The Evolving Health Care Landscape


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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.

5th Circuit Decision in Texas v. Azar ACA Case

On Dec. 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. 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 on Dec. 18, 2019, a panel of 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. As a result, the rest of the law remains in effect. The case was remanded back to Judge O'Connor for further analysis. The U.S. House of Representatives and 20 states, who defended the ACA in this case, have asked the U.S. Supreme Court to review the Fifth Circuit's ruling. For more information, read our news alert. 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 ChangeEffective DateMore 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 CERF fee for 10 years through 2029

Effective through 12/31/2029

Extension was part of the 2019 year-end spending agreement. Payment amounts set annually. 2021 amount is TBD by the IRS.

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 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
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) 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