ACA Plans Are Unaffordable, Trillions In Wasted Benefits, AI Billing Wars

Hey all,

Happy Humpday! When it was passed I was a HUGE supporter of the Affordable Care Act because it guaranteed coverage for people like me with chronic conditions. When I looked to use an ICHRA for our benefits at ZorroRX, the plans were neither affordable nor did they cover my current doctors (as promised). Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(Commonwealth Fund) and Employer-Sponsored Insurance Affordability in the U.S.

A new analysis reveals that while income growth between 2022 and 2023 modestly improved the affordability of employer-sponsored insurance (ESI), significant disparities remain, with workers in lower-income states often facing unsustainable costs. In 2023, premiums and deductibles for single and family coverage consumed a substantial share of household income—up to 10% or more in 22 states—raising concerns about underinsurance, especially where deductibles exceed 5% of income. Experts suggest expanding access to marketplace subsidies, extending enhanced premium tax credits, improving Medicaid enrollment, and exploring state-level reforms to ease the burden—because apparently, under the Affordable Care Act, “affordable” just means spending a tenth of your income before you even get to copays. Full Article.

(BenefitsPro) Employees Ignoring Trillions in Benefits

Despite employers spending nearly $3 trillion annually on benefits, most employees are unaware of their value or how to utilize them, with 75% sticking to the same choices year after year—even after major life events, according to Nayya’s 2025 Benefits Value Gap Report. This gap reflects a system plagued by complexity and outdated design, where only 10% of workers understand the worth of their benefits and nearly half can’t explain basic offerings, leading to wasted resources, low satisfaction, and rising costs. By offering more personalized benefits and modernizing how they’re communicated and taught, employers may finally see employees engage with and leverage what’s available instead of leaving value untapped: Full Article.

(The Elion Briefing) AI Denials Management in 2025

Despite rigorous eligibility checks and prior authorizations, 15% of private payer claims are still denied—leading to billions in unrecovered revenue, particularly as 65% of denied claims go unappealed. AI-driven denials management systems aim to solve this by integrating claims data, clinical records, and payer guidelines to automate root-cause analysis, appeals preparation, and resolution tracking using a mix of LLMs, machine learning, and RPA. It’s absurd that hospitals need this much technical expertise just to get paid—and we wonder why it’s so hard to get an appointment with a doctor. Full Article