayed or foregone care. The consequences of the subsidy expiration will be far-reaching, affecting not only those who lose coverage but also those who continue to receive care from struggling hospitals.
The situation is further complicated by significant cuts to Medicaid and Medicare reimbursements under President Donald Trump’s One Big Beautiful Bill Act. These cuts could exacerbate the financial struggles of rural hospitals, leading to reduced services, staff layoffs, and decreased investment in quality care. As one expert noted, “If a hospital closes, it obviously doesn’t just affect the people who are coming in without insurance, but it affects everyone who is receiving care from that hospital.” The expiration of the ACA subsidies is a critical issue that requires immediate attention from policymakers to prevent a health care crisis in rural America.
Enhanced ACA Health Insurance Subsidies Likely to End – Ogletree
The enhanced Affordable Care Act (ACA) health insurance subsidies, which were introduced as part of the American Rescue Plan Act (ARPA) in 2021, are likely to end soon. These subsidies have played a crucial role in making health insurance more affordable for millions of Americans. However, unless Congress takes action to extend them, they are set to expire at the end of 2022.
The enhanced subsidies have had a significant impact on the affordability of health insurance for individuals and families. They have increased the amount of financial assistance available to those who purchase health insurance through the ACA marketplaces, making it possible for more people to access affordable coverage. As a result, the number of people enrolled in ACA marketplace plans has increased, and the uninsured rate has decreased.
The enhanced subsidies have been particularly beneficial for low- and moderate-income individuals and families. They have made it possible for people to purchase health insurance who may not have been able to afford it otherwise. For example, a family of four with an income of $50,000 may have been eligible for subsidies that reduced their monthly premium costs by hundreds of dollars.
If the enhanced subsidies are allowed to expire, it is likely that many people will face significant increases in their health insurance premiums. This could lead to a decrease in the number of people enrolled in ACA marketplace plans and an increase in the uninsured rate. It could also have a disproportionate impact on low- and moderate-income individuals and families, who may struggle to afford health insurance without the enhanced subsidies.
Congress has the opportunity to extend the enhanced subsidies, but it is unclear whether they will take action. Some lawmakers have proposed legislation to extend the subsidies, but it is unclear whether these proposals will be passed. If the subsidies are not extended, it is likely that many people will face significant challenges in accessing affordable health insurance.
In conclusion, the enhanced ACA health insurance subsidies have been a crucial component of the ACA, making health insurance more affordable for millions of Americans. However, unless Congress takes action to extend them, they are likely to end soon. This could have significant consequences for individuals and families who rely on these subsidies to access affordable health insurance. It is essential that lawmakers take action to extend the enhanced subsidies to ensure that people can continue to access the health insurance they need.
Healthcare costs are expected to increase for some individuals in 2026, while others may experience a decrease in expenses.
A significant healthcare divide is expected to emerge in 2026, affecting Americans differently based on their insurance coverage. On one hand, Medicare beneficiaries may experience savings on prescription drug costs, thanks to the Inflation Reduction Act (IRA) signed into law by President Joe Biden in 2022. The IRA allows Medicare to negotiate prices for certain expensive medications, which will lead to lower out-of-pocket costs for nearly 9 million older adults. Starting January 1, 2026, the first negotiated drug prices will go into effect, with estimated savings of over 50% for seven of the 10 costliest drugs in the program.
On the other hand, individuals relying on Affordable Care Act (ACA) subsidies and Medicaid may face higher costs and uncertainty. The enhanced ACA subsidies, which helped keep premiums affordable, are expiring, and Republicans in Congress declined to extend them. As a result, some people may pay up to 114% more in premiums, on average, when combined with rate increases by insurers. Additionally, changes to Medicaid funding approved under President Donald Trump’s “One Big Beautiful Bill” will take effect in January, potentially leaving low-income adults in a “coverage gap” and without access to care.
The IRA has already had a positive impact on some Medicare beneficiaries, such as Tom Howie, an 81-year-old with a history of heart disease. He has seen a significant reduction in his out-of-pocket prescription drug costs, reaching the $2,000 cap by May this year. However, the law has also brought some unexpected drawbacks, including higher list prices for new medications. Some experts, like Richard Frank, a senior fellow at the Brookings Institution, warn that drugmakers may set prices higher from the outset to avoid penalties for raising prices too sharply.
Meanwhile, the Trump administration has pushed to align prescription drug prices in the US with those in other wealthy countries, striking deals with 14 pharmaceutical companies to offer lower prices in exchange for tariff relief. However, some experts, like Larry Levitt, executive vice president for health policy at KFF, have concerns about the strategy, noting that it relies on voluntary deals with drugmakers and may not lead to long-term savings.
Ultimately, the healthcare divide in 2026 may have significant consequences for Americans, particularly those who are not on Medicare. While some may see drug costs decrease, others may face higher premiums, reduced access to care, and increased medical debt. The situation remains uncertain, with potential for Congress to reach a deal to extend ACA subsidies next year, which could provide relief to those affected.
We’re Stuck With Health Insurance—But We Can Improve It
The proportion of healthcare services purchased through insurance has increased significantly over the past century, thanks to tax exemptions for employer-sponsored benefits. This has led to a surge in spending on treatment, as consumers are insulated from the cost of services. However, making patients bear more of their costs out of pocket is not an effective way to reduce wasteful healthcare spending. Instead, it can inhibit access to care, particularly for the seriously ill, who account for a large proportion of healthcare spending.
The current system, where patients have little control over the purchase of healthcare, has shifted control to bureaucrats and insurers. Critics argue that this arrangement deprives individuals of access to their preferred doctors and drugs, and displaces a personalized patient-clinician relationship with “checkbox medicine” preoccupied with reimbursement and regulatory compliance.
Advocates of “direct payment” for medical care propose cutting out the middleman and relying on cash payment for services. However, this approach is unlikely to be effective, as patients may not have the incentive or resources to shop around for the best-priced medical care. Moreover, high deductibles have been shown to reduce the utilization of medical services, rather than steering patients to cheaper sources of treatment.
The federal government’s attempt to finance healthcare by distributing cash uniformly to Americans is likely to accumulate funds in the hands of those who need assistance least. The heaviest healthcare costs are typically incurred by households that have high utilizers of medical care, who use more than average year after year.
Some forms of insurance, such as fixed indemnity health insurance, may facilitate the direct purchase of medical care by patients. However, the appeal of such plans is likely to be limited, as they may leave patients unable to pay for treatment, particularly if their cases involve costly complications.
Ultimately, improving the healthcare system requires making insurance more responsive to patients’ concerns. Allowing employers to provide pretax funds for their employees to purchase their own insurance can enable individuals to opt for more cost-effective plans that better suit their personal health needs and circumstances. This approach can reduce the largest hospital and drug expenses, rather than just shifting the burden of paying for them onto the seriously ill.
It is also important to note that Americans typically want health insurers to cover more, not less. A large majority of adults want insurance to pay for weight loss drugs, medical services without prior authorization, and to limit surprise medical bills. Therefore, improving the healthcare system requires a nuanced approach that takes into account the complexities of the current system and the needs and preferences of patients.
Trump’s cash-for-healthcare plan faces significant opposition in Congress, coinciding with a projected surge in insurance costs.
As the Covid-era tax credits for health insurance premiums are set to expire at the end of the year, millions of Americans are bracing for a significant increase in their healthcare costs. In response, Republicans in Congress are considering using a partisan tactic to force through direct cash payments to help Americans defray these costs. The idea, which was recently floated by President Donald Trump, involves using tariff revenue to fund these payments. However, the plan is facing skepticism from some lawmakers, who question whether it can pass through both the House and Senate.
Trump’s proposal involves giving Americans direct cash payments to purchase their own healthcare, which he claims will lead to better and more affordable healthcare. However, most people do not purchase insurance individually, but rather through an employer or the Affordable Care Act exchange. The plan would essentially give Americans their own money back in the form of meager cash payments, which may not cover the higher premiums they will have to pay after the ACA subsidies expire.
Some Republicans, including House Ways and Means Committee Chair Jason Smith, are skeptical of the plan, citing the difficulty of passing a reconciliation bill through both chambers. Representative Mike Lawler, a New York GOP moderate, has endorsed extending the Obamacare subsidies instead, and Senator Lisa Murkowski has expressed concerns about using the partisan reconciliation process.
However, other Republicans, including the chairs of the House and Senate budget committees, are more bullish on the prospect. They believe that there is a “critical mass” to start the reconciliation process and that a bill focused on healthcare, immigration enforcement, and military funding could pass. The White House has also expressed support for the idea, with Deputy Chief of Staff for Policy James Blair suggesting that tariff “dividends” of around $2,000 per person could be included in a reconciliation bill.
Despite the support, the plan faces significant hurdles, including strict rules around what can be included in a reconciliation bill. The process can only be used for taxation and spending provisions, and policy changes unrelated to budgeting are not allowed. Additionally, the plan would require figuring out what Trump wants and going along with it, which could be a challenge. Ultimately, the fate of the plan remains uncertain, and it is unclear whether it will be able to pass through Congress.
Medicaid expansion cuts in Idaho threaten access to health care for everyone.
Idaho’s Medicaid expansion, which was approved by voters in 2018, is facing significant cuts that could threaten access to healthcare for thousands of low-income residents. The expansion, which was expected to provide coverage to approximately 91,000 people, has been a vital lifeline for many individuals and families who were previously uninsured or underinsured.
However, the Idaho Legislature has introduced a bill that would impose strict work requirements and other limitations on Medicaid recipients, which could lead to thousands of people losing their coverage. The bill, which has already passed the House and is currently being considered by the Senate, would require able-bodied adults to work at least 20 hours per week or participate in job training programs in order to maintain their Medicaid coverage.
Proponents of the bill argue that it is necessary to ensure that Medicaid recipients are actively seeking employment and contributing to the economy. However, critics argue that the bill would unfairly penalize people who are struggling to find work or are unable to work due to illness or disability.
The proposed cuts to Medicaid expansion in Idaho have sparked widespread concern among healthcare providers, patient advocates, and community leaders. They argue that the bill would not only harm low-income individuals and families but also have a ripple effect on the entire healthcare system. By reducing access to Medicaid, the bill could lead to increased emergency room visits, hospitalizations, and other costly healthcare services that would ultimately be paid for by taxpayers.
Furthermore, the cuts to Medicaid expansion could also have a disproportionate impact on rural communities, where access to healthcare is already limited. Many rural hospitals and clinics rely on Medicaid reimbursement to stay afloat, and a reduction in Medicaid enrollment could lead to financial instability and even closures.
In addition to the proposed work requirements, the bill would also impose other limitations on Medicaid recipients, including a requirement that they pay a premium of up to $20 per month. While the premium may seem small, it could be a significant burden for low-income individuals who are already struggling to make ends meet.
Overall, the proposed cuts to Medicaid expansion in Idaho threaten to undermine the progress that has been made in increasing access to healthcare for low-income residents. The bill’s proponents argue that it is necessary to promote personal responsibility and fiscal sustainability, but critics argue that it would ultimately harm the most vulnerable members of society and have far-reaching consequences for the state’s healthcare system.
Looking for affordable health insurance alternatives to the ACA? Proceed with caution.
As the deadline for health insurance enrollment approaches, many consumers are facing a daunting task: finding affordable coverage for the upcoming year. With the likelihood of Congress extending enhanced subsidies for Affordable Care Act (ACA) marketplaces dwindling, premiums are expected to double, triple, or even quadruple for 2026. This has led some individuals to seek cheaper alternatives, but experts warn that these options often come with significant risks.
Amy Killelea, a research professor at Georgetown University’s Center on Health Insurance Reforms, has been researching these alternative plans. She notes that brokers often use confusing terminology, such as “private exchange,” to sell plans that are not ACA-regulated marketplace plans. These plans, including short-term limited-duration plans, direct primary care, health care sharing ministries, and fixed indemnity plans, do not offer comprehensive medical coverage and may leave consumers vulnerable to massive medical bills.
Lucy Culp, vice president of state government affairs at the nonprofit Blood Cancer United, agrees that marketing for these plans can be misleading. They use similar terminology to comprehensive insurance plans, but the coverage is often limited. For example, fixed indemnity plans may pay a set amount per night for hospitalization, but the consumer would still be responsible for the actual hospital bills, which could be thousands of dollars.
Short-term, limited duration plans are another option that may seem appealing due to their lower premiums. However, they are not subject to the ACA’s patient protections and can deny coverage for pre-existing conditions. They also do not cover essential health benefits, such as preventive screenings, maternity care, and prescription drugs.
Experts warn that buying anything other than a traditional health insurance plan is a significant risk. Killelea notes that there are two major risks: the insurance product may not be what the consumer thinks it is, and the consumer may experience a major medical event, such as a cancer diagnosis or heart attack, which could lead to financial devastation.
In conclusion, while the prospect of cheaper health insurance alternatives may be tempting, experts caution that these options often come with significant risks. Consumers should be aware of the limitations and potential pitfalls of these plans and carefully consider their options before making a decision. The regulated markets, although imperfect and expensive, may still be the safest choice for those seeking comprehensive medical coverage.
Thousands to face higher health insurance costs as Affordable Care Act subsidies expire.
A significant change in the legislative landscape may have profound financial implications for thousands of South Carolinians. The enhanced Affordable Care Act (ACA) subsidies, which have helped keep monthly insurance premiums affordable, are set to expire on December 31. These subsidies were initially expanded during the pandemic and extended by Democrats in 2022, providing lower monthly premiums for individuals who purchase health insurance through the federal marketplace. Without congressional action, the expiration of these subsidies may lead to substantial increases in costs statewide.
According to Michael Negron, a senior fellow for economic opportunity at the Center for American Progress, over 630,000 South Carolinians rely on ACA coverage, and the expiration of premium tax credits could result in significant “sticker shock” when premiums reset in January. Nationwide, more than 20 million Americans may be affected, with many enrollees facing average premium increases of over 100%. For example, a family of four earning $80,000 a year may see their monthly premium jump from $260 to over $560, resulting in a $3,000 annual increase.
The expiration of subsidies may have severe consequences, particularly in South Carolina, which has not expanded Medicaid. Many residents rely on ACA plans as a critical source of coverage, and without subsidies, some families may drop coverage or delay medical care. The South Carolina Hospital Association estimates that around 140,000 residents could lose coverage, while the Congressional Budget Office projects that approximately 4 million Americans nationwide may become uninsured.
Hospitals may also feel the impact, with the South Carolina Hospital Association anticipating a nearly $300 million increase in uncompensated care costs. This could strain rural hospitals and lower-income communities, where margins are already tight. While lawmakers are expected to revisit the issue in January, Negron advises families to prepare now by checking their enrollment status and exploring lower-cost plan options during open enrollment. Consumers are encouraged to review their options carefully, as lawmakers continue debating whether to extend the ACA subsidies.
Seven Americans Share Their Thoughts on Rising Health Care Costs
Frustrated and Overwhelmed: I’m a single mom working two jobs just to make ends meet, and the rising health care costs are suffocating me. I have to choose between paying for my kids’ doctor visits or our rent. It’s an impossible decision.
Retiree on a Fixed Income: As a retiree living on a fixed income, the increasing health care costs are eating away at my savings. I’ve had to cut back on other essential expenses just to afford my medications and doctor visits. It’s not the retirement I envisioned.
