Academy Holds Spring Policy Summit, Annual Hill Visits
The Academy held its inaugural Spring Policy Summit in Washington on March 9, followed by the annual “Hill visits” in which Health Practice Council (HPC) along with other practice-area volunteers, and Academy staff, fanned out across Capitol Hill to meet with staff of congressional members, committees, and regulatory agencies.
The summit featured multiple sessions with legislative, regulatory, and stakeholder groups, all of whom reinforced the value received through the Academy’s objective and nonpartisan information on important public policy issues. A key theme across sessions was delivering our expertise and insights by “meeting stakeholders where they are”—whether through short bullet-point highlights, infographics, issue briefs, or more detailed comment letters, papers, and monographs.
Academy Health Vice President Annette James said in an interview that she appreciated the health-focused parts of the summit, including in the legislative, agency, and industry panel sessions, which comprehensively covered areas that included the Academy’s work on priority health issues and emphasized the need to communicate in different ways to different stakeholders. “We have to develop our work products to meet our stakeholders where they are, and not assume a certain level of knowledge,” she said.
For the Hill visits, the Affordable Care Act (ACA) and the affordability of health care were “top of mind for everyone,” James said, with other topics including “some of the policies related to Medicaid, including implementation of the federal legislative changes from last year, and some of the proposed changes to the ACA rules in the latest NBPP [Notice of Benefit and Payment Parameters for 2027] that just came out.” (See Health News in Brief.)
“The exchanges were lively, informative, and we’re hoping to come back with some work products to meet the need of stakeholders,” James said. In addition to congressional offices, HPC staff and volunteers also met with two federal agencies—the Center for Consumer Information and Insurance Oversight (CCIIO) within the Department of Health and Human Services (HHS), and the Congressional Budget Office (CBO), both of which significantly impact health policy. “The agencies are really important because they provide insight to congressional offices and staff, so they can make informed decisions and develop sound policy,” she said.
VP Corner
HPC Off to a Strong Start With Hill Visits
The Health Practice Council (HPC) led off the year with a strong start, with returning and new volunteers taking part in the annual Hill visits on Capitol Hill in Washington, and a strong focus on health issues in the Spring Policy Summit.
In addition to the important CCCIIO and CBO meetings noted above, HPC volunteers met with staff from the Senate Health Education Labor and Pensions Committee, the House Budget Committee, the House Energy and Commerce Committee, the House Education and Workforce Committee, the Office of the Senate Majority Leader, the Senate Finance Committee, the Senate Budget Committee, and the office of Rep. Tom Suozzi (D-N.Y.), who sits on the House Ways and Means Committee’s oversight and tax subcommittees. That’s a lot, and everyone got their steps in! All those we met with appreciated the Academy’s objective viewpoints on important health issues led by availability and affordability.
And, the HPC will hold an April 16 Virtual Health Summit, covering the Broadening the Focus series and other health issues in detail.
The year is just getting going, and is off to a strong start! A big thank you to all those volunteers who took part, and the HPC always welcomes new volunteers—submit your interest via the Academy’s volunteer contact form.
Register for April’s Virtual Health Summit
Register for the Academy’s April 16 Health Summit: Broadening the Focus, which will offer actuarial perspectives and insights on the connections between health care program value and the current industry focus on return on investment.
Panels will feature discussions with health volunteers and stakeholders, and speakers will explore and discuss issues, including presenting a framework for broadening the focus, in line with the HPC’s ongoing series (see next story), followed by case studies on applying the framework to behavioral health and to food is medicine.
The full agenda is available online. HealthBegins founder and president, Dr. Rishi Manchanda, will deliver the keynote address. Register today.
Second ‘Broadening the Focus’ Issue Brief Released
Leading up to the summit, the Health Equity Committee released an issue brief, Beyond Financial Return on Investment, summarizing feedback from nonactuaries on alternative metrics to traditional financial return on investment (ROI) calculations. This is the second in the Broadening the Focus series; the first, Evaluating Health Care Programs, addressed general ROI perspectives.
