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 Commercial 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Individual Mandate Repealed
Effectively repealed mandate by zeroing out penalty beginning in 2019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
Biden Administration reverses prior administration’s policy on enforcement of sex-based discrimination protections included in the ACA

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.”

In May 2021, the Biden Administration announced the Office for Civil Rights (OCR) will interpret and enforce Section 1557 of the ACA and Title IX’s nondiscrimination requirements based on sex to include sexual orientation and gender identity.

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 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 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.