Small Business Owner: The rising health care costs are crippling my small business. I want to provide health insurance for my employees, but the premiums are becoming unaffordable. It’s a constant worry and a significant burden on my business’s bottom line.
Young Professional: I’m healthy and rarely visit the doctor, but the cost of health insurance is still a significant portion of my budget. It’s frustrating to feel like I’m paying for a service I don’t often use, but I know I need it for the unexpected.
Chronically Ill Patient: Living with a chronic illness means I’m constantly at the doctor’s office or hospital. The rising health care costs are not just financially draining; they’re also emotionally exhausting. I feel like I’m fighting for my life and my financial stability simultaneously.
Veteran: As a veteran, I’ve served my country, but the rising health care costs make me feel like my country is not serving me. The VA system is overwhelmed, and the care is not always timely or adequate. It’s disheartening to feel like my service is not valued.
Family of Four: With two young children, health care costs are a significant part of our family’s budget. From well visits to the occasional emergency room trip, the expenses add up quickly. We’re fortunate to have insurance, but the out-of-pocket costs and premiums are still a strain on our finances.
Frustrated and Overwhelmed: I’m a single mom working two jobs just to make ends meet, and the rising health care costs are suffocating me. I have to choose between paying for my kids’ doctor visits or our rent. It’s an impossible decision.
Retiree on a Fixed Income: As a retiree living on a fixed income, the increasing health care costs are eating away at my savings. I’ve had to cut back on other essential expenses just to afford my medications and doctor visits. It’s not the retirement I envisioned.
Small Business Owner: The rising health care costs are crippling my small business. I want to provide health insurance for my employees, but the premiums are becoming unaffordable. It’s a constant worry and a significant burden on my business’s bottom line.
Young Professional: I’m healthy and rarely visit the doctor, but the cost of health insurance is still a significant portion of my budget. It’s frustrating to feel like I’m paying for a service I don’t often use, but I know I need it for the unexpected.
Chronically Ill Patient: Living with a chronic illness means I’m constantly at the doctor’s office or hospital. The rising health care costs are not just financially draining; they’re also emotionally exhausting. I feel like I’m fighting for my life and my financial stability simultaneously.
Veteran: As a veteran, I’ve served my country, but the rising health care costs make me feel like my country is not serving me. The VA system is overwhelmed, and the care is not always timely or adequate. It’s disheartening to feel like my service is not valued.
Family of Four: With two young children, health care costs are a significant part of our family’s budget. From well visits to the occasional emergency room trip, the expenses add up quickly. We’re fortunate to have insurance, but the out-of-pocket costs and premiums are still a strain on our finances.
The rising cost of healthcare in the US is a dire issue, as evident from the stories of several individuals who rely on the Affordable Care Act (ACA) for their health insurance. Celia Monreal, a mother of five from Texas, is one such example. She currently pays no premium for her ACA marketplace plan due to tax credits, but if these credits expire at the end of the year, her monthly premium could skyrocket to $1,500. This would force her to choose between paying for necessities like heat and food or health insurance.
Similarly, Michael Swanson, a restaurant server from San Antonio, relies on tax credits to keep his ACA health coverage. Without these subsidies, his premium would increase tenfold, making it unaffordable for him. He is now looking for a new job that offers affordable health coverage. Steve Gomez, a construction manager from Arizona, also relies on ACA marketplace coverage for his family’s healthcare, including his son who has a congenital heart defect. However, he is struggling to find a marketplace plan that covers the care his son needs, and he believes the impending expiration of tax credits is to blame.
The expiration of tax credits would have far-reaching consequences, affecting not just individuals but also small businesses. Andrew Volk, a bar owner from Maine, is already seeing the ripple effects of the stalled extension of tax credits. His private insurance premiums are set to increase by 25-35%, making it difficult for him to offer affordable healthcare to his employees.
The stories of these individuals highlight the urgent need for lawmakers to extend the tax credits for ACA marketplace plans. Without these subsidies, many people would be forced to choose between paying for healthcare or other essential expenses. The expiration of tax credits would also have a broader impact on the economy, making it more difficult for small businesses to offer affordable healthcare to their employees and potentially driving up healthcare costs for everyone. As Amber Gustafson, a writer from Iowa, notes, “The more people that are part of the ACA, the more cost-effective it is for everybody.”
Celebrating a Quarter Century of Care: IFFCO-TOKIO’s Journey of Trust Continues
IFFCO-TOKIO General Insurance Company Limited, one of India’s leading general insurance companies, is celebrating its 25th anniversary. The company was established in 2000 as a joint venture between IFFCO and Japan’s Tokio Marine Group. Over the years, IFFCO-TOKIO has worked towards making insurance accessible to every individual, household, and business, with the objective of “Spreading Happiness” through customized policies and a high claim settlement rate.
Today, the company caters to over 86 lakh policies through 1000+ offices and 35,000 agents, built on decades of trust. IFFCO-TOKIO has also introduced affordable insurance solutions for under-covered communities, tying up with cooperatives to distribute micro insurance policies. The company has laid a strong technological foundation, with trust, innovation, and resilience at its core, and is now entering a transformational phase of growth.
IFFCO-TOKIO’s Managing Director & CEO, Mr. Subrata Mondal, reflected on the company’s journey, stating that the vision has expanded to align with people’s aspirations and a robust economy, while committing to IRDAI’s “Insurance for All by 2047”. The company has exemplified inclusive growth, with expansion in customers and employees, and a commitment to gender diversity and equality. IFFCO-TOKIO has also provided training to over 5,000 women agents, fostering financial inclusion and community trust.
The company has been at the forefront of social welfare through Corporate Social Responsibility initiatives, empowering rural youth, improving healthcare, and promoting sustainable practices. Over its 25-year journey, IFFCO-TOKIO has received numerous awards and recognitions, including the ‘Tokio Marine Group Award 2025’, ‘India’s Top General Insurance Company Award 2025’, and ‘Asia’s Best General Insurance Company – 2025’. These awards recognize the company’s excellence in business, innovation, and customer service. As IFFCO-TOKIO looks to the future, it aims to build on its strong foundation and continue to make a positive impact on the lives of its customers and the community.
Idahoans gather in Nampa to urge extension of health care premium tax credits – Idaho Capital Sun
A gathering was held in Nampa, Idaho, where individuals came together to advocate for the extension of health care premium tax credits. The event aimed to raise awareness about the importance of these tax credits and the potential consequences of their expiration.
The tax credits in question were established under the American Rescue Plan Act (ARPA) and have been instrumental in making health insurance more affordable for many Idahoans. By reducing the cost of premiums, these tax credits have enabled people to access essential healthcare services without breaking the bank.
Speakers at the event emphasized the need for lawmakers to take action and extend these tax credits beyond their current expiration date. Without an extension, many individuals and families may face significant increases in their health insurance premiums, making it difficult for them to maintain their coverage.
This could have far-reaching consequences, including reduced access to healthcare services, increased medical debt, and a rise in uninsured rates. The gathering served as a call to action, urging Idaho’s congressional delegation to prioritize the extension of these tax credits and ensure that affordable health insurance remains within reach for all residents.
The event also highlighted the human impact of these tax credits, with attendees sharing personal stories about how the credits have helped them access necessary medical care. By putting a face to the issue, the gathering aimed to convey the urgency and importance of extending these tax credits.
As the expiration date draws near, Idahoans are eagerly awaiting a decision from lawmakers. The extension of health care premium tax credits is crucial for maintaining affordable health insurance options and protecting the wellbeing of Idaho residents.
If the tax credits are allowed to expire, it could lead to a significant increase in the number of uninsured individuals in Idaho, which would have severe consequences for the state’s healthcare system and economy. Therefore, it is essential that lawmakers take prompt action to extend these tax credits and ensure that affordable health insurance remains a viable option for all Idahoans.
The gathering in Nampa served as a powerful reminder of the importance of affordable healthcare and the need for policymakers to prioritize the wellbeing of their constituents. As the debate over the extension of health care premium tax credits continues, Idahoans will be closely watching the actions of their lawmakers, hoping for a positive outcome that will protect their access to affordable health insurance.
Iowa doctor addresses rising health insurance costs and physician shortages – KCCI
A recent report by KCCI highlights the concerns of a Iowa doctor regarding the rising health insurance costs and physician shortages in the state. The doctor, who wishes to remain anonymous, expressed frustration with the current healthcare system, stating that it is becoming increasingly difficult for patients to access affordable healthcare due to skyrocketing insurance costs. The doctor attributed the rising costs to a combination of factors, including the increasing complexity of medical procedures, the high cost of medical equipment and technology, and the growing demand for healthcare services.
The doctor also pointed to the growing shortage of primary care physicians in Iowa, which is exacerbating the problem. According to the doctor, many medical students are opting for specialty fields, such as surgery or cardiology, rather than primary care, due to the higher pay and better work-life balance. This has resulted in a shortage of primary care physicians, particularly in rural areas, making it difficult for patients to access basic healthcare services.
The doctor emphasized that the shortage of primary care physicians is not only affecting patients but also having a ripple effect on the entire healthcare system. For example, when primary care physicians are not available, patients are forced to seek care at emergency rooms, which can lead to longer wait times and higher costs. Additionally, the doctor noted that the lack of primary care physicians can also lead to delayed diagnoses and poor health outcomes, particularly for patients with chronic conditions.
To address these issues, the doctor suggested several potential solutions, including increasing funding for primary care residency programs, providing incentives for medical students to pursue primary care, and implementing policies to reduce the administrative burden on physicians. The doctor also emphasized the need for healthcare providers, insurers, and policymakers to work together to develop innovative solutions to the rising costs and physician shortages.
Overall, the doctor’s concerns highlight the complex and interconnected nature of the healthcare system in Iowa. The rising health insurance costs and physician shortages are not isolated issues, but rather symptoms of a broader problem that requires a comprehensive and collaborative approach to solve. By working together, stakeholders can develop solutions that improve access to affordable healthcare, reduce costs, and ensure that patients receive the high-quality care they need.
With the Affordable Care Act (ACA) subsidies set to expire, the entire US health care economy is at risk of experiencing a severe downturn, potentially triggering a free-fall that could have far-reaching consequences for patients, providers, and the healthcare system as a whole.
Rural hospitals in the US may face increased risk of closure due to rising healthcare costs, as the enhanced subsidies for the Affordable Care Act (ACA) are set to expire on January 1. The subsidies, which were introduced in 2021 to make health insurance more affordable during the COVID-19 pandemic, have helped over 24 million Americans enroll in the marketplace. However, with the expiration of these subsidies, many Americans may opt for cheaper insurance with higher deductibles or drop their health insurance altogether.
According to an analysis by the Kaiser Family Foundation (KFF), ACA premiums for over 24 million Americans are predicted to double starting in 2026, and the Urban Institute estimates that 4.8 million Americans could lose coverage. This could have a devastating impact on rural hospitals, which often have thin profit margins and rely on a large patient population with insurance. Without the subsidies, many patients may be unable to afford healthcare services, forcing hospitals to close or reduce their services.
Emma Wager, a senior policy analyst for KFF’s program on the ACA, notes that the loss of the enhanced premium subsidies will not only affect consumers but also rural hospitals. “When you have rural hospitals that have very thin margins already, and they see a large portion of their patient population doesn’t have the ability to pay for services anymore, that could force hospitals to close,” she said. The closure of rural hospitals could have far-reaching consequences, including reduced access to healthcare services, especially for those with chronic health conditions.
Zachary Levinson, project director of the KFF project on hospital costs, adds that the significant cuts to Medicaid and Medicare reimbursements under President Donald Trump’s One Big Beautiful Bill Act could also affect the nation’s hospitals and patient care. “If a hospital closes, it obviously doesn’t just affect the people who are coming in without insurance, but it affects everyone who is receiving care from that hospital,” he said.
The expiration of the enhanced subsidies and the resulting increase in healthcare costs could have a disproportionate impact on those with chronic health conditions, who may be unable to afford the increased premiums. Wager notes that this could lead to reduced access to necessary healthcare services, which could have serious consequences for these individuals. The situation highlights the need for continued negotiations on the subsidies and the importance of finding a solution to mitigate the impact of the expiration on rural hospitals and patients.
Mississippi leaders remain silent on initiatives to address and improve healthcare in the state, according to Mississippi Today.
Mississippi has long struggled with a fragile healthcare system, and despite its many challenges, state leaders have been relatively quiet on efforts to address the issue. The state has some of the worst health outcomes in the country, with high rates of obesity, diabetes, and heart disease. Additionally, Mississippi has a severe shortage of primary care physicians, particularly in rural areas, and a high percentage of uninsured residents.
The state’s Medicaid program, which provides health coverage to low-income individuals, is also underfunded and has been criticized for its limited benefits and restrictive eligibility requirements. Mississippi is one of only 12 states that has not expanded Medicaid under the Affordable Care Act (ACA), which would have provided health coverage to an estimated 300,000 additional residents.
Despite these challenges, state leaders have been slow to take action to address the state’s healthcare crisis. Governor Tate Reeves has stated that he opposes Medicaid expansion, citing concerns about the cost and the potential for increased dependence on government programs. However, many healthcare advocates and experts argue that expanding Medicaid would not only improve health outcomes but also boost the state’s economy by creating jobs and increasing federal funding.
Other efforts to improve healthcare in Mississippi have also been met with resistance from state leaders. For example, a proposal to increase funding for community health centers, which provide primary care services to underserved communities, was rejected by the state legislature. Similarly, a bill to allow nurse practitioners to provide primary care services without the supervision of a physician was vetoed by Governor Reeves.
The lack of action from state leaders has left many healthcare advocates and providers frustrated and concerned about the future of healthcare in Mississippi. “We’re not seeing any meaningful efforts to address the state’s healthcare crisis,” said one healthcare advocate. “It’s like they’re just throwing up their hands and saying, ‘We can’t do anything about it.'”
The consequences of inaction are likely to be severe, particularly for the state’s most vulnerable residents. Without access to quality healthcare, many Mississippians will continue to suffer from poor health outcomes, and the state’s economy will likely suffer as a result. As one healthcare provider noted, “Healthcare is not just a moral imperative, it’s an economic imperative. If we don’t invest in healthcare, we’re going to pay for it in the long run.”
Cheaper alternatives to expensive Affordable Care Act (ACA) health plans often involve trade-offs.
The open enrollment period for Affordable Care Act (ACA) insurance is coming to a close, and many Americans are facing higher premiums and reduced tax subsidies. As a result, some are considering alternative options, such as short-term insurance plans or other types of coverage. However, experts warn that these alternatives may not provide comprehensive coverage and can be risky.
Short-term plans, which are not ACA-compliant, can be less expensive but often have limitations, such as annual and lifetime caps on benefits, and may not cover essential services like maternity care or prescription drugs. They also require medical questionnaires and can exclude coverage for preexisting conditions. The Trump administration has expanded access to short-term plans, but critics label them “junk insurance.”
Other types of coverage, such as indemnity plans and faith-based sharing plans, may also be available but are not considered insurance and may not provide adequate protection. Indemnity plans pay a fixed amount towards medical expenses, while faith-based sharing plans pool money from members to cover medical bills but are not required to keep financial reserves.
