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.
Supreme Court to Hear California v. Texas ACA Case
The U.S. Supreme Court will hear oral arguments in California v. Texas (known as Texas v. Azar in the lower courts) in November, with a ruling expected in spring 2021. The justices will rule on the constitutionality of the individual mandate without a tax penalty, and whether the 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; however, the confirmation of Judge Amy Coney Barrett to replace Supreme Court Justice Ruth Bader Ginsburg could impact the ruling in California v. Texas.
The 2017 Tax Cuts and Jobs Act included a permanent effective repeal of the individual mandate by zeroing out the penalty beginning in 2019, which led to the current litigation. 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 penalty. The judge further stated that because the 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.
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 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 |