Senate Hearing Draws Bipartisan Support for ACA Reforms, Unclear Path Forward

November 13, 2025

marketplace

The Senate Permanent Subcommittee on Investigations held a hearing this week on “Assessing the Damage Done by Obamacare,” with testimony from Paragon Health Institute, a right-leaning think tank that has published research on alleged unauthorized enrollments and called for an end to the enhanced subsidies.

Bipartisan members of the Committee expressed support for reforming the ACA to make coverage more affordable and reduce the reliance on federal subsidies to lower premiums. That being said, Republicans continue to assert widespread fraud in the program, despite a letter to the Committee from AHIP demonstrating there is no evidence of anything approaching “widespread, systemic fraud” nationally and how the industry has worked with CMS to identify and address improper and unauthorized enrollments.

An analysis by AHIP coalition partner Keep Americans Covered responding to claims of “fraud” was also entered into the record from Ranking Member Richard Blumenthal (D-CT).

legislation

Virginia and Hawaii Introduce PDAB Legislation

The Virginia Senate introduced a bill to establish a Prescription Drug Affordability Board (PDAB) to review drugs with a wholesale acquisition cost (WAC) of $60,000 or more per year or a WAC increase of $3,000 or more in any 12-month period. For drugs deemed to cause an affordability challenge, the legislation authorizes the PDAB to […]
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February 12, 2026

EGWP marketplace medicaid Medicare

Solutions

AHIP Shares Update on Plan Progress to Simplify Prior Authorization

AHIP shared progress on the voluntary, multi-year commitments made by AHIP, BCBSA, and leading health plans (including Cigna Healthcare) to streamline and simplify prior authorization. Health plans serving nearly 270 million Americans are participating in this initiative. The 2026 commitments took effect on Jan. 1 and include: reducing the scope of claims subject to prior […]
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February 12, 2026

EGWP marketplace medicaid Medicare

legislation

DOL Issues Proposed Rule on Improving Transparency into PBM Fees

Pursuant to President Trump’s Executive Order “Lowering Drug Prices by Once Again Putting Americans First,” the Department of Labor’s (DOL’s) Employee Benefits Security Administration (EBSA) issued a proposed rule that would require providers of PBM services and affiliated entities of brokerage and consulting services to disclose direct and indirect compensation to their self-funded ERISA fiduciary […]
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February 12, 2026

EGWP marketplace medicaid Medicare

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