For those who want to stay with ACA plans, experts recommend considering “bronze” or “catastrophic” plans, which have lower premiums but higher deductibles. Bronze plans have an average deductible of nearly $7,500, while catastrophic plans have deductibles as high as $10,600. These plans may be suitable for people who want insurance only in case of a catastrophic health condition.
To navigate the ACA marketplace, experts offer several tips:
1. Be cautious of short-term plans and other alternative coverage options.
2. Consider bronze or catastrophic plans, but be aware of high deductibles.
3. Shop around for different plans, including group plans, which may be available for small business owners.
4. Use official ACA websites and licensed brokers to avoid look-alike sites that may not offer ACA-compliant plans.
5. Don’t wait until the last minute to explore options and fill out an application.
The deadline for choosing a health plan is January 15, and coverage will start on February 1. Consumers can visit the official federal website, Healthcare.gov, or their state’s exchange website to explore options and find licensed brokers or counselors who can help with the application process. It’s essential to carefully review plan options and understand the terms and conditions before making a decision.
More competition may benefit policyholders, according to Aditya Birla Health Insurance CEO Mayank Bathwal.
Aditya Birla Health Insurance CEO, Mayank Bathwal, discussed the benefits of the new insurance bill, Sabka Bima Sabki Raksha (Amendment of Insurance Laws) Bill, 2025, and its potential to increase competition and improve penetration in the market. With the FDI limit raised to 100%, Bathwal expects new players to enter the market, bringing innovation and better offerings for consumers. However, he emphasizes that increasing FDI alone will not achieve the goal of “insurance for all by 2047,” and that consistent work on awareness, product offerings, and customer feedback is also necessary.
Bathwal also addressed the issue of conflicts between hospitals and insurers, stating that dialogue is the only way to resolve these issues. He mentioned that the industry is seeking predictability of costs from hospitals, which would enable insurers to price their products more accurately and make healthcare more affordable for consumers. Common empanelment, a platform where hospitals can gain access to all health insurers, is being explored as a potential solution.
The removal of GST on health insurance has led to a positive traction in policy purchases, with renewal rates and ticket sizes increasing. Bathwal hopes that this trend will continue, especially in segments where affordability was an issue, such as for senior citizens or the missing middle.
Bathwal also discussed Aditya Birla Health Insurance’s focus on creating a “health ecosystem” and promoting preventive care. The company aims to build long-term relationships with consumers and provide incentives for good health behavior, rather than just focusing on sickness funding. This approach has yielded encouraging results, with the company paying 9% of its customers some benefit for good health last year.
In terms of customer complaints, Bathwal acknowledged that the health insurance industry has the maximum number of complaints, but attributed this to the large number of claims processed. He emphasized the need for transparency and clarity in policy terms and conditions, and the importance of leveraging technology, such as AI, to process claims quickly and efficiently.
Overall, Bathwal emphasized the need for collaboration and dialogue between stakeholders to address the challenges facing the health insurance industry, and to create a more sustainable and affordable healthcare system for consumers. He also highlighted the importance of preventive care and promoting good health behavior, and the potential for technology to improve the claims process and customer experience.
Can Colorado provide your family with affordable health care and excellent benefits?
As a family, having access to affordable healthcare with excellent benefits is crucial for maintaining overall well-being and financial stability. In Colorado, there are various options available to ensure that families can receive the medical care they need without breaking the bank.
Colorado has implemented several initiatives to make healthcare more affordable for its residents. One such initiative is the Colorado Health Benefit Exchange, also known as Connect for Health Colorado. This program allows individuals and families to shop for and compare health insurance plans from various providers, often with financial assistance available to those who qualify. The exchange offers a range of plans, from basic to comprehensive, catering to different budgets and health needs.
Moreover, Colorado has expanded Medicaid under the Affordable Care Act (ACA), providing coverage to more low-income individuals and families. This expansion has significantly increased the number of people with health insurance in the state, ensuring that those who were previously uninsured can now access necessary medical care. Families with higher incomes may also find affordable options through the private insurance market, where they can choose from a variety of plans that suit their needs and budget.
In addition to these initiatives, Colorado is home to numerous community health centers that offer affordable healthcare services to families, regardless of their ability to pay. These centers provide comprehensive care, including dental, mental health, and substance abuse services, making them a vital resource for families seeking affordable healthcare.
The state also focuses on preventive care, recognizing that early intervention can prevent more severe and costly health issues down the line. Programs and services aimed at promoting healthy lifestyles, managing chronic conditions, and providing educational resources contribute to the overall well-being of Colorado families.
Furthermore, Colorado’s health care system is known for its quality. Many of the state’s hospitals and healthcare providers are nationally recognized for their excellence in patient care, technology, and innovation. This means that families not only have access to affordable healthcare but also to high-quality medical services.
In conclusion, Colorado offers a range of options for families seeking affordable healthcare with excellent benefits. Through initiatives like the Colorado Health Benefit Exchange, Medicaid expansion, community health centers, and a focus on preventive care, the state strives to ensure that all families have access to the medical care they need. With its commitment to quality and affordability, Colorado can indeed provide families with the healthcare solutions that fit their needs and budget, contributing to a healthier and more secure community.
Jeffries vows to ‘pressure’ Senate on health care insurance subsidies
House Minority Leader Hakeem Jeffries announced on Sunday that he expects the House to pass a three-year extension of tax credits for individuals purchasing health insurance through Affordable Care Act (ACA) exchanges. This move is part of a bipartisan compromise aimed at extending ACA tax credits, which could impact approximately 22 million Americans who may face higher premiums in the new year. Jeffries stated that the House will address this issue in early January, potentially putting pressure on Senate Republicans to pass a straightforward extension of the ACA tax credits.
The tax credits, which were implemented during the COVID-19 pandemic, have made healthcare more affordable for millions of Americans. However, some Republican leaders have expressed a desire to allow these credits to expire or be phased out over several years. On the other hand, some members of the GOP have voiced their support for extending the credits for a longer period.
The Senate recently rejected a three-year ACA extension by a vote of 51-48, with four Democrats joining the GOP in voting against it. Despite this setback, Jeffries remains optimistic that a bipartisan compromise can be reached. He believes that passing the extension in the House will force Senate Republicans to reconsider their stance on the issue.
Democrats have warned that if a deal is not reached, they will use the issue against Republicans in next year’s midterm elections. Rep. Pat Ryan emphasized that access to affordable healthcare remains a top priority for voters, and that the GOP’s handling of the issue could have significant electoral consequences. A group of centrist Republicans has already begun working with Democrats to authorization a vote on a three-year tax credit extension when the House returns to Washington in January.
The fate of the ACA tax credits remains uncertain, but Jeffries’ announcement suggests that there may be a renewed effort to extend them in the coming weeks. The outcome of this debate will have significant implications for millions of Americans who rely on the ACA for their healthcare needs. As the House prepares to take up the issue in January, it remains to be seen whether a bipartisan compromise can be reached, or if the issue will become a major point of contention in the upcoming midterm elections.
IRDAI imposes Rs. 1 crore penalty on Care Health Insurance for lapses in claims process.
The Insurance Regulatory and Development Authority of India (IRDAI) has imposed a fine of Rs. 1 crore on Care Health Insurance due to lapses in its health insurance claim settlement process. The regulator found that the insurer failed to provide adequate reasons for claim repudiation or for paying reduced amounts to policyholders. Instead of providing concrete evidence, the insurer relied on email logs, which were deemed insufficient and unreliable.
IRDAI also discovered that Care Health did not obtain signatures from patients or their attendants on crucial claim documents, such as discharge summaries and final bills. This lack of confirmation from policyholders led to uncertainty regarding the documents used for claim settlement. Furthermore, the insurer applied hospital discounts only to the portion of the bill admissible under the policy, rather than to the full hospital bill, resulting in reduced benefits for policyholders.
The regulator viewed these practices as unfair treatment of customers and a lack of transparency and accountability. In addition to the fine, IRDAI issued warnings for other regulatory violations, including deficiencies in grievance redressal, delays in addressing cybersecurity vulnerabilities, accounting lapses in reinsurance arrangements, and failure to promptly transfer unidentified proposal deposits to the unclaimed amounts account. However, these violations did not attract any financial penalty.
The fine and warnings serve as a reminder to insurance companies to adhere to regulatory guidelines and maintain transparency in their claim settlement processes. The IRDAI’s actions aim to protect the interests of policyholders and ensure that insurance companies operate fairly and efficiently. The regulator’s scrutiny of Care Health Insurance’s practices highlights the importance of accountability and transparency in the insurance industry. By imposing penalties and issuing warnings, IRDAI is working to promote a fair and customer-centric insurance market in India.
Ahmedabad District Commission Holds Iffco Tokio General Insurance Co. Liable For Wrongful Repudiation Of Valid Claim
The Additional District Consumer Disputes Redressal Commission in Ahmedabad, Gujarat, comprising President K. J. Dasondi and Member M. B. Chauhan, delivered a verdict against Iffco Tokio General Insurance Co. Ltd. The commission ruled that the insurance company was liable for wrongfully rejecting a valid claim. This decision was based on the company’s reliance on ‘Ayushman Maharashtra’ circulars, which the commission deemed did not supersede the terms of the insurance policy but rather provided supplementary guidance.
The ‘Ayushman Maharashtra’ scheme is a health insurance initiative aimed at providing coverage to economically vulnerable families. The circulars issued under this scheme are intended to ensure that beneficiaries receive the necessary medical care without facing financial hardships. However, in this case, Iffco Tokio General Insurance Co. Ltd. used these circulars as a basis to repudiate a claim, which the commission found to be unjustified.
The commission’s ruling emphasized that the circulars should be interpreted as guidelines to facilitate the implementation of the policy, rather than as a means to override its terms. By rejecting the claim based on these circulars, the insurance company acted in contravention of the policy’s terms and conditions. This action was seen as a wrongful repudiation of a legitimate claim, leading to the commission’s decision to hold the insurance company liable.
The verdict underscores the importance of adhering to the terms and conditions of an insurance policy. It also highlights the need for insurance companies to carefully consider the applicability of circulars and guidelines issued under government schemes, ensuring that they do not misuse these documents to deny legitimate claims. The commission’s decision is expected to provide relief to the claimant and serves as a precedent for similar cases, emphasizing the consumer’s right to fair treatment by insurance providers.
In conclusion, the Ahmedabad bench of the Additional District Consumer Disputes Redressal Commission has set a significant precedent by ruling against Iffco Tokio General Insurance Co. Ltd. for its wrongful repudiation of a claim based on the ‘Ayushman Maharashtra’ circulars. This decision reinforces the principle that insurance companies must honor the terms of their policies and cannot use supplementary guidelines as a justification for denying valid claims. The verdict is a victory for consumer rights and ensures that insurance companies are held accountable for their actions.
Congress departs for the holidays without reaching an agreement to extend Affordable Care Act subsidies.
The US House and Senate have concluded their final votes for the year without passing a deal to extend federal healthcare subsidies, resulting in a significant increase in health insurance costs for millions of Americans starting January 1. The deadline for selecting health plans for 2026 has passed, and consumers who rely on Affordable Care Act (ACA) coverage will see their premiums climb substantially. According to Jessica Altman, executive director of Covered California, middle-income families will be hit the hardest, with some facing an average increase of $500 per month.
The enhanced tax credits that have been in place will expire on December 31, causing the average monthly premium to jump from $74 to $158. This increase will affect millions of Americans, with some facing premium hikes of over $1,000 per month. Representative Kevin Mullin (D-San Mateo) expressed frustration with the lack of urgency from Congress, stating that his office has already received calls from constituents bracing for massive hikes.
The expiration of the subsidies is not only a concern for individuals but also for hospitals and clinics, which may see an increase in uninsured patients unable to pay for their care. This could impact the sustainability of these healthcare providers. Representative Kevin Kiley (R-Roseville) echoed the frustration, stating that the leadership of both parties is more focused on blaming each other than working together to solve the problem.
The failure to extend the subsidies is expected to have far-reaching consequences, including increased healthcare costs, reduced access to care, and a greater burden on healthcare providers. As the new year begins, millions of Americans will be faced with the reality of higher healthcare costs, and it remains to be seen how Congress will address this issue in the future. With the current gridlock in Congress, it is unclear when or if a solution will be found, leaving many to wonder how they will afford the increased costs of their healthcare.
The increasing expense of health insurance can be attributed to several factors.1. Rising healthcare costs: As medical technologies advance and new treatments emerge, the cost of providing healthcare services increases. 2. Aging population: Older adults tend to require more medical care, which drives up costs. 3. Increased demand for healthcare services: The Affordable Care Act (ACA) has led to more people having health insurance, resulting in higher demand for healthcare services and, subsequently, higher costs. 4. Pharmaceutical costs: The development and production of new, often expensive, medications contribute to rising healthcare costs. 5. Administrative costs: The complexity of the healthcare system and the need for administrative staff to manage insurance claims, billing, and other tasks add to the overall expense. 6. Profit margins: Insurance companies aim to make a profit, which is factored into the cost of premiums. 7. Government policies and regulations: Changes in government policies, such as the repeal of the ACA’s individual mandate, can impact the health insurance market and drive up costs. 8. Provider consolidation: As healthcare providers consolidate, they gain more negotiating power with insurance companies, potentially leading to higher costs. 9. Lack of transparency: The opacity of healthcare pricing makes it difficult for consumers to make informed decisions, which can contribute to higher costs. 10. Inefficient payment systems: The current fee-for-service payment model can encourage unnecessary treatments and procedures, driving up costs.These factors combined create a complex and often expensive healthcare system, leading to increasing health insurance costs.
The cost of health insurance is increasing, and several factors are contributing to this trend. According to a report by Axios, the main drivers of rising health insurance costs are:
- Rising healthcare costs: The cost of medical care is increasing, driven by factors such as an aging population, the growing prevalence of chronic diseases, and advances in medical technology. As healthcare providers charge more for their services, insurers must pay more to cover these costs, leading to higher premiums.
- Pharmaceutical costs: The cost of prescription medications is skyrocketing, with many new treatments and therapies coming to market at high prices. Insurers must factor these costs into their premiums, contributing to higher rates.
- Regulatory requirements: The Affordable Care Act (ACA) imposed new regulations on health insurers, such as requiring them to cover essential health benefits and prohibiting them from denying coverage based on pre-existing conditions. While these regulations have improved access to care, they have also increased costs for insurers.
- Administrative costs: Health insurers face significant administrative burdens, including claims processing, billing, and compliance with regulations. These costs are factored into premiums, contributing to higher rates.
- Profit margins: Health insurers aim to make a profit, and their margins can contribute to higher premiums.
Other factors, such as consolidation in the healthcare industry and short-term plans, are also driving up costs. As healthcare providers and insurers consolidate, they may gain more bargaining power, leading to higher prices. Short-term plans, which are exempt from some ACA regulations, can also drive up costs by attracting healthier individuals and leaving sicker individuals in more comprehensive plans.
To address these cost increases, policymakers are exploring solutions, such as:
- Price transparency: Requiring healthcare providers to disclose their prices could help reduce costs by increasing competition.
- Value-based care: Encouraging healthcare providers to focus on value-based care, rather than fee-for-service models, could help reduce costs and improve outcomes.
