The Evolving Health Care Landscape

Recent legislative, regulatory, and administrative changes that are impacting the ACA.

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.

ACA Ruled Unconstitutional – Law Remains in Effect during Appeal

On December 14, 2018, U.S. District Judge Reed O’Connor issued a ruling that determined the ACA is unconstitutional because of a change to the federal tax law that zeroed out the ACA’s individual mandate penalty beginning January 1, 2019. The ruling it is not an injunction and does not block the operation of the law, so the ACA remains in effect. For more information, read our Dec. 17 news alert. The ruling has already been appealed and the new case is underway in the Fifth Circuit Court of Appeals. This is expected to be a long legal process.

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 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
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Individual Mandate Repealed Effectively repealed mandate by zeroing out penalty beginning in 2019	Effective 1/1/19	Read our Dec. 20, 2017 news alert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
Impacts to the Group Market
Cadillac Tax Delayed 40 percent excise tax on high-cost employer plans delayed from 2020 to 2022	Effective 1/1/22	Read our Jan. 23, 2018 news alert
Contraception Coverage Requirement – Expanded Exemption Final rules expand exemptions for group health plan sponsors from covering contraceptive services for women	TBD	Read our Oct. 13, 2017 news alert On Jan. 14, 2019, a federal court issued a nationwide injunction that blocks implementation of these rules unless or until the injunction is removed.
Health Insurance Industry Fee (HIIF) Suspended HIIF suspended for 2019	Effective 1/1/19	Read our Jan. 23, 2018 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

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