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 |
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. Payment amounts set annually. 2021 amount is TBD by the IRS. |
|
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 |
| 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 |