- Medicare negotiation: Allowing Medicare to negotiate prices with pharmaceutical companies could help reduce the cost of prescription medications.
- State-based solutions: States are exploring innovative solutions, such as reinsurance programs and Medicaid expansion, to reduce costs and improve access to care.
Ultimately, addressing the rising cost of health insurance will require a multifaceted approach that involves policymakers, healthcare providers, insurers, and individuals working together to reduce costs and improve the overall efficiency of the healthcare system.
Texas Republicans in Congress are at odds over healthcare.
The US House of Representatives has failed to come up with a plan to extend the expiring Affordable Care Act (ACA) tax credits, which are set to lapse on December 31. The credits, which have been in place since 2014, help lower healthcare costs for millions of Americans who receive coverage through the ACA marketplace. During the COVID-19 pandemic, Congress expanded the credits, leading to a significant increase in ACA enrollment, including in Texas, where the number of enrollees jumped from 1.3 million in 2021 to 3.9 million this year.
Most Republicans in the House, including those from Texas, have opposed extending the subsidies, arguing that they are wasteful and prone to fraud. Instead, they have proposed alternative plans, such as expanding association health plans and increasing oversight of pharmacy benefit managers. However, these plans have not gained traction, and the House has not been able to coalesce around a single alternative plan.
The expiration of the subsidies is expected to have a significant impact on Texas, where nearly 4 million people could lose their coverage, according to an analysis by the health policy organization KFF. Insurers in the state have already requested premium hikes, which could lead to hundreds of thousands of people dropping their insurance coverage.
Despite the potential consequences, most Republican representatives from Texas have stood firm in their opposition to the subsidies. However, some Republicans, including U.S. Rep. Monica De La Cruz, have expressed support for a bipartisan plan that would extend the tax credits for a year, with new guardrails in place to prevent fraud.
The issue is expected to be a major point of contention in the 2024 midterms, with Democrats looking to capitalize on healthcare affordability issues. Four Republicans, all from vulnerable districts, have signed onto a Democratic-led discharge petition to force a vote on extending ACA subsidies for three years. The petition received enough signatures, compelling a floor vote in January.
The House has approved a narrow bill that would fund cost-sharing reduction payments and allow small businesses to join association health plans, but it does not address the expiring subsidies. The bill faces an uphill climb in the Senate, where a bipartisan group of members is working to craft a plan to address the issue. Ultimately, the fate of the ACA subsidies remains uncertain, with no clear solution in sight as the deadline for their expiration approaches.
Alabama churches and hospitals are preparing for the potential consequences of sharply increasing Affordable Care Act insurance premiums.
The expiration of enhanced premium tax credits for Affordable Care Act (ACA) marketplace plans is expected to have a devastating impact on Alabamians, particularly those who rely on the marketplace for health insurance. The credits, which were introduced in 2021, made health insurance more affordable for many people, but they are set to expire at the end of the year unless Congress takes action to extend them.
According to estimates, the expiration of the credits could lead to a 93% increase in premiums for individuals enrolled in ACA marketplace plans in Alabama. This could result in approximately 130,000 people losing their coverage, either because they can no longer afford it or because they will no longer qualify for subsidies.
The impact will be felt across the state, with hospitals, healthcare providers, and faith leaders all warning of the consequences of allowing the credits to expire. The Alabama Hospital Association has stated that the expiration of the credits will add “incredible financial stress” to hospitals that are already operating on “razor-thin or negative margins.” The association estimates that 27 of the state’s 50 rural hospitals are at risk of closure, with 19 of those at immediate risk.
Faith leaders are also concerned about the impact on their communities. Rev. Shane Isner, a pastor at First Christian Church in Montgomery, gets his health insurance from the marketplace and is worried about the potential increase in premiums. He notes that many pastors and faith leaders rely on the ACA and that the expiration of the credits could lead to instability and even church closures.
The expiration of the credits will also have a significant impact on the state’s economy, with an estimated $63 million in state and local taxes and $968 million in GDP at risk. The Commonwealth Fund estimates that approximately 9,100 jobs in the healthcare industry could be cut if the subsidies are allowed to expire.
Individuals like Adrienne Gilspie, a retired UAB Hospital employee, will also be severely impacted. Gilspie’s sons, who have aged out of eligibility for the VA’s student plan, will see their premiums increase significantly if the credits expire. Her oldest son, who has a rare condition, could see his premium jump from $9.79 to $80, or even $533 if he is unable to return to work.
The expiration of the credits is a result of a vote by U.S. Sens. Katie Britt and Tommy Tuberville of Alabama, who rejected a plan to extend the subsidies for three more years. President Donald Trump has stated that he will work with Democrats to find a solution on healthcare, but it is unclear what plan he supports.
Advocates are urging Congress to act quickly to extend the credits and prevent the devastating consequences of their expiration. As Debbie Smith, campaign director for Cover Alabama, notes, “There’s no doubt our healthcare system is broken and affordability absolutely needs to be addressed. But for the people who are about to lose their health coverage, there is a solution that’s right there. Congress can act now to help these individuals.”
Millions of soon-to-be uninsured Americans are seeking an alternative solution.
Robert and Emily Sory are a couple who live in Thompson Station, Tennessee, and are passionate about animals. They are starting an animal sanctuary at their home, which is currently home to a variety of animals, including a blind raccoon, Russian foxes, African porcupines, emus, bobcats, and goats. However, despite their love for animals, the Sorys are facing a difficult decision regarding their own health insurance. In 2026, they will no longer have health insurance, as the Affordable Care Act’s enhanced subsidies are expiring, and they cannot afford the new premium costs.
Robert had previously been covered through a marketplace plan subsidized by the Affordable Care Act, but when he looked up the rates for 2026, he found that even a basic “Bronze” plan would cost him at least $70 a month. With no income coming in, he decided to forgo coverage altogether. Emily, who lost her job and insurance in November, is also facing the same challenge. She has costly health conditions and has already accumulated significant medical debt.
The Sorys are not alone in their situation. An estimated 4.8 million people are expected to lose their health insurance in 2026 due to the expiration of the enhanced subsidies. Many of them, like the Sorys, are looking for alternative ways to access medical care. The Sorys have met with their psychiatrist, who has agreed to charge them $125 per visit, and they are hoping to go every three months to keep their prescriptions current.
Hospitals and clinics are also preparing for the influx of newly uninsured patients. Federally Qualified Health Centers (FQHCs) like the Matthew Walker Comprehensive Health Center in Nashville offer lower-cost care on a sliding scale, and some have on-site pharmacies that provide free prescription medications to those in need. The Dispensary of Hope, a Nashville-based nonprofit, partners with FQHCs and hospital pharmacies to provide free medications to people without insurance who have annual incomes under 300% of the federal poverty limit.
However, the demand for these services is expected to outstrip supply in the new year. Ten states, including Tennessee, have not expanded Medicaid to cover low-income adults, leaving a significant gap in coverage. The impact of this gap is expected to be most acute in states that have not expanded Medicaid, with uninsured rates expected to jump by as much as 65% in Mississippi and 50% in South Carolina.
The Sorys are aware of the challenges they will face without health insurance, but they are trying to stay positive and focus on their animal sanctuary. Emily, who has experience in healthcare staffing, understands the system and feels bad about not being able to pay her medical bills. However, she simply cannot afford it. The Sorys’ story highlights the difficulties faced by many Americans who are struggling to access affordable healthcare, and the need for a more comprehensive and sustainable solution to the country’s healthcare crisis.
ACA premiums would have risen by a significant amount this year if not for tax subsidies.
Millions of Americans are facing a significant increase in health costs in 2026 as subsidies under the Affordable Care Act (ACA) are set to expire on December 31. These subsidies, which were created in 2021, have helped lower monthly premiums for approximately 22 million Americans. If Congress fails to extend the tax credits, individual policyholders could experience financially devastating consequences, and healthcare costs as a whole may rise.
According to an analysis by SmartAsset, a investment adviser, monthly premiums for ACA plans would have been significantly higher in 2025 without the enhanced subsidies. For example, in Mississippi, average monthly premiums would have jumped from $41 to $605, a 1,376% increase. In West Virginia, premiums would have risen by an average of 1,058%. While the analysis is based on 2025 costs, it provides a close approximation of the potential price hikes people with ACA coverage could face in 2026 without the tax credits.
The health policy group KFF estimates that annual out-of-pocket premium costs will increase by 114% on average for the 22 million ACA enrollees who rely on the subsidies. The exact price hikes will depend on factors such as insurance plan, age, household income, health status, and location. If Congress fails to extend the tax credits, some enrollees may qualify for smaller subsidies, while others could lose eligibility entirely.
The Democratic lawmakers have pushed for an extension of the tax credits, but they lack enough support in the Republican-led Congress. Although four GOP members have signed a Democratic measure to force a vote on extending the subsidies for three years, it is unlikely that the tax credits will be extended before they expire on December 31. The Congressional Budget Office estimates that approximately 4 million people could drop their health insurance altogether, leading to higher costs for those with other types of health insurance due to increased uncompensated care.
Experts warn that the expiration of the tax credits could have severe consequences for individual policyholders and the healthcare system as a whole. As Emma Wager, a senior policy analyst at KFF, noted, hospitals may raise their prices for everyone to reconcile the increased cost of uncompensated care for those lacking coverage. The issue remains unresolved, and Congress is expected to revisit it early next year.
4 Republicans defy Speaker Johnson to force House vote on extending ACA subsidies
Four Republican lawmakers defied their party’s leadership, including Speaker Mike Johnson, to join Democrats in a vote to extend Affordable Care Act (ACA) subsidies. The ACA, also known as Obamacare, has been a contentious issue in American politics since its inception. The subsidies in question help make healthcare more affordable for low-income individuals and families.
The vote was forced by Democrats, who used a procedural maneuver to bring the issue to the House floor. The four Republican lawmakers who crossed party lines to support the measure were Reps. Don Bacon of Nebraska, Brian Fitzpatrick of Pennsylvania, Mike Gallagher of Wisconsin, and John Katko of New York. Their decision to defy their party’s leadership is significant, as it shows a growing divide within the Republican Party on issues related to healthcare.
The ACA subsidies are set to expire at the end of 2025, which could lead to a significant increase in healthcare costs for millions of Americans. The bill to extend the subsidies, which was introduced by Democratic lawmakers, aims to prevent this from happening. By extending the subsidies, the bill would help ensure that low-income individuals and families continue to have access to affordable healthcare.
The vote on the bill is seen as a major victory for Democrats, who have been pushing to protect and strengthen the ACA. The bill’s passage in the House is also a significant blow to Republican efforts to repeal and replace the ACA. The vote highlights the ongoing debate over healthcare in America, with Democrats generally supporting efforts to expand and strengthen the ACA, while Republicans have sought to repeal and replace it.
The four Republican lawmakers who defied their party’s leadership to support the bill cited the need to protect their constituents’ access to affordable healthcare. Their decision to cross party lines is a clear indication that there is growing support among some Republicans for efforts to strengthen and protect the ACA. The bill’s fate in the Senate is uncertain, but its passage in the House is a significant step forward for Democrats and a major setback for Republican efforts to repeal and replace the ACA.
The ACA has been a highly polarizing issue in American politics, with Democrats generally supporting it and Republicans opposing it. However, the vote to extend the ACA subsidies shows that there is growing bipartisan support for efforts to protect and strengthen the law. As the debate over healthcare continues, it is likely that we will see more Republicans crossing party lines to support efforts to expand and strengthen the ACA.
Compare United India Mediclaim with New India Mediclaim to find the better policy – The Shillong Times
When it comes to selecting a mediclaim policy in India, two of the leading public sector insurers, United India and New India Assurance, are often considered. Both companies offer comprehensive health insurance policies that cater to individual and family needs, but there are notable differences in coverage, features, benefits, and premiums. Here’s a comparison of the two:
United India Mediclaim Policy
- Sum insured: Rs. 1 lakh to Rs. 10 lakh
- Coverage: Inpatient hospitalization, room rent, ICU charges, surgeon and anaesthetist fees, day care treatments, AYUSH coverage, and domiciliary hospitalization
- Entry age: 18 years to 65 years for adults; 91 days to 18 years for children
- Renewability: Lifetime renewability
- Pre-existing diseases: Covered after 4 years of continuous policy renewal
- Network hospitals: Over 7,000 hospitals across India
- Add-ons: Critical illness cover and personal accident riders
New India Mediclaim Policy
- Sum insured: Rs. 1 lakh to Rs. 15 lakh
- Coverage: Hospitalization expenses, ICU charges, surgeon fees, day care procedures, ambulance charges, AYUSH treatment, and organ donor expenses
- Entry age: 18 years to 65 years for adults; 3 months to 25 years for dependent children
- Renewability: Lifetime renewability
- Pre-existing diseases: Covered after 4 years of continuous coverage
- Network hospitals: Over 6,000 hospitals nationwide
- Add-ons: Top-up plans and senior citizen options
Comparison
- Sum insured range: United India (Rs. 1 lakh to Rs. 10 lakh) vs. New India (Rs. 1 lakh to Rs. 15 lakh)
- Room rent limit: Both offer 1% of sum insured per day for normal rooms and 2% for ICU
- Day care treatments: Both cover over 140 procedures
- Ambulance charges: Both cover, but New India has a sub-limit
- AYUSH treatment: Both cover
- Organ donor expenses: Both cover
- Pre-existing disease cover: Both cover after 4 years
- Co-payment: Both have 10% to 20% co-payment for entry after age 60
- Network hospitals: United India has over 7,000 hospitals, while New India has over 6,000
- Policy type options: Both offer individual and family floater options
- Add-ons and riders: United India offers critical illness and personal accident riders, while New India offers top-up plans and senior citizen options
Premium Comparison
- For a 35-year-old individual seeking Rs. 5 lakh coverage, United India’s premium is approximately Rs. 6,000 to Rs. 7,000 annually, while New India’s premium is approximately Rs. 5,800 to Rs. 6,800 annually.
Customer Service and Claim Settlement
- Both companies have a high claim settlement ratio (over 90%) and offer cashless facilities at network hospitals.
- Support is available through toll-free numbers, branch office assistance, and TPA helplines.
Which Policy to Choose?
- Choose United India Mediclaim if you prefer a wider hospital network, optional riders like critical illness or personal accident, or flexible sum insured upgrades.
- Choose New India Mediclaim if you are cost-sensitive, need higher coverage beyond Rs. 10 lakh, or prefer policies with flexibility for children up to 25 years under floater plans.
Ultimately, the better policy depends on individual or family requirements, and factors such as sum insured, network hospitals, premium affordability, add-on availability, and service record should be carefully considered.
The Insurance Regulatory and Development Authority of India (IRDAI) has imposed a fine of Rs 1 crore on Care Health Insurance due to lapses in health insurance claim settlements.
The Insurance Regulatory and Development Authority of India (IRDAI) has imposed a penalty of Rs 1 crore on Care Health Insurance due to lapses in health insurance claim settlements. This significant penalty highlights the regulatory body’s commitment to ensuring that insurance companies comply with the rules and regulations governing the industry.
