Semaglutide Makes You Healthier And Poorer, Insurance Confusion Wins Again, And CMS Wonders Why 35% Of ACA Members Never See A Doctor

Hey all,

Happy Wednesday! From semaglutide users paying more each month even as their health improves, to half the country skipping care because insurance is basically a riddle with a copay, to ACA marketplaces overrun with broker fraud, the pattern is hard to miss—patients lose, sketchy brokers and insurance executives win. It’s almost impressive how the system turns every breakthrough and every reform into another revenue stream for the middlemen. At this rate, the only people getting truly “covered” are the ones cashing the checks.

Enjoy the rundown!

Jacob Brody (Co-Founder & CEO, ZorroRX)

(JAMA Network Open) Changes in Cardiovascular Risk Factors and Health Care Expenditures With Semaglutide: A large multicenter cohort study of 23,522 adults found that initiating semaglutide was linked to notable reductions in weight, blood pressure, cholesterol, and HbA1c—particularly among those without diabetes—but also to an average $80/month increase in healthcare expenditures (excluding the drug’s cost) over 13–24 months. These results suggest meaningful cardiovascular risk improvements in real-world settings, though the short-to-medium-term financial impact may challenge cost-effectiveness expectations. Of course, maybe part of that “extra” spending comes from people who, after finally losing weight and improving their diabetes, realized they might actually live long enough to make going to the doctor worth it. Full Article

(BenefitsPro) Healthcare Access and Cost Delays

According to a new study nearly half of Americans are putting off health care due to cost and insurance-related barriers, with millennials most affected by these challenges. The study highlights how out-of-network issues and confusing coverage details are leading many to skip or delay even routine care like eye exams or dermatology visits. More people are now turning to online services and just paying out-of-pocket—because when you have no clue what insurance will actually cover, sometimes it’s easier (and less painful) to just swipe your card and hope for the best. Full Article.

(Fierce Healthcare) ACA Market Turmoil Amid CMS Fraud Crackdown

New CMS data reveal a sharp rise in ACA enrollees with no claims—up from 23% in 2019 to 35% in 2024—suggesting widespread broker fraud and fueling federal efforts to tighten program integrity. These changes, combined with the potential expiration of enhanced subsidies, could shrink enrollment, destabilize risk pools, and drive premium hikes—particularly in non-expansion states like Florida and Texas—where brokers have exploited income misstatements. At this rate, the Affordable Care Act may need a rebrand to the "Absolutely Can't Afford" Care Act. Full Article