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The Evolving Health Care Landscape


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The Evolving Health Care Landscape

Recent legislative, regulatory, and administrative changes that are impacting the ACA.

The next era of health care reform began in January 2017 when, for the first time since the Affordable Care Act (ACA) became law, a Republican-controlled Congress and administration took office. While full repeal and replace efforts were unsuccessful prior to Democrats taking control of the U.S. House in 2019, health care remains a priority, with further legislative and regulatory action anticipated at both the federal and state levels.

ACA Ruled Unconstitutional – Law Remains in Effect during Appeal

On December 14, 2018, U.S. District Judge Reed O’Connor issued a ruling that determined the ACA is unconstitutional because of a change to the federal tax law that zeroed out the ACA’s individual mandate penalty beginning January 1, 2019. The ruling it is not an injunction and does not block the operation of the law, so the ACA remains in effect. For more information, read our Dec. 17 news alert. The ruling has already been appealed and the new case is underway in the Fifth Circuit Court of Appeals. This is expected to be a long legal process.

Changes to Federal Health Care Rules and Regulations

The following chart outlines key changes to the ACA and related federal health care topics through legislative, regulatory, or executive action since January 2017, when the new administration took office.

Regulatory ChangeEffective DateMore Information
Impacts to All Markets

Association Health Plans
Allows more employers to form AHPs, which are not subject to certain ACA rules

Staggered effective dates, beginning 9/1/18, based on type of AHP

Read our Association Health Plan FAQs

Essential Health Benefits State Benchmark Plans
Provides states greater flexibility in selecting a benchmark plan for individual and small group markets

Effective 1/1/20

Read our April 9, 2018 news alert

Expanded List of Preventive Care Benefits Under High-Deductible Health Plans
Expands the list of preventive care services and items for certain chronic conditions permitted to be provided by an HDHP without a deductible

Effective 7/17/19

Read the July 17, 2019 IRS Notice

Health Reimbursement Arrangements
Allows employers to offer employees HRAs to purchase Individual coverage

Effective 1/1/20

Read our June 17, 2019 news alert

Individual Mandate Repealed
Effectively repealed mandate by zeroing out penalty beginning in 2019

Effective 1/1/19

Read our Dec. 20, 2017 news alert

Short-Term, Limited Duration Insurance Plans
Allows plans, which are not subject to certain ACA rules, to have a maximum initial coverage period of up to 12 months and be renewed or extended for no more than 36 months

Effective 10/3/18

Read our Short-Term, Limited Duration Insurance FAQs

Impacts to the Group Market

Cadillac Tax Delayed
40 percent excise tax on high-cost employer plans delayed from 2020 to 2022

Effective 1/1/22

Read our Jan. 23, 2018 news alert

Contraception Coverage Requirement – Expanded Exemption
Final rules expand exemptions for group health plan sponsors from covering contraceptive services for women


Read our Oct. 13, 2017 news alert
On Jan. 14, 2019, a federal court issued a nationwide injunction that blocks implementation of these rules unless or until the injunction is removed.

Health Insurance Industry Fee (HIIF) Suspended
HIIF suspended for 2019

Effective 1/1/19

Read our Jan. 23, 2018 news alert

Impacts to the Individual or Medicare Market

Medicare Part D "Donut Hole" closure accelerated
Originally scheduled to end in 2020, will now close in 2019

Effective 1/1/19

Read our Medicare Part D Coverage Gap FAQ