The penalty was imposed after IRDAI conducted an investigation into Care Health Insurance’s claim settlement practices. The investigation revealed that the company had failed to settle claims in a timely manner, leading to delays and hardship for policyholders. IRDAI found that Care Health Insurance had not adhered to the stipulated timelines for claim settlement, which is a critical aspect of health insurance services.
IRDAI’s penalty is a clear indication that the regulator will not tolerate lapses in claim settlement, which can have serious consequences for policyholders. The regulator has emphasized the importance of insurance companies settling claims promptly and efficiently, as delayed settlements can cause significant financial hardship and emotional distress to policyholders.
The penalty imposed on Care Health Insurance serves as a warning to other insurance companies operating in India. IRDAI has made it clear that it will closely monitor the claim settlement practices of insurance companies and take strict action against those that fail to comply with the regulatory requirements.
The development is expected to have a positive impact on the health insurance industry in India, as it will prompt insurance companies to review their claim settlement practices and ensure that they are compliant with the regulatory requirements. Policyholders can expect more efficient and timely claim settlements, which will enhance their overall experience with health insurance services.
In response to the penalty, Care Health Insurance has stated that it is taking corrective measures to improve its claim settlement processes. The company has assured that it is committed to providing prompt and efficient services to its policyholders.
The IRDAI’s penalty on Care Health Insurance highlights the importance of regulatory oversight in the insurance industry. The regulator’s actions demonstrate its commitment to protecting the interests of policyholders and ensuring that insurance companies operate in a fair and transparent manner. The development is a significant step towards promoting a more efficient and customer-centric health insurance industry in India.
Vulnerable Republican slams decision to send health insurance costs soaring as ‘political malpractice’
House Republican leaders have decided to move forward with a healthcare bill that does not address the impending expiration of pandemic-era tax credits for Affordable Care Act (ACA) coverage, which will result in significantly higher insurance costs for millions of Americans in 2026. The bill, which is expected to be voted on this week, focuses on expanding insurance coverage options for small businesses and the self-employed, but does not include measures to extend the subsidies that have helped keep premiums low for many Americans.
The decision has been met with criticism from some Republicans, including Rep. Mike Lawler, who represents a competitive district and has been pushing for a temporary extension of the subsidies. Lawler called the decision “political malpractice” and argued that it would hurt many Americans who rely on the ACA for health coverage. Democrats have also criticized the bill, saying it does not address the root causes of rising healthcare costs and will ultimately lead to more people being priced out of coverage.
The House Republican bill includes provisions to expand access to association health plans, which would allow small businesses and self-employed individuals to band together to purchase health coverage. It also includes measures to reduce prescription drug costs by increasing transparency among pharmacy benefit managers. However, an analysis by the Congressional Budget Office estimates that the bill would actually decrease the number of people with health insurance by an average of 100,000 per year over the next decade.
Meanwhile, a bipartisan group of senators is still working on a compromise to extend the ACA subsidies, but it is unlikely that any legislation will be passed before the end of the year. Senate Majority Leader John Thune said that there is a “potential pathway” to an agreement in January, but acknowledged that significant issues, including disagreements over abortion funding, still need to be resolved.
The expiration of the pandemic-era tax credits is expected to have a significant impact on many Americans, particularly those who live in states that President Donald Trump won in the 2020 election. Rep. Lawler noted that most people who get their health coverage through the ACA live in these states, and that the changes proposed for a temporary extension were “conservative reforms.” However, the decision by House Republican leaders to move forward with their own bill without addressing the subsidies has been seen as a missed opportunity to find a bipartisan solution to the problem.
Overall, the debate over the healthcare bill highlights the deep divisions between Republicans and Democrats on healthcare policy, and the challenges of finding a solution to the complex and contentious issue of rising healthcare costs. With the expiration of the pandemic-era tax credits looming, many Americans are bracing for significant increases in their insurance premiums, and lawmakers are under pressure to find a solution before it’s too late.
House Speaker Johnson rejects attempts to prolong healthcare subsidies, proceeding with Republican proposal
House Speaker Mike Johnson has rejected efforts to extend health care subsidies, instead pushing forward with the Republican plan to overhaul the Affordable Care Act (ACA). The subsidies, which were introduced during the COVID-19 pandemic, have helped millions of Americans afford health insurance. However, they are set to expire at the end of the year, leaving many concerned about the impact on healthcare access.
Johnson’s decision to reject the extension of subsidies has sparked criticism from Democrats, who argue that it will lead to increased healthcare costs and reduced access to care for vulnerable populations. They have proposed legislation to extend the subsidies, but Johnson has refused to consider it.
Instead, Johnson is pushing ahead with the Republican plan, which aims to repeal and replace the ACA with a new system. The plan, which has been met with skepticism by many, would introduce new rules and regulations that would allow states to opt out of certain ACA requirements. It would also introduce new tax credits to help individuals purchase health insurance.
The Republican plan has been criticized for potentially leading to higher healthcare costs and reduced access to care, particularly for those with pre-existing conditions. Democrats argue that the plan would undermine the progress made under the ACA, which has helped to increase healthcare access and reduce the number of uninsured Americans.
The debate over healthcare subsidies and the Republican plan has significant implications for the millions of Americans who rely on the ACA for health insurance. If the subsidies are allowed to expire, many may struggle to afford healthcare, leading to reduced access to care and potentially poorer health outcomes.
Johnson’s decision to push ahead with the Republican plan has also sparked concerns about the potential impact on the healthcare system as a whole. Many healthcare providers and organizations have expressed concerns about the potential disruption to the system, which could lead to reduced access to care and increased costs.
Overall, the debate over healthcare subsidies and the Republican plan is a critical issue that has significant implications for the healthcare system and the millions of Americans who rely on it. While Johnson and Republicans are pushing ahead with their plan, Democrats and many healthcare advocates are urging caution and calling for a more thoughtful approach to healthcare reform. The outcome of this debate will have far-reaching consequences for the healthcare system and the Americans who rely on it.
Irdai fines Care Health Insurance ₹1 crore after inspection flags failures in claims and internal controls.
The Insurance Regulatory and Development Authority of India (Irdai) has imposed a penalty of Rs 1 crore on an insurer due to non-compliance with regulations. During an inspection, it was found that the insurer had failed to properly communicate with policyholders regarding claim settlements, deductions, and partial payments. In several cases, the insurer had sent communications to hospitals, but there was no evidence that the policyholders had received the same information.
The regulator examined several cases and found that the insurer had not provided adequate proof that policyholders were informed about the claim settlements, including what had been paid, what had been disallowed, and the reasons for the disallowance. The insurer attempted to submit internal email logs as evidence, but these were rejected by the regulator. The regulator stated that these logs did not establish that customers had been properly informed about the claim settlements.
As a result, Irdai imposed the penalty under the Insurance Act, citing the insurer’s failure to comply with regulatory requirements. The penalty of Rs 1 crore is a significant one, and it highlights the importance of insurers maintaining transparency and communication with policyholders. The regulator’s action is intended to ensure that insurers adhere to the required standards and provide policyholders with accurate and timely information about their claims.
The imposition of the penalty also underscores the importance of proper documentation and record-keeping by insurers. The insurer’s inability to produce convincing proof of communication with policyholders led to the rejection of their internal email logs, and ultimately, the imposition of the penalty. Insurers must maintain accurate and reliable records of their communications with policyholders, including claim settlements and payments.
In conclusion, the Irdai’s penalty on the insurer is a significant development that highlights the importance of transparency, communication, and proper documentation in the insurance industry. Insurers must ensure that they comply with regulatory requirements and maintain accurate records of their communications with policyholders. Failure to do so can result in significant penalties, as seen in this case. The regulator’s action is intended to protect the interests of policyholders and ensure that insurers maintain the required standards of transparency and accountability.
House Republicans Unveil Alternative Health Care Plan Following Senate Setback
The US Congress is facing a time-sensitive issue as the enhanced Affordable Care Act (ACA) tax subsidies are set to expire at the end of the year, which could lead to a significant increase in healthcare premiums for millions of Americans. Democrats have been pushing to extend these subsidies, but the Senate failed to advance bills to address healthcare costs this week. In response, House Republicans released a proposed legislation on Friday that does not extend the enhanced tax credits but includes other measures to improve access to healthcare.
The House Republican proposal includes allowing small businesses to join together to buy insurance plans for their employees and implementing new requirements for pharmacy benefit managers to lower drug costs. It also aims to lower premiums for low-income Americans through federal payments, known as cost-sharing reduction payments, starting in 2027. However, health plans that provide abortion coverage would be excluded from these payments.
House Speaker Mike Johnson stated that the proposal aims to tackle the real drivers of healthcare costs and provide affordable care, increase access and choice, and restore integrity to the nation’s healthcare system. However, Democratic House Minority Leader Hakeem Jeffries criticized the proposal, calling it a “toxic Republican Healthcare plan” that hurts everyday Americans and fails to extend the ACA tax credits.
The Senate had previously considered two proposals, one led by Democrats and one backed by Republicans, but both failed to pass due to lack of support. President Trump has advocated for giving money to people to pay for healthcare costs instead of tax credits for ACA plans, stating that he wants to see people buy themselves great healthcare instead of giving billions of dollars to insurance companies.
The issue has sparked concerns among Republicans, with some warning that ending ACA subsidies could cost their party the midterm elections. Some Republicans in the House are seeking ways to extend subsidies, including forcing a vote on the House floor over the objections of party leaders. The House has only four days left in the session before their holiday recess begins, and the Senate’s recess starts on December 20, making it a challenging task to pass legislation before the subsidies expire.
Iowa farmers claim that the expiration of federal health care tax credits will negatively impact their budgets.
Iowa farmers are expressing concern about the impending expiration of federal health care tax credits, which they claim will significantly impact their budgets. The credits, part of the American Rescue Plan Act, have been instrumental in helping farmers and their families afford health insurance. With the credits set to expire at the end of 2022, many farmers are worried about the financial strain they will face in maintaining their health care coverage.
The tax credits have been a lifeline for farmers, who often struggle to afford health insurance due to the high costs associated with farming. The credits have helped reduce the financial burden of health care, allowing farmers to invest in their farms and support their local communities. However, with the expiration of the credits, farmers will be forced to absorb the full cost of their health insurance premiums, which could lead to significant financial hardship.
According to a recent survey, nearly 70% of Iowa farmers reported that the loss of the tax credits would have a significant impact on their farm’s budget. Many farmers have already begun to feel the effects of the impending expiration, with some reporting that they will be forced to reduce their health care coverage or opt out of insurance altogether.
The impact of the expiration of the tax credits will be felt not only by farmers but also by their families and local communities. Farming is a high-risk profession, and access to affordable health care is essential for farmers and their families. Without the tax credits, many farmers will be forced to choose between paying for health insurance or investing in their farms, which could have long-term consequences for the agricultural industry as a whole.
Iowa lawmakers are being urged to take action to address the issue, with many calling for an extension of the tax credits or a permanent solution to make health care more affordable for farmers. Farmers and rural advocacy groups are also pushing for increased funding for rural health care programs and expanded access to affordable health insurance options.
In conclusion, the expiration of federal health care tax credits will have a significant impact on Iowa farmers, who are already struggling to make ends meet. The loss of these credits will lead to increased financial hardship, reduced access to health care, and potentially long-term consequences for the agricultural industry. It is essential that lawmakers take action to address this issue and ensure that farmers and their families have access to affordable health care.
Health care deal slipping away as Affordable Care Act subsidies near expiration
As the year comes to a close, millions of Americans are facing a potential increase in their health insurance premiums due to the expiration of enhanced Affordable Care Act (ACA) tax credits. The subsidies, which were expanded during the pandemic, are set to expire on December 31, and lawmakers are struggling to come up with a solution. The Senate failed to advance two competing health care bills last week, and the House is now considering a GOP-led package that aims to lower premiums through cost-sharing reductions and market changes, but does not extend the expiring ACA subsidies.
House Speaker Mike Johnson has announced that Republicans will hold a vote on the package this week, but the odds of passing a clean extension of the subsidies before lawmakers leave Washington on Friday appear slim. House Democratic Leader Hakeem Jeffries has criticized the Republican plan, calling it inadequate and warning that it fails to address the looming premium hikes. Despite the setbacks, Senator Bill Cassidy, a Louisiana Republican, believes that a compromise is still possible and has suggested a hybrid approach that addresses both sides’ priorities: easing premiums while also helping patients afford high out-of-pocket costs.
The White House has also weighed in on the issue, with President Donald Trump expressing a preference for a system that sends federal aid directly to individuals through health savings or insurance accounts, rather than continuing broad subsidies to insurers. However, he has left the door open to a limited extension if it comes with changes that Republicans support. The consequences of a lapse in subsidies could be severe, with Democrats warning that hundreds of thousands of people could lose coverage. Senator Jon Ossoff of Georgia has called the potential loss of coverage a “life and death” issue, emphasizing the urgency of the situation.
As the clock ticks down, lawmakers are facing increasing pressure to find a solution. The House may pass a bill this week, but the Senate is unlikely to act before lawmakers leave town, making a temporary lapse in subsidies increasingly likely. The stakes are high, and the outcome is far from certain. If a deal is not reached, millions of Americans could see their health insurance premiums jump, and some could lose coverage altogether. The situation is a stark reminder of the ongoing challenges facing the US healthcare system and the need for bipartisan cooperation to address the complex issues at hand.
ManipalCigna Health Insurance links winter pollution to rise in respiratory conditions › Mediabrief.com
ManipalCigna Health Insurance has reported a significant increase in respiratory-related claims during the winter months, with a 321% surge between 2020 and 2024. This four-fold increase highlights the growing impact of worsening winter air quality across the country. The company’s six-year analysis shows that respiratory conditions account for 18.8% of all seasonal disease-related claims during the winter months, with chronic obstructive pulmonary disease (COPD) and asthma being the leading causes.
The data reveals that Tier 2 and Tier 3 cities are disproportionately affected, accounting for over 84% of all respiratory claims. Among metropolitan cities, Delhi NCR has the highest percentage of respiratory claims at 6.5%, followed by Bengaluru and Mumbai at 4.5% and 4.2%, respectively. This suggests that pollution-linked respiratory conditions are not limited to North India, but are a nationwide concern.
The findings underscore the rising respiratory vulnerability across the country, affecting not only major metros but also emerging urban centers. Dr. Vidyadhar Dhaware, Head of Claims and Provider Network at ManipalCigna Health Insurance, notes that the increase in respiratory diseases during the winter months closely mirrors the increase in smog and particulate pollution. He emphasizes that polluted air weakens the lungs’ natural defense system, making individuals more susceptible to infections and complications.
The most vulnerable populations include children, the elderly, and people with pre-existing respiratory conditions. To mitigate the risks, Dr. Dhaware recommends limiting outdoor exposure, using protective masks, improving indoor air quality, and seeking timely medical care if symptoms escalate. The data highlights the need for increased awareness and proactive measures to address the growing burden of respiratory diseases in India, particularly during the winter months. Overall, the report suggests that the worsening air quality in India is having a significant impact on public health, and urgent action is needed to address this critical issue.
House Republicans introduce healthcare plan without extending Affordable Care Act subsidies ahead of upcoming vote
House Republicans, led by Speaker Mike Johnson, have introduced a healthcare package aimed at addressing rising costs. The proposal, which will be voted on in the House next week, includes measures to expand association health plans, impose transparency requirements on pharmacy benefit managers, and appropriate funds for cost-sharing reductions to lower premiums in the individual market. However, the plan does not extend the expiring enhanced Affordable Care Act (ACA) subsidies, which are set to lapse at the end of the month.
