Short-term Limited Duration Insurance Plans (STLDIs)
Challenge: Plans are contrary to the ACA, e.g., allow for health-based rating, exclude pre-existing conditions, impose annual limits, do not cover all essential health benefits, and, by nature of the expansion to 364 days or less, are not short-term
Potential Outcome: Reverse STDLI expansion rule
Potential Impact: STDLI policies will only be available for a maximum of three months with no renewal eliminating any coverage option for those who are uninsured more than three months and who are outside of open enrollment in the individual market or their employer plan, or for those who would choose less coverage and to self-insure a portion of their healthcare expenses

Wellness Program Incentives as Modified by the EEOC
Challenge: AARP states the wellness incentive maximum of 30% does not meet the voluntary requirement for wellness programs under the law since the cost differential is so high that the program ceases to be voluntary – court agrees and asks the EEOC to substantiate or rules will vacate on January 1, 2019
Potential Outcome: EEOC does not respond and rules are vacated
Potential Result: Rules revert back or modify leaving some employer's plans in violation of prior or newly interpreted rules

State Healthcare Reform Horizon
A consistent message from the administration over the past two years has been the impetus to return more decision-making and the customization of healthcare and health insurance back to the states. The release of the new AHP and STLDI rules along with the removal of the individual mandate penalty shows varying reactions from the states. Some states have taken steps to further adopt or limit these rules and others. Here are examples of this state diversity with just the three most recent challenges:

Short-term Limited Duration Plans (STLDIs)
Prohibiting sale
CA - prohibits the sale of products containing pre-existing condition exclusions, effective 1/1/19
HI - prohibits sale to anyone eligible to purchase an exchange plan in the preceding calendar year
Adding limitations
MD - limits plans to less than three months with no renewal or extension
VT – limits term to 3 months or less and no renewal
IL - limits term to 6 months or less without renewal or extension

Association Health Plans (AHPs)
CA - eliminates working owners as eligible, and ability for small employers to band together as one large employer
HI - requires associations to follow the rules of the state regardless of state of domicile

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