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  • Home Employers Industry Insights Informed on Reform The Evolving Health Care Landscape

    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.

    Impacts to All Commercial Markets

    Regulatory Change
    Effective Date
    More Information

    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


    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 [PDF]

    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    Individual Mandate Repealed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


    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

    Regulatory Change
    Effective Date
    More Information

    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


    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

    Regulatory Change
    Effective Date
    More Information

    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.

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