According to Johnson, the Republican plan will “tackle the real drivers of health care costs” and provide affordable care, increase access and choice, and restore integrity to the nation’s healthcare system. The plan has been met with criticism from Democrats, with House Democratic Leader Hakeem Jeffries calling it “toxic legislation” that fails to address the coming hike in ACA premiums. Jeffries stated that Democrats are willing to work with Republicans on extending the subsidies, which tens of millions of Americans rely on to afford their healthcare.
President Donald Trump has also weighed in on the issue, stating that he wants a healthcare plan that would directly funnel aid to patients, rather than insurance companies. Trump expressed his desire to see money given to people for healthcare through an insurance account, allowing them to buy their own healthcare and save money. While Trump kept the door open to extending ACA tax credits, he emphasized that any deal would need to come with caveats that Republicans want.
The fate of the Republican healthcare package is uncertain, with the Senate unlikely to take further action on healthcare next week. The enhanced premium subsidies are all but certain to lapse, leaving millions of Americans facing increased healthcare costs. Despite this, House GOP leadership aides hope to pass the healthcare package next week, which they claim will “actually deliver affordable healthcare” to Americans.
Congress is racing against time to prevent a significant increase in healthcare costs that could affect millions of people.
As the holiday season approaches, lawmakers are racing against time to address the looming expiration of enhanced tax credits that make health insurance premiums more affordable for millions of Americans. The credits, which are set to lapse at the end of the month, have been a crucial component of the Affordable Care Act (ACA). If they expire, it could lead to a significant increase in healthcare costs for many individuals and families.
The Senate recently failed to advance healthcare plans proposed by both parties, and now the House is taking up the issue. Speaker Mike Johnson has vowed to hold a vote on a Republican-led bill that includes provisions to lower premiums for certain ACA enrollees, but it does not extend the Covid-era subsidies. However, GOP leaders are expected to allow an amendment to extend the ACA credits to come to the floor, which could potentially force a vote on the issue.
Despite the efforts, the legislative path to passing a short-term extension of the expiring subsidies before Congress leaves for the holidays appears to be challenging. House Minority Leader Hakeem Jeffries has expressed skepticism about the narrow GOP healthcare plan, and it is unclear whether Democrats will back efforts to strong-arm votes on bipartisan bills to extend the Obamacare tax credits.
Senator Bill Cassidy, who chairs a key health committee, has expressed cautious optimism that Congress can find a way to shield Americans from exorbitant healthcare costs. He suggested that a bipartisan compromise could be reached by putting money directly in the pockets of Americans who cannot afford healthcare and briefly extending enhanced Obamacare credits for those who depend on them the most.
The issue has become highly politicized, with Senate Minority Leader Chuck Schumer placing the “onus” on GOP leaders to come to the table for a compromise. Senate Majority Leader John Thune has accused Democrats of propping up a “blanket” ACA subsidy extension that is not sustainable. Meanwhile, Senator Jon Ossoff has warned that a failure to address the expiring tax credits would be a “political disaster” for Republicans and could have life-or-death consequences for many Americans.
As the deadline approaches, lawmakers are under pressure to find a solution to the impending healthcare crisis. With the stakes high and the clock ticking, it remains to be seen whether Congress can come together to pass a bill that addresses the expiring tax credits and provides relief to millions of Americans who rely on them for affordable healthcare.
Obamacare Expiration to Trigger ‘Death Spiral’ in US Healthcare, Experts Warn
The expiration of subsidies for Affordable Care Act (ACA) health insurance is likely to have a significant impact on the healthcare sector in the US. According to healthcare policy experts, Americans who rely on these subsidies will probably switch to plans with lower monthly premiums and high deductibles or decide not to purchase any coverage. This will have a serious and damaging impact on the entire sector, including rural hospitals and people with employer-sponsored health insurance.
The average annual premium for ACA plan enrollees is estimated to more than double, from $888 this year to $1,904 in 2026, according to a KFF analysis. This will lead to economic downstream effects, including a significant portion of people dropping their marketplace coverage and being uninsured. Emma Wager, a senior policy analyst for KFF’s program on the ACA, notes that this will not only impact those who drop their coverage but also everyone else, as it will lead to a sicker pool of people remaining in the program.
A recent survey by KFF found that if the subsidies expire, a third of the 24 million US adults who buy coverage through the ACA marketplace said they were likely to select a lower-premium plan with higher deductibles and out-of-pocket costs, while a quarter of enrollees said they would be “very likely” to go uninsured. Gerard Anderson, a professor of health policy and management at Johns Hopkins University, warns that this will lead to a “death spiral” where the healthy people drop out, and the sicker people are the only ones who stay in the program until it becomes no longer sustainable.
The expiration of subsidies will also have a disproportionate impact on rural areas, where people are more likely to rely on the ACA and rural hospitals. The Century Foundation, a progressive think tank, notes that people in rural areas will see an even greater premium increase than those in urban areas. This will make it harder for small and rural hospitals to operate, as they will have to treat more people who do not have the means to pay for their care. Natasha Murphy, director of health policy at the Center for American Progress, notes that the full impact of the subsidies expiring won’t become apparent until open enrollment ends on January 15.
House Republicans are striving to develop a healthcare plan, but the party remains divided.
The US Senate has failed to reach an agreement on a healthcare plan, and now the House of Representatives is taking up the issue. Speaker Mike Johnson has unveiled a Republican alternative plan, which focuses on enhancing access to employer-sponsored health insurance plans and clamping down on pharmacy benefit managers. The plan does not include an extension of the enhanced tax credit for millions of Americans who get insurance coverage through the Affordable Care Act (ACA), also known as Obamacare, which is set to expire on December 31.
The Republican plan proposes expanding access to association health plans, which would allow small businesses and self-employed individuals to band together and purchase health coverage. It also requires more data from pharmacy benefit managers to help control drug costs. However, critics argue that the plan provides skimpier coverage than what is required under the ACA and does not address the issue of rising healthcare costs.
House Democratic Leader Hakeem Jeffries has strongly opposed the Republican plan, calling it “toxic legislation” that hurts hardworking Americans. He has instead proposed a discharge petition that would force a vote on a clean three-year subsidy extension, which has 214 signatures from Democrats but no support from Republicans.
Meanwhile, a group of centrist GOP lawmakers is aligning with Democrats to push for a temporary extension of the tax credits to prevent Americans from facing rising healthcare costs. They have filed discharge petitions that could force a floor vote on a bill that includes a two-year subsidy extension and provisions to combat fraud in the ACA marketplace.
President Donald Trump has weighed in on the issue, saying that he wants to see a better plan than Obamacare and has proposed providing Americans with stipends to help buy insurance. However, his idea has few details and it’s unclear how much money he envisions.
The political pressure is building for many lawmakers, particularly vulnerable House Republicans representing key battleground districts. With time running out for Congress to act, it remains to be seen whether a consensus solution can be reached. The House is set to vote on the Republican plan next week, but it’s unclear whether it will pass or if a bipartisan solution can be found.
People seeking alternatives due to impending health insurance premium increases
Tax credits for the Affordable Care Act (ACA) are set to expire at the end of 2025, which will result in a significant increase in health insurance premiums for millions of people. Terry Davis, a self-employed woman in her 60s, is among those who will be affected by the expiration of the subsidies. She currently pays around $500 per month for her health insurance, but expects her premiums to rise to at least $3,000 per month if the subsidies are not extended. This would be unsustainable for her and her husband, and they may be forced to stop paying for insurance altogether.
Davis is not alone in her concerns. Many people are seeking help to understand their options for health insurance and to find more affordable alternatives. Staff at Mercy Medical Center in Cedar Rapids, Iowa, are assisting individuals with enrollment and navigating the complexities of health insurance plans. One of the challenges is ensuring that people choose plans that cover their needs, including their providers, hospitals, and prescription medications.
The expiration of the ACA subsidies is a result of congressional inaction, despite efforts by Senate Democrats to extend the credits during the recent government shutdown. The odds of lawmakers intervening to extend the subsidies appear bleak, leaving many individuals and families to face significant increases in their health insurance costs.
As the open enrollment period approaches, organizations like Mercy Medical Center are offering assistance to those who need help navigating the system. Individuals can contact the hospital’s Eligibility Team for guidance on choosing a health insurance plan that meets their needs. For Davis and many others, the expiration of the ACA subsidies is a daunting prospect, and they are hoping that federal lawmakers will take action to address the issue and provide relief to those who will be affected. Without an extension of the subsidies, many people will be forced to make difficult choices about their health insurance, and some may be forced to go without coverage altogether.
Higher cost, worse coverage: Affordable Care Act enrollees say expiring subsidies will hit them hard – KWKT – FOX 44
The Affordable Care Act (ACA), also known as Obamacare, has provided health insurance to millions of Americans since its inception in 2010. However, the subsidies that make the coverage affordable for many are set to expire, leaving enrollees worried about the significant impact on their finances and access to healthcare.
The subsidies, which were enhanced by the American Rescue Plan Act in 2021, have helped reduce the cost of premiums for many low- and middle-income families. According to a report by the Kaiser Family Foundation, the enhanced subsidies have resulted in an average premium reduction of 23% for ACA enrollees. However, these subsidies are set to expire at the end of 2022, which will lead to a significant increase in premiums for many enrollees.
ACA enrollees are expressing concern about the impending expiration of the subsidies, citing the potential for higher costs and reduced coverage. Many are worried that they will no longer be able to afford their health insurance premiums, which could lead to a loss of coverage and reduced access to essential healthcare services. A survey conducted by the Kaiser Family Foundation found that 61% of ACA enrollees reported that they would not be able to afford their premiums if the enhanced subsidies were to expire.
The expiration of the subsidies will disproportionately affect low- and middle-income families, who are already struggling to make ends meet. These families will face significant increases in their premiums, which could lead to a decline in enrollment and an increase in the number of uninsured individuals. For example, a family of four with an annual income of $60,000 could see their premium increase by over $1,000 per year if the subsidies expire.
Lawmakers are being urged to extend the enhanced subsidies to prevent the potential disruption to the healthcare system. The Biden administration has proposed extending the subsidies through 2025, but the proposal is still pending in Congress. If the subsidies are not extended, ACA enrollees will face significant increases in their premiums, which could lead to a decline in enrollment and an increase in the number of uninsured individuals. As the expiration date approaches, ACA enrollees are anxiously waiting to see what the future holds for their healthcare coverage.
House Republicans Release Health Plan to Allow Subsidies to Expire – The New York Times
The House Republican Party has released a healthcare plan that would allow subsidies for low-income individuals to purchase health insurance to end. The plan, which is part of the American Health Care Act, aims to repeal and replace the Affordable Care Act (ACA), also known as Obamacare. Under the new plan, subsidies would be replaced with tax credits that would be based on age, rather than income. This change could lead to higher costs for older and lower-income individuals.
The plan would also allow states to waive certain requirements of the ACA, such as the essential health benefits that insurers must cover. This could lead to skimpier insurance plans that do not cover essential services like maternity care, mental health treatment, and prescription medications. Additionally, the plan would allow insurers to charge older adults up to five times more than younger adults, which could lead to unaffordable premiums for older Americans.
The plan would also phase out the Medicaid expansion that was implemented under the ACA, which has provided health insurance to millions of low-income Americans. Instead, the plan would provide block grants to states to fund their own Medicaid programs, which could lead to reduced funding and fewer benefits for low-income individuals.
The release of the plan has been met with criticism from Democrats and advocacy groups, who argue that it would lead to millions of Americans losing their health insurance. The plan would also allow insurers to deny coverage to individuals with pre-existing conditions, such as cancer, diabetes, and heart disease, if they have a lapse in coverage.
The plan is expected to be voted on in the House of Representatives in the coming weeks, and it is likely to face significant opposition from Democrats and some moderate Republicans. The Senate is also working on its own healthcare plan, which is expected to be released in the coming weeks.
Overall, the House Republican healthcare plan would make significant changes to the healthcare system, including ending subsidies for low-income individuals, allowing states to waive essential health benefits, and phasing out the Medicaid expansion. While the plan’s supporters argue that it would increase competition and reduce costs, critics argue that it would lead to millions of Americans losing their health insurance and facing higher costs for healthcare. The plan’s fate is uncertain, and it is likely to face significant debate and opposition in the coming weeks.
House Republican healthcare plan does not extend Obamacare subsidies
House Republican leaders have introduced a healthcare proposal that fails to address the impending expiration of enhanced Affordable Care Act (ACA) subsidies, which are set to lapse on December 31. This expiration will affect approximately 24 million Americans, who will face significant increases in health insurance premiums starting January 1. The proposed bill does not extend these subsidies, instead offering cost-sharing reductions that will not take effect until January 2027.
The bill’s prospects are uncertain, with dim chances of passing in the Senate, where it would require at least 60 votes to advance. Republicans in Congress are divided on the issue, with moderate House Republicans pushing for a two-year extension of the enhanced tax credits. However, some GOP lawmakers are conditioning their support on addressing abortion coverage, a non-starter for Democrats.
The proposed bill includes other measures, such as expanding access to association health plans, which would allow small businesses and self-employed individuals to pool resources and purchase group health insurance at lower costs. It also introduces transparency rules for pharmacy benefit managers and expands the use of Health Reimbursement Arrangements, which enable employers to reimburse workers tax-free for healthcare expenses and premiums.
Despite these provisions, the bill’s failure to address the looming subsidy expiration has raised concerns among lawmakers and healthcare advocates. The House Rules Committee is set to meet on Tuesday to decide whether to allow amendments to the bill, including a potential extension of the subsidies. If approved, these amendments could be offered during floor debate next week, potentially altering the bill’s trajectory. However, the outcome remains uncertain, and the fate of the enhanced subsidies and the millions of Americans who rely on them hangs in the balance.
Speaker Johnson Unveils Healthcare Plan Amidst Republican Division in Search of Alternative – Colorado Springs Gazette
Speaker of the House Mike Johnson has unveiled a new healthcare plan, as Republicans struggle to come up with a unified alternative to the Affordable Care Act (ACA), also known as Obamacare. The plan, which Johnson has dubbed the “Lower Costs, More Access” plan, aims to reduce healthcare costs and increase access to healthcare for Americans.
The plan includes several key provisions, including allowing individuals to purchase health insurance across state lines, expanding health savings accounts, and providing more funding for community health centers. It also includes measures to reduce the cost of prescription medications and to increase transparency in healthcare pricing.
Johnson’s plan is an attempt to provide a Republican alternative to the ACA, which has been a target of Republican criticism since its passage in 2010. However, the plan has already faced criticism from some Republicans, who argue that it does not go far enough in repealing and replacing the ACA.
The lack of a unified Republican alternative to the ACA has been a major challenge for the party, which has long campaigned on repealing and replacing the law. Despite numerous attempts, Republicans have been unable to come up with a plan that can gain widespread support within the party.
The divisions within the Republican Party on healthcare are reflective of the broader challenges the party faces in developing a coherent policy agenda. With a narrow majority in the House, Republicans are struggling to pass legislation, and the party is deeply divided on a range of issues, including healthcare, immigration, and government spending.