ASB Approves ASOP No. 6 Exposure Draft
The ASB approved an exposure draft of a proposed revision of ASOP No. 6, Measuring Retiree Group Benefits Obligations and Determining Retiree Group Benefits Program Periodic Costs or Actuarially Determined Contributions. The exposure draft is open for comment through May 15. To comment, visit the ASB website.
Professionalism Webinar Set for March 26
Register for the Academy’s March 26 professionalism webinar, Changes Ahead for ASOP No. 6: Your Input Requested! ASB member Judy Stromback will moderate and ASB member Chris Noble, ASOP No. 6 Task Force Chairperson Jim Rizzo, and former ASB Pension Committee Chairperson Matt Smith will present. Attendees of the live webinar may earn up to 1.5 organized and professionalism CE credit. Register today.
Academy Health Outreach
Senior Health Fellow Cori Uccello and Al Bingham, a past Academy health and professionalism vice president, presented at Select Health’s Feb. 19 monthly actuarial department meeting. They gave an overview of Health Practice Council (HPC) activities, the HPC’s strategic goals for 2026, and volunteering at the Academy.
Speakers Bureau—The Academy is available to provide speakers to actuarial clubs, employers, and educational entities. The Academy’s Speakers Bureau provides qualified speakers on professionalism and public policy topics.
HPC Seeking Volunteers for Two New Task Forces
The HPC is seeking volunteers to support two new Task Forces. One focuses on AI considerations specific to health insurance, and the other group relates to health reinsurance. These task forces are still being formed, and the HPC is seeking both leaders and members for each. If interested, please email Health Policy Project Manager Michelle Anaba at anaba@actuary.org and State Public Policy Outreach Director Katie Dzurec at dzurec@actuary.org.
Highlights From
HealthCheck
Prefer to watch your news? Check out this “Highlights From HealthCheck” video for a quick recap of what you need to know.
Health News in Brief
The Individual and Small Group Markets Committee, along with the Health Solvency & Financial Reporting Committee, submitted a joint comment letter in response to the HHS Notice of Benefit and Payment Parameters (NBPP) for 2027 and Basic Health Program proposed rule.
In response to a request from the NAIC’s Health Risk-Based Capital (E) Working Group, the Health Underwriting Risk Factors Analysis Work Group submitted a comment letter on the XR013 Investment Income Adjustment Stand-alone Factor of the Health RBC formula.
The Medicare Committee submitted comments to the Centers for Medicare & Medicaid Services on a proposed rule and request for information on contract year 2027 policy and technical changes to Medicare programs.
Academy in the News
Health Vice President Annette James, Board member and Health Equity Committee (HEC) Chairperson Becky Sheppard, HEC Vice Chairperson Sara Teppema, and Senior Health Fellow Cori Uccello co-authored a Milbank Memorial Fund blog post about the HEC’s work “exploring ways to help address health disparities and unmet needs through better health insurance benefit design.”
The Academy provided background to STAT News for a story on at-home health and genetic tests.
Legislative/
Regulatory Activity
Federal
The Centers for Medicaid & Medicare Services (CMS) announced first-year rounds of awards for the five-year $50 billion Rural Health Transformation Program meant to support health care in rural America. In 2026, individual states will receive awards ranging from $147 million to $281 million.
In late January, CMS announced an increased focus on enforcement and complaint resolution related to enrollment activity within ACA exchanges.
A federal district court judge in Illinois issued a temporary order barring the Trump administration from cutting nearly $600 million in public health funding in four states. The grants—intended for California, Illinois, Minnesota, and Colorado, had previously been revoked by the U.S. Health and Human Services Department following a determination that the programs were not in line with the administration’s priorities.
The White House announced on Feb. 5 the launch of TrumpRx.gov, a website that allows Americans to access pharmaceutical medication at a discount, including those manufactured by AstraZeneca, Eli Lilly, EMD Serono, Novo Nordisk, and Pfizer.
President Trump unveiled The Great Healthcare Plan, a multifaceted plan which includes codifying the “Most Favored Nation” language to lower prescription drug costs, send federal dollars directly to U.S. consumers to purchase private market health insurance, and require health insurance plans to publish rates and coverage comparisons in “plain English,” along with the percentage of revenues paid out to claims versus overhead costs and profit, and the number of claims that are rejected and average wait times for routine care on their websites.
