- Finalizing the rule expanding health reimbursement arrangement (HRAs)
- Broadening of contribution and distribution of health savings account (HSA) funds
- Adding flexibility for grandfathered health plans in the individual market
- Additional responsibilities and consumer protections regarding the disclosure of protected health information (PHI) under HIPAA
- Implementation of nondiscrimination rules for health programs
- Guidance on the fiduciary rule
- Development of final guidance following the EEOC’s interactions in wellness plan rules
- Finalization of rules for religious and moral exemptions and accommodations
- Enforcement of parity and nondiscrimination in the design, offer, and operation of health plans
- Expansion of value-based care requirements and mandates
- Creation of cost transparency requirements and tools
- Increasing flexibility in state waivers for modification to ACA provisions (section 1332 state waivers)
Judiciary healthcare reform horizon
As Congress and the regulatory agencies wind their way through the myriad of potential changes and improvements ahead, some outstanding health plan related lawsuits will need resolution. The election results modifying both congressional seats and state authorities, like the governor and the attorneys general, will influence the ongoing pursuit of these actions. Final rulings may significantly affect the employers and individuals in the health plan arena. Here are the ones to watch:
Constitutionality of ACA's Individual Mandate
Challenge: The reduction in the 2019 individual mandate penalty to $0, as passed in the Tax Cuts and Jobs Act, has the effect of no tax and, if not a tax, then the individual mandate is unconstitutional
Potential Outcome: Individual mandate, community rating, and guaranteed issue are all unconstitutional and removed from the law
Potential Impact: Pre-ACA rating methods may return, including use of pre-existing health history to determine cost and accessibility
Association Health Plans (AHPs)
Challenge: Reduces consumer protections by allowing AHPs to circumvent ACA health plan requirements, employer definition conflicts with ACA, and is outside scope of the DOL
Potential Outcome: Eleven states and the District of Columbia's attorneys general ask for the rule to be vacated
Potential Impact: If the new AHP rule is reversed, the marketplace is status quo and no additional opportunity is added for entrepreneurs and small employers to band together as a single large employer plan with fewer plan and rating mandates