Johnson’s plan is an attempt to bridge the divide within the party and provide a unified alternative to the ACA. However, it remains to be seen whether the plan will gain widespread support within the party, or whether it will be subject to the same criticisms and divisions that have plagued previous Republican healthcare plans.
Overall, the introduction of Johnson’s healthcare plan highlights the ongoing challenges facing the Republican Party as it attempts to develop a coherent policy agenda and provide a unified alternative to the ACA. With the 2024 elections looming, the party will need to find a way to overcome its divisions and develop a clear and compelling vision for the country’s healthcare system.
For Republicans, Trump’s hands-off approach to health care is a problem.
The New York Times article highlights the concerns of Republicans regarding President Trump’s hands-off approach to healthcare. Despite the party’s long-standing goal of repealing and replacing the Affordable Care Act (ACA), also known as Obamacare, Trump has taken a surprisingly passive stance on the issue. This has left many Republicans frustrated and worried about the potential consequences of inaction.
The article notes that Trump’s approach to healthcare has been marked by a lack of clear direction and leadership. Unlike his predecessors, who actively worked to shape healthcare policy, Trump has largely delegated the issue to Congress. This has resulted in a lack of cohesion and coordination among Republican lawmakers, who are struggling to come up with a unified plan to replace the ACA.
The consequences of Trump’s hands-off approach are already being felt. The ACA’s individual mandate, which requires individuals to purchase health insurance, has been repealed, and the administration has expanded the use of short-term, limited-duration insurance plans, which are not required to cover pre-existing conditions. These changes have led to increased uncertainty and instability in the healthcare market, causing premiums to rise and coverage to decline.
Many Republicans are concerned that Trump’s inaction on healthcare will hurt the party’s chances in the 2020 elections. The ACA remains a highly popular program, and the party’s failure to provide a viable alternative could alienate voters who rely on the program for health coverage. Furthermore, the lack of a clear healthcare plan could also undermine the party’s ability to attract moderate voters who are looking for a more pragmatic approach to healthcare reform.
The article quotes several Republican lawmakers and strategists who express frustration with Trump’s approach to healthcare. They argue that the party needs to take a more proactive and coordinated approach to healthcare reform, rather than relying on the courts to dismantle the ACA. Some have even suggested that the party should work with Democrats to find common ground on healthcare reform, rather than trying to repeal the ACA outright.
Overall, the article suggests that Trump’s hands-off approach to healthcare is a problem for Republicans, who are struggling to come up with a unified plan to replace the ACA. The party’s failure to provide a viable alternative to the ACA could have significant consequences for the 2020 elections and beyond. As the healthcare debate continues to unfold, it remains to be seen whether Trump will take a more active role in shaping healthcare policy or continue to delegate the issue to Congress.
Navigators are assisting Minnesotans in finding affordable health care coverage options amidst the ongoing stalemate in Washington.
The deadline to enroll in the Affordable Care Act (ACA) for coverage starting January 1, 2026, is December 15. In Minnesota, MNsure navigators are working to help residents determine which health care plans they can afford. However, a stalemate in Washington, D.C. over ACA subsidies has created uncertainty for many individuals and families. Democrats proposed a three-year extension of enhanced subsidies, while Republicans proposed redirecting the funds to health savings accounts, but both proposals failed to pass the Senate.
As a result, many Minnesotans may face higher premiums and reduced financial assistance. Approximately 90,000 residents are expected to see increased premiums, with 19,000 losing all financial help. MNsure navigators are reporting a high volume of calls, with about 1,000 more calls per day than this time last year. The nonprofit organization Portico Healthnet, which helps over 9,000 people enroll in health care each year, is finding that many individuals are deciding that health care is unaffordable without the enhanced subsidies.
MNsure is encouraging those who have not yet signed up to reach out for help, as tax credits will still be available, although fewer people will qualify and they will be less generous. Northpoint Health and Wellness Center, another certified MNsure navigator organization, is also working to educate individuals about the changes and is preparing for an increase in demand for its services. The center expects to see a rise in uncompensated care, with approximately 30-40% of its patients being underinsured or uninsured, up from the current 26%.
To address the issue, Northpoint Health and Wellness Center is expanding its capacity and opening up more appointments. The center’s CEO, Kimberly Spates, emphasizes the importance of individuals prioritizing their health care needs and exploring affordable options. “I think it’s important for people to understand they still have agency,” she said. “I think it’s going to be important to folks to think about ‘What can I actually afford?’ and try to prioritize the things that are actually important to their family.”
Those seeking help can find a navigator through MNsure’s website. With the deadline approaching, it is essential for individuals and families to take action and explore their options to ensure they have access to affordable health care.
Dueling Senate bills aimed at addressing healthcare affordability have failed to pass, according to the American Hospital Association.
The American Hospital Association (AHA) has reported that two dueling Senate bills aimed at addressing healthcare affordability have failed to pass. The bills, which were introduced in an effort to reduce healthcare costs and improve access to care, were unable to gain sufficient support to move forward.
The first bill, sponsored by Senator Lamar Alexander (R-TN), focused on targeted, bipartisan solutions to address healthcare affordability. The bill included provisions to lower prescription drug costs, increase transparency in medical billing, and expand access to affordable health insurance options. Despite its bipartisan support, the bill was ultimately blocked by Democrats who argued that it did not go far enough to address the underlying issues driving healthcare costs.
The second bill, sponsored by Senator Patty Murray (D-WA), took a more comprehensive approach to addressing healthcare affordability. The bill included provisions to strengthen the Affordable Care Act (ACA), expand Medicaid, and lower prescription drug costs. However, the bill was met with opposition from Republicans who argued that it would lead to increased government spending and interfere with the private healthcare market.
The failure of these bills to pass highlights the ongoing challenges in addressing healthcare affordability in the US. Despite widespread agreement that healthcare costs are a major concern, lawmakers have struggled to find common ground on solutions. The AHA has expressed disappointment at the failure of the bills, noting that the status quo is unsustainable and that action is needed to address the growing burden of healthcare costs on patients and families.
The AHA has called on lawmakers to continue working towards bipartisan solutions to address healthcare affordability. The organization has emphasized the need for a comprehensive approach that addresses the root causes of high healthcare costs, including the high cost of prescription drugs, administrative burdens, and inadequate reimbursement rates. The AHA has also urged lawmakers to prioritize solutions that promote transparency, affordability, and access to care, and to work together to find common ground on these critical issues.
Overall, the failure of these bills to pass is a setback for efforts to address healthcare affordability, but it is not the end of the conversation. Lawmakers must continue to work together to find solutions that prioritize the needs of patients and families, and that promote a more sustainable and affordable healthcare system for all.
Indiana lawmakers reject new congressional map; Senate fails to pass health care bills
Maryland Democrat David Trone has announced his candidacy for the House of Representatives, seeking to reclaim the seat he previously held. Trone, the founder of Total Wine & More, had unsuccessfully run for the Senate in 2024, spending over $60 million of his own money on the campaign. His entry into the race sets up a fierce primary against incumbent Rep. April McClain Delaney, who had succeeded Trone after he left the seat to pursue his Senate bid.
Trone launched his campaign with a video on social media, positioning himself as a champion of democracy and a fierce opponent of former President Donald Trump. He highlighted his past votes to impeach Trump and vowed to continue fighting against him. Trone’s announcement was met with a swift response from Delaney, who accused him of “abandoning” the district during his Senate bid and having “the arrogance of Trump.”
Delaney also noted that Trone has a history of running against female candidates, including Aruna Miller, Kathleen Matthews, and Angela Alsobrooks, and suggested that he had tried to intimidate her into dropping out of the race. Despite Trone’s significant financial resources, Delaney expressed confidence in her ability to win the primary, citing her endorsements from Democratic Gov. Wes Moore and her colleagues in the Maryland congressional delegation.
The primary is set to take place on June 23, and the contest is expected to be highly competitive. Trone’s wealth and willingness to self-fund his campaign could give him an advantage, but Delaney’s experience and connections in the district may ultimately prove to be decisive. The race is also seen as a battle between two of Maryland’s wealthiest families, with Trone’s Total Wine & More empire pitted against the Delaney family’s financial interests.
Ultimately, the primary will be a test of whether Trone’s message of resistance against Trump and his own personal wealth will be enough to overcome Delaney’s incumbency and connections in the district. As Delaney noted, “money is not the only thing it takes to win elections” – the candidate and the narrative will also play a crucial role in determining the outcome of the race.
Idaho health insurance enrollment deadline approaches
Idaho residents have until December 15 to enroll in health insurance coverage for 2026 through Your Health Idaho. To be eligible, individuals must not have affordable employer-sponsored coverage, be under 65 or not eligible for Medicare, and not be eligible for Medicaid or other federal health insurance programs. They must also be a U.S. citizen or lawfully present and have a primary residence in Idaho.
However, Idahoans may face increased monthly health insurance premiums if Congress does not renew Affordable Care Act (ACA) tax credits that are set to expire this year. Over 100,000 Idahoans currently receive these tax credits, according to the Kaiser Family Foundation. The Senate recently rejected a proposal to extend the subsidies, with Senator Mike Crapo (R-Idaho) sponsoring a Republican alternative that would have created new health savings accounts.
The rejection of the proposal has sparked a heated debate between Idaho’s Republican and Democratic leaders. Senator Crapo stated that the Republican proposal would have reduced premiums and given Americans more control over their healthcare, while Idaho Democratic Party Chair Lauren Necochea argued that the expiration of the tax credits would lead to a healthcare crisis for Idaho families. Necochea claimed that the Republican proposal would shift costs and risk onto patients and that Democrats are committed to lowering costs and protecting coverage for all Idahoans.
If the tax credits are not extended, approximately 25,000 Idahoans may be forced to drop their coverage, while many others may see their premiums double or triple. Individuals who miss the December 15 enrollment deadline will have to wait until next October to enroll, unless they experience a major life event such as marriage, moving, or having a baby. Coverage for plans selected during Open Enrollment will begin on January 1. The fate of the ACA tax credits remains uncertain, leaving many Idahoans anxious about their healthcare coverage for 2026.
Senate to Vote on Dueling Health Care Proposals with Little Sign of Resolution: NPR
The US Senate is set to vote on two healthcare-related bills on Thursday, but both are expected to fail. The subsidies for the Affordable Care Act (ACA) are set to expire at the end of the month, affecting millions of Americans. Democrats are seeking a three-year extension of the subsidies, warning that without it, healthcare premiums will skyrocket in 2026. However, the Democratic proposal lacks enough Republican support to pass.
Republicans argue that extending the subsidies would allow “waste, fraud, and abuse” in the ACA to continue, benefiting insurance companies. Instead, they have proposed a plan by Senators Bill Cassidy and Mike Crapo, which would provide up to $1,500 a year in payments for health savings accounts for Americans earning less than 700% of the federal poverty level. However, this plan does not extend the ACA tax credits and the money cannot be used to pay for healthcare premiums.
Democrats have rejected the GOP proposal, criticizing it for limiting coverage to plans on the ACA marketplace that provide less coverage and excluding abortion services and gender reassignment. Senate Minority Leader Chuck Schumer said the plan “would not extend the ACA tax credits for a single day” and does nothing to address the impending price increase.
The timeline of the GOP proposal has also been criticized, with Democrats arguing that Republicans have waited too long to unveil their plan. Senator Jack Reed pointed out that 24 million Americans face losing their subsidies at the end of the year and that the Republican plan cannot be implemented in time. He urged the GOP to approve an extension of the ACA subsidies now and deal with changes later.
The outcome of the votes is uncertain, with Senate Majority Leader John Thune unsure if all Republicans will back the Cassidy-Crapo plan. Meanwhile, Schumer has confirmed that all Senate Democrats are unified behind their vote to prolong the ACA subsidies. The failure of both bills to pass would leave millions of Americans facing uncertainty about their healthcare coverage in the new year.
‘NoRKA Care’ insurance launched exclusively for non-resident Keralites – Kerala Kaumudi
The Kerala government has launched ‘NoRKA Care’, an exclusive insurance scheme designed specifically for non-resident Keralites (NRKs). This initiative aims to provide comprehensive protection and support to NRKs, addressing their unique needs and challenges while living abroad.
NoRKA Care is a joint venture between the Non-Resident Keralites Affairs (NoRKA) department and a leading insurance provider. The scheme offers a range of benefits, including life insurance, health insurance, and accident insurance, tailored to cater to the distinct requirements of NRKs.
One of the key features of NoRKA Care is its affordability. The premium rates are competitive, making it accessible to a wide range of NRKs, regardless of their income level or social status. The scheme also provides flexible payment options, allowing policyholders to pay premiums in installments or annually.
The life insurance component of NoRKA Care offers a lump sum payment to the nominee in the event of the policyholder’s death. The health insurance aspect covers medical expenses, including hospitalization, surgeries, and other treatments, up to a specified limit. The accident insurance component provides additional protection in the event of accidental death or disability.
NoRKA Care also includes a range of value-added services, such as emergency medical evacuation, repatriation of mortal remains, and travel assistance. These services are designed to provide NRKs with comprehensive support and protection while living abroad.
The Kerala government has taken several steps to promote NoRKA Care and encourage NRKs to enroll in the scheme. The government has established a dedicated website and helpline to provide information and assistance to potential policyholders. The scheme is also being promoted through social media and other channels to reach a wider audience.
Overall, NoRKA Care is a significant initiative that aims to provide NRKs with a sense of security and protection while living abroad. By offering a range of benefits and services, the scheme addresses the unique needs and challenges faced by NRKs, providing them with peace of mind and financial security. With its competitive premium rates, flexible payment options, and comprehensive coverage, NoRKA Care is an attractive option for NRKs looking for a reliable and affordable insurance solution.
Home Health Aides to Receive New Medical Insurance Coverage
New York State has announced that it will replace the company providing health insurance to hundreds of thousands of home care workers next year. The current provider, Leading Edge Administrators, has been criticized for underpaying doctors, billing patients for care that should be covered, and attempting to cancel patients’ insurance without notice. The company has also been accused of pocketing money meant for low-wage workers and directing profits to a shady charity.
Leading Edge was hired by Public Partnerships LLC (PPL), a care management company, to oversee health insurance for employees of the $11 billion Consumer Directed Personal Assistance Program (CDPAP). The program allows low-income elderly and disabled New Yorkers to hire their own in-home caregivers. However, home care workers and activists have criticized PPL’s health insurance offerings, saying that they are inadequate and expensive.
Currently, full-time home care workers are required to pay for a custom health insurance plan that doesn’t cover basics like hospital visits and primary care, even if they already have other health insurance. The plan costs $2,500 annually and has a $6,000 deductible. However, PPL has announced that it will replace Leading Edge with a new company to manage its health care plan in May.
Health policy expert Michael Kinnucan has welcomed the announcement, but says that it is only a “marginal improvement” in a “disastrous situation” created by PPL. He suggests that instead of taking a cut of workers’ salaries to pay for bottom-tier health insurance, PPL could simply give workers the money in cash.
PPL has announced a new and slightly improved health insurance plan starting January 1, which covers more services than the current plans but is more expensive at $3,000 a year. However, many home care workers, including Saba Nakhai, a health aide in Ossining, say that the new plan is still too expensive for them to consider enrolling. Activists are calling for PPL to provide better health coverage and to allow workers to opt out of paying for insurance that they don’t want.
