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 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
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	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) 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

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