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Since the Affordable Care Act (ACA) became law, policymakers have been divided on what the best path forward is for the U.S. health care system. After assuming office, President Joe Biden took almost immediate action on health care by signing an executive order (EO) outlining his administration’s policy to “protect and strengthen Medicaid and the ACA and to make high-quality health care accessible and affordable for every American.” The EO also directs federal agencies to reconsider current rules and other policies that limit Americans’ access to health care and consider actions that will protect and strengthen that access. As a result, legislative and regulatory action on health care is expected to stay center stage.
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 in recent years.
| Regulatory Change | Effective Date | More Information |
|---|---|---|
| Impacts to All Commercial Markets | ||
|
Association Health Plans |
Staggered effective dates, beginning 9/1/18, based on type of AHP |
Read our Association Health Plan FAQs |
|
Comparative Effectiveness Research Fee (CERF) Extended |
Effective through 12/31/2029 |
Extension was part of the 2019 year-end spending agreement. |
|
Essential Health Benefits State Benchmark Plans |
Effective 1/1/20 |
Read our April 9, 2018 news alert |
|
Expanded List of Preventive Care Benefits Under High-Deductible Health Plans |
Effective 7/17/19 |
Read the July 17, 2019 IRS Notice |
|
Health Reimbursement Arrangements |
Effective 1/1/20 |
Read our June 17, 2019 news alert |
|
Individual Mandate Repealed |
Effective 1/1/19 |
Read our Dec. 20, 2017 news alert |
|
Short-Term, Limited Duration Insurance Plans |
Effective 10/3/18 |
Read our Short-Term, Limited Duration Insurance FAQs |
|
Section 1557 Nondiscrimination Rule |
Effective 5/10/21 |
In 2020, the Trump Administration replaced the original Section 1557 final rule, repealing the 2016 definition of discrimination on “the basis of sex.” |
| Impacts to the Group Market | ||
|
Cadillac Tax Repealed |
No longer exists and will never take effect |
Read our Dec. 20, 2019 news alert |
|
Contraception Coverage Requirement – Expanded Exemption |
TBD |
Read our Oct. 13, 2017 news alert |
|
Health Insurance Industry Fee (HIIF) Repealed |
Effective 1/1/21 |
Read our Dec. 20, 2019 news alert |
| Impacts to the Medicare Market | ||
|
Medicare Part D "Donut Hole" Closure Accelerated |
Effective 1/1/19 |
Read our Medicare Part D Coverage Gap FAQ |
Supreme Court Dismisses ACA Case
On June 17, 2021, the U.S. Supreme Court issued an opinion in California v. Texas dismissing the case because the Texas-led states and individual plaintiffs lack standing to challenge the ACA. As a result, the ACA remains in effect with no changes.
The litigation challenged the ACA’s individual mandate, which provided that most people must maintain a minimum level of health insurance coverage; those who did not do so previously had to pay a financial penalty to the IRS. In the 2017 Tax Cuts and Jobs Act, Congress reduced the penalty to zero dollars as of Jan. 1, 2019, leading to the current litigation.
The Justices ruled the plaintiffs lack standing because they, “failed to show a concrete, particularized injury fairly traceable to the defendants’ conduct in enforcing the specific statutory provision they attack as unconstitutional.” This is the third time SCOTUS has upheld the ACA in major challenges to the law.
To learn more about the case and ruling, click here.