GOP Senators to Counter Democrats’ Bid to Preserve Health Care Subsidies
GOP Senators are set to counter a bid by Democrats to preserve health care subsidies, according to a report by The New York Times. The move comes as Democrats attempt to extend the enhanced subsidies provided under the American Rescue Plan Act, which are set to expire at the end of 2022. These subsidies have helped make health insurance more affordable for millions of Americans, particularly those with lower incomes.
The American Rescue Plan Act, signed into law by President Biden in March 2021, increased the Affordable Care Act’s (ACA) subsidies for two years, making it easier for people to purchase health insurance through the ACA marketplace. The enhanced subsidies have led to a significant increase in health insurance enrollment, with many Americans able to access affordable coverage for the first time.
However, with the subsidies set to expire, Democrats are pushing to extend them as part of a larger budget reconciliation package. This effort is aimed at ensuring that Americans who have come to rely on these subsidies do not see their health insurance costs skyrocket. Democrats argue that allowing the subsidies to lapse would lead to a substantial increase in uninsured rates, undermining the progress made in expanding health coverage under the ACA.
In contrast, GOP Senators are expected to resist this effort, citing concerns over the cost of extending the subsidies. Republicans argue that the enhanced subsidies are too expensive and that the funds could be better spent on other healthcare initiatives. They also contend that the subsidies create an unfair incentive for people to remain on government-subsidized health plans rather than seeking private insurance.
The stalemate between Democrats and Republicans over the health care subsidies reflects the broader partisan divide over healthcare policy. While Democrats are keen to preserve and expand the ACA, Republicans have long sought to repeal and replace the law, citing concerns over its cost and efficacy.
As the debate unfolds, the outcome remains uncertain. If the enhanced subsidies are allowed to expire, it could have significant implications for the health insurance market and the millions of Americans who rely on these subsidies to access affordable coverage. On the other hand, if Democrats succeed in extending the subsidies, it would mark a major victory for the party and a significant step forward in their efforts to strengthen and expand the ACA. Ultimately, the fate of the health care subsidies will depend on the ability of lawmakers to find common ground and negotiate a compromise that balances competing priorities and concerns.
Vulnerable Republicans are growing anxious due to the divisions within the GOP on healthcare, according to a report by The Hill.
The Republican Party is facing internal divisions on healthcare, leaving some vulnerable members of Congress sweating about their reelection prospects. The party’s inability to come up with a unified plan to replace the Affordable Care Act (ACA), also known as Obamacare, has created uncertainty and exposed deep divisions within the party.
Some Republicans, particularly those in conservative districts, are pushing for a full repeal of the ACA, while others, especially those in moderate districts, are advocating for a more nuanced approach that preserves popular provisions of the law, such as protections for people with pre-existing conditions.
The divisions are putting vulnerable Republicans in a difficult position, as they try to balance the demands of their conservative base with the need to appeal to independent and moderate voters. Some of these lawmakers are facing tough reelection battles, and their position on healthcare could be a decisive factor in their campaigns.
The GOP’s failure to repeal and replace the ACA in 2017, despite controlling both chambers of Congress and the White House, has left the party without a clear alternative to the law. This has created an opportunity for Democrats to attack Republicans on healthcare, a issue that has consistently been a top priority for voters.
The internal divisions within the GOP are also reflected in the party’s leadership. Some leaders, such as Senate Majority Leader Mitch McConnell, have taken a more pragmatic approach, acknowledging that the ACA is unlikely to be repealed and instead focusing on making incremental changes to the law. Others, such as Senator Ted Cruz, are pushing for a more aggressive approach, including a full repeal of the law.
The implications of the GOP’s divisions on healthcare are significant. If the party is unable to come up with a unified plan, it could leave vulnerable Republicans exposed to attacks from Democrats and potentially cost them their seats in Congress. Furthermore, the lack of a clear alternative to the ACA could undermine the party’s credibility on healthcare, an issue that is critical to many voters.
Overall, the GOP’s divisions on healthcare are a major liability for the party, and vulnerable Republicans are sweating about the potential consequences. As the 2024 elections approach, the party will need to find a way to resolve its internal divisions and come up with a coherent plan on healthcare if it hopes to retain its majority in Congress.
Over the past 25 years, health insurance premiums have increased at a rate nearly three times that of worker earnings.
A recent study published in the journal JAMA Network Open found that health insurance premiums in the US have increased significantly between 1999 and 2024, outpacing worker earnings by three times. The main driver of these premium increases is the rising cost of medical services, particularly hospital services. Hospital costs have increased the most, while physician services and prescription drugs have risen more slowly. The study suggests that hospital consolidation, where hospitals and healthcare entities merge, has led to higher prices as hospitals raise their prices above their costs.
The research also found that hospital CEOs prioritize profit over delivering high-quality care, with their compensation often tied to growing profits and organization size rather than quality of care. This has raised concerns that financial success is the dominant priority at these institutions. To address this issue, it has been suggested that nonprofit hospitals should be required to disclose their executive compensation guidelines, allowing the public to pressure companies to prioritize affordability and quality of care.
Some economists have proposed regulating hospital prices, capping prices at the most expensive hospitals and restricting price growth for all hospitals. This approach would involve flexible but service-specific oversight to respond to market disruptions. Employers, who bear the bulk of premium increases, can also play a role in keeping insurance affordable by introducing price sensitivity when designing benefits for their employees. For example, offering health insurance plans with tiered copayments based on hospital prices can achieve savings without reducing quality.
The study highlights the need for greater accountability and transparency in the healthcare industry, particularly among nonprofit hospitals. By restraining price growth and introducing greater price competition, the healthcare market can become more affordable for everyone. The mission statements of nonprofit healthcare systems often express a desire to improve community health, but it is essential to hold them accountable for prioritizing the health of their communities over profit. Ultimately, addressing the rising cost of healthcare will require a multifaceted approach that involves regulating hospital prices, increasing transparency, and promoting affordability and quality of care.
Obamacare Users Will Be Asked to Pay More for Plans That Cover Less – The New York Times
According to a recent report by The New York Times, users of Obamacare, also known as the Affordable Care Act (ACA), can expect to pay more for health insurance plans that cover less. This change is a result of the ongoing efforts to repeal and replace the ACA, as well as the Trump administration’s actions to undermine the law.
The report states that many people who buy their own health insurance through the ACA marketplace will face higher premiums and reduced coverage in the coming year. This is due to the fact that the Trump administration has expanded the availability of short-term health plans, which are less comprehensive and often less expensive than ACA plans. These short-term plans can deny coverage to people with pre-existing conditions and do not have to cover essential health benefits, such as maternity care, mental health treatment, and prescription drugs.
As a result, many insurers are opting to offer skimpier plans that do not comply with ACA requirements, but are cheaper and more attractive to healthy individuals. This, in turn, is driving up premiums for ACA-compliant plans, which are required to cover a wider range of benefits and cannot deny coverage to people with pre-existing conditions.
The report also notes that the Trump administration’s actions have led to a decline in ACA enrollment, particularly among young and healthy individuals who are no longer required to purchase health insurance due to the repeal of the individual mandate. This decline in enrollment has resulted in a higher percentage of sicker and older individuals remaining in the ACA marketplace, which has driven up costs for insurers and, in turn, led to higher premiums for consumers.
The increase in premiums and reduction in coverage will likely have a disproportionate impact on vulnerable populations, such as low-income individuals and those with pre-existing conditions. These individuals may struggle to afford the higher premiums and may be forced to choose between paying for health insurance or other essential expenses.
Overall, the report suggests that the efforts to undermine the ACA have led to a situation in which users of Obamacare will be asked to pay more for plans that cover less. This could have significant consequences for the health and well-being of millions of Americans who rely on the ACA for their health insurance.
Approximately 450,000 New York residents are expected to lose their Essential Plan health insurance coverage due to a funding cut in the federal budget.
New York state is facing a healthcare crisis as hundreds of thousands of families may soon lose their health insurance due to funding cuts. The state’s Essential Plan, which provides low-cost health coverage to over 1.6 million people, is funded in part by federal dollars. However, the federal budget has been cut, and as a result, 450,000 people on the Essential Plan have been notified that their coverage will end this summer.
These individuals, including freelancer Mike Walsh, will be left without affordable healthcare options. Walsh, who works multiple part-time jobs, relies on the Essential Plan for his medical needs, including low co-pays and access to medication. Without it, he fears he will struggle to make ends meet and prioritize his health. The loss of the Essential Plan will not only affect those who received letters but also over 700,000 families in the Tri-State area who purchased insurance through the Affordable Care Act’s Health Insurance Marketplace and are facing expiring premium credits.
According to Dr. Donald Morrish, CEO of Episcopal Health Services, the loss of the Essential Plan will lead to more people delaying care and relying on emergency rooms, which is more expensive and inefficient. This, in turn, will result in higher costs for both patients and hospitals. Dr. Morrish predicts that the healthcare system, including hospitals and healthcare workers, will be severely impacted by the increase in insurance premiums and the loss of healthcare coverage.
The state is seeking to reorganize the Essential Plan, which may result in most enrollees being transitioned to a “basic” plan. However, the 450,000 New Yorkers who received letters will lose their insurance due to their incomes not meeting federal poverty level guidelines. As the situation unfolds, individuals like Mike Walsh are left with uncertainty and anxiety about their future healthcare options. The state’s request for reorganization is pending, and the outcome will have a significant impact on the lives of hundreds of thousands of New York residents.
Swing District Republicans Prepare for Potential Political Backlash if Health Care Subsidies Lapse.
As the deadline for renewing health care subsidies approaches, Swing District Republicans are bracing themselves for potential political fallout. The subsidies, which were expanded under the American Rescue Plan Act, are set to expire at the end of the year. If they are not renewed, millions of Americans who receive financial assistance to purchase health insurance through the Affordable Care Act (ACA) marketplaces will face significant increases in their premiums.
This could have major implications for Republican lawmakers in swing districts, who may be held accountable by their constituents for the potential disruption to their health care coverage. Many of these lawmakers campaigned on a promise to protect and strengthen the ACA, and failure to renew the subsidies could be seen as a betrayal of that promise.
The potential consequences of allowing the subsidies to expire are far-reaching. Without the subsidies, premiums for ACA plans could increase by as much as 50% or more, making health insurance unaffordable for many Americans. This could lead to a significant increase in the number of uninsured individuals, which could have serious consequences for public health and the economy.
Swing District Republicans are aware of the potential fallout and are working to find a solution. Some are pushing for a temporary extension of the subsidies, while others are advocating for a more permanent fix. However, with the current divided government, it is unclear whether a solution can be found before the subsidies expire.
The expiration of the subsidies could also have significant political implications. Democrats are likely to use the issue as a campaign talking point, accusing Republicans of trying to sabotage the ACA and harm vulnerable Americans. This could put Swing District Republicans on the defensive, potentially hurting their chances of re-election.
In conclusion, the potential expiration of health care subsidies has significant implications for Swing District Republicans. With the deadline for renewal approaching, lawmakers are working to find a solution to avoid potential political fallout. The consequences of allowing the subsidies to expire could be severe, with significant increases in premiums and a potential increase in the number of uninsured individuals. As the debate over the subsidies continues, one thing is clear: the fate of the ACA and the health care coverage of millions of Americans hangs in the balance.
Trump’s initial challenge lies in acknowledging difficulties with the economy and healthcare.
President Donald Trump is facing a critical test this week as he attempts to address the rising costs of healthcare, groceries, and housing, which are a major concern for millions of Americans. Despite his claims of a thriving economy, many Americans are struggling to make ends meet, and Trump’s response has been met with skepticism. The Senate is expected to vote on extending expiring subsidies on Affordable Care Act programs, which could leave millions without affordable healthcare options if not renewed.
Trump’s administration has been criticized for its handling of the economy, with a recent CNN/SSRS poll showing that 61% of Americans believe his policies have worsened economic conditions. The president’s claims of success are at odds with the lived experience of many Americans, who are feeling the pinch of rising prices and stagnant wages. The issue of affordability has become a major political liability for Trump, with Democrats eager to highlight his failures on the campaign trail.
The fight over healthcare is a key aspect of the affordability crisis, with the expiration of enhanced subsidies threatening to leave millions without affordable coverage. Republicans are divided on how to address the issue, with some pushing for an extension of the subsidies and others seeking to reform the Affordable Care Act. Trump has been accused of being out of touch with the concerns of working-class Americans, and his response to the crisis has been criticized as inadequate.
The president’s visit to Pennsylvania this week is seen as an attempt to show solidarity with voters who are struggling with high prices. However, his message is likely to be met with skepticism, given his track record on the issue. Trump’s tendency to blame his predecessor, Joe Biden, for the economic woes and his refusal to accept the reality of the affordability crisis have only added to the perception that he is out of touch with the concerns of ordinary Americans.
The issue of affordability is a defining one for the 2024 election, and Trump’s failure to address it effectively could have significant consequences for his reelection chances. The president’s claims of a thriving economy and his dismissal of the affordability crisis as a “hoax” are unlikely to resonate with voters who are struggling to make ends meet. As the election approaches, Trump will need to find a way to connect with voters on this issue and offer a credible solution to the affordability crisis if he hopes to win over skeptical voters.
Republicans in Congress have yet to propose a comprehensive health plan, despite ongoing discussions and criticism of existing healthcare policies.
As the deadline for repealing and replacing the Affordable Care Act (ACA), also known as Obamacare, looms closer, Republicans in Congress are still struggling to come up with a viable healthcare plan. Despite having seven years to devise an alternative, the party remains deeply divided on the issue, with factions disagreeing on key aspects such as Medicaid expansion, pre-existing conditions, and the role of government in healthcare.
The lack of a clear plan has raised concerns among lawmakers, healthcare experts, and the public, who are worried about the potential consequences of dismantling the ACA without a suitable replacement. The ACA, which was enacted in 2010, has provided health insurance to over 20 million Americans, and its repeal could leave millions without coverage.
Republicans have proposed several bills, including the American Health Care Act (AHCA) and the Better Care Reconciliation Act (BCRA), but both have been met with opposition from within the party and from Democrats. The AHCA, which was passed by the House of Representatives in May, would have cut Medicaid funding and allowed states to opt out of certain ACA provisions, including those protecting people with pre-existing conditions. The BCRA, which was introduced in the Senate, would have also cut Medicaid funding and repealed many of the ACA’s taxes and regulations.
However, both bills were ultimately rejected due to opposition from moderate Republicans, who felt that they did not do enough to protect vulnerable populations, and from conservative Republicans, who felt that they did not go far enough in repealing the ACA. The lack of a clear plan has led to frustration among lawmakers, with some expressing concerns that the party is running out of time to come up with a viable alternative.
As the deadline for repealing the ACA approaches, Republicans are facing increasing pressure to come up with a plan that can pass both the House and Senate. The party has promised to repeal and replace the ACA for years, and failure to do so could have significant political consequences. With the 2018 midterm elections approaching, Republicans are eager to deliver on their campaign promises and demonstrate their ability to govern. However, the lack of a clear healthcare plan has raised questions about their ability to do so.