State
New York Gov. Kathy Hochul signed several health-related bills into law at the end of 2025, including:
- A 5480C, which shields both patients and medical staff who receive or provide reproductive health care or gender-affirming health care from civil and criminal liability or professional sanctions from out-of-state jurisdictions.
- A 136/S 138, which allows medical aid in dying for terminal patients.
- A 9510/S 8817, which states insurers and health care plans are permitted to impose fees on providers for payments made through credit cards, virtual credit cards, or electronic funds transfers as long as they notify providers of that fact and offer non-fee payment alternatives.
Illinois Gov. JB Pritzker signed HB 1085, establishing reimbursement rates for mental health and substance use disorder treatment services for all group or individual policies of accident and health insurance or managed care plans that are amended, delivered, issued, or renewed on or after Jan. 1, 2027.
Pritzker also signed HB 767, requiring health insurance policies to cover certain vaccinations and preventive services without cost-sharing and revamping pharmacy benefit managers (PBMs) regulations to enhance transparency in drug pricing and reimbursement practices, promoting broader access to essential health services.
Former New Jersey Gov. Phil Murphy signed A 5217 in January, requiring third-party discounts and payments for those covered by health benefits plans to apply to copayments, coinsurance, deductibles, or other out-of-pocket costs for covered benefits.
The Virginia Senate passed several health-related bills in January, including:
- SB 172, which updates health insurance claims processing and provider communications by requiring carriers accept electronic attachments for claims documentation to enhance efficiency and fairness.
- SB 630, setting a cap on the rate charged by individual and small market health care plans for tobacco users of no more than 1.5 times that of non-users.
- SB 361, requiring health insurers to provide access to contraceptives, contraceptive products, and contraceptive devices without a co-pay.
- SB 626, mandating coverage for screening mammograms, postpartum services, early intervention services for children, and biologically based mental illness.
Also in January, the Virginia House also approved several measures, including:
- HB 1207, establishing a comprehensive framework for paid family and medical leave benefits, eligibility, employer contributions, and program administration, with key implementation dates beginning in 2028 and 2029.
- HB 328, requiring the Bureau of Insurance to select a new essential health benefits benchmark plan for the 2029 plan year that includes, among other things, coverage for doula care services; infertility; fertility treatment and diagnosis; and hearing aids.
- HB 830, requiring a pharmacy benefits manager (PBM) use the pass-through pricing model and prohibits a PBM from deriving income from pharmacy benefits management services provided to a pharmacist.
- HB 736, introducing new requirements for the prior authorization process for prescription drugs that require insurers accept electronic, telephonic, or facsimile submissions through standardized systems under stricter time frames.
The Washington State Senate approved SB 5981, which protects patient access to discounted medications and health care services through Washington’s health care safety net by preventing manufacturer limitations on the 340B drug pricing program.
The same chamber passed SB 6210, a measure that authorizes the state’s health insurance exchange to establish and annually update certification criteria related to market conditions–including cost-sharing, benefits, premiums, provider networks, and quality.
The Washington State House approved HB 2384, requiring continuing care retirement communities offering life care contracts to provide an actuarial analysis prepared by a qualified actuary by July 1, 2027.
Both the Wisconsin Assembly and Senate passed AB 699, establishing a new long-term care insurance assessment and a corresponding tax credit applicable to certain insurers and taxpayers in the state.
On Feb. 19, the Wisconsin Assembly passed SB 23, amending the state’s Medical Assistance program to extend eligibility for postpartum women up to a year after they deliver a child. The same bill passed the Senate last year.
The Mississippi House passed HB 605, creating the Mississippi State Health Insurance Exchange, which will be funded through a dedicated trust fund supported by fees on policies sold through the exchange.
The Kansas Senate approved SB 360, establishing licensing requirements for PBMs, mandating that they obtain a valid license to operate in the state.
The Kentucky House passed HB 388, implementing medication synchronization programs within Medicaid to improve treatment adherence for chronic illnesses.