CENTER UPDATE | DECEMBER 2025
In this Issue:
- CMMI MA V-BID Model to End After 2025
- HDHP Enrollment Shows Significant Change
- Braidwood v. Becerra Increases Uncertainty for Cancer Screening Coverage
- Impact of the Affordable Care Act on Pregnancy and Abortion
- Coverage of Obesity Medications Can Make America Healthier (Again)
- Financial Burden on Small Business Employees
- 2025 V-BID Summit
Supreme Court to Hear Challenge to Obamacare's Preventive Care CoverageCMMI MA V-BID Model to End After 2025
The Centers for Medicare & Medicaid Services (CMS) will terminate the Medicare Advantage Value-Based Insurance Design (VBID) model at the end of 2025 due to its costs to the Medicare Trust Funds—$2.3 billion in 2021 and $2.2 billion in 2022. Despite efforts to adjust the model, analyses found that increased risk scores and Part D expenditures drove these excessive costs, leaving no viable policy modifications. Many interventions tested in the V-BID model are now widely available in the Medicare Advantage program, ensuring continued support for enrollees.
High-Deductible Plan Enrollment Shows Significant Change
Enrollment in high-deductible health plans (HDHPs) has historically been higher among individuals with directly purchased plans compared to those with employment-based coverage, but this gap has narrowed significantly in recent years, according to a National Health Statistics Report. From 2021 to 2023, HDHP enrollment rates between these groups were comparable, with enrollment increasing alongside family income and education levels.
Braidwood v. Becerra Increases Uncertainty in Coverage for Cancer Screenings
Despite the benefits of lung cancer screening, only 26% of cases are diagnosed early. Recent legal challenges, including the Braidwood v. Becerra case, threaten to eliminate cost-free coverage for preventive services like lung cancer screening, which could reduce screening rates and worsen health disparities. The Justice Department has filed for Supreme Court review, and health organizations are advocating to preserve access to essential preventive care to improve outcomes and reduce the financial barriers to early detection.
Impact of the Affordable Care Act on Pregnancy and Abortion
New research suggests that reducing financial barriers to contraception can effectively lower unintended pregnancy and abortion rates. After the Affordable Care Act (ACA) was implemented, average annual contraception costs fell from $88–94 to nearly zero, leading to increased use of long-acting reversible contraception (LARC) and a slight overall rise in contraceptive use. Pregnancy rates declined more rapidly post-ACA, while abortion rates continued to decrease.
Coverage of Obesity Medications Can Make America Healthier (Again)
The Biden administration has proposed a rule allowing Medicare to cover obesity medications, aiming to tackle the nation’s obesity crisis. While the Congressional Budget Office estimates an increase in federal spending of $35 billion from 2026 to 2034, the coverage is expected to improve patient outcomes and reduce healthcare disparities.
Financial Burden on Small Business Employees
A recent Commonwealth Fund report highlights that workers at small businesses often face higher health insurance costs and receive less financial protection compared to employees at larger companies. In 2023, small-business employees paid an average of $7,529 annually for family premiums—$733 more than their counterparts at larger firms—with contributions in some states nearly doubling those of large-firm employees. Despite paying more in premiums, small-business workers often encounter high deductibles.
