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 |
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Individual Mandate Repealed |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 8/18/20, with exceptions |
Read our June 16, 2020 news alert |
| 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Cadillac Tax Repealed |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Health Insurance Industry Fee (HIIF) Repealed |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 Individual or Medicare Market | ||
|
Medicare Part D "Donut Hole" closure accelerated |
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.