The Evolving Health Care Landscape


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The Evolving Health Care Landscape

Recent legislative, regulatory, and administrative activity impacting federal health care regulations.

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 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

Comparative Effectiveness Research Fee (CERF) Extended
Originally expiring in 2019, extends the fee for 10 years through 2029

Effective through 12/31/2029

Extension was part of the 2019 year-end spending agreement.

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Individual Mandate Repealed
Effectively repealed mandate by zeroing out penalty beginning in 2019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

Section 1557 Nondiscrimination Rule
Replaces the original final rule from 2016 and repeals or revises key provisions of that 2016 rule

Effective 8/18/20, with exceptions

Read our June 16, 2020 news alert
On Aug. 18, 2020, a district court stayed the rule’s repeal of the 2016 definition of discrimination on the “basis of sex.” The 2016 definition will remain in effect pending further court or administrative action. Other provisions in the 2020 rule remain in effect as of Aug. 18, 2020.

Impacts to the Group Market

Cadillac Tax Repealed
40 percent excise tax on high-cost employer plans repealed

No longer exists and will never take effect

Read our Dec. 20, 2019 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
The expanded exemption was challenged; however, the Supreme Court ruled in favor of the Trump Administration and sent the case back to a lower court to dissolve the nationwide injunction that blocked implementation.

Health Insurance Industry Fee (HIIF) Repealed
HIIF in effect for 2020, repealed as of 2021

Effective 1/1/21

Read our Dec. 20, 2019 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

Supreme Court to Hear California v. Texas ACA Case

Oral arguments in California v. Texas (known as Texas v. Azar in the lower courts) were held in the U.S. Supreme Court on Nov. 10, 2020, and a ruling is expected in spring or summer of this year. The justices will rule on the constitutionality of the individual mandate without a tax penalty, and whether the individual mandate is severable from the rest of the law, which will determine the future of the ACA. The Supreme Court has twice upheld the ACA in the previous major challenges to the law.

In 2018, a district court issued a ruling that determined the ACA is unconstitutional because of the federal tax law change that zeroed out the tax penalty. The judge further stated that because the individual mandate was essential to the law, it could not be severed from the rest of the ACA, which meant the entire ACA was invalid. This ruling was appealed, and in December 2019, the United States Court of Appeals for the Fifth Circuit ruled the ACA's individual mandate is unconstitutional, but it did not invalidate the rest of the law. It remanded the case back to the district court judge for further severability analysis. Soon after, the Supreme Court agreed to review the case.

The ACA remains in effect while the litigation is pending.